My dad 93 was weak when he came here in Sept and we have worked with him while Covid had assisted living closed up but the goal was always to move him. He was doing much better, walking 1/4 mile a day and doing other exercises. He has some dementia but copes pretty well on the day to day stuff, like dressing and eating. Anyway, the assisted living opened up dining and some activities so we moved him to it... it's one of the big names and pricier choices. Close to us which is a plus. He loved it and was so excited to be going. But in less than a week he has declined a lot. He was recently on prednisone and came off about a week ago and was feeling tired when he moved. I presumed it was because of the prednisone withdrawal. Now, however, he's falling in his apartment and seems disoriented etc. I'm SURE it's strange being in a new place and not knowing your way around or how things are done. Maybe it was too much for him. He fell twice today within an hour of each other. He doesn't press his call button but they just found him on the floor; he was rushing to answer the phone. He really wanted this one bedroom place and I see plenty of very old frail people there (as well are more higher functioning people), Maybe this wasn't the right place for him. I know a week is not enough time to evaluate, but two falls in a day? (he fell twice in 9 months at my house). The care staff are in and out all day and he is on level 2 care. How can you tell if it's the right place for your LO? At that age, does anyone adjust to this big of a change?
It is a huge upheaval for them, especially with dementia, and yes, it takes time to acclimate. They also probably won't acclimate to a level of what was "normal" before, because when someone has dementia (at least in the case of my mother), any shock to the system like a move, an illness, or an emotional shock (my dad's death) results in a step down in her ability to bounce back. The bouncing back also takes a LONG time once it does happen.
One thing I did for both the nursing homes my mother has been in was to write a short biography of my mother for the staff. It gives them an opportunity to know a bit about who she was before she came to live there, plus I also put in important information I felt they needed to know. For example, she has macular degeneration and can't see faces, so I asked that they identify themselves when talk to her and don't touch her without speaking to her first, because she may not see them coming. I also gave that biography and the notes to the hospice people when I signed her up with them as well, and they were thrilled to have it. They meet their clients for the first time at the end of their lives, so it's been very good for them to understand what kind of person she once was.
Consider writing a biography for your dad to share with the staff. Be in touch with them, let them get to know him, and obviously stay in close touch with your dad as well. Remember to be part of the team that cares for him, not an adversary.
Concerns:
Lookup says this medication suppresses the immune system and has withdrawal issues:
"Prednisone withdrawal: Why do I need to slowly taper down the dosage?
(from mayoclinic)
If you abruptly stop taking prednisone or taper off too quickly, you might experience prednisone withdrawal symptoms:
*Severe fatigue
*Weakness
*Body aches
*Joint pain
*Nausea
*Loss of appetite
*Lightheadedness
Prednisone is similar to cortisol, a hormone naturally made by your adrenal glands. If you take prednisone for more than a few weeks, your adrenal glands decrease cortisol production. A gradual reduction in prednisone dosage gives your adrenal glands time to resume their normal function.
The amount of time it takes to taper off prednisone depends on the disease being treated, the dose and duration of use, and other medical considerations. A full recovery can take anywhere from a week to several months. Contact your doctor if you experience prednisone withdrawal symptoms as you are tapering off the drug."
At least 3-4 of the withdrawal issues they list could lead to falls. How long it takes to wean off depends on what it was for and probably how long he was on it and the dosage.
Since you had been "working" with him at home, getting him walking and active, it might be a good idea to have a good checkup and perhaps get OT/PT in to help him build up more stamina and strength.
Good checkup should include blood work and a urine culture. Since this is an immune system suppressor, he could have picked up a UTI or other infection. If he isn't eating and drinking enough, it can cause imbalances in the blood. Even drinking too many fluids can lead to issues - my mother managed to do that and end up really looking ill and confused! Once they stabilized her with an IV drip bag, she was back to her grumpy old self!
It's possible that he has experienced a small stroke, which is why he is having balance problems and disorientation. I would recommend a medical evaluation.
It's also possible that he may need a higher level of care now - but he should be evaluated medically first.
I love the biography idea. We do that for every new move in and share it with staff. It gives us a chance to know them more.
Hopefully time will help. And hopefully you can do inside visits. We are able to do that now with essential caregivers.
I can see in my mother, now 96, that her ability to adapt and learn is becoming extremely tenuous. She really should have moved to residential care at least 5 years ago when the change would have been easier for her. Even then the choice would not have been assisted living, but some range of nursing care. In our state there are specific behavioral guidelines regarding the type of care each level involves. "Assisted living" behavior looks like someone who could manage well enough at home, but benefits from a little help now and then. I think Mom wouldn't have qualified for that much past 85--and at that age she was adamant that she wouldn't go. Of course, that decision would not have lasted long if she didn't have daughters to fill in where she was no longer able. The longer it goes on, the less she is able to see that she really can't manage. That will become part of the problem of adjusting to a new place when the move absolutely must be made.
We all wonder if we have made the right choice in enabling Mom to stay in her own home for so long. The worse she gets, the harder the move will be. It is so very difficult trying to make the right decisions in caring for the elderly. Each is so different and the "right" decision is never very clear. The fact is that the end of life is a really difficult time and we will probably always doubt the choices we make, however good our intentions.
I would approach this from a methodical manner and don’t rush into moving him again. Moves are hard on them and usually take 3 months to adjust to them.
Dad is reluctant to go to activities because everyone is masked and he's basically deaf and lip reads so he's frustrated that he can't sit near someone and talk to them face to face.
I have a tablet set up with a daily agenda calendar that he refers to of all the events as well as his doc appointments or reminders from me. However he can't seem to remember when the time comes to get to the event. If I call him to remind him, he has done it... but I can't keep that up!