Dad has dementia -- will he settle into the care home eventually?

3 answers | Last updated: Oct 22, 2016
Bellabean asked...

My father in law is 86 yrs old with dementia. He has lived on his own with us looking after him, meals and medicines.

About 10 weeks ago he fell at home and my husband found him. Not sure how long he was on the floor. Took him to the hospital and he was diagnosed with congestive heart failure. His oxygen level is low. He was in the hospital and then rehab until the insurance would no longer pay. We could send him home with 24 hr care, private pay or assisted living. He has been there about four days. Today he was unruly. He was combative and wanted to go home all day long. This evening the nurse finally called the doctor to give him something to calm down. We finally left about 10:30 pm. No one could reason with him. He cannot walk more than 25 feet without getting tired out and his feet are swollen. He also has a hard time getting dressed without help. His oxygen level is in the low 80's and he has been refusing to wear the oxygen. What can we do, will he eventually adjust? The staff is wonderful. I believe it is his dementia. He does not remember that he had been in the hospital.

Expert Answers

Deborah Cooke is a gerontologist specializing in dementia, delirium, caregiving, and senior fitness. She is a certified dementia care provider and specialist through the Alzheimer's Foundation of America. Cooke currently manages several multidisciplinary programs to enhance well-being for hospitalized seniors and other vulnerable patients at NewYork-Presbyterian Hospital in New York City. She also serves on the board of NewYork-Presbyterian's Patient and Family Education Advisory Committee. She has 18 years of experience working with the aging and caregiver communities.

You certainly have your hands full but are not alone in making decisions regarding your dad settling in an assisted living facility. My biggest concern is his recent behaviors. I address this in #6; however, I think you will benefit from the rest of the information. Sometimes knowledge can be very powerful and empowering. That being said, I'd like to break down the issues you are experiencing, especially since there are a lot.

  1. You are lucky that your dad was able to live so independently for so long. You should be proud and happy that you were able to help him with little assistance. You helped preserve his dignity.

  2. Falling is a very difficult experience for older adults, especially for someone like your father who already has his own healthcare issues. Even though your father-in-law's fall was unexpected and disturbing, it facilitate a dianosis of Congestive Heart Failure, a chronic illness. Hopefully his doctors will be able to manage him better knowing this is an issue. Making a full recovery from a fall at his age is very difficult. He might surprise us, but realistically he may now be at a new "baseline" of independence and cognition.

  3. Your experience with maxing out insurance and having to make the difficult decision to place him in an assisted living is frequently experienced by other caregivers. Sometimes, it actually is easier to make this transition from care facilities and not from home.

  4. You definitely have to take into consideration his dementia. A difficult issue in these care transitions is that your father-in-law moves from place to place and he likely does not remember being in the hospital. Dementia individuals need stability and structure. Given his dementia, this can make him even more confused and even scared. I know I would be, regardless of my mental status.

  5. Your father-in-law's behavior is not uncommon in those with dementia. Paranoia, unrecognition, and fear often come into play. Sometimes they may become unruly like he did. To start, I recommend looking at things from his perspective. What could be unsettling to him? Did someone look at him weird and make him scared? Could another resident have approached him the wrong way? Or, was he simply revolting for his loss of indepence. These are all things to consider. The important thing is not to rationalize with him. You can try distraction and redirect his behavior, but he lives in his own world. Rationalizing or convincing him otherwise only leads to further frustration and agitation for everyone.

  6. Your father-in-law's nurse was absolutely correct in calling a doctor. However, the purpose of calling him/her to sedate him (although well-intended) may not help the real cause (whatever that may be). Given that this seemed to happen suddenly and he has underlying chronic health issues (including his very low oxygen), it sounds like something more may be happening regarding his health. I am not a physician; however, I do know that patients can become very confused and unruly when a number of health factors come into play (low oxygen, swelling of the feet, dementia, his recent fall and his diagnosis of Congestive Heart Failure). Because of his limitations, he may not be able to say "Help me! Something isn't right." As a result, this thought pattern often results in inappropriate behaviors, especially if the "strange" behaviors happen suddently and are not him norm. I strongly encourage you to seek further medical assistance from his doctor. This experience may or may not be his dementia, but it's always better to err on the safe side.

I know this is a lot of information, but I truly believe your father would benefit from a doctor's follow up, especially all that he has been through. And...find some support for yourself. This isn't an easy road and you shouldn't have to do it alone.

Community Answers

Paz2u answered...

You have given the most excellent thorough answer to this question. My mother has dementia and was placed into the nursing home 6 weeks ago and began saying she was sick and starting praying. Already dehydrated and UTI after that short of time in the NH. Her feet were also swollen. Me and my sister insisted she go to the ER because no one was listening to us. Hospital got her feet down and she is back in the NH and after 3 days feet swollen again and once again no one is listening to us not even the Dr. Her behavior took a major turn (cursing, trying to bite the staff etc)

John m c answered...

I am going thru this now with my mom....I would like to add that, in my experience, it may also have to do to some extent with the assisted living staff...there are some at my mom's facilitty with whom she has a good rapport and they seem to have little problem dealing with her..others do not have much of a rapport and those are the ones she seems to have a problem with...while you have to maintain perspective [becuse she does deal with paranoia as part of the dementia] I can agree with her in many cases as the staff she does not relate well to are not at all friendly to me is curious in that her dementia places her in "her own world" not so much in touch with reality, yet she is also surprisingly perceptive about certain things [i.e. whether a certain staff "like her" or not]...notwithstanding, you have to do the best you can in working with the to the manager of the facility about who he may be having a problem with and see if another staff can take the lead instead....encourage your dad in seeing the staff he likes as representative of the care he will get at this facility...if they will let you, assist the staff in his care so he sees them "teaming" with you to faciliate their relationship with him....tell the staff the way he likes things done so they can learn his peculiarities [thus avoiding a potential point of conflict]...and have patience, as time is really what is needed....hope this helps.