How to move parent with anosognosia dementia to a care home?

i would be very careful about exercising a POA under these circumstances.

Why is it that women are expected to care for all manner of folks and no one gives a rip about so called “burnout,” but men are not held to even close to the same standard. If you want to help, give her husband a vacation from caregiving and pay for it if you can. A doctor can’t “mandate” anything as long as the person is legally competent. Throwing a 71 year old woman into a long term care facility without exhausting all other remedies just to make life easier for her husband is an abuse of the use of a POA.

Some of the answers to this post make me cringe. Tricking, deceiving, spying, medicating, use of force, all to give a male caregiver relief from burnout?? What are you thinking of? These are examples that prove that a significant portion of people who post on this website really despise their parents or loved ones for forcing them to face the reality that they have obligations to their elderly parents. If you can’t be anything else, at least be kind to your loved ones as you think through solutions. Someday, some of these posters are going to get the same sort of treatment from children who have observed their terrible attitude toward having to plan for their parents’ care in old age. What goes around comes around! What your kids see you do today will wash back up on you tomorrow! We saw our mother howl in anguish when she was forced to place her mother in a nursing home and she never got over the guilt. We managed to keep our mother in her home until she was 99, then visited her three or four days a week until she died two years later. She was afforded the best of care which depleted a substantial estate that could have benefited all of her five children. Why? It was her money. Long term care should be postponed as long as possible. There is no such thing as a “good” long term care facility!

I have no idea what motivates some of these posters to suggest the things they do but I am sure of this. Planning and paying for an elderly loved one’s care is a test of character. Depriving a loved one of their human rights to force her into placement says a lot more about who you than it does about her.

Since her husband is competent, it’s not your place to interfere in their life together as husband and wife. Most caregivers have some burnout - what balances it out is the reward he gets by remaining together with his wife and her with him.

Please have her doctor examine her for mental competency. She/He can "mandate" that she needs to move into a more "secure" environment for her health. It might help if your father is amenable to moving into assisted living with her - as long as she gets plenty of care by the facility staff. The doctor can also "mandate" that your father needs to quarantine away from her for a period of time (yes, use COVID as an excuse).

Imho, to tie her up or shut off the water in the house is not the answer. Perhaps say something akin to "We're going to lunch somewhere." That somewhere will be a facility.

Being in my mid 80s I think your dad can't handle much more. My mother-in-law refused to go to a nursing home. She fell and hurt her head and we called 911. They took her to the hospital for observation several days and then said she couldn't live alone. We chose the place and they took her there and admitted her. We weren't to blame. Maybe a doctor can give you advise as to how to get her admitted to a geriatric ward for evaluation. May have to "trick" her some way, I wouldn't want to be pulled out of my home against my will. I agree avoid trauma and drama. You are now in the place of the responsible adult. Hard choices.

How serious is her dementia? Does she need help with most things? Does she wander? Does she do things that are a danger to herself or the household? If it's only the first one, then she may be OK with in-home help, or she might qualify for assisted living. If she wanders and does dangerous things, then she should be in a memory care facility, unless your parents can afford 24/7 aides. Moves to assisted living work out best when the person is involved with the decision. Moves are difficult for older people, it's hard to get used to every new thing and person. Can you use aides until the pandemic is over, and then re-consider an assisted living facility? With aides, it might be best to move her to a separate room where they can sit by her without disturbing others. This might be a transitional way to get her accustomed to being cared for by different people. Also, lock up all valuables and financial papers if there are "strangers" in the home. Once she moves into an assisted living facility, you and your father may not be able to visit her as often as you'd like. My mother had the same condition and never understood why she was being moved to assisted living and then memory care (and resisted and was unhappy with the moves). Only when her condition declined to the point where she can't do anything for herself does she seem to accept it. The facility has been closed to visitors for a few months.

I would prefer professional in home care to whatever level necessary, over forced moving to a facility, including but not limited to a live in, and a night shift, and safety modification to the home and furnishings. Me and my family did this for my mom, who had far more issues than what you describe for yours. I realize each case is unique and there can be essential needs which require a facility and cannot be provided in home.

Looks like your mom doesn't want to leave home, and you'd better consult an attorney to determine if you can trump her decision b4 involuntarily moving her.

My mom had the same condition. She thought she was perfectly fine although it was obvious to everyone else that things were going from bad to worse. We found a reason that she had to be alone fir a while and essentially tricked her into doing a trial month at a great AL place that also had memory care for later.

in your case can you make up a reason why your father would need to be somewhere else for a while and she couldn’t go with him? I know it’s hard during COVID but that’s a thought.

This is a tough one because they do believe they are fine when they are not. And your dad is now in danger and should NOT be subjected to having to tend to her - he has enough problems. Get in cahoots with the doctors so they back you up. You say you have Power of Attorney so you could hire a caretaker who must be strong enough to stand up to her shenanigans and not allow her to scream and rant and misbehave. That could be a tough call before they walk out. I personally would seek out a suitable, well cared for place and then take her out to lunch or whatever, have an excuse you are picking someone up to come along or visit them, etc. Take two strong people with you and if you must, then you "take" her into the new place. Perhaps she could be slightly medicated before you take her into the facility. Many years ago I saved someone's life - she had dementia - and was determined to kill herself that night. It was a pure nightmare getting her physically into the hospital - she was "fine" - well, she was not and with help we got her into the hospital. She has full dementia and is in a nursing home ever since. Sometimes gentle force is your only solution. Do NOT let her stay home if you are positive it is unsafe and very bad for your father.

The answers suggesting home care seem unrealistic since that won’t be 24 hour care and things will definitely progress. If you are waiting for your loved one to suddenly agree to move, you will be disappointed.
My husband and I went through the same thing with my MIL but she lived alone. We resorted to lying to her to get her to the facility. Yes, she was initially upset, but within a few days she was very happy to be in her new home and never mentioned “going home” again. You need to take control of a bad situation similar to when you need to make decisions for young children.

I agree with many of the answers posted but I disagree with some others. I sometimes get the feeling that some people who have never actually been in this situation try to offer their uninformed advice. Even though I realize each situation is unique. My mother also has dementia with anosognosia diagnosed by a neurologist. She has no self awareness of her many deficiencies and she could not live alone. We started researching assisted living options without her because due to her anosognosis, she would never agree to move. You're the only person who really understands how bad it is for your parents so you're the best person to make that decision. We also used a little fib to get my mother to the AL residential home on the day we left her there. We told her that she was going on a vacation. The AL home she's in watches her closely and they will not let her leave. They are state licensed and they follow the Covid 19 restrictions. Plus, they've arranged Covid 19 vaccinations for the residents and staff. Initially, it was a rough start but my mother has adjusted well but of course she still talks about going home often. They will also restrict her visitors and her calls if there are issues with people trying to take advantage. Don't let anyone make you feel guilty about ensuring the best care for your mother because I'm sure it's already hard enough on you emotionally. Sometimes letting them age in place at home is just not the safest option and her safety is the first priority. Good luck.

In-home health care sounds like your best option. If your mother resists outside help, you can explain that someone is there to help that "distant relative who lives with her.". Look for a health care aide or agency with a high enough level of skills to handle the variety of needs of both of your parents.

Have you considered trying in-home care first? That would relieve your Dad from being her sole caregiver, lessoning burnout and the effects on his health. It might even make their time spent together more enjoyable and spark a bit of their husband & wife relationship. With the pandemic I don’t know what is being offered in your area, but there are day programs for folks with dementia to get them out of the house for a good portion of the day thus giving your Dad time to himself. Again, with the pandemic, these may not currently be open. Also, some assisted living facilities provide short term care in which Mom could move in for a short period of time while Dad gets a break. This might be helpful before making a facility a permanent decision.

CaregiverSonKD,

First off, make sure you have ALL your ducks in a row!!

Read the POA very carefully!
Do you have a diagnosis from a Geriatrician or Neurologist?
Perhaps speak with an elder care attorney.

We told my Aunt (Alzheimer's), that her home needed repairs and she needed to stay elsewhere while it was going on.
Although she still tells me periodically that she's going home tomorrow, she has no idea how long she's been in memory care. It took a little while, but she has settled in nicely.

I thought about cameras etc..., but after witnessing her start kitchen fires twice, I knew that wasn't a plausible idea in her case.

You'll get lots of advice pro and con ALFs! Only you know what the best option is for your parents!
There is no shame in placing LOs in ALF or trying to keep them at home.

Your local Council on Aging may also be able to give you sound advice.

Best wishes!!!

With my dad we had to resort to “tricks” a lot too. I’d make up letters with fancy logos at the top saying things like why he can’t ride his bike anymore or where his boat went (they were in the shop!). It helped convince him...sometimes. Unfortunately, the only way we got him into a home was when he ran away and we had the police pick him up. Our elder attorney said if the police pick him up, you can use that as an opportunity to send them to a hospital and stay there for a few days and get the hospital to transfer him over to a living facility (there could have been other reasons we had to do it this way too). This might be an extreme case for you, because your mom doesn’t sound a far as my dad was (he was 80).

You should deffiently not force her!

Especially with Dementia, it's better for her to continue living in her own environment tgat she is use to.

Why not install cameras to help keep an eye on her and have a Caregiver come by 2 or 3 hrs a day.

If you make your mom move befire she is ready..
Your mom would be lonely and very unhappy and could catch Covid.
I would think your Dad would also be lonely living by himself.

Later, You might see if they both would consider moving into an assisted living apartment together.

"We have power-of-attorney and could force her..."

You might want to double check the document AND the attorney who drew up the POA. Our mother, despite having AL in her plans before dementia kicked in, refused to consider moving anywhere, ESP not AL. Our attorney told me we could NOT force her to move, and suggested guardianship. I don't think she would have qualified for guardianship at that time, or perhaps a minimal level (I didn't know there were possible "levels", but Bab75 was granted SOME guardianship), but it was a moot point anyway, because the facility we chose would not accept a committal. In order to make the move happen, we had to come up with a plausible fib/scenario that she would buy into. Similar to what you and Geaton777 suggested.

This
https://www.agingcare.com/articles/things-you-can-and-cant-do-with-poa-152673.htm
spells out a number of things you can/can't do with medical or financial POAs, but basically a POA is giving you the ability to perform certain duties AS that person, in their stead. It can allow certain decisions to be made if the person isn't capable, but before assuming this also allows you to force a move, you need to double check with the attorney. The article doesn't mention moving.

Even staff in the MC unit told me they can't force residents to do anything they say no to, such as taking their meds, bathing, getting medical/wound treatment. They have to become adept at coaxing the person, working to get them to agree.

Shutting off the water might be a way to move her, saying it's temporary. Once in the MC unit, it should be sufficiently locked that no one leaves without staff allowing it. Do NOT try AL - they don't "watch" over them, so she could walk out at any time! I had suggested my brother mess with the Nest thermostat he installed - make it way too hot, then too cold, and tell her it needs to be replaced and will take some time (it was already into winter.) She injured her leg just before the move, developed cellulitis, which delayed the move a few days, but he used that to draft up a fake letter from 'Elder Services' telling her she moves to where we pick or they will pick. Thankfully it worked (but, funny note - not long after, when going there to work on clearing, cleaning and repairing, to sell it, the heating system DID die!)

Maybe, if possible, work with the place you choose and see if dad can move in with her, briefly at least, just to keep the hotel "ruse" up. Explain the unit lock is to keep infected OR bad people out. Have him leave, as if going to work on fixing the problem during the day. Eventually, given a little time, he can return home and visit during the day. She may also need some meds, to calm any anxiety during the transition. They did that for my mother - minimal dose, just to take the edge off. It was used later, when she had a UTI with major sun-downing, so I know she wasn't "doped up."

Never heard the term before, but it does seem that most people with dementia think they are fine. Part of that is due to short term memory loss. They are seeing themselves as they were several years ago, still healthy and capable! Mom was certainly adamant there wasn't anything wrong with her! I'm Fine. I'm Independent. I can cook. Nope. Nope. Nope. I also never used the "D" word around her. She might acknowledge forgetting some things, but wrote that off as she's "old and entitled to forget once in a while!" As she moved back in time, she thought a pic of herself was her mother. Self-image does change.

Another option, for getting her to see these places aren't what many remember from long ago is to schedule a meal with them (when allowed) and pretend you're going to a restaurant. When done, amble around (with a tour guide) to see the place. Mom actually thought the place was nice, but asked who's going to pay for it. I just said VA (long story, didn't pan out, but they don't cover that much!) By the time she was home, she'd forgotten why we were even there!

Does she actually have a medical diagnosis by a doctor for her dementia/ALZ? I'm only asking because 71 is very young and just need to discount UTI or thyroid condition, among other possible variables.

If she does have a diagnosis then employing an "therapeutic fib" like you suggested is perfectly acceptable. I would stop trying to get her buy-in into transitioning into a facility...it's never going to happen. Tell her the pipes froze or there is a mold or insect infestation that requires everyone to vacate the home for a week. Resettle her into MC care on the pretense it is the "hotel". Make sure the facility is in on this ruse (they will be happy to go along).

Is it possible to hire some outside agency help to manage her/be a companion to her during the day? Or adult daycare? None of this will feel good or easy, but it sounds like it is necessary. All you can do is what is in her own best interests and what doesn't burn out the other caregivers. May you gain peace in your heart about this decision.