This is the ninth in a series of articles about the issues that arise over time for older people who experience mental declines -- and how you, as a family member or friend, can help.
Has your elderly relative with dementia wandered off, only to be found confused, hungry, and dehydrated hours later and miles away, unable to explain where he had gone or why?
Have you found lots of checks for large amounts written to questionable "charities" whose pitches your mother would have dismissed six months earlier?
Have you found empty pots scorched and sitting on burners that are still lit, while your parents sit in the next room, oblivious to the smell and the smoke?
If so, then the physical danger and financial risks are so high that unless you can arrange 24/7 care in their home or yours, assisted living may be the best choice.
But suppose they still insist that they're never leaving their house?
A number of authorities say that misdirection -- what you and I would call lying -- may actually be the best choice here.
Dr. Linda Rhodes, author of The Essential Guide to Caring for Aging Parents and formerly a secretary of aging for Pennsylvania, suggested in written notes, "Ask the doctor whether he could 'prescribe' a week at a 'center' for necessary treatment for their condition. If this is coming from their physician instead of their 'interfering or over-reactive' children, they might listen. If it's written as a prescription, your parent might be less resistant and might view taking this action as medical treatment, which might be more acceptable to them than seeming defeated by Alzheimer's."
Her notes continued, "If the doctor presents going to the center as a temporary measure, they might not feel like they're being backed into a corner. Also, if their sense of time has been affected, the temporary 'week' might easily transition into a permanent solution."
Jennifer FitzPatrick, a licensed certified social worker and adjunct instructor in the gerontology program at Johns Hopkins University, offered a similar view:
"In cases where there is advanced dementia, adult children need to take over and be more assertive and start making plans. It's sometimes not even a conversation that we're going to have with the older parent, because they're not able to reason."
What makes the situation black and white and moves it out of the gray zone, according to FitzPatrick, is any incident, like those described above, that reveals an imminent risk to the elderly person or to others. "You can't have someone burning down the condo that they live in," FitzPatrick said.
"If the person is saying, 'I want to live here, I don't ever want to move,' that's going to be a normal response from somebody with advanced dementia if you say, 'Mom I think it's time we start looking at assisted living.' They may be confused, and their response is a reflexive defense, not a well-reasoned choice."
FitzPatrick pointed out that aging relatives may argue with you and 10 minutes later forget that they ever had the conversation. Then you may just be putting yourselves and them through a stressful conversation over and over again that isn't going to change anything.
Assuming that your parents' doctors agree that a move to assisted living is the right step, talk to the staff at the site about how to make the move go smoothly.
FitzPatrick described one approach, which she termed the "therapeutic fib." Some adult children entice their parents to check in to an assisted living community by convincing them that "they're going on a vacation, going on a trip, going to stay in a hotel." Assisted living communities may be happy to support this deception so that the new resident is comfortable being there.
I have seen retirement communities that offer so many activities and outings that they seem like summer camp for grown-ups, so describing the experience as a stay in a resort may come closer to reflecting reality than you might think.
Next week's column will talk about how to avoid putting people you care about in the position of having to make such decisions and arrangements for you when you get older.