I, too, am facing the same situation in that my father needs additional care. We recently moved him to an assisted living dementia unit. He is not adjusting and just
this past weekend he had declined so significantly that we took him to the ER. It turned out that he was over medicated. He is now in the hospital and we realize that the situation must play out and we now need to lean on the resources they will be providing us (i.e. social worker, discharge plan, etc.) You asked the million dollar question because I am learning the following things through experiencing this terrible disease:
1. In relating to a person with dementia, always remember not to fall into the trap of trying to rationalize with the person regarding complex decisions. This is counter-intuitive but I try to remember my goal is to keep him calm. I tell myself that in these instances, I am having a relationship with a disease and not my father when things get difficult.
2. Does your father go and visit his wife at this point? Is it possible that he could start going to the nursing home for regular visits with his wife? This way he would establish a routine of being in that environment which might help with the eventual transition.
3. It is good that he doesn't drive anymore. Why can't the car go with him to the nursing home? It sounds like it is parked outside where he lives so why can't it be parked at the nursing home? Just be sure he doesn't have access to the keys.
4. I try to remember that behavior can be driven by fear and need. When your Dad becomes hurtful, try remembering this, "Hurt people hurt people."
5. Don't feel guilty. You sound like a very caring person doing the very best they can!! I am amazed at everything you are doing for your dad plus still working and trying to be part of your son's life.
6. If it helps, use the framework of "Is my father safe in his environment?" It sounds like he is no longer safe in that you mention falling. Once you answer this question, allow that to be your motivation as you move forward in the care for your father. Remember, he is losing his ability to rationalize so try and avoid that pitfall. Redirect, redirect, redirect when your father is irrational. Continue to plant seeds like, "I'm glad mom doesn't have to worry about steps anymore. I used to worry all the time that she would fall and that would have been a bad situation." "You know Dad, you are so important to me and right now the most important thing is your safety and happiness."
6. There are no easy answers. Hang in there -- lean on the experts -- remember to take a breather for yourself -- and absolutely no blaming of yourself during this very difficult time with your father. I have a feeling you will figure this out.