What do you do when your father refuses to move to an assisted living facility?

I'm dealing with a very similar situation. Reading these comments has been helpful.

Quite frequently it is everyone else that is the problem. That sounds wrong doesn't it? Because WE are facilitating everything for them - it makes it easy for them them (and us) to believe they are able to do a lot more than than they can. You may not even realize just how much you and others are actually doing - on top of the cognitive decline.

In our case - my FIL's first noticeable decline was the other way around - it was the physical decline first (or that was what we thought). He was physically dependent on the family for the vast majority of his needs and we had told him that if he got to a certain point, we would not be able to sustain keeping him at home. Due to a personality disorder, he did not believe us.

I think what did it for us was the fact that we had to inventory all of the physical decline as well. We knew he had a lot of physical issues and we drew a line in the sand. The problem was "we" (technically my SIL and DH) kept allowing the line to move for far too long. My FIL is a huge bully and uses guilt as a weapon.

My FIL needed a nursing home. He was far beyond assisted living. But he expected us to facilitate him being home. We lather, rinse, repeated that so many times I lost count from COUNTLESS rehab facilities after multiple falls and other illnesses on the generosity of Medicare and even the VA for respite care.

Finally we hit a wall. From November 2022 to February 2023 we cycled in and out of rehab THREE times and back home. In that just over 3 month period he managed a grand total of @130 HOURS AT HOME combined. plus three trips to the hospital. He sat in that last rehab and told them he was going home.

And FINALLY - we said unless he hired 24/7 caregivers - he was an unsafe discharge because we were not taking care of him anymore. We forced his hand. He knew he couldn't do it alone. HE made the decision for placement.

He didn't have a choice but to go. And it was once he was there and didn't have our 24/7 interventions with other things that we realized just how much of his cognition had slipped in other areas. We were actually propping him up in a lot of ways we didn't even realize. We thought we were just enabling him physically. It was so much more than that. But we were too close to the situation and didn't realize that in "helping" we were actually facilitating his ability to appear much more "independent" than he really was.

Sometimes you have to get out of your own way and realize that the only way you can help is to let someone else do the heavy lifting. It isn't always about what they want - it has to be about what they NEED. That's not always easy. And they are rarely happy about it. Their bubble shrinks and they want what they want (when they want it). They don't think about what they actually need because NEEDS are just supposed to be met. Cognitive decline makes it even more complicated.

You have to do what is best for all concerned but sometimes you may have to get outside help and let them deem competency. And go from there. You can't force him without a lot of other things in place first. That "unsafe discharge" is often your lifeline/first step.

Our job is to keep our parent safe first and not worry about happiness. I do what is best for my mom and assisted living is where she is. She complains quite a bit but she is safe, well fed and I control the money so she can afford to pay her bills. A lawyer could help you get control legally. This is a tough job indeed. Good Luck.

My friend told her mom she had termites to move her out of the house.

So sad that he has early onset dementia of this degree already.

My mom lived with me for 7 years. Cognitive impairment came, soon followed be dementia and then the doc said no driving and then declared her incompetent which activated my DPOA. When her living here, even with caregivers, was too much, I decided it was time for AL. I found a place and applied as her POA. When the time came, I told her 2 days before that she was moving. She was pissed! But I stayed firm though I was very upset at her outburst. I just said something about it being too much work and helpers were always calling out sick and she would be better off with more help and socialization. And that it was for me since I was too busy with babysitting for my grandkids. The next day, my husband I set up her apartment and the next morning I brought her over. While it was a big of a challenge, she quickly accepted it and adjusted to it. She doesn't love it there and never will but that's ok. At 80 with dementia, there aren't many good options. And no matter where she lives, she won't be happy since dementia makes their lives so difficult.

I agree with using therapeutic lies. Your situation if perfect for them. Do what you need to do for him to be taken care of and safe. He doesn't have to like it.

Best of luck!

If he is declared mentally incompetent by his doctor, you can use the POA to make decisions for him. If he is not mentally incompetent, you need to allow him to experience the results of his decisions.

Follow the advice by Geaton about a crisis with the house. Plumbing, termite tenting -- something that will require him to be out of the house for several days.

He needs a Memory Care facility, not assisted living. Don't make a mistake and put him in the incorrect level of care, because you don't want to do this a second time if you can help it. He appears to have early onset Alzheimer's or another dementia, so that's what you need to focus on when selecting a facility. Memory care is a locked facility with lots of supervision and activities designed to stimulate their minds. It's the best place for his particular needs.

My parents refused to move into a care facility of any kind for two main reasons… First, they had a very distorted view of what the place would be like. In the larger area around the town where my parents lived, the care facilities are actually very nice, clean, and inviting. Not all of them, but many of them— especially the newer ones with the newer designs. The second is that my dad especially thought there was absolutely NO way they would be able to afford a place like this, and he was very set on making sure that his money did not run out before the end of his and my mother’s lives. In my dad’s mind, the nice IL & AL facilities were only for the rich.

Those are both very difficult hurdles to get over, especially when someone’s cognitive abilities are beginning to slip. But, after my dad passed away, I sat down and did the numbers. And my mother was much better set financially for a transition into a care home than I would have thought.

It helped a lot to take my mother over to a couple selected assisted living facilities to visit. Not just one visit, several. There was a welcoming committee of women that made it a point to come over and talk to my mom each time we went to visit. We did not have an opportunity to have meals there, but she was able to see the kinds of things that were being served. Actually getting her eyes on the place, and meeting some of the people there, made a huge difference in her buy-in.

I would like to comment also on how much of a difference good food and low stress can make in a person’s health and cognitive ability. There have been several couples that moved into my MIL’s IL facility that were on a pretty steep path of decline. Once they got settled in, and began eating regular, nutritious meals, their mental health stabilized dramatically, and they were able to stay in IL for many years. It was impossible over the last years to get my parents to eat good nutritious food. They lived— literally— on cocoa and English muffins. The reality is that they were not very hungry, and they ate junk all the time, with truly no real food. I live many hours away. I cooked for them and filled the freezer. The food went untouched, still there when I came for my next visit. There was a wonderful meals on wheels program in our city that I tried, and the food really was very good, and they kept turning off the service because they didn’t have anywhere to put the food. (!) Because they were not eating it. One visit, I found bags of the food sitting out on their back porch, rotting and spoiling. And they continued to eat English muffins and drink cocoa with extra whipped cream and marshmallows.

Anyway, all of the good care, and all of the good programs in the world don’t make any difference if your loved one refuses to participate in them. By the way, my parents also refused home care. The couple of times that we tried to dip our toes into home support were disasters. One aide stole their medications, and another was just a very bad personality fit. All of the home care people that came to our house treated my parents like they were idiots. I hear great stories about home care people from time to time, so I know good people are out there, we just didn’t find them in time for it to make a difference. And again, being many hours away, I wasn’t able to manage that as well as I would’ve liked.

Good luck with your search!

Mp4lkw: Perhaps you can reach out to the social worker at his town's Council on Aging.

Yes, you can ask his PCP to assign a Geriatric Care Specialist, or Licensed Social Worker to his case; this individual should be able to help you and your father with the transition. You can also call 911 if he presents unsafe, non compliant , or other diagnosis related behaviors and have 911 transport him to ER ; once there, as POA, you can talk with social services and other medical staff, share the appropriate documents and, insist that he be placed in appropriate care setting for safety reasons; you can also share that he cannot be returned home ( refuse for them to return him home) , and go forward with them transporting him at some point directly from hospital to whatever appropriate facility you as POA and social services choose .
Expect the transition to a facility residency at any level of care to be met with potential denial, anger, blaming, guilt tripping, grief , other behaviors . Do not allow these behaviors to change the decision that has already been documented as needed by PCP. If needed you can also confer with an Elder Law Attorney for more input on the circuitous journey that you as POA for aging parent are on. No easy answers, Grief for all involved....be sure that you are getting appropriate counseling to support your emotional, spiritual health also.

I would add that weith significant memory problems at the realtively young age of 66, your father is likely to need a lot more care than is provided by Assisted Living.

Why do you need to move him? If he cannot live alone, Home Care is the other option. He does not automatically have to "go someplace." Yes, Home Care costs money, but you and he cannot expect willing volunteers to carry the load.

Please look into in home care options! There is not need to throw him into a one of these horrible places. Do you know of the abuse and neglect? If you love your father than research for in home care options. We have one program here that is called IRIS which allows them to choose their own providers (including family). Every state has similar programs. This one is through Medicaid. It will help to pay for his care and things he may need in the home.

I am very sorry to learn about your father's situation, lost his independence. Do not tell him he is moving but that he is going out for a ride. Get a social worker to talk with him and to be in a safer place, with love.

My sense / suggestions:

(1) He will not agree to moving. This is not the point.
(2) If he has the authority to stay where he is, it is at his own risk. You cannot do everything to support him in getting the care he needs.
(3) If you have legal authority to relocate him. Do it. Period.
(4) He will (continue to) exhaust everyone.

You do what you need to do, with or without his consent, as you have the legal authority to do so.

Often what happens is:
1) An injury occurs
2) person sent to emergency / hospital
3) then goes to rehab (or)
4) directly into AL / nursing home, etc.

He either goes before an injury happens or waits - and with the need to be moved, he is needing to heal from an injury.

This decision is not up to him. Clearly, with the medical authorization you have, you can make decisions that are in his best interest, without his consent. As is said 'he'll get used to it' although it could take a few weeks (a new location).
With brain / cognitive changes and losing his independence, his home, he will be scared, fearful, feel lost. Comfort him as best you can while making these hard decisions.

Start looking for an AL facility.
Make arrangements.
When you create his room, bring in all his own furniture, paintings, etc. Make it look like his home. This is important. Be equally strong emotionally and gentle and compassionate. He is frightened. He needs reassurance you are there for him. (He won't hear this although tell him anyway - smile, hold his hand, make good eye contract.). People with dementia 'pick up' on these things 100%. It isn't what is said, it is the behavior with what is said.

Lastly, when you say: "He manipulates and turns the conversation around anytime the subject comes up."
- Of course he will.
- He will do any and everything to avoid what is needed (moving).
- You use reflective listening "I hear you saying xxx". Do you not agree or disagree with his statements. Realize to him, he is advocating FOR HIS LIFE as he knows it.
- You never argue.
- You show empathy (I know this is really hard for you).

Lastly, do not tell him he is moving. He take him out for a ride ... tell him you/he are visiting a friend of yours ... take him to his room and when he fights like hell to leave, you say something like "we'll JUST try this out for a couple of days" - give him all the emotional support you can. Visit daily (although many say it is best to not visit and let him adjust on his own. This is up to you.)

It will affect you too emotionally. This is hard for you, too.
It is a huge change. Cry, with our without him. Be compassionate for both of you.

Gena / Touch Matters

You said; "Are there social workers that help with this? I understand I could get conservatorship or Guardianship but that still does not explain how to actually get him moved?"

Firstly, get support for YOURSELF in understanding all of this. This is ALOT. Yes there is a network of professionals that can help you in this area. When we were learning about our own situation, we quickly learned that "first thing is FIRST".
In other words, getting him moved isn't your bane of existence right now. Seeking a conservatorship is. THEN worry about a move.
Moving will involve alot of logistics such as WHERE, WHEN, and the circumstances under which these things will have to happen.

If you have POA
If you have documentation that he is not competent
You have the right legally to make decisions for him that are for his well being.
This could be placing him in a facility that will meet his needs
OR
You can hire (dad pays) caregivers that will be with him as much as he needs them
That could mean 247 caregivers. Or it could mean several hours a day.
But you have to make sure the house is safe for when he is alone.
This might mean disconnecting appliances, making renovations (again dad pays) that will enable him to remain in his home.
There are Adult Day Programs that can keep him occupied and safe during the day.
If he is a social person Assisted Living might be a good option. It should have a Memory Care portion of the facility as well. AL is generally not locked and if he begins to wander safety is an issue.
If he is a Veteran the VA might be able to provide some help, it might be a little or a LOT depending on where and when he served. (Contact your local Veterans Assistance Commission and they can help determine what benefits he may qualify for)

Well, for us, it happened when my mom fell and broke her leg, up in her hip. With that, came rehab and and more memory loss. The doctor from the rehab called me and told me that there was no way she was going to sign off on my mom being able to live alone. Besides her hip, her memory is just too bad. Thankfully, I had already started searching ALs when she had broken her back and ribs over a year earlier. Once I got that call, I had to get the ball rolling. I contacted an eldercare attorney, the AL that she liked the best when we had visited earlier in the year (just in case). When her insurance quit paying for rehab (I got 2 days notice), I let her know that they will not sign off on her living alone and we had to put her in a facility. I will say that breaking my mother's heart, was one of the hardest things I had to do. It took her a couple of months, but she's thriving in her facility. She's eating better than she had for years. She's more active and social than she had been in the 6 years since my dad died. I, absolutely, believe we did the right thing. We were lucky to be able to research places, eat lunches and participate in some of the social activities of these ALs, so we were able to find the right fit. It's not the most expensive. It's not the newest place, but she's in a lovely community. Her relationship with her kids is better, because now we can visit for pleasure and not just a "honey-do" list or the constant worry of finding her on the floor. She is safe, she is clean and she is fed. I regret nothing.

My MIL was 2 years past the point in deterioration that I signed my grandmother into assisted living. The straw that broke the camels back was a fire truck reverse beeping down my driveway at 3 am because MIL being the manipulative, defiant, demanding, self harm threatening when she didn’t get her way old coot she was, instead of playing her infernal poker machine games in the safety of her room instead did what she’d been told not to and tried to sneak out to the dark lounge room. Long story short her large behind missed the couch and she got wedged between the couch and coffee table. They had to call our local fire brigade for a push chair for large people as the ambos didn’t have one. She went to hospital for 2 weeks and my other half enacted his POA and it was straight to the nursing home, don’t pass go, do not collect 200 bucks.

I went through this with my mother. I called the County Area of Aging . They sent a social worker to the house . She spoke with Mom , gave her hypothetical scenarios and asked Mom what she would do. Mom could not “ come up with a plan “ . The social worker said Mom was not safe living alone and needed 24/7 supervision . The social worker then said she would return in two weeks with strong men to physically remove Mom from her home and place her in an assisted living facility that I had chosen . ( I already had one chosen on my own because Mom would never tour ) . I let the facility know the date she would be coming The social worker had suggested all my siblings and I meet with Mom in person and tell her she can not live alone and that she was going to be moved from her home to assisted living with the help of the Area of Aging . Before we could all meet with Mom together , One of my sisters told my aunt ( Moms sister ) what was going to happen . That aunt called my mother to tell her to refuse to go. Mom then faked a heart attack ( and had somewhat of a panic attack ) to avoid being removed from her home . My Mom called my faraway sister because Mom was so angry with me and my sister called me and I called an ambulance and Mom went to the ER. When I got there I told them what was going on . The hospital social worker called the social worker from the Agency of Aging that had been to Moms house.
Anyway , after a heart attack was ruled out , they did cognitive testing , finally diagnosing dementia ( Mom had been refusing to go to a neurologist and her primary ( family physician ) was useless , he just said go to a neurologist or a geriatrician ) . When Mom left the hospital she went straight to assisted living facility that I had chosen via ambulette with 2 men . If I had taken her in my car Mom would have refused to get out of the car . I was lucky the AL could take her sooner than expected .

Try calling your County Area of Aging .
Good Luck

Poa gives you many powers but it does not give you the power of placement. The last 2 answers have been great but for actual placement you will have to get guardianship and with the medical documentation you have, you can file in court per se and just pay the minimal filing fee. Sometimes if finances are an issue the judge may waive that as well. It’s important to keep good medical and incident records including any falls to prove to the judge that guardianship is needed. I wish you all the best, you have been given some wonderful wisdom by the forum!

First thing is to stop thinking you'll convince him to make the move willingly. Even if he agreed this afternoon that he wants to move to AL, by tomorrow morning he won't remember agreeing to it. Second thing is to just accept he's going to be upset and angry with you. These are the basic facts of the situation. Once you stop worrying about those two things it all gets easier. Also, get used to theraputic fibs. At first you'll feel like it's wrong to tell these little lies all the time but eventually you'll find that it's totally necessary. Tell some little tale to get him to the AL for an interview so they can determine placement and level of care. Then get everything ready for him at his new accommodation and finally, enlist the help of friends and neighbors to get him actually moved. Some people take them out to lunch and then return to the AL and drop them off. He won't know why he's there and you'll make up some story about his house needing work and then you leave. He will call you and be angry and he'll blame you and then you can come here and we'll remind you that you had to do it and you did the right thing. Don't accept his ranting about going back home, just don't respond. My dad, 5 years later and 102+ years old, has finally accepted that the AL is "an OK place" but he really doesn't understand why he needed to move from his 3 story single family home where he lived alone because he was "doing fine."

Once you have conservatorship or guardianship the move is easy. You already have the MD recommendation that he is no longer safe alone, and he is not. This is early onset. I am so sorry. This can mean a long road in a nursing home or MC.

As far as the physical move, that is the easiest part. You will arrange the care, have the place ready, and either they will assist you with their social worker in transport or EMS will come to your home and this will be ambulance transport.

I am so very sorry, but he currently is in a very unsafe place. Anything could happen when he is alone from fires to anything else. This is a tragedy so young. My heart goes out to you. I hope you will update us as you maneuver through all of this.

He has now been declared incompetent to make his own decisions. The ball is now in your court. You find an AL or MC. He no longer decides where he lives. Its no longer safe for him to live alone. You find a man to help you take him to the facility. We told my Mom when she got to the AL that this was where she was going to live. She was getting a nice apartment and meeting new friends. If you think he will become aggressive, ask his PCP for something to keep him calm.

You need to get yourself into the mindset that you now make all of Dads decisions. When I took Mom to a diner with us the first time, I handed her a menu. Next time it was 3 choices I knew she liked. Later, 2 choices then it was just Liver and Onions one of her favorite things. I never asked her if she wanted a bath, because the answer would have been NO. I just said "time for a bath". They can no longer make decisions. And its really not right to ask them to try and make one. The brain is broken, actually dying.

Since your Dad is only 66, a fall at this age most likely won't send him into a medical crisis like if he were 86. As a PoA whose authority is legally active, you don't need to wait for cooperation, you use a therapeutic fib to get him in. If you talk to the AL/MC's facility admissions head in advance, they will certainly help you with this since they've seen it all. (Also, he may need MC and not AL but the facility will be able to tell you which is more appropriate for him).

You'll tell your Dad that his residence has a 1) gas leak, 2) bug infestation, 3) water main break so no water or heat or a/c or whatever... and tell him you've arranged for him to temporarily stay in an apartment. Don't tell him too far in advance since he won't remember. Once he's in, he's in.

Respectfully, based on what you've written in your post, you don't have a full understanding of how to deal with people with ALZ. I found Teepa Snow videos on YouTube to be immensely helpful. People with dementia lose their abilities of reason and logic, and therefore, judgment. They also lose their ability to empathize with others. This is why you simply cannot try to "reason" him into moving -- that ship has sailed and you need to use another technique. That's where the therapeuctic fibs come in. It is perfectly moral and ethical to do this since you are operating in your Dad's best interests and they are not harmful or destructive fibs.

Also, with memory loss, even if you could persuade him one day, he'd forget it the next. I wish you much wisdom and peace in your heart in this process.

MP, welcome!

This is a tough situation and one not easy to navigate.

The usual answer in that if you have an uncooperative elder, you very often need to wait for something bad to happen--a fall or severe illness that puts them in the hospital. Once admitted to the hospital, you can work with the discharge planners to get him safely placed.

If friends nearby call YOU to say he needs more supervision, encourage them to call Adult Protective Services to report him as a vulnerable adult. You should do this as well. They will tell you that as long as he can do his ADLs, they can't force him into care, but it gets him on their radar

Another good resource is the local Area Agency on Aging. They can offer a needs assessment and case management services.