HI

Mostly I just read this forum, today I thought I would open my computer and type. My father worked on the railroad for 30 some years. Couldn't wait to retire! He retired in 1998. He was often gone for 2 to 3 days at a time for work. Now every single (I wish I could swear) night he packs up a ridiculous assortment of clothes and random crap (oars from the boat, flashlights, remote controls, whatever is not tied down) and insists he has to go to work. We've tried distraction, nothing distracts, we've tried treats, nope, we've tried taking him for a drive, nope, we've tried medication, nope, we've tried playing along, makes it worse, we've tried ignoring, he gets angry we are not helping. He thinks we all work on the railroad. Last night he was trying to call the railroad dispatcher on the remote control, then tried to find their phone number in a puzzle box. Then he turns to the phone. Every night he sits at the phone for 3 hours at a minimum trying to call the dispatcher. He used to reach them. One time he insisted he was at a crossing and there was an accident. We got a visit from the RR police the next morning. He often calls 911 and asks for the number. The police know my parents house well... I sometimes give him my husbands number and tell him its the dispatcher. For as "gone" as dad is he manages to have a pretty complex conversation about RR stuff and my husband can't always answer correctly. Last time I did this, dad got suspicious and accused me of playing games and tried to kick me out of the house. He goes out to the garage sometimes 30 times a night to load or unload crap in his truck (which he doesn't have keys for. I'm worried. We are in Maine and this can't go on in the winter. I also think he will just start trying to walk to the railroad. You just can't imagine how strong his drive is to go to work. Since nothing else works last night I tried some tough love, showed him the picture of the day he retired, where he hand wrote the date and "Last trip", told him he was having a bad memory night, tried to get him to watch tv with me, nope. I'm just at 

a loss. Sigh. I guess there is no question in there. Just venting.

I am sorry for what you go through each night.  Your father must have really loved working with trains.  I am hearing "I've been working on the railroad"

song in my head and mean no disrespect.  Has his dr prescribed any meds to help him calm down at night?  Could you set up a model train set for him or would that be too childish for him.  I pray you find something that works to help you and him.

Hi,

     This is something that occasionally happens when LO had a strong work ethic, and felt people depended on them doing their jobs. I'm a nurse with years of experience in dementia care. Here is a story I wrote about one of my residents with dementia. I hope it will help you as it is a good way to handle this problem.

     Harold worked hard to support his family. After 15 years on the assembly line, he had been promoted to shift foreman and took his job very seriously often meeting with workers or taking their calls after hours to address any issues or concerns they had. Several times he had won awards for outstanding performance and he proudly displayed his plaques and letters of recognition on his den wall. When Harold started having problems in work because of early dementia, the employees working under him rallied around to protect him but eventually the company had to let him go. 

We expected that Harold would have some problems settling in, but were surprised at the length of time it seemed to be taking.  He continued to be uncooperative around personal care, swore at the staff at times and insisted he needed to go to the factory. We arranged for a psychiatrist to evaluate Harold, but since he was already on the appropriate medications for depression, it was decided that we should monitor his behaviors and try to develop a behavior modification plan.  

     I usually tried to listen to the report on the dementia unit every few days when the nurses changed shifts.  As Director of Nurses, this gave me a chance to catch up on any difficulties the nursing staff might be having with the residents and it was a good teaching opportunity. While report was being given one afternoon, Harold came up to the desk and started yelling at Jane and the nurses and banging his fist on the desk. “Get back to work! What’s the matter with you? Break time is over!” At the same time, Harold was trying to pull the staff away from the desk. A nursing assistant tried to distract him but Harold continued to rant about people being on a break too long and he insisted they get back to work.  

     We held a staff meeting later that afternoon to discuss Harold’s problems and Jane had an idea. We called Harold’s wife and talked to her to get more information about his job. The next day when she came to visit, she brought one of Harold’s caps with her. It had an automobile logo on it and was the same one he wore to work every day. His main responsibility as foreman had been to manage the workers in his division. Among other things: he did the scheduling, made sure the employees came in on time, did their jobs well, followed the rules for breaks and days off, and came to him with any problems they were having.  We decided to try to use this information to help Harold with his depression and manage his behavior.   

     We gave Harold his cap to wear and a clip board with copies of our old schedules. Although he was too confused to actually understand the schedules, he proudly walked around with his clip board and a pencil “checking off” a few things every now and then. When the nurses met at the desk for change of shift, they told him they were having a business meeting and gave him “minutes” which were actually old regulations from the housekeeping department. The nursing assistants started calling him “boss” the way the men and women who worked under him used to do and soon we began to see changes in Harold.  

     As long as the staff responded to his anxiety about work by assuring him that they were following the schedule or were getting a report for him, Harold stayed calm. Even better, he became brighter and less depressed. We also found that when the staff approached him for personal care, calling him “boss” and telling him they were there to help him get dressed for a big meeting, this approach usually earned his cooperation. 

 What we learned: 

     Harold filled several important roles in his life but even with dementia, the one he missed the most was his job as shift foreman. We all need something important to do each day. For many of us it is the reason we get out of bed in the morning. These feelings may not change just because the person who has them also has dementia. Allowing Harold to get back into that role did not solve all of his problems but it helped him to be more cooperative and did help significantly with his depression (we even caught him laughing every now and then.)  All of this made it easier for us to provide his physical care and he definitely had a higher quality of life because he believed he was working again. 

Hope this helps

Stephanie

Stephanie, thank you for that story. I know it to be true. I just don't know how to "play" along with it. Being an outdoor and very solitary job, and of course missing the ever important prop... the train...

Horizon, I was going to mention in my initial post, that when he is not in the railroad delusion he is also in the Air Force delusion. He was only in for 4 years. Stationed in Japan. About every three weeks he believes he is either being deployed to Japan and must report or the AF police will call him AWOL and arrest him, or he believes we are IN JAPAN and he is being sent home, so he packs up all his clothes and anything else in the house he wants to keep. One day I called and AF recruiter who said he would write dad a letter on official AF letterhead thanking him for his service and wishing him well in his retirement. I stopped short of getting it because we got one for the railroad. When my mother attempted to use it to calm a delusion he ripped it up and accused her of doing it to get him fired. I didn't bother the poor recruiter again. Let me know if you find anything that works for the AF delusion.

My mother used to be a mail carrier.  When she was first placed in the nursing home, she was in rehab and had somewhere to be every morning and afternoon.  But when her rehab was done and she was just going to activities, she began to get restless and started the "going home" thing.  So the activities staff came up with the idea to have her "help" them deliver the mail.  Of course, it took longer for them to make the rounds, but it gave Mom great satisfaction that she was doing her "work".

Three days before she died, she tried to get out of bed, something she hadn't been able to do un-assisted for a long time.  When we asked where she thought she was going, she said "I have to go to work."

A strong work ethic never dies, apparently.  Stephanie's story is a great one of making adjustments for an individual patient to keep them more content in their current reality.

Maybe you can figure out something that will help your dad, even if it is only for a few minutes at a time.

Welcome to the forum!