Is assisted living the correct next step if home health nurses can't get Dad to take his medications?
I am the primary caregiver for my 83 year-old father. He is currently living independently in his own apartment. Over the last several months, two home health care companies have discharged him because of inappropriate behavior towards the female nurses and aids and for refusing to take his medications. He is an insulin-dependent diabetic and cannot remember to take his insulin or other medications. I think that assisted living is the next step but what facility will take him based on his behavior? He cannot/will not swallow pills so management of his other medication is a challenge. This is taking a huge toll on me and I am overwhelmed. I work full time, have a husband and three young adult children. I don't know what to do next? A nurse suggested this may be the beginning signs of dimentia and the brain not being able to filter thoughts. Any suggestions?
Expert Answer
Forgetting to take life-saving medications is a sign of cognitive decline; it is not a normal part of aging. It could be caused by depression or poor nutrition or a urinary track infection or a host of other conditions. A thorough check up by a physician who specializes in older adults is the first step. If the problem causing the memory loss is resolved, he can remain in his current environment.
If the physician believes the forgetfulness is due to early dementia, relocating to an assisted living community where medications are monitored is a good solution. These can be very expensive. When you visit, use other criteria besides the distance to your house. Ask about extra costs, such as medication supervision, incontinence, cueing to meals and activities, as well as the criteria for discharge.
I recommend that you use your state's oversight website to research assisted living communities in your general area. The government sites usually post the number of type of complaints brought against facilities. Remember that all problems cannot be solved, so a facility does not have to be free of complaints for it to be a good place. However, the few the better. Then choose 3 to visit without your father. Take the tour and let them tell you all the wonderful benefits of living in their building. Be sure to take home a copy of any month's menu and an activity calender. Go over the menu and the activities with your father.
Activities can be life saving, literally. They are reasons to get up and get dressed and have contact with peers, they stimulate the brain, and generally act as 'neuro-protectors'. Food is important, too, as we tend to eat at least 3 times a day. Then choose the best one of the 3 communities that you visited and go visit with your father. This time, ask for a tour with a meal. Sit in the dining room and eat with your dad. Observe how the meal is served, the interactions between the staff and the residents, whether there is meal time conversation among the residents, and the quality of the food. Be sure to ask about alternate meals. Attend an activity if possible. If this building does not meet his expectations, then try the next one on your list.
Be sure that he understands that if he rejects all of the possibilities, that is not a reason to remain in his current situation. He must choose one, or you will choose for him.
Remember not to feel guilty! It is NOT your fault that he is diabetic, or that he forgets his medications. You are doing the best you can to cope with a difficult situation, and you should be pleased with yourself. Guilt is something we feel appropriately when we have not done our best. It is not helpful, or do not allow yourself to indulge. You will be better able to help him when you recognize your own worth.