How to tell narcissistic Dad he has to go to memory care?
September 23, 2023 6:50 AM   Subscribe

My Dad has Alzheimer's disease and lives alone. His doctor has said he has to go to memory care. We have power of attorney, a decent facility, and money to pay. But Dad doesn't think he needs care. He is a legit narcissist. How can we make this easier?

Dad is in his 80s and in perfect health except for his brain. He CAN do all the things he needs to do to live alone, like cooking, housework, bathing, etc. But he hasn't been doing well and has become unsafe.

I live far away and there is no one else who can provide live-in support.

He of course doesn't realize this and thinks he's doing fine. He is very ego driven and HATES being told what to do. He is a legit narcissist but not malicious at all. He just believes he's doing fine and doesn't remember all the times he's gotten sick from rotten food, forgotten to eat, wandered off, made devastating financial decisions, etc.

We have a facility and the move-in date is in a few days. He has to go or the doctor will hospitalize him. We haven't told him yet.

A lot of the advice I've seen involves tricking the person, telling them it's an apartment, telling them it's a free trial stay, etc. Dad still has very good reasoning, it's just his short-term memory that's gone. He's not going to be fooled by a simple trick like this.

The facility is one of the better ones in his town and we were thinking to play up the exclusivity and independence they offer to assuage his ego. But we just found out the spot that opened up is a smaller and less nice room that doesn't look AT ALL like an exclusive place for the well off.

Please share your experience and any tips that can help our family get through this transition.
posted by Frenchy67 to Human Relations (12 answers total) 5 users marked this as a favorite
"Dad, you have to go or the doctor will hospitalize you. There is no other choice."
posted by cooker girl at 7:20 AM on September 23 [8 favorites]

Sorry, yes, that is how it happened with my mom. Nobody could tell her. The doctor hospitalized her and then from the hospital would only release her to the care center. He was the “bad guy” and we were “helpless to stop him. So sorry mom.” It sucked, but it was absolutely necessary. I feel for you. This a tough stage of life.
posted by probably not that Karen Blair at 7:26 AM on September 23 [35 favorites]

Talk to the facility and to his doctor about his state of mind - they likely deal with these situations often and may be able to offer suggestions or support.

The Alzheimer’s Association has a 24/7 helpline (800.272.3900) and offers free care consultations. They will talk through the situation with you and help you make a plan.

Good luck to you and your dad.
posted by bunderful at 7:58 AM on September 23 [5 favorites]

Dementia on a foundation of narcissism is so cruel for the family. I'm so sorry you're dealing with it. Sadly there is no magic solution that you just haven't come across yet. The options are exactly as you've laid them out: Try to trick him/make up any lie to get him in the door behind the locked access, try to reason with him, or get a medical professional to be the heavy.

One of the symptoms of dementia anosognosia--the inability to recognize symptoms or understand their illness. It's very likely not just short-term memory that your dad is lacking. Has he been deemed unable to make his own decisions? I assume so, given he's been accepted at a memory care place and a lease is signed on his behalf but not by him.

His judgment--already burdened by narcissism--is severely impaired. You are very unlikely to be able to convince him to go along with your plan. If you think he won't fall for any type of ruse, not even one carried out by a trusted friend instead of a family member, then I urge you to have him hospitalized and allow the doctors to set the wheels in motion.

In our case, my mother was hospitalized after being admitted due to disorientation and malnutrition. (She'd forget to eat.) The doctors diagnosed her via brain imaging and immediately wrote a "to whom it may concern" letter saying that my mother was medically incapable of making major life decisions such as where to live or handling her own money. They also contacted the DMV to say she could no longer drive and that they needed to yank her license. Despite hearing these words, and her diagnosis, she discredited it. Just flat out denied it all, even though doctors were explaining it to her. Then later, she didn't remember any of it, because short term memory loss. So convincing her was never going to work. Our best option at the time, I thought, was tricking her. We relied on a trusted friend to execute a ruse. It ended up being traumatic for that friend. And my mother yelled for days once in the facility, even lashing out trying to hit and bite people. This apparently can happen even if they agree to go, because dementia. But I believe this was my mother's narcissism at play. She wanted all the power, and she didn't have any. Plus, who doesn't want to be in their own home? Anyway, if I had to do it all over again, and if it were an option for her to be medically ordered into memory care, then I wouldn't hesitate to choose that option.
posted by ImproviseOrDie at 9:26 AM on September 23 [3 favorites]

There is no convincing. You are in a situation where this isn’t a conversation, or a discussion to resolve an issue, or even a debate with pros and cons. He is at the point where you can’t make any sort of convincing argument, regardless of its merits or severity. Even a moment of lucidity will not be remembered. I appreciate that you do not want to deceive him.

You note he retains his reasoning but lacks reliable memory- does he trust himself? Would current day him trust yesterday him?

Your dad was on trail, and I’m not kidding with that language, because the doctor has made a decision, a legal one, based on facts, and there is only two outcomes. If not one, then the other.

Have the trail: marshal the evidence and present the case. His memory prevents him from being able to assemble these issues together as a coherent and life changing predicament. The mock trial, call it an explanation, is for him to witness the process that he is in and an explanation of why the judge, the doctor, has decided his sentence. There is only one option in front of him and he can choose to accept that outcome in the assisted living facility or he will be forced into the other. Your dad has spent his whole adult life deciding between X or Y, but this is not the choice he has, he can only accept 1 or will be put in 2.

The other issue you face is that even if he does come to some recognition of this moment, future him is unable to remember that. So you record the whole thing and ensure it is readily available in a medium and format he can readily access. Have him write and date a note, and you do it even if he doesn’t accept the doctors judgement. It’s been decided. Regardless of his opinion of it. Record a short selfie video for every one to refer to.

This mock trial doesn’t need to lay every single thing out, and you are not trying to re-litigate any of it, you are presenting the specific incidents the doctor based their decision on. The first evidence happened on date mm dd where this occurred. Second, this happened on XY and resulted in consequences AB. Testimonies from others, hell I would try to call or zoom in any witnesses, and I know time is limited. Just like in court he has time for objections, disputes and extenuating circumstances, which he might feel compelled to re-argue even if you remind him that the actual decision has been made.

You cannot fully satisfy his need to be convinced or even feel heard, as that will be reset every time his failing mental state is challenged by the reality of his situation.
posted by zenon at 10:04 AM on September 23 [1 favorite]

What happens if the doctor sends him to the hospital? Like, will he go?

There’s only so much power you have to make him do the thing you believe he needs.
posted by chesty_a_arthur at 10:28 AM on September 23 [3 favorites]

If you can get your dad's doctor on board with sending your dad for tests, do that. Post-testing (whether or not performed on an in-patient basis), head to the memory-care place on doctor's orders. Maybe it's a *different* doctor, the specialist head of the department, who reviewed the test results and issued the directive, as an appeal to your dad's ego (and to lessen hostility to the regular doctor providing ongoing care).

Is there anything that can be done to spruce up the smaller, less-nice room, so it better matches the overall upscale tone of the facility?
posted by Iris Gambol at 4:17 PM on September 23

The thing with short term memory loss is that the people suffering from it no longer see things as connected to eachother because there are so many gaps. They live inherently in the moment in the enviroment that they are in.

So if you are providing cues that things are alright, this is normal, things are okay people with short term memory loss will in general go with it. ( there's additional problems of dementia that can include paranoia and agitation but you didn't mention these a problems specifically) . The hows and the why's should be kept short, simple and as positive as possible. And if he gets stuck in a negative feeling or agitation, distraction to move him into different moment is the best. He may see and be able to read that the building you are entering is an memory care facility, but he may not hold that once inside.

My grandfather is in a memory care unit, fairly functional guy aside from the dementia. He currently thinks he's at work, and complains he can't get time off to come home. And that's just how it is. It wasn't a lie we made, but it ended up being how he currently rationalized his now.

Some of the people do focus on trying to leave, and there are simple strategies that the staff uses to redirect based on what people may be seeking. For example signs that say planes are canceled due to weather, or the next bus to city will be the next day. It is frustrating but distraction and excuses do alot provided you aren't expressing that this is wrong in some way.

So yes, sometimes something as simple as " we are here to visit my friends dad" can be enough to get him in the door or "this hotel room is smaller than we thought" or "the doctor said you needed to live here now. How is the tea/coffee/snack"

It's really hard and people really don't want to go sometimes. People with memory problems can and do acclimate to their facilities even if they sometimes have a rough start. I know it can be heartbreaking, but also there are real dangers than can happen to someone living alone with dementia & the results can be very heartbreaking too.

Take care of yourself during this time.
posted by AlexiaSky at 7:15 PM on September 23 [3 favorites]

I'm curious about the "move in date is in a few days" part. Was there something that happened to require an immediate change? This sounds very sudden, and I can't imagine anyone being happy to be forcibly moved on such short notice, narcissist or not. That's hardly any time to get your head around the idea. In my expereience with my dad with advancing Alzheimer's (who was also adamant about his ability to take care of himself), we did the convincing over a period of about 10 weeks, and it took multiple conversations with a lot of resistance from him at first (and there was no narcissism issues to contend with).

Your question is "how can we make this easier?". I think the answer is that on that timeline, you really can't. Given that you only have days, I would enlist the doctor to follow through on whatever health change has occurred and use that as the frame for the doctor to order the move. A hospital stay might even help facilitate the change. If presented as "doctor's orders", then the doc can play the bad guy, and you can be the sympathetic and helpful child.

I had done a lot of research before selecting a place for my dad, and so I made a show of sharing my documentation, and showing my dad my reasoning for choosing the place that I did. It did seem to help him to see that I was being thoughtful and thorough, and while he could have used that opening to argue for something else, he was also at the point where his dementia prevented him from genuinely being able to quibble over details. He just knew that he didn't want to move. I gave him the "choice" of which apartment he wanted (the facility had two different units available on different floors with different views) to shift the argument from "if" he would move to "which unit" would he move to. Sounds like your timeline is too short even for that, but my point is that you can make it clear that you are doing everything in your power to manage and negotiate things in his favor, and commiserate that it sucks, but that it is happening and you are doing everything you can for him.

Is he able to move any of his furniture and belongings to the new place or is it more of a nursing home kind of setup? If so, a short hospital admission would enable you to move some of his things in so that when he arrives he has something familiar there.
posted by amusebuche at 7:51 PM on September 23 [1 favorite]

Best answer: I had to talk my dad and my sister and mom tried to trick him into it against my wishes. We got to the place and when my dad figured out what was happening, he wrestled away from the staff and ran out the door. I jumped in the my car and picked him up as he ran from the place (along with my infant) and we drove around for a few hours.
I convinced him that this place was the very best there was to offer, and if he resisted, he'd end up in a really lousy place. I said something is going on with his brain, and they really need to figure out what it is. He agreed to go, but when we went back they wouldn't take him. He did indeed, go to a terrible place.

I would suggest the place based on how terrific it is and the worst alternatives.
posted by ReluctantViking at 9:13 AM on September 24 [1 favorite]

Response by poster: Thank you so much everyone.

In response to:
I'm curious about the "move in date is in a few days" part. Was there something that happened to require an immediate change?

We were waiting for a spot to become available and were only given a few days' notice. We didn't want to have the same conversation repeatedly over months because he doesn't remember anyway, but he would retain the negative emotional part.
posted by Frenchy67 at 10:30 AM on September 25

Best answer: You say the room that opened up is smaller and less nice. Do you know how long it's likely to be until a nicer room opens up? Could he take the smaller room while waiting for the better one? I have a narcissistic father also and agree the best way to convince him to do anything is to make it seem like something exclusive and fitting for his refined tastes. My father wants people to be envious of him so if yours is similar if you can think of something that your father would be able to boast about with this facility then play that up. Do any well known rich people stay there? Have the doctors treated any celebrities? Is it in a fancy part of town even? Etc.
posted by hazyjane at 5:29 AM on September 28

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