My siblings and I are not seeing eye to eye on caring for our dementia dad. When should we put him in a facility? We all work.

This is a tough one. I have an aunt who is 99 and living alone in a small rural area. Several years ago her 3 children determined she wasn’t safe living alone, 2 live nearby and the third 2 hours away. One child handles all the money issues, one handles everything else medical and care wise.

My cousins agreed to take turns staying with their mom, staying 5-7 days each in turn. They have employed a lady who comes 4 days a week to spend the day freeing the cousins to attend to their own life but being with Auntie at night.

All three are in their 60’s and retired so they do have more flexibility than you and your sibs. Unfortunately no one expected my aunt to live so long and the arrangement has begun to wear on all of them.

The cousin who lives away is seen as not having such a burden as the other two, while she resents all the travel and being away from her family for extended periods of time. I worry that their relationships to each other will not survive.

So, my advice is ALL of you sit down and propose ideas, everyone listen and then decide which solution will be best for you in the future.

1) What does dad think?
2) Is dad safe being left alone when caregivers are not available?

If dad has done nothing to show that he is unsafe (leaving on the stove, unable.to manage bathing and toileting himself, falling), maybe it is too soon, unless dad says he'd prefer a facility

If dad is not agreeable, you are going to have to get guardian/conservatorship to make that decision for him, unless one of you already has POA. If there is a POA, it would be up.to that person to make the decision.

Praying for a smooth transition for your dad.

It is all very simple.
You all work and assuming you want to split care of Dad equally you would all have to quit your jobs. Possible?
Unless you are all independently wealthy.
Then the choice is obvious.

You, as POA are the one that can make this decision.
If you can not care for dad and the one sibling that has had him up until this point can no longer care for him and none of the others want to step up then the only option is to place him in Memory Care.
Now if one of the other siblings wishes to care for dad then that should be discussed. (If they live farter away it might be more difficult for you as POA to manage his affairs.)
I will tell you that moving dad from place to place, from one set of caregivers to another, from one house to another can be difficult for someone with dementia. consistency and routine is important.
And the siblings that do not want him placed in Memory Care are they willing to contribute $$ to pay for caregivers that may, in the near future be needed 24/7/365? Are they also willing to help with modifications to the house so that dad will be safe?
Again as POA you are the one that has been entrusted to make these important and sometimes gut wrenching decisions. If his care is more than can be safely done at home then it is time to place him in Memory Care.

There are so many people who don’t know a thing about what modern memory care looks like. Find a place that seems appropriate, then insist that your nearby siblings visit with you. Then all of you can convince everyone else, maybe even do a virtual tour. Depending on how long it’s been since they saw him, they may also need some video on an interview with him that demonstrates his loss of faculties.

Please schedule a group meeting with an Elder Law Attorney. Each person needs to express his/her opinion after listening to the sage advice.

The ones that don't want Dad in a facility, are they willing to take care of him themselves, either in his home or theirs? Medicare will pay (small amount hourly) for family to take care of him at home if they apply for the benefit. If they are not ready for a job change, or willing to suppliment the hourly payment for atHome Care employee, Medicaid has a 5 year look back with penalties. Check to see if your parents have a Long Term Care policy they can use. When the family decline the responsibility then the rest of you check out the facilities open in your area. Be sure to ask if they are "age in place". so you don't run into the problem of having to keep moving your loved one with each stage of decline in ability or health. Forcing someone into a facility is never a good idea, they may fight acclimation and socialization and fall into depression and the next stage of dementia. They may refuse medication or continually seek to "escape". which in an assisted living leads to expulsion. It may work best to talk about elder care with them prior to the need for it, after all we are living longer. Take your parent/loved one to visit the facilities in the area and see which ones they prefer. Check out the cost of renovating their home to accommodate their coming needs. Remind them of the benefits of living in a care facility and look also into the option of in home care. Average was $25-$30 hourly when I called around (Indiana) and medicare offers some help with services, like 360care and Grace At Home types of services. Other option for us was to do some remodel to Moms condo and we (children) take turns living with her. Mom eventually decided it was time for her to move to assisted living. Her mental health declined quickly after that and to be honest I will always wonder if we should have held off a bit longer to make the move. She had the signs of the onset of dementia, and it scared her and us. Oh for those good old days. There is no good or easier time to move them into a facility. Mom never enjoyed it like we hoped and the facility was marketed like this wonderful place full of great care takers and home made food. Then reality settles in and you realize you may have jumped the gun, because facilities want to keep as many "residents" sedated as they possibly can, shift work is easier and they need less RN staff. So look around for that Zombie affect in your choice of facility. Ask about resident the RN ratio on shifts. When mom moved into assisted living ($5000 monthly) the only pill she took was a multi vitamin and an occasional aspirin. 6 months later and in a memory care facility ($7000 monthly) she is on 7 anti-psychotic pills, 2 for constipation, 2 laxatives and suffering from heartburn, high blood pressure, GI problems and had three UTI's. If I had it to do it over I would have used assisted living or any facility as the "last resort". we have a fight with the RN Coordinator every time we remove a medication that is not needed! They call her primary Doctor and request more narcotics. I didn't know they could do that!! My husband and I are now in our 60's and in the process of remodeling our home to accommodate my Mom. Knowing that in the near future we also will need to use the elder care features ourselves. We plan to stay in our home till we die rather than go to a facility. Too many of the residents are left in facilities with no one on the outside looking in on them and checking their medications or welfare. We as their loving family are sold the concept that they are in a happier in a facility, a placewith other people, well cared for and treated with respect, we have busy lives and dementia is not fun to deal with, so we convince ourselves we are doing the right thing for our parent or loved one. I can tell you from our experience that is not always the case. So keep your foot in the door, eyes and ears open to what is going on, and request medication lists often

Is your sister, who has him in her home, able to handle his care? Are any of you able to do it? If not, it would be best for him to live in a memory care facility where they have 24/7 skilled staff to look after him. They will take care of his daily needs like bathing, dressing, toileting, meals, housekeeping, laundry, and will have appropriate activities. He'll also be around other people with the same condition, and he might be able to make some friends. When my mother was in memory care I was touched to see how the other residents were usually understanding and kind to each other. Try to find a place near you and your family members so that you can visit often. All the best to your father and family.

Discussing the issue is a good idea, it helps when the family is involved and working together for their parents happiness. It's also important to get your loved ones opinion on the matter. They usually know when they are ready and in need of more assistance. Then it comes down to who is the legal medical/health Power of Attorney for Dad? That's who should make the final decision, with the parents approval, because that's who Dad trusted to do what was in his best interest.

Devris: Perhaps now is the time for managed care facility living for your father.

Set up a group meeting with a Geriatric Psychologist or Psychiatrist (who can write medications). Options are to give money or time...............if both are rejected, then that person should not attend: it's a "put up or shut up" situation. It's a team effort to make Dad's life worthwhile.

I agree it is time to place. I still wonder how you do that if he is in early dementia and will discuss moving but not actually make the move.

This happened to me. I was named POA and I just let my siblings know that I was placing Daddy in a facility. I kept them up to date on his declining health. I knew that all of them worked and I knew they could not come and take care of him. I checked out several places and we all chipped in for the extra cost for the facility. I told them I would go and check in on him, only because the facility was closest to me... 12-15 minute drive. My Daddy was not the easiest to place. He kept asking to go home and I had to redirect the question. His other children did come visit him occasionally like on weekends, holidays and special occasions.

It’s easier on the patient when it happens as early as possible. We waited too long for my dad (my mother insisted she was fine taking care of him and she was fine .. but he was not fine. He was trapped in their house living on her fast food runs with no social interaction.)

I think his adjustment was harder than it would have been earlier in the disease. Was there a dramatic decline when he moved from his home to your sisters? Expect another one when you move him again but the sooner the better FOR HIS SAKE. He needs the care, supervision, meals, activities that a memory care facility provides. He will not get better - dementia only goes one way. My dad is doing surprisingly well now. He participates in things and gets a lot more social interaction than he got when it was just him and mom. He used to tell me he was lonely. (Mom likes to eat pills and “lie down”.). He no longer says that.

It shouldn’t be about what your sister wants … unless she’s a professional well versed in dementia care, she’s not likely qualified.

I have a feeling that your situation, like many caregiving situations, are complex involving financial, emotional, legal, and logistical challenges. I think it’s ok to to see things differently but in the end perhaps you could all meet together to discuss what would be best for your father. It may be that one of you wants to step up and take care of your father at his home while the others contribute financially to you as a full time caregiver. Or, it may be that your father has assets that can be used to compensate you or the sibling that can take care of him at your home. Or, perhaps you can hire someone to take care of him. There are many things that are not known at this point and I think trying to list up all the available options may help you.

Things were different long ago. Homes were multi-generational. Women worked at home. Couples had a lot of children. People didn't live as long. All of those things contributed to being able to take care of a family member if they became sick or elderly. Today, things are much different. Everyone works outside of the home. Couples only have a few children and they are involved in extracurricular activities. People are living longer and dementia is becoming more prevalent. Today there are facilities that have memory care units and programs. I suggest you and your siblings visit several facilities to find one that suits your dads needs, one he can afford and one that is close by or in the middle of all of you. You can all take turns visiting and making sure dad is involved in his new surroundings. You can take turns filing his taxes. You can take turns with his doctor visits, etc. The point is not to dump all of the responsibility on one person. Everyone has a life and a job and other responsibilities. Many hands make light work.

No question. Place him now, for all the reasons so ably mentioned here. I did move my husband from day program to the facility, and it worked well. And you don't have to explain it to him...if he is stage 5. If so, how did he get a divorce? A legal step when he is not cognizant ? Just curious. One piece of advice: visit often, even after he no longer recognizes you-- if for no other reason that to keep tabs on his care

The best time to place someone in managed care is when the person (or people) taking care of the person are starting to not want to take care of the person.

However, it isn't as simple as that. One has to look at the finances of the person and find a place that is suitable for the person and/or start the process to find the funding to place the person.

Taking care of a dementia patient is a lot of work, both mentally and physically. As they progress, there are behavioral and incontinence issues as well as social issues and no one person follows the exact same pattern.

Start your research now as there are many, many options available. The options are different depending upon what state your Dad is in and what you are expecting for the future. In addition, some facilities are restricted on the kind of care they can give. Your Dad might not want to go, however, you might find something that suits his personality. Also be aware that putting your Dad in a facility does not necessarily mean that it is going to be easier on everyone. Someone will still need to oversee his care, potentially take him to all his appointments, and answer the phone calls from the facility and him, if he knows how to use a phone.

However, placement in a facility will hopefully give you and your family, the peace of mind that he will be safe and cared for, nearly all the time and that the caregivers can be sons and daughters again.

Dementia? Facility placement is to happen now.

If your Dad stays home, it will take at least 4 siblings to supervise around the clock. It's next to impossible to do this when everyone works for paid jobs and requires their breaks and much needed rest.

Your sibs can say all they want about what THEY want for dad, but if they are not willing to step up and discomfit themselves--then they don't get a 'vote'.

And they don't get to sit an whine b/c they think dad deserves better care. If they are not 'boots on the ground'-then they have no say. They can be very supportive from a distance--paying for CG's, grocery delivery, day care, whatever, if it means so much to them to have dad home.

I bet they haven't laid eyes on him in months. It's easy to armchair quarterback this kind of thing!

Now. If he's not safe being alone anymore, the answer is now. Also, none of you should be pressured into quitting your jobs to care for him. The only situation in which that might work is if dad had enough money to pay you at least the same amount you earn at work, benefits and all, for as long as needed. (and we know that is unlikely).

Since you do not say who has the POA it is hard to say who is on first.

With that said, it is best to place before it becomes a national emergency. Waiting until the last minute is not wise.

They acclimate themselves better when they still have some of their facilities. Make new friends, enjoy activities and so forth.

When we placed both our mother and step-father and his wife we toured 15 homes, some twice, talked to anyone we could. Made an informed decision.

Step-father has passed, now my mother is still in AL and step-mother has been moved to MC in the same facility. We chose one that had a step up program so we would not have to move them somewhere else.

Don't wait too long at least do your homework now.

I think the sooner the better. Otherwise one or another siblings will attempt to take too much on him or herself in caregiving. That will cause resentment all around.

If Dad is no longer safe living alone all siblings should sit down with him and tell him this. Attempting to work around it all enables it.

You have given us little in details, so with what there is to work with I would vote for the sooner the better for being in care.

Devris, in my opinion the best time to place someone into a facility is when that person is still able to learn their way around the facility, still be able to recognize faces, and still be able to make some friends.

Depending on how far long your Dad is in this dementia journey, is what type of facility he should be placed. If your Dad can budget for this, maybe start out with Assisted Living and later Memory Care, only if the facility offers both types of care. My Dad had that and it worked out great, he was so happy being around people of his own age group :)

If Dad is unable to budget for Assisted Living/Memory Care, then have him apply for Medicaid [which is different from Medicare]. If accepted by Medicaid, then Medicaid will pay for your Dad's room/board/care in a nursing home.

I just read your profile. Dad is living in your home? Correct?

The way I see it is that you don’t need your siblings approval for wanting your dad to be placed.

If your siblings don’t want him to be placed, then tell them that you will be happy to pack your father’s belongings up and they are welcome to come pick your dad up.

If you truly feel that dad needs 24/7 care then say that no one should be caring for him at home. He needs to be placed in a facility so that he can receive proper care around the clock.

You say that all of you are employed. While this makes the situation more difficult, the fact is that even when a person isn’t working, it’s nearly impossible to do all of the caregiving alone. Many people hire additional help if they have a parent living in their home.

Who has POA? How did you become his caregiver? How long have you been his caregiver? Do you have any outside help? Have you contacted Council on Aging or a social worker to help guide you through the process of finding the best solution for your father’s needs?

Best wishes to you and your family.

Without more information, it's hard to recommend an answer. Who's watching after him now? Is keeping him home an option by hiring a person to stay with him? How much help does he need with his tasks of daily living? Does one of you have POA, and has that been enacted yet, or is this a committee decision?

Seems like there are four options: a family member moves in with him and cares for him for free, which usually builds up tremendous resentment and control issues and micromanaging; a family member moves in and is paid by the rest of you, which can still be really fraught; an aide moves in with him; you move him into a facility.

Best of luck!