How to handle the move to a care home

Some years ago my MIL developed cancer although she wasn’t told about this( not my decision.) She hated being alone even for a few hours. She was quite weak after surgery so we also suggested “convalescence.” She wasn’t sure about the care home at first but soon settled in and was well looked after. She didn’t have dementia but was getting rather vague and helpless. She made her own decision to remain there and died there a year later. She was so well cared for. As long as she had frequent visits and outings when possible she was content.

We arranged it all for my mother without telling her- her dementia was pretty bad by then but in her head there was absolutely nothing wrong with her so she’d never have agreed to go. A lot of surreptitious arrangements were made and finally we took her’out for lunch’ at the care home - a 60 mile drive away. TBH I’ve never dreaded a day so much in my life, but it all went rather better than we’d feared.
The CH had sent someone beforehand to ascertain that she did need 24:7 care - by then TBH it was pretty obvious. She was self funded so we had not involved social services at all. The CH was a specialist for dementia and was very good. She went on for another 8 years, until she died at 97.
I’ve never felt in the least guilty about it - TBH it was overdue / she was simply no longer safe to be left alone even for half an hour.

A few years ago I was in a similar situation to you but with fewer siblings. My parents had given POA, then my Father died after a fall. My poor Mum had started to show signs of Dementia prior to this and as her situation deteriorated I suggested a period of 'respite'in a very special care home for her which she agreed to as she still had capacity. Following Mum settling in she then told me she didn't want to go back home so I had the problem solved for me by her decision. We then sold her flat to fund her care and as her Dementia increased over the years I moved her to a specialist Nursing Home where she received wonderful care until this year when she died aged 98. I'm sorry for your plight but by family members handing over decision making to you via POA you have to trust your instincts that you are making the correct choices for them. It is all very sad and difficult at the time, but he will flourish with companionship and stimulation more than you realise now- believe me!

Some of the residents in the unit I visit think they're in a hotel. They often feel they should be paying. The rooms are all single and ensuite bathrooms and actually do feel like hotel rooms albeit with some personal items. The only thing that spoils the ambience at times are the alarms that go off sometimes if someone tries to walk who shouldn't. There are some very frail and unsteady residents.

My daughter worked in a care home for a while when she was a student. One gentleman with dementia had been told by his wife that he was going on holiday. He accepted this and was perfectly happy, keeping up his holiday role until he died. He was another tipper, thinking that his meals were being served in the hotel restaurant.

My late DH, with Parkinson’s making him ever frailer and less safe at home and with Lewy body dementia robbing him of his ability to understand and make decisions, went into the excellent local nursing home ostensibly as respite for me because I had such a bad back. He died there seven weeks later, safe, unafraid and well looked after, though I don’t think he quite forgave me. Better to make such a decision before a serious fall at home means there is no choice.

How is the assessment of need going to be carried out? Generally a care home will want to do an assessment to ensure his needs can be met. He may well have a lucid moment when being assessed either in his own home or at a visit to the proposed care home. Someone should at least try to convey to your DF he will be moving from his current home to a new one. Appreciate he may not comprehend what is being said, all depending on the level of his illness but trying to afford him some dignity wouldn't go amiss.
Such a sad and very distressing situation for all involved.

I think convalescent is a very good word to use.
I volunteer in an NHS dementia unit. The ladies I see are all very different as you'd expect. There are friendship groups as well as people that just plain don't like each other. They're human! Their ability level can vary from day to day. One lady was just singing 'Yellow Submarine' over and over one day but the next told me that she's an inpatient here and can't go home. Quite insightful. Sometimes I wonder if people really have dementia but then something comes up and it's all back in focus. One sad coffee break the ladies all tried to remember their husband's names. Ended in some tears.

I admit to being a little devious about this…. after my third stroke in 2021 my Mixed dementia/ Alzheimers with Lewy bodies husband had to go into respite care while I recovered..… I’d been looking after him by myself since his stroke 26 years ago …..my daughter and son convinced me that I’d ‘done enough’ over all the years and it was time to reclaim a little bit of what was left of my life….I must say I agreed wholeheartedly …I’d had enough, especially as he had turned violent toward me! He was supposed to be there six weeks ( that’s your yearly allowance for respite) but he never came out! I spoke to him and told him I could not cope any longer as my health was now deteriorating ( arthritis !) and I could no longer lift him from floorthree times a day….I kid you not….and he weighs 12 stones of dead weight! So he acknowledged what I was saying to him and after a few visits where he asked “ when am I coming home”… he has settled down. I visit 2-3 times a week only as I dont drive and my knees are useless …. I’m not going to say it’s easy but you must all now start to accept the inevitable. My kids were correct …my health is better now than it’s been for the last 15 years…I’m thankful for the time left to me …I’ve been his nurse/ doctor /psychiatrist for 25 years …it was 10 years too long! Doctor said next stroke would kill me …so decision was easy …..you’ll have plenty of guilt …plenty of people saying you’ve ‘dumped him’….I say to these people “
here’s my shoes , and you can walk around in them for a couple months!!! See how fast they shut up!

Just because you have Poa doesn't mean your Dad shouldn't be consulted He may be deemed to have a degree of capacity

It depends how bad his memory is. We told my mum she was going for some respite care. We actually used the word convalescent as it was a word she knew. She got a new lease of life. She was well cared for, well fed, had her hair done every week and was kept clean.

This was a Local Authority Home. The staff were lovely., all of them had worked for the home for several years. She lived much longer in the home and had a better quality of life than she would have.

My family and carers know that I do not wish to go into a care home after having spent two weeks in one for rehabilitation after an operation.
For the amount care homes charge it will be possible to have care at home.
Wouldn’t be for long as I am in my 101st year.

My mum has Alzheimer’s and was transferred to a care home from hospital. She had no insight into her own care needs. She spent most of her early days there fighting to go home, refusing to settle. She has screamed, kicked, sworn at and eventually even bitten the staff as her condition worsened. She is now on a “ much more severe” dementia wing where she has at last found a friend. She tells me she hates me when I go to see her. She is 96. I tell this story because, despite all her objections, she could not have stayed at home. There was no choice. She threw objects at my elderly Dad who had vertigo, hid his iPad, stood in front of the tv, emptied kitchen cupboards in the middle of the night and expected him to clear the mess up and drove any help we got for them out of the house. Alzheimer’s can make people aggressive not gentle and if you do discuss something with them, they can forget the second after you speak. No situation is the same and no situation is easy .

We couldn’t move mil with vascular dementia into a care home as it was considered by the authorities that she still had mental capacity and therefore could decide for herself. She had carers 4 times a day and it was a constant worry. She ended up in hospital with a twisted gut weighing 5 stone. The hospital wanted to send her home but we refused so a compromise was reached that she would go into a care home for 6 weeks which would be funded. It was such a relief to know she was safe and looked after and we just kept her there. If she asked to go home the staff would divert her question.

You try to keep them at home for as long as possible but sadly it reaches the point where they have deteriorated to the extent that there is no real choice. At the moment if dad is at early stages he had the right to say no and you have to respect that. You can try persuading him but you can’t force him. It is very difficult for caring relatives who know mental capacity or not their parent would be better off in a care home. I think you should take dad to a few care homes to see which ones he likes.

I would have to tell my parents, even if they didn't understand. As someone else has said it might be an idea to suggest going in for respite and take it from there.

When my brothe in law was getting too much for my sister to deal with the assessment discussed a care home with him. He said he wasn't going to go but 5 minutes later he'd forgotten he didn't want to go. He did go for respite first and got on fine. Then he came home for a bit and the same thing happened, no way was he going to a care home to live. But he was told it was for respite care again as my sister was ill. He was happy to go then, and is very happy there, he thinks he is the care home's resident handyman and he thinks my sister is an old girlfriend from the 60s. Generally speaking as long as you agree with them most dementia patients are content with living in care homes.

I assume that your two siblings who have principally dealt with all this have done so following one or more consultations with your Dad's GP and have made sure that they legally can take this step on his behalf. I assume you can, as all of you have a power of attorny, but I am not a lawyer.

My field of expertise is history of religion, and going on that background, I can safely say that you and your siblings have a moral duty to take care of your father, now that he is no longer fully competent to make his own decisions.

Most of us feel slightly guilty when facing your dilemma, but really there is no need. You are all doing your best for your father in a very difficult situation, and managing it without falling out with each other in the process. Few siblings do so well!

Someone now needs to tell your father of these plans and agreements you have put in place.

If at all possible, I would suggest that all of you( that is his children ) should be present, delegating the actual telling to one person.

This precaution ensures that you all know exactly what was said and whether your father took it in at all, and if so, how he reacted.

You need all to be prepared for him either refusing point- blank to conform, or at the other extreme forgetting immediately what has been said.

However, the step is necessary for his well-being and for you and your siblings' peace of mind, so the matter will have to be broached.

Depending on how much your father still takes in and remembers of what is said to him, you may find it best to leave the actual announcement until as near the time of his move as possible.

Please do all remember that as dementia increases, it becomes more and more dangerous for a dementia patient to live alone, and that your father both now and later will be far better off being cared for professionally.

If you leave it much longer, you might end in the situation two brothers I have known since we all were children ended up in. Their mother was found wandering in the roadway outside her house unable to find her way back home, at four o' clock on a winter morning when the temperature was well below freezing, clad only in nightie and slippers!

Your father must be involved, LPA doesn’t necessarily mean you can do what you want. He may have capacity for some things and not for others. As others have said, respite in a nursing home initially might help.

My late father went into a nursing home for the last few months of his life, via the hospital pathway - he didn’t have dementia, although the SW at first thought he did because dad wanted to go home, which was (as far as he was concerned) reasonable. We took turns to look after dad for 3 years in his house until he became too physically weak to stay at home with just one person. We should have got help in sooner. But one sister didn’t want to spend the money on care but it seems that the money will go either on care or on tax, so do what makes you feel comfortable.

We searched hard for a good nursing home, and it worked well.It wasn’t the most expensive, but the staff were wonderful, and that’s what is important/

It was, nevertheless, all hugely upsetting. Seeing one’s father deteriorate is very very sad.

🌷🌷🌷

When my older sister had a stroke, causing dementia and the hospital would not release her to anything other than a nursing home, we activated the Powers of attorney, found a large room in a nice home, had it painted in her favourite colour, used her curtains, brought some furniture and ornaments from her home. When she was brought in in a wheelchair she said, "Oh, there's my cupboard I love so much" (a display cabits with orbaments). BUT the hospital social worker deemed her to have capacity to decide where she wanted the home to be and she chose the town she was living in, which was 143 miles away from where we live. For seven and a half years until her death last year, we trogged up and down that distance one day a month and it was a killer. Check that any social worker involved doesn't say your father has capacity to refuse to go into a care home. And you won't be consulting him, but informing him, since the decision has been made. I'm sure you will do it kindly.

We told mama she was going for a little holiday so I could have a rest. Within 2 days she had forgotten she had ever lived anywhere else. Good luck.

This has brought back memories and has made me cry. It is so sad having to put a parent into care but when you weigh it all up it is for the best as looking after someone with dementia is very difficult. Our circumstances were different - Dad's wife who was 10 years younger than him died within two weeks of her cancer diagnosis, therefore we had no alternative but to put Dad into care as he had dementia and couldn't possibly look after himself, his wife had been his carer for 10 years. He begged his wife not to send him away but there was nothing that could be done, he went to the same care home that he had spent a week in for respite but this time he had a much nicer room which we said we would pay extra for as we didn't want him moved again. Dad settled really well, he loved the food, and we visited often until covid hit and then it was just FaceTime. When visiting resumed and we could eventually enter his room again, it wasn't long before he died, he was in care for almost three years. The staff were lovely, it wasn't the fanciest of places but we felt he was happy there. I had PoA and sold his house to fund it all. Only you and your siblings can make the decision about his involvement at this stage, I wish you all the luck in the world as it is truly heart breaking.

Elderly people with capacity do have rights. My neighbour point blank refused to move into a care home. His son only had the financial PoA and Frank refused to give permission to use it. He had carers twice a day instead. He had very limited mobility, the house was a complete mess (nobody cleaned or maintained it) and his family worried - but still, he did have the right to choose to stay there.

Oh my goodness if I put myself in your Dads position I d be mortified if my children put me in a home without even discussing it with me unless I was far gone enough not to know but you say early stages so please do talk with your Dad and hear what he wants and expects
It’s heartbreaking for you all I had my Nan with vascular dementia I looked after in my home for 3 years
When my mum got Alzheimer’s she was not knowing the time of day by the time we had to find her a home, we couldn’t discuss it as she was beyond understanding but I did have to tell her it was just for a night or two and that settled her till the next day
It was awful I can’t even tell you how bad for her me and Dad
Please please don’t just spring it on Dad if he has some understanding still

As an only child it fell solely to me after my father died to look after my mother who, at that point, had mid stage dementia.
Luckily I had power of attorney (thank you parents) and when caring for mum became too difficult I moved her into a dementia home but told her repairs/decorating was ongoing at her bungalow and it wasn't safe to live their at that time.
She luckily accepted this and I was able to sell the property to fund her care home fees.
It's an awful time for all concerned. Hope all goes well

My father had dementia which got worse dramatically a year ago and he became doubly incontinent. So my brother and I decided to move him to a care home. All the family talked to him about. On the day of the move I was with him and he looked totally amazed when he realised he was staying there and said it was a wicked trick. The first night he wasn't happy, but after that he seemed to settle. Then 10 days later he had a cardiac event, he was taken into hospital where they said he won’t be coming out. Twelve days later he died. The hospital consultant said this often happens when older people are moved. I felt dreadful but we really had no choice. He was unsafe and scared in his own home, couldn’t even work out how to open the front door. Awful time, but we made the decision to keep him safe.