If visiting with and talking to extended family members unsettles my father, who has Alzheimer's, should we continue while he still remembers them or stop?

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My father in law was recently put into a nursing home for Altzheimer's, and for the first month or so seemed excited about the whole thing.  Now that the new is wearing off he is ready to go back "home" and is expecting my husband to take him home when we go to visit. It seems that when he speaks to members of the family it really unsettles him. For instance, last time we went to see him, my husband called his uncle (dad's brother) and they were talking about moving to a different town, etc. and ever since then he has been talking about going home.  My questions is, which is better?  To not let him talk to extra people, or take visitors to see him, or to allow him to see them as much as possible before he forgets?  It seems to upset him more than help. My dad and my father-in-law have birthdays one day apart and we always celebrate them together.  We are planning to go and have aparty with him at the facility, but I just feel that this might be a mistake considering the mental state he is in right now.  My dad is the same age and they have always hung out together, so I think it might unsettle him when we leave without him.

Expert Answer

Beth Spencer is a social worker in Ann Arbor, Michigan, with more than 25 years of experience with families who have a member with dementia. She is coauthor of Understanding Difficult Behaviors and Moving a Relative with Memory Loss: A Family Caregiver's Guide. Previously, she directed Silver Club, early-stage and adult day programs serving individuals with Alzheimer's disease and related illnesses.

Helping people with dementia adjust to a move is always tricky and very individual.  For your father-in-law it sounds like reality has set in and he wants to go home now.  Think about what you, other family, and staff are saying to him.  He is most likely getting mixed messages.  It can be helpful to figure out what is most likely to reassure and comfort him, write it down and ask everyone to try to respond similarly.  Of course this raises issues about truth and lying, so you may want to find something that is a partial truth.  For example, would it be helpful to remind him that he is there for treatment (which is true but does not address the long term)?  Or that he is there because there are lots of things to do and people to be with, which was not there at home?  Telling a person the whole truth – this is where you are going to live from now on – can sometimes make them very angry or plunge them into despair.  Only you and the family can gauge what is going to work best for your father-in-law, but you want to help him feel as comfortable as possible.  Do not tell him that it is temporary if it is not; that will only backfire later.  

If visitors are unsettling to him, then I would recommend talking with the visitors and helping them think about what to say or not say.  To deprive him of celebrations or visitors seems cruel, but you want to find a way to make them less upsetting.  Sometimes it is helpful to limit the number of people.  For some folks with dementia a lot of people and noise is distressing – they can’t handle that much stimulation – and it increases agitation or distress.  

Ask the staff to help with good-byes.  It's often difficult for the person in residential care to see everyone leave while he remains behind.  Sometimes timing visits is helpful.  For example visit before a meal or favorite activity and have him go to lunch while you leave.  Or ask a staff member to help by distracting him or asking him to come do something while you leave.  Also ask staff how he is after visitors leave.  Sometimes the resident begs family to take him home, but the moment they are out of sight, the whole memory and emotion disappears and they are fine.  It can be comforting to family to find out what happens after a visit.