How do you tell them they aren’t coming home?

[bridgetreilly]

My dad has been in hospital for over a week following a heart attack. He is now medically fit for discharge but needs assessment by the physio and occupational therapists. His mobility is extremely limited, his memory is very poor, and he has numerous minor needs. My elderly mother and I have reached the difficult decision that it is no longer safe for him or her to have him cared for at home. We have been to look at a care home and the plan is that he will be discharged from hospital directly into the home, probably next week.

He will hate the idea. He doesn’t see why he isn’t at home now. Partly that’s because he doesn’t remember the heart attack, and partly because while he is in hospital with people to help him with everything, he feels quite well. He has no idea how hard life has been for Mum over the last year. They have had carers coming in, but she has also done a lot and she is exhausted. We’ve discussed 24/7 care at home but there are a lot of reasons why this won’t work.

I actually think he will settle quite quickly and contentedly into life at the home, but the prospect of telling him - and it will have to be done repeatedly because of his memory problems - is daunting.

Does anyone have experience of this and suggestions of what to say/not say?

This brings back memories of the nightmare waiting for the deprivation of liberty assessment. I don't know what I'd have done if they'd said she had capacity and could go back home but that's the law. She would never have agreed to go into the home. She could, on a good day, be quite convincing hence my nightmare.

@TheignT I had that nightmare and started a DoLS thread on here and the marvellous people of MN came with their wisdom - which included assessors. The assessment was exactly as they said it would be and I felt so much better for having an idea of what it all involved beforehand.

Just to say a massive thank you to everyone for your support. We talked to Dad earlier today and although he would prefer to be coming home, he understands why that isn’t possible and has agreed to the home. It all went much more easily than I had feared and he was very receptive to the idea, especially when we were able to show him the place we have in mind. He wanted to know what his room would be like, and when he would be going. Hopefully very soon!

Thank you for the update OP it all sounds positive.

The home my grandma was in had 'events' in the evening, one I thought looked fun was a 'cheese and wine' evening.

They also did day trips to places.

One question to ask the staff is how long people stay in the job. It reflects the home's attitude as an employer and therefore their attitude to residents.

The home my Nana (I had a Nana and Grandma) was in at the end of her life were also fantastic, one of them would do the residents nails and a couple came to the funeral.

That’s really good news. Hope your dad goes from strength to strength

Why can't he go home with an adequate care package to support him and your mum? (Of course he may be beyond that but worth exploring )

I work in a care home and many residents are never told its a permanent arrangement. Respite residents often stay for weeks. Just leave the arrangement as temporary to him and see how it goes.

Pleased to hear your conversation went well OP. Hopefully once his room is set up with some of his familiar things from home, and he has more privacy and people looking after him, he'll relax and be content there. I was a carer for my late DH when he became terminally ill and I can empathise with your mum how difficult and stressful it is. It definitely affected my own health.

I'm so pleased, OP. Just a thought (and this may be something you have in mind or have done already), but one great tip I read on here was to have lots of photos of special people and places, including pictures of your dad in younger years, with really clear and detailed captions, so that staff can talk to him about them - ideally some out on display as well as in albums. I made my mum a photo book like that recently after reading that tip on MN (and she's still living at home and in only the earlier stages of probable dementia at the mumemt), and she spends literally hours looking at it. It's one of the few things now that brings her real joy, and the captions make a real difference because, although she'd still probably recognise all or most of the people for now, it allows her to say 'oh, that was us on holiday in the Dordogne in 1987' etc, so she doesn't have to feel sad that she doesn't remember those details.

Please read the op - at home has been tried and this isn’t a decision taken lightly.

The lady we met had worked there for 40 years. The manager’s grandmother started the home and it is still family run.

That’s a great idea. A few years ago, I put together a book about Dad’s life, mostly for his grandchildren who might be too young to talk to him about all those things. We can certainly take a copy of that in with him.

Hopefully once his room is set up with some of his familiar things from home, and he has more privacy and people looking after him, he'll relax and be content there.

This is what I am really hoping, and I think it will happen. It’s near to where all his family live so we can all visit regularly.

No it isn’t.

Mum is 76, has had two hip replacements, needs a knee replacement, and has been caring for him at home for over a year. No matter how much care happens at home, even live-in care, it’s not going to keep them both safe. She will rush in to help and end up doing herself more damage. She still has an injury from helping him two weeks ago which is not improving because she needs more rest than she can get.

When my DM was in hospital the hospital decided that it wasn't safe for her to back home on her own so had to be discharged straight to a care home.

This has to be a decision made with him. It's his life too. Unfortunately that will necessitate some home truths and telling him how hard it is on your Mum, how she can't cope and how she needs respite. It can be a trial. That shouldn't be a lie. Obviously if he doesn't get on there you'll need another plan. Your DM may miss him too much you just don't know.

My Mum went into a residential home for a few weeks until they sorted out home care, this was after being in hospital severely ill for 6 months , it was meant as a stop gap . By the time they got the care package sorted she did not want to go home and decided to stay off her own back . Your Dad may decide this off his own back . I think the key is getting them into the right home. Good luck @bridgetreilly.

If the person has dementia, or any other memory loss issue, so are going to forget whatever you say anyway, then from (too much!) experience, you say whatever will keep them happy for the moment, fib or not.

What is the point of telling someone they will never be going home, when it will only distress/anger them, and they will very soon forget what you said anyway?

What about an electronic photo frame with them all loaded?

My DSis told our DM that she was going from hospital to a "convalescent home". Once she was moved to the care home, she thought she was on holiday. We didn't burst her bubble.

You say the doctor says your mum is too frail now to cope. You say it's until he gets stronger. You keep saying these things every time you visit! But eventually, in my experience, if its a nice care home, he will make friends and get to like it there.
Stay strong and insist for your mum's sake.

What about an electronic photo frame with them all loaded?

Yes, I'm sure that would work well for lots, though there is something quite nice and tactile about being able to curl up on the sofa and turn the pages. In my DM's case she is utterly hostile to anything vaguely resembling technology, so a screen version wouldn't have worked for her, but not everyone's like that!

Talk to him about needing to be in a care home for a period of respite care to help him get better. Then it could become permanent (because he won’t get better). I would talk about his needs short term until it’s very apparent to him that it needs to be long term

@bridgetreilly have you got POAs in place for if/when mental capacity is an issue?

Yes, sorted ages ago. Also a Respect form.