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Posted February 2, 2007

Ask An Expert

Caregiver Care: Fearing Mom's Move to Alzheimer's Facility

Q. My mother lives alone in her home of 50 years. Dad died 6 years ago. She is very set on living in her own home and has done OK with help from family until now. She suffers from dementia and possible Alzheimer’s and is now sundowning. She’s restless in the evening, calling me on the phone, angry, suspicious. We moved her into an assisted living facility a week ago, but it was not a locked facility. She was very angry and wandered the halls. She was given Adivan, but it made her worse.

The facility did not want her, so we moved her back into her home. There were no vacancies at locked facilities, but I put her name on a waiting list. We have hired a home health care service to come in and be with her in the evening from 4-7 pm. This just started. My mom does not want help from anybody but me, but this has to work to buy us some time. My mom calls on the phone all evening, unsure and angry.

We have found vacancies now at nice lockdown memory home, but I am afraid to move her as she was VERY angry and would not cooperate with the staff before. She told me she would "kill herself" when she was in the assisted living facility. I know the new lockdown facility knows how to handle this, but I am so traumatized by the move that I am taking Zanex too much and am a nervous wreck. Home health care is very expensive, and that is why we only have the four hours in the evening. My mom does have assets, but we can’t exhaust her assets if we are eventually moving her to a locked environment.

My husband says for me to just let the home health care people do their job and see how it goes. I am having trouble relaxing -- just sick over this. How can I ever leave town or just plain relax? I have seen two counselors, but it does not really help my anxiety. I also take Paxil. Maybe I need to up the dose? I would really like to move her to this nice lockdown home, but want it to be the last time we move her. Can she get kicked out of the expensive Alzheimer’s locked facilities? I can't take much more.

Ellen H., Salem, Oregon.

A. It's obvious that you care for your mother very much, and you want the best for her.

Twenty years ago, if you could have shown your mother a video of herself as she is today, I wonder if she wouldn't have said, "Keep that person safe and protected, no matter what she says, because she is no longer the reasonable person she was, and she can't make good decisions for herself any more."

Having the home health caregivers come in for three or four hours in the late afternoon is a good start, but it is just a start. She will eventually need care around the clock, and that is extremely expensive. It is also very isolating to be cooped up in the house with only a caregiver. Many dementia patients actually seem to be much happier in a more stimulating environment, even when they were angry and resistant at first.

Please don't wait to take advantage of a good dementia residence. They are trained and equipped to handle the anger and anxiety your mother is expressing, and they will be able to help you, too. I suggest that you go in and have a frank conversation with their administrator. Ask about how they have managed other residents with the same kinds of behavior. Ask if they have a support group for families that you can attend where you can talk to others who have been through this.

The more skills and memory your mother has when she becomes a resident, the better she will adjust and the better she may be able to relate to other residents and the staff. If you wait, she will not get all the benefit of being in a good residence.

No one can predict whether this will be her last move. Life is unpredictable and health challenges in addition to dementia can sometimes arise. Good facilities have access to physicians and psychiatrists who can help if necessary. I can say that, more often than not, moving into a good care facility is often less stressful for the resident than the constantly changing schedules and faces of home caregivers.

Just knowing that your mother is safe and never alone will be better medication than anything you could take. You and your husband will be able to be away from the phone without worrying that she is on her own and having a true emergency. You will be able to check in with the staff whenever you want, even if you are out of town, without upsetting her. The availability of a room in a good dementia residence is a gift to all of you. Please take advantage of the opportunity for her, and for you.

This answer is provided by Molly Shomer, MSSW, LMSW, a family caregiving specialist and licensed geriatric care manager. Molly, a nationally recognized expert on eldercare issues, is the author of The Insider's Guide to Assisted Living. Her website is www.eldercareteam.com, and she can be reached at molly@eldercareteam.com.

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