Dad with dementia has moved aged care homes - how to help him cope?
November 4, 2014 11:44 PM Subscribe
My dad has multiple health problems and dementia, but since moving into care his mental and physical health have improved. Now we've had to move him to a new place and he's really unhappy there. How can we help him cope? Have you had similar experiences with an elderly relative?
Dad has been in aged care (we're in Australia) for about two years. He was really unhappy at first - didn't want to be in care at all, but he was not right to live on his own - he was not eating or taking his medicine. After about six months he settled down and became content there. Yay!
Alas, that aged care home is going to be knocked down and rebuilt. It'll take two years. They have guaranteed him a place should he return once it's rebuilt. Unfortunately with his meagre finances, our choices for a new place were limited. I've found him somewhere roughly as close to me as his old place. It's a nice facility - his room is better laid out and nicer, the food is better, the staff seem OK. But it's a lot bigger than his old place and therefore more institutional. He moved in last Thursday and at the moment he's really, really unhappy.
He cries when I visit. He says that all the "girls" (the staff) at the old place were lovely and hugged him, but nobody at the new one has time to chat. He also cries because he thinks his wife doesn't love him any more because she's put him in "this place". In reality they've been divorced 25 years, although they became friends again in later years and she visits him frequently. Also, his old room looked out on a garden, whereas this one looks out on the car park.
He feels he has nothing to look forward to, and in a way that's true. At the moment he is not in a state to appreciate his normal pursuits like reading and TV, and he can't paint or do crafts because he has developed arthritis. He has never liked things like darts or bingo and he complains that none of the other residents are his intellectual equal (but that's been a complaint for decades, no matter where he goes). He refuses to use gadgets (so an ipad or anything is out). We try to get him to walk in the garden but he just rolls his eyes and says it's all very well to say that, but what's the point. He suffers from depression, and even when he wasn't depressed he was always very self-pitying and self-centred, a "glass half empty" type. I can raise a smile from him sometimes but it's gone very quickly.
Even though intellectually I know there was no choice, I feel so guilty! I'm unhappy and stressed in general, and knowing he's unhappy is adding to the giant ball of stress. He hated the old place too at first, but he was too physically frail and mentally unstable when he moved in there to complain this much. Maybe he will come to appreciate the new place as well?
So, my questions: Firstly, do you have any advice for talking to a depressed older person in this situation?
And secondly, have you gone through something similar with an older relative with dementia? Did they settle after a while? Basically, can you reassure me there is a chance this will get better?
Dad has been in aged care (we're in Australia) for about two years. He was really unhappy at first - didn't want to be in care at all, but he was not right to live on his own - he was not eating or taking his medicine. After about six months he settled down and became content there. Yay!
Alas, that aged care home is going to be knocked down and rebuilt. It'll take two years. They have guaranteed him a place should he return once it's rebuilt. Unfortunately with his meagre finances, our choices for a new place were limited. I've found him somewhere roughly as close to me as his old place. It's a nice facility - his room is better laid out and nicer, the food is better, the staff seem OK. But it's a lot bigger than his old place and therefore more institutional. He moved in last Thursday and at the moment he's really, really unhappy.
He cries when I visit. He says that all the "girls" (the staff) at the old place were lovely and hugged him, but nobody at the new one has time to chat. He also cries because he thinks his wife doesn't love him any more because she's put him in "this place". In reality they've been divorced 25 years, although they became friends again in later years and she visits him frequently. Also, his old room looked out on a garden, whereas this one looks out on the car park.
He feels he has nothing to look forward to, and in a way that's true. At the moment he is not in a state to appreciate his normal pursuits like reading and TV, and he can't paint or do crafts because he has developed arthritis. He has never liked things like darts or bingo and he complains that none of the other residents are his intellectual equal (but that's been a complaint for decades, no matter where he goes). He refuses to use gadgets (so an ipad or anything is out). We try to get him to walk in the garden but he just rolls his eyes and says it's all very well to say that, but what's the point. He suffers from depression, and even when he wasn't depressed he was always very self-pitying and self-centred, a "glass half empty" type. I can raise a smile from him sometimes but it's gone very quickly.
Even though intellectually I know there was no choice, I feel so guilty! I'm unhappy and stressed in general, and knowing he's unhappy is adding to the giant ball of stress. He hated the old place too at first, but he was too physically frail and mentally unstable when he moved in there to complain this much. Maybe he will come to appreciate the new place as well?
So, my questions: Firstly, do you have any advice for talking to a depressed older person in this situation?
And secondly, have you gone through something similar with an older relative with dementia? Did they settle after a while? Basically, can you reassure me there is a chance this will get better?
Speaking of gardens and flowers, would it be possible for him to have a window box in which to grow something? Something easy like greens that he could actually nibble would be great. Flowers would be nice too.
posted by mareli at 6:08 AM on November 5, 2014 [2 favorites]
posted by mareli at 6:08 AM on November 5, 2014 [2 favorites]
Is he on anti-depressants? Are they an option?
posted by glasseyes at 7:05 AM on November 5, 2014 [1 favorite]
posted by glasseyes at 7:05 AM on November 5, 2014 [1 favorite]
You said he was really unhappy in the first place he was at in the beginning as well. While it's not nice to see people you love sad, I'd give him at least that much time before worrying he's going to hate the new place. More people mean more chances to make friends, most likely more activities organised to keep the residents occupied etc. Is there someone at the facility you can talk to about what's available? How does he feel about card games? Could you take him on outings to the local coffee shop or some favourite place? All but drag him out if you have to.
Next time he says what's the point to a walk in the garden, say well you'd like to go for a walk with him & jolly him along until he's out there walking with you. I know you say he has dementia but have you asked him what he'd like to do to make the place feel more familiar?
He really sounds like he has depression, which is entirely understandable considering what he is going through, have you spoken to his doctors about the matter?
posted by wwax at 7:33 AM on November 5, 2014 [1 favorite]
Next time he says what's the point to a walk in the garden, say well you'd like to go for a walk with him & jolly him along until he's out there walking with you. I know you say he has dementia but have you asked him what he'd like to do to make the place feel more familiar?
He really sounds like he has depression, which is entirely understandable considering what he is going through, have you spoken to his doctors about the matter?
posted by wwax at 7:33 AM on November 5, 2014 [1 favorite]
This message board has constant discussions of this very issue: http://forum.alzheimers.org.uk/forum.php
posted by Riverine at 7:53 AM on November 5, 2014
posted by Riverine at 7:53 AM on November 5, 2014
Perhaps placing a bird feeder outside the window? If the facility would allow it of course?
posted by moonlily at 11:31 AM on November 5, 2014 [1 favorite]
posted by moonlily at 11:31 AM on November 5, 2014 [1 favorite]
Best answer: We are at (what we hope is) the tail end of dealing with a very similar issue with my MIL. Getting her back on an antidepressant really helped a lot - she's old, has outlived all her friends, has lost so much mobility and other things of which she was proud - gee, why would anyone find that depressing?? We also got her involved in a lot of activities at the new place. It's a delight to hear her grouse about the behavior of the *other* people in the group, instead of her moping about!
Your mention of how he felt remote from the staff at the new place reminded me that my MIL felt the new staff didn't like her while the staff at the old place were very solicitous of her. We worked with the coordinators at the new home to assign staff for her that should would like, then facilitated them getting to know each other. Now there's much greater warmth, and she loves it.
posted by DrGail at 11:45 AM on November 5, 2014 [2 favorites]
Your mention of how he felt remote from the staff at the new place reminded me that my MIL felt the new staff didn't like her while the staff at the old place were very solicitous of her. We worked with the coordinators at the new home to assign staff for her that should would like, then facilitated them getting to know each other. Now there's much greater warmth, and she loves it.
posted by DrGail at 11:45 AM on November 5, 2014 [2 favorites]
Best answer: He's an old man who's lost and lost and lost, his homes, his contacts and his hopes for something better in the future. Now he has dementia and that means he's dealing with confusion and uncertainty every time he turns around. He found some semblance of order at the place he's been in for the last couple of years and the nursing personnel there were fond of him and expressed it - and he enjoyed the garden. Now he doesn't get those hugs and smiles - and he's not sure he ever will again. What's he supposed to think? And why? So many studies have shown that depression in the elderly and in people with dementia is helped in huge part by physical contact - hugs and pats and squeezes - affection makes all the difference.
Sometimes we have to do these things - you had to move him to a different place and there was no choice. If he had all his wits about him, he'd understand that, but even so he'd still be sad because, choice or no choice, it's another loss. I don't have an answer, but having worked in nursing homes for many years I can tell you that sometimes it takes time for a new person to find a niche where they're comfortable; usually it involves finding a particular staff member who dotes on them in particular - it helps when they can look forward to seeing that person come on duty.
I really doubt that he's trying to lay guilt on you or be an "unhappy victim" (??!!) Overall, people who live in nursing homes are just like everyone else in that they've lived long, busy, complex lives with many ups and downs, many relationships, wins and losses, but the difference is they've done it for a much longer time than the rest of us and as old age and infirmity claims more of the person's freedom, the losses outweigh the gains. It's life, if you live long enough.
I'm so sorry for the position you're in, but overall I'd just give it time and try to do anything you can to encourage him to engage with other residents and with staff. A bird feeder or flower box is nice, but only if he's allowed to go outdoors to care for it - otherwise it just makes something else to look at and wish he could be there. Take him out as often as you can, be as positive as you can, and then know you've done all you can and it's good.
posted by aryma at 7:03 PM on November 5, 2014 [1 favorite]
Sometimes we have to do these things - you had to move him to a different place and there was no choice. If he had all his wits about him, he'd understand that, but even so he'd still be sad because, choice or no choice, it's another loss. I don't have an answer, but having worked in nursing homes for many years I can tell you that sometimes it takes time for a new person to find a niche where they're comfortable; usually it involves finding a particular staff member who dotes on them in particular - it helps when they can look forward to seeing that person come on duty.
I really doubt that he's trying to lay guilt on you or be an "unhappy victim" (??!!) Overall, people who live in nursing homes are just like everyone else in that they've lived long, busy, complex lives with many ups and downs, many relationships, wins and losses, but the difference is they've done it for a much longer time than the rest of us and as old age and infirmity claims more of the person's freedom, the losses outweigh the gains. It's life, if you live long enough.
I'm so sorry for the position you're in, but overall I'd just give it time and try to do anything you can to encourage him to engage with other residents and with staff. A bird feeder or flower box is nice, but only if he's allowed to go outdoors to care for it - otherwise it just makes something else to look at and wish he could be there. Take him out as often as you can, be as positive as you can, and then know you've done all you can and it's good.
posted by aryma at 7:03 PM on November 5, 2014 [1 favorite]
Yep, unhappy victim. My mother died May 23rd, she was in assisted living ten years, give or take, part of that time in Phoenix, part of it in Illinois, after the strongest person in her support group there in Phoenix -- my brother -- died from lung cancer.
In both places, she had many visitors, and had myself and all of my sibs and some cousins watching over her like a hawk, making certain that she was not being left to rot, as so many are if they don't have strong people "on the outside" looking in. I have a fairly strong presence -- I can make flags run up and/or down poles with a well placed phone call -- my mother got to where she'd not mention anything to me unless it was really needed, cuz I'd tell her "Hey Mom, lemme call you right back." and before she could count out two minutes or three her needs were very, very politely being attended to.
Unless it was just her unhappy victim stuff playing out, and nothing really wrong. She played that card on me my entire life. On all of us, really, myself and my sibs. It wasn't until about fifteen years ago that I'm talking to her, and I notice my gut is hurting, and I'm all "wtf?" and that's when I learned to get off the phone, pronto -- "Um, I think my leg hurts or something, Mom, catch you next time bye."
God only knows how many she slid past me still but I began to catch a lot of them, and the instant I did I was outta there --"Adios, Momma Bear!" And then I'd not call her for a longer while than prior. She got it.
Some day when you're strong, and can bear a horrific story, I'll tell you the whys and the wherefores of my mothers depressive state, how it all started out. She damn sure was a victim, she was a beautiful little girl with a step-father and a step-brother; you put it together. But it wasn't fair play for her to pass that around, the elevator game.
They didn't have therapists behind every bush in the 1930's, to help people deal with trauma. What she had was Jesus. Period. What happened to her was a fkn tragedy, one she never, ever dealt with. She'd just open her bible and go on about leviticus this or hosea that or whatever. If you don't deal with something, you pass it on, not really much choice. It's just that my sibs and myself became unwilling to play, once we got onto it.
People can and will play victim games, assisted living or not, surrounded by loving people and excellent care or not, no matter their age, if that's their wont. Sometimes if they're called out on it, they can adapt.
posted by dancestoblue at 8:25 PM on November 5, 2014 [1 favorite]
In both places, she had many visitors, and had myself and all of my sibs and some cousins watching over her like a hawk, making certain that she was not being left to rot, as so many are if they don't have strong people "on the outside" looking in. I have a fairly strong presence -- I can make flags run up and/or down poles with a well placed phone call -- my mother got to where she'd not mention anything to me unless it was really needed, cuz I'd tell her "Hey Mom, lemme call you right back." and before she could count out two minutes or three her needs were very, very politely being attended to.
Unless it was just her unhappy victim stuff playing out, and nothing really wrong. She played that card on me my entire life. On all of us, really, myself and my sibs. It wasn't until about fifteen years ago that I'm talking to her, and I notice my gut is hurting, and I'm all "wtf?" and that's when I learned to get off the phone, pronto -- "Um, I think my leg hurts or something, Mom, catch you next time bye."
God only knows how many she slid past me still but I began to catch a lot of them, and the instant I did I was outta there --"Adios, Momma Bear!" And then I'd not call her for a longer while than prior. She got it.
Some day when you're strong, and can bear a horrific story, I'll tell you the whys and the wherefores of my mothers depressive state, how it all started out. She damn sure was a victim, she was a beautiful little girl with a step-father and a step-brother; you put it together. But it wasn't fair play for her to pass that around, the elevator game.
They didn't have therapists behind every bush in the 1930's, to help people deal with trauma. What she had was Jesus. Period. What happened to her was a fkn tragedy, one she never, ever dealt with. She'd just open her bible and go on about leviticus this or hosea that or whatever. If you don't deal with something, you pass it on, not really much choice. It's just that my sibs and myself became unwilling to play, once we got onto it.
People can and will play victim games, assisted living or not, surrounded by loving people and excellent care or not, no matter their age, if that's their wont. Sometimes if they're called out on it, they can adapt.
posted by dancestoblue at 8:25 PM on November 5, 2014 [1 favorite]
Best answer: IANYALA: I am not your assisted living administrator
Transfer trauma is a very real thing, especially for people with dementia. Change is hard for everyone, but it's even harder when you are confused and not really sure what's going on at the best of times, let alone in a brand new environment. Your dad needs time and encouragement, and yes, talk to the doctor: maybe some medication would help him deal with the chemical aspect of his depression.
I would visit, but keep the visits brief and cheerful. Talk up the new place while you're there, take him out into the garden (don't ask, just tell him that's where you're going, get up, and start moving! If you ask, the answer will almost surely be no). End your visits on a positive note by ending them with another activity: "Well, dad, time for you to have your dinner, I'll see you soon!"
Arrange to meet with the activity director or administrator of the care home and tell them your worries, ask them what their plan is to help your dad fit in. Give them suggestions of his favorite music, foods, books, stories from the past, so that they can use them as tools to get to know him better and help him feel loved. It's all about helping build a relationship between your dad and the home, so that he feels as much a part of it as he did at his old place.
posted by assenav at 10:45 PM on November 5, 2014 [4 favorites]
Transfer trauma is a very real thing, especially for people with dementia. Change is hard for everyone, but it's even harder when you are confused and not really sure what's going on at the best of times, let alone in a brand new environment. Your dad needs time and encouragement, and yes, talk to the doctor: maybe some medication would help him deal with the chemical aspect of his depression.
I would visit, but keep the visits brief and cheerful. Talk up the new place while you're there, take him out into the garden (don't ask, just tell him that's where you're going, get up, and start moving! If you ask, the answer will almost surely be no). End your visits on a positive note by ending them with another activity: "Well, dad, time for you to have your dinner, I'll see you soon!"
Arrange to meet with the activity director or administrator of the care home and tell them your worries, ask them what their plan is to help your dad fit in. Give them suggestions of his favorite music, foods, books, stories from the past, so that they can use them as tools to get to know him better and help him feel loved. It's all about helping build a relationship between your dad and the home, so that he feels as much a part of it as he did at his old place.
posted by assenav at 10:45 PM on November 5, 2014 [4 favorites]
Best answer: My grandmother took a while to adjust to her assisted living place, though she didn't have dementia or depression, so they might not be as helpful. But these are some things that make her happy/make her apartment feel like home.
Pictures of the family, potted plants (she has the entire floor by the window taken up by various plants), sun catchers on the window (especially butterflies, since she loves them)
Attending some of the events her place holds. If not crafts and bingo, how about concerts? Movie nights? Her place also has 'living room' style common spaces with comfy seats, a TV & DVD player, a puzzle table (great social activity that doesn't require conversational skills), and a library (mostly of books residents have supplied).
Taking the bus out. This might not be doable without assistance, but by taking the bus to the grocery store one day a week and the library another day, she feels so much more independent (even though she needs help getting her books on the bus!). Getting out and moving is good for her, plus she gets to make a new friend each day on the bus by sitting with someone new.
More for socializing: do they do group meals? Does he have a table he likes or could he be assigned a different table? Could he have/find/be assisted with having a walking buddy? Even if it's just around the building or along the floor he lives on.
Family: are there other folks who visit him? Will take him out for lunch occasionally? Maybe get a routine of having a different relative call him every day. I don't live close enough to visit daily and suck at remembering to phone, so I try to send a card or letter every couple of weeks with chatty things about my life.
posted by carrioncomfort at 8:28 AM on November 6, 2014
Pictures of the family, potted plants (she has the entire floor by the window taken up by various plants), sun catchers on the window (especially butterflies, since she loves them)
Attending some of the events her place holds. If not crafts and bingo, how about concerts? Movie nights? Her place also has 'living room' style common spaces with comfy seats, a TV & DVD player, a puzzle table (great social activity that doesn't require conversational skills), and a library (mostly of books residents have supplied).
Taking the bus out. This might not be doable without assistance, but by taking the bus to the grocery store one day a week and the library another day, she feels so much more independent (even though she needs help getting her books on the bus!). Getting out and moving is good for her, plus she gets to make a new friend each day on the bus by sitting with someone new.
More for socializing: do they do group meals? Does he have a table he likes or could he be assigned a different table? Could he have/find/be assisted with having a walking buddy? Even if it's just around the building or along the floor he lives on.
Family: are there other folks who visit him? Will take him out for lunch occasionally? Maybe get a routine of having a different relative call him every day. I don't live close enough to visit daily and suck at remembering to phone, so I try to send a card or letter every couple of weeks with chatty things about my life.
posted by carrioncomfort at 8:28 AM on November 6, 2014
Response by poster: Thanks all. He is on antidepressants already - given the cocktail of drugs he's on for various health issues, I think we'll wait and see whether they need adjusting.
Wouldn't you know - tonight he was all smiles! It's like a switch has been flipped. We spoke to a staffer who said he is beginning to fit in, is talking to the other men on his dinner table, etc. It's a big relief. We're working on getting his photos framed and on the wall, and I'm going shopping for a bookshelf tomorrow so we can get his books all displayed and he realises they're there - at the old home the bookshelf was built in.
Thanks everyone for your help. Some really helpful comments in here which I will incorporate.
posted by andraste at 12:48 AM on November 7, 2014 [2 favorites]
Wouldn't you know - tonight he was all smiles! It's like a switch has been flipped. We spoke to a staffer who said he is beginning to fit in, is talking to the other men on his dinner table, etc. It's a big relief. We're working on getting his photos framed and on the wall, and I'm going shopping for a bookshelf tomorrow so we can get his books all displayed and he realises they're there - at the old home the bookshelf was built in.
Thanks everyone for your help. Some really helpful comments in here which I will incorporate.
posted by andraste at 12:48 AM on November 7, 2014 [2 favorites]
This thread is closed to new comments.
People caught in self pity, it's really hard for anyone on the outside to spring them; they're determined to be unhappy, their life A Quest For Dung. Generally, once they find the dung they seek -- and anyone can find dung, it's all over the joint -- once they find some they like to spread it around onto anyone in their sphere, and then everyone can sit around and be unhappy.
You do know that there are people who fart in elevators so that they can see others suffer, even though they also have to suffer it.
I'm not trying to be all light here -- Alz took my father and all of his sibs, and it's nasty stuff. The day we *finally* pried the car keys out of his hand he plummeted precipitously, his mental state and my mothers physical state demanded that they move into an assisted living place, but he tanked even further as Alz come on more, and had to be moved to the other side, away from his wife of over sixty years, and he lost what little he had left, and lost it fast.
But it sounds like your father is not -- yet anyways -- sounds like your father is not that deeply into it, that his problems stem mostly from symptoms of his depression. Which truly are a bitch, but you need not stay in that stenchy elevator with him.
Tried and true, if he'll do it -- have him write a gratitude list. What is he grateful for. He can start with a ceiling over his head, three squares a day, your love, his ex-wifes love. He can express his gratitude for even being alive, much less relatively lucid. Gratitude lists puncture self-pity, they'll blow it out of the water.
Likely, he's not going to want to do this simple thing, because he's vested in being an unhappy victim.
I wrote one the other day, just because, not that I was in trouble that day, just wanted the lift they provide. I spent maybe five minutes writing, end up smiling, happy. Not that my life isn't a mess -- my life most certainly is a mess, I'm a mess. But that doesn't preclude the beauty that's in this whole thing, and I've got my share of it.
Don't be surprised if Dad tries to turn it into a Resentment List rather than a Gratitude List -- it sounds like he's not happy unless he's not happy. If he insists on heading on that course, remember suddenly that you've got something to do 'cross town, tell him you love him, wave him goodbye, tell him you'll see him next time. The third time he feels you about to head out the door he will drop the bullshit immediately, and begin to be pleasant in your company. Unless he just is unable to do so, unless the depression is just carved into him too deeply, in which case I still say that you've got to get out of there, enjoy the flowers -- you do have flowers in Australia, right? Hows about cars, and electricity and stuff -- you're all set up down there, right, just like regular people? If yes, hop into your car, and take a drive, look at some springtime flowers, enjoy your day.
I wish you peace.
posted by dancestoblue at 3:12 AM on November 5, 2014 [2 favorites]