What type of housing is best for Dad, who is an alcoholic and has dementia?

Bfkvn8r123 asked...

My dad is 80 years old and has been diagnosed with moderate dementia. He also is an alcoholic. I have a caregiver taking care of him from an agency. Dad has stopped eating and was taken to the hospital for severe dehydration. I can not keep going on like this. I need to move him to a facility that he will receive full time care. What type of facility do I move him to? Seems like the doctors/social workers do not want to help and I do not know what to do with him. Need guidance.

Expert Answer

Helene Bergman, LMSW, is a certified geriatric care manager (C-ASWCM) and owner of Elder Care Alternatives, a professional geriatric care management business in New York City. She consults with nursing homes and daycare programs to develop specialized programs for Alzheimer's patients.

Older adults with dementia require specialized care. When substance abuse further complicates the situation, very highly trained caregivers are needed. Seniors with these dual diagnoses usually have very compromised judgment and decision-making skills and are at danger to harming themselves. Memory impairment interferes with someone even remembering they had a drink! And trying to stop someone from drinking can precipitate anger and behavior problems. Alcoholism especially will impact on ones appetite and can easily result in dehydration and malnutrition.

Caregivers need training on how to encourage eating and hydration for such older adults and how to either deny access to alcohol or limit intake for harm reduction. This is where the caregiver's skill begins. Before you consider relocation, you might want to address some of his present issues. After all, when an older adult moves, they usually take their "˜problems' in their luggage. I am curious why your dad has not been eating. Is he still drinking and thus not hungry? How does he secure alcohol? Is he being expected to direct meal planning and unable to do so due to his dementia? Is the food he is being offered appetizing? Does he need direct feeding? Is he depressed? Perhaps he has some insight into his situation despite his moderate dementia. Maybe his refusal to eat or drink is intentional.

Unless the reasons are identified, he may also stop eating/drinking if and when he relocates"¦.and wind up hospitalized again. Relocation to a facility might not be the solution and I wonder if a facility would even accept him. Most nursing homes require applicants to have skilled nursing needs and despite your dad's poor judgment and moderate dementia, his needs may be more more supervisory than health related and he may not be eligible. Perhaps that is why you are not getting the help you need. You can begin by speaking to a geriatric care manager in your local area to identify viable options. Most facilities, whether Nursing Homes or less restrictive Assisted Living facilities, do not look kindly on applicants with substance abuse. Dementia is more acceptable only if you are looking at dementia-specific facility (example: ALF for memory impaired. Of course, access to alcohol would need to be blocked and if he has behavioral issues then he may be a less desirable applicant.)

If your dad is still drinking at this time, you may want to begin denying his access to alcohol. His dementia should limit his ability to secure it himself and liquor stores are very cooperative when they learn that selling can be potentially harmful. Your dad may even need a hospitalization to detox and then a structured environment for recovery. His dementia understandably would limit his insight and ability for psychological recovery but just being sober under medical monitoring might render him "˜clean' enough for relocation. In summary, your problem has no ideal solution but as you address each specific component, you may find the larger problem easier to solve.