How to cut back on FIL visiting MIL in care home

[I8toys]

MIL recently admitted to a care home (March) indefinitely under DOLS due to dangerous behaviour which has happened very rapidly. Diagnosed with mixed dementia and vascular dementia. FIL also has the same diagnosis but if you spoke to him you would think everything is okay. He has trouble remembering but before her diagnosis MIL was the one in charge.

He's in assisted living and walks to see her every day and sometimes spends upto 9 hours there. He is missing his medication times - administered by the people at assisted living and his warfarin levels are getting messed up. We've added a timer to his phone but its not working.

Spending time with someone who is not well and aggressive and violent at times can't be good for him. We've just had a call with him and he is totally confused with everything when he's with her, mum says I've had a stroke, when he's fine.

The home sent him away on Tuesday because they were shouting at each other. She demands things and shouts at him when he's there and he can react angrily at times which is hardly surprising given the amount of time he's there. The home have said they are happy to have him there apart from last Tuesday.

I feel its all going to come to head and something will happen. The confusion when they are together is crazy. I know he wants to but we're not sure its good for him to spend upto 9 hours in a dementia care home with someone who constantly belittles and blames him for everything. No idea what to do to help him.

his assisted living doesn’t sound like it’s doing much assisting
or it isn’t of a level sufficient to properly assist him and you need to increase

His assisted living has an open door policy so they cannot stop him leaving the premises. He is able to walk to the shop, doctors and hospital. We remind him of appointments and he is able to get there himself. They do monitor him coming and going and let us know when he's not there so I'm not sure they can do much more in that respect.

It's lovely that he wants to spend his time with her. It's a tricky one, and I get why you are worried, especially with the medication being missed. I just don't think there's anything you can do though. Sometimes you can see it'll all go wrong at some point, but you have to just let it happen. Sorry.

well more care needs to be put in place for him and sharpish

Can he stay in the care home with your Mum ?
Only that seems the kindest thing to happen bless him .

The care home did mention him moving him in and we would of course consider it but she's so aggressive with him. I don't think that would be the right thing for them as he triggers her. She would have access to him then 24/7 to take out her frustrations on.

She wanted to leave him before she went into the care home and blamed him for everything. If they we loving with each other and enjoying each others company definitely but she hates him more than she loves him if you know what I mean. She's not the same person she was unfortunately.

Could the care home send him back to his after an hour or two? So he's back at his for medication times (does he organise his own meds? Or do staff at his assisted living place help him with that?) then he could have another visit in the afternoon after lunch, and he sent back home after an hour or two etc.? So he could get into a routine of very regular short visits instead of spending all day there and missing out on his own care?

he needs to go to care home
but a different one

He gets his meds in the morning and evening. They need to be evenly spaced to avoid overdose of warfarin. So it could work if we ask them to send him home by a certain time. The issue is his leaving - she gets aggressive and her behaviour deteriorates. I think this is why he has issues leaving at times. Maybe we could ask the nursing home to distract her and get him out of the building by a certain time.

It sounds like he needs occupying on the other days & a set visiting routine. He needs to know he'll be seeing his wife, say on a Tuesday & Thursday, and make it for set times so they both have routines. @I8toys ask the local authority if there are any services that can help him join activities, lunch clubs, groups etc. If he's occupied, he'll not want to visit every day.

I disagree that he needs a care home nothing you've said suggests this at all & you cannot go against his wishes.

Its very difficult, I'd suggest you try get the care home onside to support you, for example say they have a change of policy and don't want visitors there at lunch /tea time so suggests he only visits in morning and leaves at lunch and returns home , if you explain you are trying to help him, while you appreciate their facilitating them, I'm sure they can suggest to him it's time he leaves, even if they agreed to only do this every second day it might break the cycle, Or can you try get him involved in something a few mornings so he doesn't go to her that day till later, or afternoons so he has a reason to leave.

We feel at this stage that he does not need a care home as he still has some independence and can function on his own - prepare meals, wash and dress himself and is able to use the bus and walk to places. We are obviously closely monitoring this daily.

I agree with getting him occupied and busy with other things - dementia robs you of your confidence and ability to talk to others and I think its knocked him and made him more solitary and withdrawn.

In his assisted living, others ask him to join in activities and he was going to church but that has stopped once Mil went into the home.

I would look to him moving into the care home too. That way he will get his medications and to his appointments on time because the staff there will ensure of it.
Yes that means he could end up spending even more time with his wife but the staff should be able to manage that. If he's there all the time he may also feel less pressured to spend prolonged time with her as he can just pop back to his own room or to the lounges without her. I'm guessing when he goes visiting he doesn't really have anywhere to go other than to be in her room with her.
The staff can also encourage him to be a bit more independent and make friends with other residents and go to activities etc.

Perhaps do a couple of weeks trial and see how it goes?

Ps I worked in the care sector for over 15 years and this isn't an uncommon situation. Lots of couples move in even when one doesn't necessarily need a huge amount of care. The care home will likely have come across this before so I would let them guide you a bit.

in my experience

you don’t want to wait until they need it when it is 100% inevitable they will need it at some point soon

it’s a lot easier to sort before there is a screaming need

I don't think it's reasonable to try to stop him. If he wants to spend his time with his wife, that's his right.

Regarding the medication, could he (or you) talk to the gp and see if the schedule can be adjusted, so that he only needs to take them first thing and night times? Might be possible depending on the type of drug.

We would never want to stop him but 9 hours every day is extreme and is affecting his meds. If they had a wonderful loving relationship he would be in there with her if he wanted to be but its not great when they are together and I'm not sure its good for either of them. I need to speak to someone at the home to gauge opinion.

We've given him the DOLS paperwork so he knows why she's there and we think he understands that its a care home. She thinks she's in hospital so he could believe what she tells him. Its just so hard when they both have dementia.

We've put on his noticeboard - Mum is safe and she's at the care home as he sometimes calls us asking where mum is. We've given him a letter with his dementia diagnosis on it because he wanted his car back and he didn't believe he was ill.

How do you tell people they have dementia when they forget every day? Its just never ending.

Just to update re this - we asked him what he wants to do and he doesn't want to change anything. Offered for grandson to drop him off and pick him up so he can get back for meds - doesn't want that. Offered for him to move in with her - doesn't want that. Just wants to maintain the status quo. Have to respect that until it becomes unmanageable. We've asked the nursing home to kick him out at a certain time so will see if that works.

We've asked the nursing home to kick him out at a certain time so will see if that works.

I wouldn’t rely on the Care Home staff being able to do this consistently, unless it’s very small and mostly the same staff are on duty every day. In larger care homes and where the home uses a lot of agency staff, or staff are moved between floors, the message will often not get through to those on duty at the relevant times, or will just get forgotten.

I’ve known a couple who moved into separate care homes. The wife had pretty bad dementia - he was Ok mentally but very frail, and TBH worn out with having done his best to look after her for years.
He thoroughly enjoyed his time at his care home, but sadly died after only a few months.

You mentioned that your MIL moved into the care home because of dangerous behaviour. I wondered if you'd thought about applying for CHC funding for her including for a one to one carer for her for at least part of the day, if they are there when your FIL is there they can help to defuse things if necessary.

If you think this is something that might be possible then I would strongly advise you to make sure that the care home is keeping very detailed records of any incidents that happen and any incidents that they manage to avoid happening by intervening. Having lots of evidence is very important for the assessment.

I would ask his Gp or district nurse if they can change his warfarin, could he go on abixaban instead?
How long realistically are you expecting him to be able to stay in sheltered housing if he has times when he does not remember his wife is in a care home? Has his dementia deteriorated a lot since his wife has been in care? Personally I would be looking at getting him into the same care home as his wife, the staff will be able to better manage the situation then.

She's been assessed for CHC but they gave us FHC instead.

I think he's actually been better without her around. The confusion when they are together is crazy. He actually thinks better without her around if that makes sense as she was telling him what to do and she was not being sensible in her decision making.

When my mum was getting in a muddle with Warfarin, the GP switched her to Edoxaban which she only needed to take once a day.