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After my dad was hospitalized and I realized my 88yo parents could no longer live independently, they both came to live with me 13 months ago. Mom has some age-related decline but is mostly self-sufficient. Dad has dementia and needs a great deal of care. I am their only child. Mom and Dad have been married 69 years. Even with his dementia, Dad still knows Mom and doesn't ever want to be apart from her. I am married and work full-time, and we're managing right now with hired caregivers during my work day. It's getting more and more difficult, not to mention more and more stressful, to care for Dad, and I anticipate some point in the future when we will have to put him in a memory care unit. Mom does not want to go to a facility with him, nor does she need that level of care. It breaks my heart to think of him in a place without my mom, knowing how emotionally dependent he is on her and knowing how confused and sad he will be without her. How do I handle the emotions that will come from separating him from his beloved wife?

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Just do it. I know, I know, there is a lot of anguish there but it might not be as bad as you think. If your mother does not want to go with him, then find a memory care facility as near to your home as possible, just to cut down on travel. He will be confused and sad but those things happen at that age. The staff will really keep him occupied, he will be cared for and he will adjust. It will be sad and painful for you too, because this is the end of their lives together but there are hard choices and you are suffering too. And your mother is limited in what time you have to enjoy her because of the care he needs. So in the land of "trade-off's, having him in MC and having her still able to be out and about with less stress for you and your family is a reasonable one. Try to not feel guilty; this is really hard. My inlaws were married 70 years. We initially placed them together because they both needed some care, her more than him. She fell after 6 weeks in MC and broke her hip so they had to be separated. And really the two of them together, with the different stages they were in, was not going well anyway. He was sad and he worried about her and it was sad for us too, but it was making the best of a bad situation. Sometimes that is all you can do.
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There are ALs with memory cares attached. She could live on the AL side and him MC. Then she can visit him when she wants. She needs to realize that this is a strain on you. Its now what he needs, not what he wants.
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You have a lot of advice here to do quite different things; and this is sensible, because the path ahead is not yet clear. Having been married 57 years myself, with my wife 10 years into dementia and confined to bed and incontinent for the last 22 months, I feel for you. Here are my thoughts:
1. If you have a good hospital bed (in the United Kingdom there is the Dyna-Form Air-Pro Plus bed that is an air mattress that adjusts sections of the bed every 20 minutes by electricity), this makes it possible for someone to remain in their home and still have a surprisingly contented life. I pull up a separate bed frame and mattress and sleep beside her each night, which we both appreciate.
2. You do need carers (or the Americans say, caregivers) to come especially in the morning and evening to change incontinence pads and help with meals. We have Home Instead, a US firm, that has local franchises especially in the USA. Each franchise will be different but our experience is that they are very competent and caring. If you try to keep care for yourself or within the family, you will burn out.
3. Both persons going into a care facility at the same time is a possibility, but you have to make the choice cautiously. It could be difficult for someone without dementia to spend the entire day surrounded by dementia. However, it might be a possibility with a shared room and different activities. I considered this, but rejected it. A lot of the problem in the United Kingdom is that care facilities are quite regimented with people being required to eat, sleep and do specific activities at set time. Each of us are unique human beings with different needs. For example, my wife is sleeping some 16 to 18 hours out of 24 (with 12 to 13 each evening and morning and afternoon naps). This is essential for her to be able to relate to others; and there is research evidence that sleep helps a person to cope with the Tau tangles and amyloid plaques in the brain--not to remove the underlying problems, but to temporarily diminish their impact. In a care facility this is hard to handle, unless the person just stays in bed and is somewhat ignored.

Be encouraged and move ahead slowly. There will be a solution that is right for everyone.

Love and Prayers
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You have my sincere sympathy, and this is just to give you another story of how you never know how things will work out. My parents in law needed more care because of my MIL’s health and mobility issues, and we finally got them into a fantastic facility which was AL with NH level care provided to each unit via a common back corridor that served all the units. It also provided a shared unit, and allowed them to keep their little dog. Three weeks later our dear FIL went out to walk the dog using his walker, fell, went to hospital and died three days later. We suspected that the changeover in medication wasn’t done right, but it was too late to help him or anyone else by making a big fuss.

See if you can move them in together. But don’t assume that your mother will outlive him, just because she seems self-sufficient now. Just keep them together as long as you can. Lots of love to all the family, Margaret
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Although mom doesn't need the care and doesn't want to move to a facility, could you talk her into moving there at least temporarily? Guarantee her that she will come back to your home and ensure that she has capability to get out of the unit during the day (if she doesn't drive, some places offer transport to shopping, etc or you can hire drivers), even if it is to take a walk or hang with other residents (assuming the facility has other levels of care, such as AL.)

At some point he will begin to forget your mom, and that is likely when you can bring her home again. If she would agree, going out during the day will require some fibbing on her part, to assure him she'll be back. She could say she's going to work or out to shop, etc. Another option is to have her spend part of her day there, taking meals with him, maybe lunch or dinner and then come home when it's his bedtime. That way she gets to be with him without having to provide care but doesn't have to live there or incur the cost of living there. It would make his adjustment a little easier. It's only temporary, until he adjusts.
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Check other home agencies in your area if more are available. Before covid I used two different ones. Also check into Hospice at home for the dementia diagnosis. My mom has been in Hospice at home for 6 months now and was just renewed for another 9 weeks. Hospice supplied everything we needed (We already had a Hospital bed through the Lions club) and a nurse to bath mom twice a week. One home care agency had a 2 hr limit great for putting mom to bed or coming in mid day for meals. The other had a 4 hour minimum requirement. This was good for mornings, get mom up dressed and through breakfast & teeth brushing. My dad is like your mom self sufficient but not able to do moms (94/dad 96) care. I fix dinner for everyone. If I have to go away I bring in someone to cover lunch through dinner. I pray you find a solution that works for everyone.
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Do you have the authority to separate your father from your mother? Unless your father gave you his power of attorney/health care proxy I think you might find this is her decision to make and not yours. What does your mother want to do about his care?

She may be longing for a break, you know. Be prepared to keep your face neutral.
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They can both go to same place in different units of care maybe. Call around get info will they be able to visit each other with assistance there?!
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I agree with Countrymouse. Not knowing their history, it is possible your mom may not share/vocalize her deepest thoughts but may internally be looking forward to “freedom” from having to deal with her husband. Many women (and possibly men) from that era stay in marriages and put on a happy face even if they aren’t happy. Just a thought...I could be totally off base.
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Does the memory care facility you are looking at have a campus that includes Independent Living? I recently moved a family into a senior campus that offers an Independent apartment and the spouse can walk through the facility and go in to the memory care unit and visit every day

Kimberly G., BSN RN SRES
Geriatric Nurse Consultant/Senior Real Estate Expert
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