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I have made the incredibly tough decision that it is time to put my dad in assisted living. He has been in a rehab facility for about two months now. Not that it has been any easier since we have had major issues with this facility since day one. (I recently wrote about my "caregiver burn out" as I get no help from my family.) My question is, do I tell him before he is transferred? As POA, can I make this decision without his consent? He may not question the move at first, because I had mentioned I was going to try to get him moved because of all the issues we were having with the current place. He has been diagnosed with dementia and aphagia. It is getting worse and I work full-time and have two children to take care of. He cannot be left alone all day as he is a fall risk and this is now a safety issue. Since he has been in rehab for so long, he has lost his in-home care through the VA and would have to go back on a wait list when he comes out...this could take weeks to months to get services back and it only cover 4 hours a day 3 times a week. Anyway, to get back on topic, my brother, mother, and I had planned to sit and talk with him. Then, at least two people told us not to tell him till the transfer was done. The assisted living director said they could have one of their doctors sit with all of us (after transfer) and tell him that he needs to be there for his safety. The AL place sent over all the paperwork to the rehab place, but that director at rehab is saying she cannot fill out the paperwork because my dad has not been told yet. Can she force our hand here? I am so torn. He will be upset either way. He may refuse to go if I tell him now. I know he will be very mad at me either way. I guess I am asking what is the best way to handle this situation? How do you handle telling a person the time has come for him to be cared for in assisted living when he doesn't want to go?

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I think what I would do is tell your dad that you've found a MUCH better place for him to stay, where the doctors need him to be to practise walking and speaking. You leave it vague (don't being up home unless he does), if he asks about that, you tell him that down the road, the doctors will assess his ability to live safely at home.

We did something like this when we moved my mom, post stroke, to a really nice AL ( she had been livingi,in an IL at that point). We needed to tell her she was being discharged and where she was going.

It didn't really help. I took her in my car ( don't do this, I would use medical transport if possible) and she became hysterical, tried to grab the steering wheel.
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I had to move both my parents into assisted living. Prior to moving them (from CT to MD) my husband and I looked at 5 assisted living situations. We chose one that was a two bedroom apartment balcony in a pretty setting with great staff. Turned out to be the best price as well. Neither of my parents wanted to leave their house which had become a death trap - my dad was falling continuously and my mom was sleeping in the dining room on a hospital bed due to a stroke. Neither could navigate the steep stairs, manage their medications, purchase food or sadly understand the calendar of appointments I'd created and put on their refrigerator. We kept showing them photos of their new apartment, talking about the food, how they'd be safe and well cared for and would have things to do, make new friends. And, having a doctor tell my dad he could no longer drive was helpful. We ultimately had a family meeting with my mom's brother and they were more accepting, though they still ask if they can go back to their house on occasion.
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I've been told by the VA assisted living that if we bring my dad there and he says he doesn't want to stay, they will not admit him even though I am DPOA. They say we need to get guardianship by the courts to force him to stay. That costs money for attorneys.
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Thank you all for the advice. We are actually putting him in a privately owned AL. He has the means to pay for it month to month with very little coming out of his savings and does not have to apply for medicaid at this point. And, he really can't refuse...I am not in a position to care of him anymore (I have been doing it for 5 years) and no one else can take him. He requires too much care and he is a fall risk. For his own good and safety, he needs more supervision.
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The issue with the rehab director saying she can't process the transfer to the ALF because he hasn't been informed: she is correct.

Until your father is deemed to lack mental capacity, the decision of where to live is his. You have POA for him, which is good, which means you can act on his behalf. But what you can't do is act without his consent until he is formally recognised as being unable to consent on the grounds of his (legal) incompetence. A dementia diagnosis on its own won't cut the necessary mustard.

So you either have the difficult conversation with him - which I hope will be a lot less difficult if you adopt some of the sensitive approaches others have described - or you go through the process of having his mental competence assessed.

If the worse comes to the worst and he flat-out refuses AL and his doctors won't agree that he lacks capacity, how much time in hand have you got at rehab and what other in-home services are available? The same director who's digging her heels in might like to go through his options with you, if she can't support this one.

Please don't think I don't sympathise with your position. You have every right to make it clear how much his staying at home has depended on your commitment to date and to make it equally clear that that can't continue. Just not (not yet, anyway) the absolute right to decide what's good for him.
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Ah, ok...I guess the decision is made for us then, we have to tell him. My brother and I are planning on speaking with him today. Wish us luck.
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You owe your father the respect of talking to him first, not hauling him to new places against his will.
Yes, this will be a hard conversation, and likely he will have 101 reasons why he won't go--but when we had this talk with hubby's father--he finally said, Ok, he'd go. He really didn't want to be a burden, he knew enough to know he was not capable of even walking up/down stairs and he couldn't feed himself.

I did most of the talking. Hubby sat on the couch in trembling fear. It wasn't a "here's your choice, dad" kind of conversation, it was a "this is your only option, we're so sorry" kind of situation.

Had he been in better health he would have fought us, I'm sure he was simple exhausted.

I wish you luck in this difficult task. Make sure you and brother are ON THE SAME PAGE!! My brother will routinely tell me he's got my back over something and then caves in when Mother kicks up a stink. Talk beforehand and rehearse what you're going to say and make sure you support each other in this.
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kdaly0273, when my Dad needed to move from Independent Living over to Memory Care I was so worried about what to tell my Dad. Then I used a therapeutic fib and told him it was less expensive [he was self-pay] at Memory Care because his room would be like that of a single college dorm. We laughed about the "dorm", told him the only difference it would be quiet at night, no loud parties going on :) Dad had always been fugal so the thought of saving money worked for him.

So don't be afraid to use a "therapeutic fib" to help your Dad get through the move into Assisted Living.
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I certainly do wish you luck, but also - don't meet trouble half way! Explain that it's a positive move to get him the extended convalescent care he needs and that then you can all see how he gets on, and anticipate that he will *want* to get better and play ball. Go in with good expectations and an optimistic smile and maybe - pray, fingers crossed - he'll respond in kind.

Let us know how it goes!
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Remember that while you cannot force a decision for a competent adult, you can certainly make decisions for yourself. And you have decided that you can no longer care for him in your home. If necessary, be firm that that is not an option.

My heart goes out to you. Nearly all the caregivers in my local support group have had to place their loved ones in a care center of one kind or another. It is truly a heartbreaking decision to have to make.
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It doesn't help while you're in the thick of it, but the positives to remember are that dad is going to assisted living which in my opinion is far more pleasant than a nursing home and that he has financial wherewithal to afford it

I didn't tell my mom when I made the decision to move her to memory care straight from the hospital - she fought tooth and nail going into her room - it was agonizing for both of us

Do the best you can to reassure him he's not being abandoned and make his room as pleasant and familiar as possible with some of his favorite things
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MsMadge had a good suggestion about making your Dad's room as familiar as possible.

When my Dad moved to senior living, I tried to make his bedroom the same as how he had it back at his house. Sometimes it can be tricky if the furniture is big, but I was able to get his highboy to the left of his bed, so in the middle of the night he wouldn't feel like he woke up in a strange room.

I also read to keep the same bedspread... which I didn't because I read the article after the fact. But Dad did like his new bedspread because it was much warmer for winter. But for someone else it might be confusing.
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My brother and I went over today and spoke to dad...it went better than I thought. We just laid out everything that has been going on in the current facility, from missed showers, to them losing or not washing his clothes, to the most recent incident...he had poop on his sneakers that they knew about and did not wash off before putting back on his feet. My kids and I walked into his room yesterday and it smelled like poop. They had called me in the morning to tell me to bring another pair of shoes, but I did not think they were going to put the poopy shoes on him. Anyway, we said we were incedibly unhappy where he is (which we are) and we think there is another favility that would take better care of him (which there is.) He can take a shower 7 days a week at the new place, if he wants to. (This place only showers him twice a week. My dad actually likes his showers.) They have church on Sunday where the place he is at now has it on Wednesdays. We highlighted all the postive reasons why he needed to go to the new place and all the negatives as to why he needed to leave this place. He said he understood and agreed. We didn't give him timeframes and he did not ask. I am really hoping he understood everything we told him today and we have a smooth transition. Thank you everyone.
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Thanks for coming back and telling us how it went. There will be other bumps in the road but I know you and brother feel better having been upfront with him. I also think a parent likes it when their children agree on next steps. There is a measure of comfort there.
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kdaly0273, best of luck to you. I moved Dad to Memory Care May 1 from rehab. I did tell him, but it was not required. I too have POA and a letter from the dr stating he shouldn't make his own decisions. I told him I just couldn't take care of him anymore, and they have a full staff of young people. He's still sad about it, but it took over my life completely, and he's a big guy continuing to decline. Siblings were no help either. Since he's no longer in my home, I don't have to talk to them or see them.
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Talkey, it sounds like we were in identical situations. Although I appreciated my brother coming with me yesterday, he hasn't helped much the last 5 years. Simply taking dad to lunch, church or a haircut would have been such a huge help to me...neither he, my other brother, nor sister seemed to understand that.
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Have you ever told one of your siblings, specifically, that you would like them to do one of those things?
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If you tell him and he refuses to go, what will you do then?
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Sometimes, the way you "frame" the situation determines the answer. So by framing the situation as "we're moving you to a MUCH better place", resistance is usually avoided.

Of course, there are some incredibly stubborn people who will always say "no". That is their choice.

But adult children also have a choice. There is no law that says that you are obligated to house and care for your parent. In that situation, if it become clear that the parent was not going to cooperate with reasonable accommodations, it would be clear that "someone else" (the state, the NH) would have to get guardianship.
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I would definitely tell him. maybe something like this: dad, we've been able to take care of you up until now but we want you to be safe. it's time for us to think about moving to a safer place. that's how people take care of themselves today. we want you to be safe. let's go look at a good place and see what your room might look like. won't it be cool to have a place where you can make friends? and they will do all the cooking! I've given the best I can give you and now the people here, where you will live, can keep an eye on you. this will be an adjustment but you have made other changes in your life"

I would definitely break that paragraph into chunks, depending on how much your dad can understand at one time. telling him is kind.

with the power of attorney, I'm Michigan you have to have it activated. two doctors must put in writing that he is not able to make his own decisions. his attending physician can make that determination as well as the doctor at rehab.  then you can move him without his consent but

I WOULD TALK WITH HIM ABOUT IT BEFORE THE MOVE and talk about it frequently. he needs to have some time to adjust to the idea before the move and after the move. after the move I would say some of the following things to him every time you see him...keep it positive and deflect his complaining to help him stay positive. "dad, I'm so happy you found such a nice HOME. it makes me happy that you are safe and comfortable. tell me about who you eat dinner with." things like that. when he says he wants to go home, " I wouldn't call it a facility. I would call it home. 

make sure and put plenty of non food comfort items in his room. I say non-food bc he may start to have difficulty swallowing and not realize it. if you want to bring him food, I would supervise that and maybe eat with him.

that's a lot of information. I disagree wholeheartedly with not telling him.  just be straightforward and honest with him.  he might not say it but he will appreciate it.
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I had to move my dad to a memory care ALF earlier this year. His home situation had become dangerous on many levels. He was still living at home with my mother. I lead up to it for a few weeks by suggesting we find him a little apartment where he could live on his own. I did have to "drop him off" without giving him a full heads-up of his new living situation. After about 4 months now we are all adapting to the new-normal and I sleep well at night knowing he is in a positive living environment. I visit twice a week - I'm having lunch there today. I'm getting to know some of the other residents and their families. It's comforting to meet others that are in the same situation our family is in...other people just don't truly understand the dementia situation.
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I am sorry I can't give you my suggestion because I am in the same boat. I am in the process of finding a facility for my dad even though he has in home care right now. Once I find the right facility, I don't know how to tell Dad that he needs to go. He is 90 and has moderate dementia. I have cerebral palsy and I can't physically make him go.
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My mother never wanted to leave her home, and I was so afraid she'd refuse and beg me to take her home later, but she didn't. I got my mother's stuff ready in front of her, and I took her to the home for lunch the 2 days before I moved her, but I didn't explain anything or tell her she was moving. When I left her there, I told her I was going out of town for a few days, and she had to stay there. She cried and yelled she wouldn't, but I distracted her with a puzzle and left quickly. She has been ok ever since, but she doesn't seem to know she lives there even though she knows everyone and does word search and plays games with me. . People ask me if she's happy there. I don't think she's happy or even content, but she doesn't complain about being there; she just has outbursts sometimes when they try to help her or take her to the toilet or even to the table. I go almost everyday and she's mostly ok with me although she still has outbursts when I change her Depends. She's wet whenever I go there; maybe because she resists letting them take her to the toilet. These places are always short-handed, so they can never take care of them the way we do at home. But what can we do?
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Is it possible to schedule for him to spend a few hours at the facility? I used to work at one and we will have potential residents spend the day and we will match them with a friend for the day. I feel that when families do this, it helps their parents acclimate a little better and not to be fearful of their future home.
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Yes, BarbBrooklyn is right on point. You should VERY MUCH ELABORATE on the amenities of the new facility as much as you can. Most elders dislike change and who can blame them really? Expound on how much this facility has to offer and he will be more inclined to try to be receptive to the idea. I say "try" because I know of no elder who likes change. Nothing in life stays the same.
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BarbBrooklyn, yes, I have definitely told them all that...they definitely know. So does my mother. They are all just too busy with their own lives.

RbBear, we told him on Sunday. We pointed out all the reasons we are not happy with the current facility and how much better the new place will be. We told him we just want to do what is best for him. We gave him the opportunity to say anything and all he said was that he understood and that he was OK. It went smoother than either ofus thought it would. We will keep saying things before he moves just to make sure he really does understand.

Isabel's daughter, if he refused, I am not sure what I would have done. He needs more care than I can provide. It is unsafe for him to be home alone and I need to work. Proof of that came yet again tonight when I got home and the rehab facility called me to tell me my dad had fallen trying to get himself to the bathroom.
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Your father has dementia and asphagia. He cannot go home. He HAS to go to a place where he can get the care he needs. And your father cannot go against you in any realistic or legal way.  Let him object.  He is falling down and crapping a diaper.  His house is not a place where he can live, nor are there any people around to provide Sunday dinners and helping him wash the car or plant a garden or go to a sportsball game.   This is the end of his life, and he is darn lucky he has you to look out for him!..... Those days for him are over.  ...Sad as it is, YOU are in charge of his well-being, take him to his new home and say 'you are going to stay here till you get your strength back. I will come and visit and bring you  (-----fill in the blanks - ice cream, a bottle of Samuel Adams, a donut, a magazine) when I come to see you next week' ..... You are not 10 years old any more, go do this. It has to be done. You are doing a good thing. Go do it.
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Kdaly0273, thank you for taking us on this journey with you. I appreciate your sensitivity toward your father. Many who are in crisis can't or won't be so caring. But I was wondering why your mother is playing a minor role? I am in a similar situation. Dad has been living independently with PT companion care for 2 years, but much still falls to me. He has moderate dementia and uses a walker. Has poor stamina and naps a lot. I'm financially strapped and need to find employment so I won't be as available to him. I have asked repeatedly for help from siblings - general and specific - for years but they are too busy to provide any consistent attention to him. He had two falls in the past month - nothing hurt, thankfully - and it was enough to get the attention of medical personnel (recommended 24/7 assistance). I've been looking at places with him for 2 years and we were wait-listed at one place for a larger room which didn't come through. After the fall, I set up a move to a smaller apartment at the facility we had chosen just to get him in. Just before the move, he and two siblings objected to the dramatic downsizing, so I'm having to redo the process. (No help from them, of course) Found another (bigger) place closer to me; he doesn't want to go there. Will lose his companion. Wants to stay where he is or go back to the first place. We have had many discussions. Now getting pressure from family for decision and I am wondering if he should go directly into memory care at a later date or assisted living now, which is different than independent living with assistance. It is an extremely difficult choice and with the dementia, they can't really help you make it.
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In my case my husband was already having memory issues so I had explained to him that the house needed some major repairs and we had a place he could stay. He did ask a few times if the house was fixed (we always told him it was taking a long time) but after a few months he no longer asked. Good luck
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My mother had Lewy Body dementia and was at the point where she didn't even recognize her own home. We had big yellow signs up on the walls pointing to 'bedroom' and 'bathroom'. Oh it was a terrible time, she was falling down and ...it was just horrible. So we got her on Medicaid and into a nursing home, and me and her wonderful caregiver packed up all her clothes and toiletries and put the suitcase in the car. Then we got Mom in the car and said we were taking her to the doctor for a special exam. Drove her there, they met us at the entrance with a wheelchair and they did indeed take her to be examined while we got the suitcase into her room. We sat and talked with admissions for quite a long time while I filled out all the forms. Then we went to see mom in the day room, she was sitting at a table with some pudding. She was still talking, but nothing made sense. I said she would be there for a day or so while the doctors examined her, and she said, ok. It was a bittersweet moment, but went much easier than I thought. But of course, she was pretty far gone. I went back a few days later and she recognised me, and we 'chatted' , sort of. She seemed happy enough and didn't say a single word about her new surroundings or her old home. Mom lived there for two years mostly contented, declined gradually, and passed away last year. I felt she and I were lucky, there were so many other much worse off residents there!
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