Dear Family Advisor

Father and In-Home Caregivers

Last updated: Apr 06, 2011

Medications for an old woman

My parents live in an apartment attached to our home. Caregivers are required almost 24/7 for my mother, who has advanced-stage Alzheimer's. My father has Alzheimer's too, but it's not as advanced as my mom's. I recently learned that Dad, who is almost 90, has been repeatedly making inappropriate sexual advances to some of the caregivers. When one of them threatened to tell me, he chalked it up to being a "dirty old man." What can I do? We can't afford to lose these caregivers . . . and what will I do if and when he needs physical care?

I don't have to tell you that this kind of caregiving is heart-wrenching and exhausting. And if your dad does have Alzheimer's or some other neurological disorder that's causing this, then you've got a double-whammy on your hands. Your dad's diminishing ability to control his behavior is probably a mix of two things: He's acting out for attention (after all, your mom is getting most of it right now), and it's likely that he's starting to have more neurological problems, whether from the Alzheimer's or another condition. If he only behaves this way when you're not around, he's probably acting out. If you start to see that it's random, then it's more likely his brain (particularly the front-lobe regions, where his behavior "monitor" is starting to fail him).

Take him to a neurologist so you know his condition and what to watch for in the future. You might ask about dementia medication for him, because it works best in the early stage of the disease. If he becomes so difficult that you can't manage him, then anti-anxiety and other medications that help with mood and behavior might be in order.

Alzheimer's and other neurological diseases can bring out all kinds of things: anger, paranoia, cursing and "ugly" talk, hallucinations (visual and auditory), and, yes, sexual urges. Read up on Alzheimer's and other brain disorders. Once you understand what they do to the brain and how they change a person, you'll begin to see your dad with even more compassion than you can now. He simply can't help what's happening to him. He's not a bad person -- and just because he says and does things that shock you now doesn't mean this was underneath the surface all along.

There are also great online resources, here at and at the Alzheimer's Association. Join an online forum where you can talk to other caregivers who share how they've dealt with their situation. You can also check for local caregiver workshops and other resources. Make sure that your caregivers are experienced in handling clients with Alzheimer's and are well trained in behavioral techniques such as redirecting (quickly offering something else to the person with dementia, to draw their attention away from what they were doing). This can help enormously -- as long as you're extremely consistent, because your dad won't remember for five minutes that he's not supposed to say that/touch that. Write down what you want care providers to say and do to handle this situation so that your dad is getting the same message from everyone.

Meanwhile, be sure to give your dad some individual time. If a care person is with your mom, then take your dad to an antique car show or rent some World War II movies and watch one together. Talk with him, call to check on him. I realize his behavior has been frustrating, but separate that from the fact that your dad needs you, and if you can get him redirected, focused on something else, and in a better mood, that it'll be easier for everyone.

I want to bring up one other point: What are you doing outside of caregiving? Even though you have in-home help, your parents' care is still always on your mind. Alzheimer's has a way of isolating the family. It's not easy to take your parents out in public, or even to invite people in to visit. Behavior like your dad's can be so embarrassing and frustrating that you find yourself not even wanting to talk about it. As hard as it is, don't let this happen. Don't let go of your friends and other interests. They might not understand the disease, but they care about you. Force yourself to get out at least once a week to see them or take a class or otherwise do something completely outside of caregiving.

You've got a lot on you -- and you probably will for some time -- so you've got to take care of yourself.

You also need to have a Plan B ready. While your dad's sexual advances aren't too much more than an annoyance right now, you probably already know that people with Alzheimer's can become violent or find bizarre ways to hurt themselves or others (stick things in light sockets, swallow objects, and so on). Having only one person on duty for eight hours at a time, which is expensive, still might not be enough to meet all of your parents' growing needs.

The good news is that once you and your staff accept responsibility and proactively plan for and counter your dad's "moves," then you're free to accept your dad just as he is, and you're not caught in that awful tendency of trying to change him. It's a relief when you stop blaming your dad, yourself, God, or anyone else, for that matter. Alzheimer's is a disease, and yes, it's lousy, but no one caused it or even allowed it.

Give yourself, your caregivers, and your parents heaps of compassion. While you have to process many emotions, such as anger, guilt, resentment, bargaining, and denial, in the end it's love that gets you through. Pull in all your resources and surround yourself with lots of help and guidance, and be willing to make the tough decisions and changes needed for your own health and welfare -- and for that of your parents. You'll still be their daughter and their care advocate no matter where they live. It's your role to make sure that not only are your parents safe but that everyone (including yourself) emerges from caregiving with heart and health intact.