Recently my parents moved my Grandmother into an assisted living community. I'm certain that is was one of the hardest things they've ever done. I know that it was one of the most stressful experiences my father has gone through.

My grandmother has early stage dementia. Not bad enough to create big problems, but certainly enough to make day to day life a challenge. She's had a collection of health issues as is not uncommon for someone in their late 80's. She had a hip replacement, had a number of procedures done to help correct her macular degeneration (loss of vision in one eye) and glaucoma. She hasn't driven in at least 5 years which is a very good thing, and was recently living alone in the house she and her late husband shared for about 35 years. Her husband, my grandfather, died in the late 1990's.

Our family has been trying to convince her to move into assisted living for at least 5 years. Her house was too much to care for, she wasn't eating properly, and local 'kids' were telling her they had mowed her lawn and done her gardening and demanding $200...which she paid them. No gardening or lawn mowing was being done however. A kind woman from her local senior center would take her shopping for groceries (and gambling - video poker is legal in her state) once a week. The highlight of her day was watching Jeopardy and doing the crossword. With the gradual loss of her vision, even the large-print crosswords were becoming too hard to see.

My folks, (who live 1500 miles away) had hired home care agencies to help her out. She consistently fired all of them.

My father told her it was time for her to move to an assisted living. She absolutely refused. Her perspective was that if she left that house it would be feet-first. When my father told her that she must move for her own safety, her response was "If you do move me, I'll do something drastic." My grandmother is a very tough, determined woman. Everyone understood what she meant.

About 3 weeks ago, my parents decided there was no other option than to move her. She was clearly no longer safe alone (she had stumbled and fallen, giving herself a huge bruise on her head recently. She had also let this 'kid' and his friend into her house again despite previously understanding they were stealing from her.)

My father had a terrible time coming to this decision. He knew that she would always blame him for the move. He also knew there was a very good chance that she might make good on her threat to "do something drastic". My father spent over 25 years as a partner in one of the top management consulting firms in the US. I've seen him stressed before. This decision was a completely different level of stress for him. Torn between following your mother's wishes, doing what's best for her well being in spite of them, and knowing that doing the right thing could result in losing her or minimally losing his relationship with her. I wouldn't wish this on anyone.

As it happens, my cousin's wife works for A Place for Mom in my grandmother's city. She had lined everything up for my parents. A great assisted living community with an excellent reputation, an experienced geriatric care manager, and a top gero-psych doctor for her dementia. The care manager recommended that she take my grandmother to the doctor's office for her regular check-up. Then afterward, she would take my grandmother to the assisted living community and explain that this was her home now. She recommended this to soften the family dynamic of such a move. Meanwhile my parents and my cousins moved her things from her house to the assisted living community so when she got there her apartment was already 'home'.

Her comment after all of this was "I don't remember agreeing to this". My Dad, being the steadfastly honest guy he is, told her "No Mom you didn't agree to this. But this is the best thing for you and I, Bruce (her other son) and the kids (me, Pam and my cousins) all know this is the right place for you."

It's been nearly 3 weeks now. Nothing dramatic has happened. She's eating far better than she did before though she's still not socializing as much as we'd like. Reluctantly she's settling in. When my parents take her out for lunch or dinner she gets tired and and asks to go 'home' to her assisted living community. And in 3 weeks she hasn't yet mentioned her old home.

I don't know how this is going to turn out. I know that my Dad did the right thing. I know my grandmother is healthier and safer than she was. But I also know that my Dad is a deep believer in personal freedom and everyone's right to make their own decisions about their own lives, regardless of the outcome. I would suggest that dementia is an extenuating circumstance and personal freedom may not extend to endangering oneself due to mental illness.

But this is family. Personal philosophy is about ideas in the abstract. Where those ideas apply to family...well that's a whole different story.

Thanks for reading,

John

(original post date: August 2007)