Caregiver’s Diary: A Very Difficult Conversation

An e-mail from youngest sister late at night to youngest brother and me. Our 89 year old widowed father had fallen again; presented himself to the night nurse covered in blood, then denied it had happened the next day. Could we do a conference call in half an hour? Things needed deciding.

Serenity Towers had called youngest sister in. After last night’s incident, they were very worried about his safety. When youngest sister confronted him with the fact he’d fallen again, he said he hadn’t. She asked where he’d gotten the bandage, and he said he’d had it for days, but youngest sister, who had seen him the day before, told him that wasn’t true.

He’s been falling for years. He drinks, he gets up at night to pee, he falls, bleeds, and goes back to bed. Before she died, my mother was always washing blood out of his towels, pajamas and sheets. He’s never broken anything, even recently, in his extremely fragile and enfeebled state. We think he’s too feather light to do much damage on the way down.

Anyway, as younger sister has said in her e-mail, it’s time for the second floor, where they keep residents who need more supervision.  He can get round-the-clock care and watching there, there’s a nurse always on duty, and he takes all three meals right on the floor. He’ll have to downsize from his three-room suite to a single room and bathroom, but all he does is sleep anyway nowadays.

Dad is deathly afraid of the second floor. This is not going to be easy. Youngest sister suggests a family intervention at lunch on the weekend. Youngest brother says, “no, tomorrow, let’s get this over with”. Youngest sister says “I’ll tell him we’re coming for an early Christmas lunch”. I say “No, tell him it’s a family conference. Scare him a little”

It scared him. He saw all three of us waiting for him at lunch at Serenity Towers the next day and said, nervously “Youngest sister brought three of you, am I going to have to pay for all of you?”

Youngest sister, over dessert, said “Dad, we’re not just here to have lunch with you. We’re here to talk about your options”. Dad belligerently said “My options are staying in my apartment. You’re just trying to tell my memory’s no good, why should I listen to you?”

This wasn’t going well. Youngest sister had said we had to offer him choices, not box him in. His choices were to move to the second floor, to engage a full-time care assistant to stay with him 24 hours, or he could go to a local full-care nursing home (which would surely kill him). Serenity Towers would do everything in their power to allow a resident to stay, but they would insist they leave if they became belligerent and uncooperative.

I broke in. “Dad, we’re very worried about your safety, and so is Serenity Towers. They’ve asked us to tell you if you want to stay here, you’re going to have to move to the second floor”. His face crumpled a little.

“They have insurance liabilities, Dad. They can’t allow you to stay in your apartment if they can’t care for you. They could get sued”. He said weakly “I’m fine in my apartment”. I said “Dad, you fell the other night and showed up at the nurses station covered in blood. They notice things like that”. He said weakly “I did not. There’s nothing wrong with my memory, I have no recall of that”.

“Besides, what would I do with my stuff? I can’t live in one little room”. I thought – Bingo! – that was the close. Now we talk about everything else but the decision. Youngest sister leapt in with “Oh that’s easy, I can get the kids to do it in a couple of hours, You go down for lunch and come back to your new room”.

He made one last stab “Well, I’m not going to take it from you. I’ll wait until the staff tells me”. Apparently, when I had left the table for a moment, he had lit into youngest sister, accusing her of meddling and plotting with the staff against him. Youngest sister puts up with this, but it’s not easy, I can tell.

He shuffled off up to his room on his new walker to get his corns seen to. Youngest sister cornered the Manager and explained our conversation. She said she would back us up to the limit, and tell him it was their decision at Serenity Towers. She said many residents don’t have family to help them make this decision, and the staff have to inform them, which is much harder for everyone. Serenity Towers was fully on our side.

On the way out, we stopped in for a look at the second floor. Nicely decorated, a reception desk, a small dining room. We asked the staff member in the kitchen about residents and alcohol. She said they hold occasional happy hours, for those who are competent to take part. They have one old lady whose booze they keep locked at the front desk, and if she complains enough, they’ll give her a shot.

This won’t do. Dad has been a drinker all his life, and while it’s slowly killing him (when he’s 119, maybe), it’s also keeping him alive by giving him something to look forward to every day. One room, no one to talk to and no booze? No, we’ll never get dad to agree to that.

In many families, the most difficult conversation is getting a parent to give up their car keys. Fortunately dad got too feeble to get into his car before he got too feeble to drive it, and he gladly gave it away. No, in our family, the most difficult conversation is about dad giving up his three rooms and his fridge of booze. He’ll get used to the company on the second floor, he doesn’t socialize much, and he’ll get used to his single room, he only really sleeps and reads the paper now. But if he has to ask for a drink, there’ll be hell to pay.

 

Postscript

Youngest sister writes a day later that he has become belligerent, blaming her for conspiring against him along with youngest brother and me, and saying that we’re just after his money (he doesn’t have much). He does this, forgets he’s made a decision then gets defensive about it. I think in his heart he knows he’s going to the second floor, though, and this is one last outburst of defiance. The next weeks won’t be easy for youngest sister.

A day later. He has said no, he will not move. Youngest sister has, as in the past, left him to stew in his juices. No visits, no calls, no runs to pick up his booze. This is really too bad, because the next time he falls, Serenity Towers may decide he is past the comforts of the second floor, and ask him to move straight to a nursing home. We haven’t told him this is his final option, but I’m sure it’s occurred to him. He doesn’t realize its closer than he thinks.