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'Facility' or 24-hour-care at his home

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Old 01-10-2013, 09:45 AM   #1
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'Facility' or 24-hour-care at his home

My 87-year-old dad with vascular dementia currently lives alone an hour and a half from my home. I go there every couple of days and get others to look in on him, but there are no other members of the family who help out. So my plan is to move him to a combination Assisted Living/Memory support village where those who are high functioning still have lots of activities, socialization, and support, rather than being in the locked part of the facility.

A cousin has been telling me of studies about when people are moved from their homes, they go downhill quickly. She suggests that we hire people, perhaps around the clock, to not only watch him, keep him from going out alone, but to add activities, healthier food, exercise, normal sleeping hours, etc, as that would be similar to the Assisted Living place without the stress of moving him.

Dad doesn't think he needs either. He just wants his car back (he won't get it). I admit I feel some guilt in not choosing to move him in with my wife and me. I don't think it would be good for any of us in the long run. (I know that many other cultures would automatically do that and many people on this board have done that and I appreciate and support you all in doing that). Forgive me, but I just selfishly, want to generally maintain my current mode of living, and if I can move him closer to me, I can visit him quite regularly without making it most of a day. I recognize that we can afford to move him to a high-quality place that he gets this stimulation.

I would love to hear from any of you about your experiences, ideas, pros and cons, etc about these issues. Thanks very much for your support.


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Old 01-10-2013, 01:35 PM   #2
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Re: 'Facility' or 24-hour-care at his home

It is a tough decision. One question: is the AL or memory unit near your house or city?
One reason we moved my late FIL to a memory unit is to be near us. If you hire caregivers from home care agency (preferred CNA and trained caregivers), they will still be in his house which is far from you. Also you still have to manage the caregivers yourself to make sure they don't mess up. We had had home care for 6 years for my late FIL in his old house which was far away from us. He had only one son (my hubby) in the same country or continent.
Each option has its plus. We were told that we needed to wait until my late FIL forget about his own house or didn't care where he was to move him. Well, the home care expenses for 24/7 is much more than the NH. It was hard to manage caregivers. Each caregiver has her/his own mind... No, it was not under the table - we hired certified professionals so it was more expensive. Well, he was already very bad in his memory when we moved him. He moved downstairs once in his own house and that was bad enough for him to understand his own house.
Frankly, it is better for demented person to stay in familiar place or house/home. The memory remains is in the house. But, you need to balance it out - say, your own life with your wife and your own energy and the money. It is complicated.
You can try home care first. If Dad knows he is going to the AL in his mind, he would be very upset that you move him. If Dad doesn't care, it is OK.
My late FIL thought he was to work in the new memory unit so he did. Yes the first week he was a little aware that something "was wrong". He thought he came to "work with my hubby" (they are not in the same fields.)

It is really personal. If you are concerned with Dad becoming worse, you can try full-time home care first. When it comes to 24/7, a nursing home may be better. Also my late FIL was 90 and got sick a lot and went to the hospital once a year - he hated hospitalization!!

It is really your call. Nothing is definite. If Dad doesn't like the AL, he can always go home. So keep his old house for a while to make sure Dad is OK in the new place.
Actually you still have to go to the AL a lot to see to things - talk to the caregivers and directors and buy him stuff. Honestly, you are stuck in this.
The only thing you can do is try to see which way is more balanced and practical.

Good luck,

Old 01-10-2013, 09:31 PM   #3
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Re: 'Facility' or 24-hour-care at his home

Randy, much depends on your father. You are right that he does not need to be living on his own. What your cousin says is not necessarily true. Mom and Dad moved to AL and then a memory unit. Dad lived 2.5 years after the move. With his cardiovascular problem I honestly do not believe he would have lived that long without the excellent care he received that last 2.5 years. Mom lived for over 5 years. Her decline actually slowed after she went into a care facility. I can cite you many examples of those that have lived for years after moving to a care facility. Yes, some do decline quickly but was it because they were moved to a facility?

What you will frequently see is just how bad the dementia really is. It is not a decline but a clear picture of how well Dad functions. At home he is pattering around in his known environment. It is where he has been for years and he is doing what he does using long held past memories. When he moves to a new environment he will lose those long held memories and have to figure out how to exist using new memories. I wish I knew how many times I have been told... Mom/Dad was doing well at home but seems to be lost at the facility. My Dad was one. He could find a bowl, spoon, milk, and cereal. Then he could put it together and call it breakfast. He had done the same thing in the same house with everything being in the same place for over 50 years. Once in AL he could no longer fix a bowl of cereal because had no idea where the kitchen was. That didn't make him any worse... just highlighted his real level of cognition.

Your Dad may not like care givers in his house. They are intruders in his normal routine. He remembers the house but those people are not supposed to be there. Therefore he may try to run them out. My Mom did this and that is why they ended up in AL. Or you might find care givers he likes and he will be very happy at home. Your Dad might like the socialization and activities of the AL or he might not. It's hard to tell. You know your Dad better than anybody.

24/7 in home care is actually more expensive than a care facility. If you want to give it a try I would go with a agency. This way, if there is a care giver that can not come in the agency will replace them and you will not have to make alternative plans. Be sure the agency is reputable and the care givers are checked out. It is very easy for a care giver to scam one with dementia. It might be worth trying it for a while but be vigilant that the care givers are doing what they should be doing.

If you do decide to move him to a facility then take him there a few times to see if he seems interested in what is going on. Be sure to check the facility out. Online ratings, state web sites with penalties and star ratings should be checked, you need to visit the facility at different times a day, and talk to those that have family members there. You might even want to try a respite period to see if it is a good fit. If you find the right facility, he just might be happy and enjoy all that is going on there.

So explore your options and see what you might want to try first. Just know that no decision is final. You can always do something different if the first trial does not work.

I have tried both with my parents, and for them, a facility was the answer. You have to do what you feel is right for now... and then adjust if necessary

Love, deb

Old 01-14-2013, 08:58 AM   #4
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Re: 'Facility' or 24-hour-care at his home

Since your Dad doesn't want either option, you may want to try to convince him using some excuses. It is always harder in the beginning if he is aware of everything. You can try to tell him he needs a cook or a house cleaner to introduce the caregiver and gradually he will get used to it. My late FIL didn't accept caregivers at first unless we told him it was for legal reason or the neighbor will call social worker. He was not willing to spend money on caregivers. Later on when he lost some independence, he liked the caregivers. Similarly, he didn't like to go to a nursing home but he ended up liking the new NH because he thought he was to work.
If you feel it is urgent, you really have to ignore Dad and bring in the caregiver or set up the new AL for him. The trick is to get some excuses so he can accept that.

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