How do you help someone with dementia understand that he or she needs to live in a care facility?

Answer 1

Dementia DilemmaArm yourself with knowledge. I recommend the book, The 36-Hour Day, A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, andMemory Loss in Later Life, by Nancy L. Mace, M.A. and Peter V. Rabins, M.D., M.P.H. It is hands down the best book I have read on the whole subject of loving and caring for those with dementia and memory loss.

This is an extremely difficult task, and is often thankless and can cause friction between family members, as you probably know by asking the question. Assuming depression and other medical or prescription-related problems have been ruled out, and dementia has been diagnosed by a medical professional, and appropriate treatments are being utilized, then how to approach it can depend on the stage and type of dementia and, of course, according to the individual.

The early stages are the hardest times to try to convince them there is a problem. They may have been denying the problem for a very long time and compensating for memory loss to keep it unnoticed for long enough to have developed some really good denial skills and covering skills. They often are more adamant and more set in their ways by the age that the symptoms of some forms of dementia appear and become recognized by others. They have excuses and arguments ready to fire off to convince you, and themselves, that they can keep things as they are. Change is the enemy (or the bringer of change sometimes is), unfortunately for the loving people trying to help.

It is highly frightening to some people to think of just moving to a new place. To give up driving - and other things they see as symbols of their independence, on top of that - is more than many people are willing or able to face. This is a very significant adjustment and causes much stress, even in the lives of younger people with full memory and brain function. But it can be emotionally debilitating, or can cause angry outbursts in those with any form of dementia, but especially Alzheimer's Disease. This is in addition to their fear that they have been "found out" and that they must try to accept what they have denied for so long, i.e., that they are unable to care for themselves or live alone.

They will need to hear it presented calmly and lovingly and, most likely, multiple times by multiple people. If there is someone whom they have always respected and trusted and who can be there to back you up (with really nothing more than their presence and a well-timed nod), that can help.

With my mother, that was her family doctor. We slowly started introducing the topic when at our appointments with him, but, in our case, luckily, she was not living alone at the time and was being cared for by my stepfather. He was also able to move with her to an independent living section of an assisted-living community, so that when they needed more nursing involvement in her care, the move was down the hall instead of to a brand-new place. New locations are unsettling to them to a degree we can not even understand. It makes them lose the routines and visual reminders of life as they know it and can essentially grind their thoughts to a halt.

Others that the person may respect and trust are clergy and policemen. The doctor and a wonderful policeman who was willing to talk to her about her need to no longer drive and why (I called the non-emergency police department number and asked if anyone could help) told her the same things we had been telling her repeatedly (but calmly and sensitively). And little by little, she started to accept it. No actual bickering or arguments are allowed, even if they start it. That is a common denial tactic they may use, at best... a losing battle for you, at worst. It gives them justification to make you the "bad guy," and they often will pick a person to be the target of their anger and, sometimes, paranoia ("they only hurt the ones they love"). Your strength will be tested, too.

Later in the dementia process, it is actually easier in some ways, but harder in others, to convince them. As mentioned above, The 36-Hour Day will give you excellent suggestions and explanations of why their behavior is as it is, which will help you better help them.

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Answer 2

It can be difficult to help someone with dementia understand the need for a care facility. It's important to approach the conversation with empathy and understanding, validating their feelings while providing clear and simple explanations. Involving a healthcare professional or counselor in the discussion can also be helpful in identifying the best way to communicate and support the person with dementia in this transition.