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Short-term overnight respite - resistant
Posted: Tuesday, March 12, 2019 8:41 PM
Joined: 2/26/2018
Posts: 27

I'm hoping someone has some ideas on how to approach needing to put my father into a week of respite care in the near future when he will be very resistant to going.
The situation I'm in is that I'm the sole caregiver for my father who while still considered in the mild stage requires a lot of oversight (meal prep, help with showering, tv assistance, instructions on using prosthetic leg and dressing, etc.).  He's good being on his own for a few hours so long as I leave meals and snacks for him out and turn the tv on before I leave the house for example.

Well, my mom who lives out of state has a sister (my aunt) who is on hospice and isn't expected to last much longer.  When she passes I would really like to go visit and be there for my mom who doesn't have much support locally.  The thing is I can't go for a week and leave my dad alone.

I'd really like to put him in a respite care facility but he is resistant to it.  I have no one responsible to cover for me while I'm gone.  A respite facility is the best option since they can accept him at a moment's notice since I don't know exactly when my aunt will pass and I'll need to fly out.  I spend so many hours on him caregiving and do way more than he even understands for him.  I really want to be able to be there for my mom and I honestly will resent him if he doesn't go and I can't get back to her home state.  I tenderly broached the subject with him letting him know I'd like to go visit mom and his response was "I'll think about it" (said with an attitude).  He won't think about it, he'll forget I even brought it up 5 minutes later.  He's getting harder to reason with so I'm really not sure how to get him to go.  If he refuses, what do I do?  Bringing someone in while I'm gone isn't a great option either.  He will just tell me he's okay on his own (which he is not).  How do you make a reasonable request of someone who can't reason anymore?  How do I get him to go into respite for a week so I can be there for my mom.

Posted: Tuesday, March 12, 2019 9:10 PM
Joined: 11/13/2014
Posts: 2117


 We don't usually ask them. We just take them and visit for awhile, the aids should take over and we slip out. You can always call him while on your trip. I know it sounds awful but we do what we have to do. You aren't deserting him. You will be back. 

NC caregiver
Posted: Wednesday, March 13, 2019 5:54 AM
Joined: 2/7/2018
Posts: 856

The respite care in my area usually require that you have a 3 week or more stay & aren't easy to set up with short notice.   Hopefully you have better success than I have with this .  I would probably tell Mom the day of the respite as she worries too much about upcoming events.   Im sorry about your aunt & hope all goes well for you .
Bob Sacamano
Posted: Wednesday, March 13, 2019 6:31 AM
Joined: 1/31/2012
Posts: 450

You need to do this with fiblets (white lies) to get him to do anything. He will always be resistant to any change. Don't be resentful, it's not him it's a disease that he has no control over. 

I would tell him that you're taking him to lunch and leave unannounced when he is concentrating on eating. Ideally, if it's in your budget, you might want to do a trial placement, so that you know what his issues will be ahead of  time and you can manage them locally with the staff.

Posted: Wednesday, March 13, 2019 7:53 AM
Joined: 3/6/2017
Posts: 1443

You can not reason with an individual who can no longer operate the remote control to the television. You make the decision to place him and then you take him there by whatever means necessary so that you can be with your mom. 

It's probably time for a Plan B anyway in case you were unable to look after him because you needed your appendix out or something anyway. We had a similar situation with dad because my mother and I wanted to attend her sister's memorial service and burial. This was to be in Maine, so we had firm travel dates. 

I already had a Plan B in the form of a SNF where he did rehab previously which would accept him on the fly if something happened to my mom. He didn't particularly like it there though his care was good. I wanted respite to be a trial run for an eventual MC placement, so I toured about a dozen places that offered secure MCF. 

I would advise doing this asap. As NC Caregiver suggested, this requires some planning. Most of the nicer options near me have limited respite beds and make them available for stays in one month increments. I found SNF to be more open to shorter stays, but about twice as expensive for a semi-private vs private room. 

Getting the paperwork, preadmission doctor appointment and staff evaluation can take a couple of weeks. Some places will want your to bring dad for an in-house assessment to determine care level required; some places will come to you to interview dad at home. One place interviewed dad and declined to accept him into their community on a temporary or permanent basis, so we had to apply at a second facility. 

Physically moving dad required a therapeutic lie. We told him his PCP wanted him to do a short stay in a fancy rehab to get stronger on his feet. It was that or chloroform on a rag. The days leading up to dropping dad off at MC and the actual day of getting him there were emotionally very difficult. He did settle in surprisingly well. Other people have created tales about insect infestations, mold and sewer backups to convince their LO to go to a "nice senior apartment" while the work is being done on the house. 

Posted: Wednesday, March 13, 2019 10:57 AM
Joined: 2/26/2018
Posts: 27

A bit more information since I think where I am coming from is being lost.  My dad has already been to this respite facility back in December for 3 weeks while I was out of the country.  It was easier to get him to go then because he was recovering from his femur fracture and I could use that as leverage.  This facility does not have a minimum number of nights one has to stay and they can take him on short-notice.  That is not the issue.

The problem is that my dad is at a stage where he needs someone available to him to help; however, he still has enough mental faculties that fiblets and manipulation rarely work on him!  I can't just say "we're going to lunch" and then drive him to the facility and disappear.  He will see the place and immediately know it's not a restaurant and will refuse to go in or get out of the car.  He'll know something isn't right as soon as I start driving out of the neighborhood.  I'm all for using fiblets when they work but I can't think of one that would work in this situation.

Saying "you take him there by whatever means necessary" that's not very helpful.  I don't know what means I have to get him there which is why I'm asking for help.  I can't pick him up and manhandle him to go or push him out of the car at the facility!

MN Chickadee
Posted: Wednesday, March 13, 2019 11:39 AM
Joined: 9/7/2014
Posts: 746

Is there an issue with him not supporting or having the cognition to support you going to help your mom? (I gather they are divorced?) Maybe try telling him you need a break or a vacation or it's for work or something with your kids instead of telling him where you are actually going? Try to appeal to his softer side, saying you would be worried sick about him all alone and he would be doing you a huge favor to go to the "senior hotel" so you can sleep at night and not worry the whole time and besides, there will be more to do there than sit home alone and the meals are good and talk up any amenities you can think of.
Mimi S.
Posted: Wednesday, March 13, 2019 11:44 AM
Joined: 11/29/2011
Posts: 7036

My advice. Just do it. This is an excellent way of checking out the suitability of any ALF. 

Use fiblets as needed but don't expect him to understand.

Posted: Wednesday, March 13, 2019 1:54 PM
Joined: 3/6/2017
Posts: 1443

I'm sorry the advice wasn't useful to you. Nothing about this disease is "ideal"- sometimes you only have a choice between bad and awful.

It sounds a bit like your dad was where mine was about the time he was initially diagnosed. His neurologists and his geriatric psychiatrist deemed him "mild" at the time, mostly based on how well he still did on MMSE and MOCA but those who knew him well would have been reluctant to leave him alone for than 2-3 hours during the day. We were the ones who saw dad struggle to answer a phone, work the remote to the TV/fan or not stick metal knives in the toaster.  

Dad's awareness of his independence being taken away combined by anosogonosia which prevented him from appreciating how impaired he was made for some very ugly times when we needed to keep him safe and have some respite to attend to mom's medical care. 

What's dad's living arrangement now? Does he live with you in your home? Does he live in his own home with you visiting daily? If you can't get him to cooperate with a respite placement, perhaps you need to enlist someone to stay with him. You could sell this person as a friend from work whose house is being painted so she needs to stay for a couple days. When mom was hospitalized for surgery I brought a cousin in with some story about new carpets. I knew appealing to dad to humor my nervousness about him being alone or mom's need to have her knee replaced would not have worked- dementia also took away his empathy.
Mom's Baby
Posted: Wednesday, March 13, 2019 1:55 PM
Joined: 12/19/2011
Posts: 1131

Let's just look at the facts here:

1) Your dad can't be left alone for a week.

2) He can't be reasoned with, so there's no point in trying to convince him that he should go.

That leads us to your options:

1) Bringing a caregiver in to watch him while you're away. Logistically difficult, but eliminates your worry about how you get him to the respite facility and out of the car.

2) You fib to him about where he's going and have the aides at the facility take over after you pull up. Hopefully, they're able to get him inside so you can leave. Is he on any medications that might make him less combative in this situation?

3) You take him with you (certainly not viable but it IS another option).

Unfortunately, there is no easy answer to your problem. Either you try one of the options above, or you don't go see your mom. I wish there was an easier way for you, but I just don't see one.

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