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My family has been struggling with this question. We are extremely fortunate and blessed that he is still able to financially support himself and he has the resources for either full-time care at his home or to be moved into a nursing home. My grandmother has already moved to a retirement community (where he could move to skilled nursing) because she doesn't want to manage the house or the professional caregivers and she wants more social interaction. My grandfather isn't mentally well enough to say much. We know that he loves being at home but we also know that it's really lonely for him without my grandma around. How do we decide what to do?

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Don't put him in skilled nursing if dementia is his biggest problem. He needs mental stimulation of memory care.

I made the mistake of putting my mom in SNF because I didn't know any better, and because she didn't need any actual nursing other than getting her pills handed to her, she was terribly neglected by the staff. I moved her to a memory care facility, and she did much better.
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Moving him to the same facility as grandma is a slam dunk! You have them both in the same place and don't have to worry that one is taking more of your time than you can give.

Sounds like grandma made a very wise choice! Why didn't Gpa go along with her?

The costs involved would be less (I'm guessing) if you add grandpa to the assisted living! I'd probably be of the mind to lean on him pretty hard to join grandma at the place where she lives.

Ask grandma what she thinks. Would they be living in the same rooms? Does she miss him, too?

If gpa cannot make this decision himself, who is his POA to help facilitate something for him? Time to step up and do the right thing by gpa. I wouldn't hesitate to move him in with gma, or at least in the same NH.
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Who is managing the house and caregivers for grandpa now? Are they willing to go on doing that indefinitely? I can't imagine that they are.

I'd choose moving grandpa to the same facility as grandma so they could see each other sometimes. You don't really know that he loves being at home. He might love a place where there's more going on also.

Family caregiving can go on and on. It's easy to be exhausted by it even if you are not doing the daily hands-on care. I'm not only thinking of grandpa but of all the rest of you.
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Memory Care offers plenty of social interaction. If there is a break between structured programs. The staff encourage residents to get out into the community room where other residents interact in their own way. If you place him in the same community as his wife, even if they are in different wards, she can get over to visit him.
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Your question is excellent and one we commonly hear. One of many options available to you is to try a temporary residential visit to an assisted living facility. Contact the facility you think best suits your Grandfather’s needs and ask if they will allow a 30 day residency as a trial run. Reevaluate his state throughout this period and decide what’s best for him. He may thrive in a community with structure and 24 hour support. If it doesn’t work out, take him home.
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TouchMatters Jan 9, 2024
Thank you for this sensitive and kind advice, recommendation and support.
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If grandpa isn’t very verbal , how do you know how happy he really is at home but also lonely ?

Are you assuming these things ?

I would most likely encourage him to join his wife . He’s 90 and who knows how much longer he will recognize her . Perhaps he would adjust better to a facility while he still can recognize her, even if they aren’t necessarily living on the same unit. The facility can arrange visits and sometimes meals together for grandma and grandpa .
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If home care is currently working very well, and he appears happy at home, and this is affordable, can you tell me what gives weight to considering the move other than your imagining he wants more social interaction (I doubt this is true with advanced dementia. Others around can sometimes be overwhelming in those circumstances.
What does your Grandmother think of this question, either pro or con?
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Care homes are great for people who are still capable of taking care of themselves, and by that I mean, they have the mental capacity and ability to ask for what they need and can mostly manage themselves. Otherwise they really, really aren't great. In the US, most care homes are strapped for staff because most of them are owned by investment groups who expect a nice ROI, so they don't pay nurses enough, and end up employing lots of temp workers to fill in staffing gaps, especially on the weekends. Temps are usually newly certified, and are left to just figure things out with very little oversight as management doesn't work weekends. These facilities also cut a lot of corners because there are just so many Boomers hitting nursing home age that it's a big shotr-term investment area right now, and those investors care more about profit than actually caring for people.

My 96yr old grandmother is doing great in one. She's mentally able to manage herself just fine, but has some physical limitations. Her facility offers swim classes which she does, and she likes to socialize.

As a contrast, my mother-in-law has been in a care facility near our home for three years now, and it's just been a constant source of stress for us. She had a series of strokes 4yrs ago, that has made speech difficult, diminished her mental ability, and she's mostly bed-bound. We have to check in on her daily, and when we can't we have to hope that nothing happens because something always happens if we aren't watching her like a hawk. She needs help with eating, and sometimes the care workers will help her, and other times they put a bowl of soup in front of her and leave her to struggle to get any of it into her mouth. A few months ago, we had an incident when a newly minted care worker didn't understand that my MIL is just not able to help get herself from her wheelchair to her bed, and the care worker lifted her improperly causing them both to fall and get injured. She wears diapers, and we've arrived to find that she's been sitting in a soaking wet diaper and bed for hours (based on the dried outer circle of urine on her bed pad) because of short-staffing.

These are just a few of the issues we've dealt with since she's been there. This place is the best we could get that's close enough for us to monitor her regularly. Some of the nursing staff are great and they really care, but they're over-worked, so they do the best they can with what management is giving them.
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TouchMatters Jan 9, 2024
He may need to be in memory care.
All caregivers / providers at facilities should be trained well. This isn't the situation everywhere. Certainly not in a nursing home where my friend had to go. When paying more, one would expect more attentiveness / and training of staff.

I think this writer needs to assess the care facility carefully - and ask for references (family members who have loved ones there) - everyone writing here may have a very different experience (certainly I could write a book - I contacted the licensing board of the nursing home ... after many months of ongoing issues).

If I were the writer, I would go several times to a facility - sit and watch how staff interact with residents, ask administrator how they handle issues that come up, how they train their care providers.

Short staffing is an issue for many care facilities, however a resident (family) can hire outside care givers to supplement as they feel needed. In this situation, they can afford to do that.

Wet disposable underwear, improper lifting from wheel chair is inexcusable. This is the type of situation I would report to the Umbudman, if not the licensing board. Gena
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I’m reading this that GM is happy. GP is lonely. Also that GM might not be too happy to have GP to look after again. We know she wouldn’t actually have to look after him but that feeling might return.

How often do they see one another? How long has GM been gone from home?

So I would consider that you have one successfully in facility care and one not so happy with the chance of having two not so happy if you move GP in to GMs facility.

Since money isn’t a problem and GP loneliness the issue, I would consider hiring GP a companion. Someone to come visit daily. Have lunch or dinner with him, take him for a ride, enjoy a few hours of tv. Maybe a walk in nice weather. Try that for a month or two and see if his mood improves. You could try more than one. Susie on M, W, F and Sam on T, T and S. Family on Sunday. Whatever you could work out.

Dementia is progressive and he won’t remain the same. Plan to revisit the situation every quarter if not every month. Make sure the person is a good fit and you have a proper contract. The elderly are easy to prey on regardless of where they are living. They are vulnerable and fragile and precious and sometimes lucky to have family working to keep them as content as possible.
Let us know how things are going and what works for all concerned.
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Dementia does not require a skilled nursing facility. Is there assisted living where grandmother lives? That would be my choice if available.
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TouchMatters Jan 9, 2024
That was my first thought, too. Why not?
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