Within the next few weeks, I'll probably have to move my father from his apartment in New York to a nursing home near me in Maryland.

I'm wondering how to handle his transportation. He's 87, late stage 6, physically sound apart from the Alzheimer's (apart from that, Mrs. Lincoln, yes...) and easily agitated when he gets outside familiar surroundings. Two days ago his care manager took him across town to the hospital for a checkup and told me later that throughout the trip he was upset and kept saying, "I don't know where I am."

He's on Seroquel, 25mg/day. We tried him at 50mg but he got more agitated and boderline violent, so we pulled him back.

With all that in mind, I'm trying to figure out his transportation options. I'd originally intended to drive him myself, in part for symbolic reasons (I need to get him where he's going). But a friend with a strong public safety background has convinced me that's a bad idea - it's fine if my father stays calm, but if he gets upset, I'm not going to be the world's safest driver.

His suggestion was to hire a car and driver, and also bring along a traveling nurse. The nurse and I could work with my father, while the driver focused on driving.

Are there other ways to move him? Should I think about an ambulance or ambulette? Additional or different sedation?

How have you done this? What should I be considering?

Thanks in advance for any and all insight.


Best,
Alan

I don't have any words of wisdom. But I do agree with anyone who says it should not be just you and him driving all that distance, with the strong possibility he will become upset.

When we had to take away my mom's keys recently, she started badgering me to give them back every time I drove her somewhere (in MY car, mind you). She made me really nervous.

You will probably be somewhat emotional about the experience yourself, so it would probably be too hard for you to drive.

Take care. You are in my thoughts.

If you think that something like a little bit of Atavan would calm him down, you might try seeing if you can get some from his doctor. Might help, but you know your Dad and what meds will work on him.

Other than that, I'd say to get a car and driver as it seems more "normal" than a medical transport. But then again, you know your dad best. A medical transport might freak him out or worry him about where he's going. A car and driver would be a lot more relaxing and the two of you could have a nice visit on the trip.

Alan, how long a trip is it?

Since his health in general is OK, the main reason for an ambulance/ambulette would be to isolate him from the driver so if he became extremely agitated, it would not compromise the safe driving of the vehicle and if absolutely essential he could be physically restrained.

Personally, my vote would be to go in a comfy car (rental if need be) and get a prescription for a sedative from his doctor and knock him out for the trip.

Plus, you don't want him bouncing off the walls when you get to the LTC facility.

This is what we did with my mom and it worked very well. We didn't wake her for anything - food, drink or bathroom. When she roused a bit, we checked on whether she was hungry or needed to make a bathroom stop.

We had food and drinks in a cooler and stopped only for two bathroom breaks - one for her, then another for us.

Exhausting but it got it done and over with. DH and I were so wired we had no trouble making the 12-hour drive!

(The fact that raising his Seroquel went badly makes me a bit nervous about what'll happen when he gets to the LTC facility.

Usual protocol would be to up his existing meds if he's real agitated by the new place - but sounds like that won't be advisable.

So make sure the right doctor's lined up to try something else, because it won't be good for anyone if he's wheels-off once you get to the new place.)

Oh, the other thing I wanted to add.

Agree that you mustn't do this alone. You need another adult with you, preferably someone your dad knows and is comfortable with.

Even if your dad is calm, it will still be distracting to have him there. You will constantly be cutting your eyes towards him, seeing how he's doing, etc.

One person has to be able to drive without distraction. The other has to be available in case Dad needs distraction, calming down, or whatever.

I would suggest putting Dad in the back seat if at all possible.

Child-lock the doors and windows so he can't open them.

Plus, if something goes wrong with the car, one person needs to be able to stay with Dad while the other makes calls, deals with tow trucks, etc.

Hi Alan

may you take your time..and decide what you feel is best for your father..

I feel...its always good to have a plan and a plan B..

and the more relaxed he is..with the person..he is with..the better..comfort zone...

the day we admitted our Loved one to a nursing home..she wanted ice cream when we got in the car.....so we stopped at dairy queen..the drive up window..we all had ice cream..

a thought might me..to play the old tunes in the car..or some music that would help your father stay relaxed..during his ride..if it is a Long ride..

but my friend..a positive attitude..is the best thing..anyone can give your father..as he needs it..for his feeling of well being.

so may you take..time and decide what is best..and know whatever you decide..is what is best for him..

out of love to keep him safe..and help him..not feel scared..in his new surroundings out of his comfort zone..

our Loved one...that day..was Lucid yet did not ask where we were going..she just trusted..her son..as she had done..many times before..

it was an emotional day for my husband..oh signing all those pages of..the admission process..

the staff..were very kind..

it was good to meet each of them..

and help them .

.help margie...feel safe..and know that we were going to be back Later..and she accepted..this well when her son said it.

she thought she was at the hospital..the whole 3 weeks she was there..

the answers are within you my friend..

and you are so..blessed that you..have a friend..who is making suggestions..from his heart to yours..

may you be a good Listener..he just may be right.. good friends are gold..Namaste Rosie

Alan i know what a HUGE deal this has been for you..i follow your blog...and if you have read any of my story you know that I have transported my father 3 times...he always enjoyed the ride though and didn't get agitated but we did have the ativan just in case...never went alone and don't think you should either.

Grassflower has given excellent suggestions and tactics for you. It will be an adjustment you know that, so don't get flustered yourself..when you get to the NH you need to have those nurses and aides in place..just a few to really welcome him and fuss over him and to help you..Will he have a private room? Is there a way that you can get familiar things in his room before he arrives? I did that with dad and it made him very comfortable.

I wish you the very best my freind and you and dad will be in my prayers...please keep us posted..we will definetly want to hear how it goes.

God Bless,
kim

Thanks, guys - as usual, this is a big help.

The drive is about four hours, which makes it more likely that at some point he'll come unglued. And it's stressful driving, too - the New Jersey Turnpike and then continuing on I-95 through Delaware and Maryland (Baltimore can be hair-raising) and then the Beltway. So not an easy trip.

I should clarify one thing - I'd never anticipated having just him and me in the car. There was always going to be a nurse or attendant. But I think everybody's right that I'm a bad choice to drive if we get into worst cases.

I hadn't thought about how he's react to the sight of an ambulette but yes, it might freak him out. That's definitely something to consider. Private car and driver might be the best choice.

I'd never thought about the breakdown scenario, but yes, that's important - also argues for someone who can look after the car while two of us look after him.

And I hadn't really thought through the arrival at the nursing home and the work I'll have to do to get him checked in...

As far as sedatives are concerned, we've had to list him as allergic to Ativan because of what happened the last time we tried it (three solid days of full-blown paranoid hallucinations - it was amazing). But maybe there's something else that can work.

In all, it sounds like car service is the way to go. There's one nearby him that we use for hospital trips that might be good. He knows some of the drivers and we could probably request a familiar one.

I think that'll be the plan but believe me, I'm still more than open if anybody has anything else to suggest.

Oh, and Rosie - namaste, indeed.

Thanks again!


Best,
Alan

Kim -

We cross-posted, but thanks - I remember you've had those experiences and I'm glad you checked in.

I'm not sure how much I'll be able to do to get the room set up ahead of time - because of the distance, and because I don't want to tip him off beforehand (he won't be able to handle it or hang onto it), I'll probably just have to take a few objects with me when we go, then get to the room ahead of him when we get there. His care manager suggested we try to re-create the view from his bed at home, which is a neat idea, but I don't know how I'm going to be able to get the five-foot chest of drawers in there. Maybe the lamp and some of his pictures will give the same effect.

I've applied him for a semi-private - I suppose I can always try to upgrade him, but on the other hand, I've got to get the funds to stretch over three years, so I'm not sure if that'll be possible. He might like the company if the roommate is tolerable, but that's a big if - not sure how he'll take to it.

We'll definitely need to have some kind of sedative in reserve.

Thanks again, and of course I'll keep everybody posted here and on the blog as this comes together.


Best,
Alan

1) I would expect the trip to pretty much wipe him out physically, unless sedation's not an option and your worst case scenario of extreme agitation comes true.

2) So he may be ready to collapse into a bed as soon as you arrive. That would be ideal.

3) No rule says you have to go during the day when traffic is a nightmare.

Is there a time of day when he is less likely to be agitated? Would traveling at night be better or worse for him?

FYI, when we moved my mom we sedated her ahead of time, vs waiting to see if she was upset.

Grassflower -

Yes, exhaustion on arrival is a good scenario. It could happen - or he could get into one of his endless-seeming energetic loops where he tries to figure everything out. It's the reporter in him, still working as best he can...

I hadn't thought aboud traveling off-hours. I suppose it might work - though he's very sensitive to time of day. If we took him out at night and put him in a car, that'd probably throw him. But maybe it's still worth thinking about. After he gets over that reaction, he might be more likely to sleep.

Re: sedation - yes, my take is it's best to drug him in advance, not "as needed." Sleep is his friend and we might as well get him into it as quickly as possible.

Thanks!


Best,
Alan

Alan,

I am not familiar with your blog, but I was wondering if your dad likes to keep his hands moving. When my mom was agitated, I would take putty for her to work with in her hands. I taught her some "exercises" to do (this was putty I used after a hand surgery a few years ago). Anyway, it gave her something to do with her hands, relaxed her, and seemed to take her mind off whatever was bothering her. I thought I'd throw this out to you in case you think it might help. You can find the putty at medical supply stores, or you can simply use Play-Doh or Silly Putty.

If he doesn't sleep, it will be good to keep his focus off the trip. I like the idea of old music.

Let us know what your final plan will be.

Interesting question. He sometimes "works" his hands by pulling obsessively on his fingers. Usually this goes along with some form of discomfort or disorientation - the hands don't "feel right." But it's possible that giving him something like Sillly Putty to work with would calm him down. When he was first given the MMSE, his geriatrician pointed out that he calmed down during the clock-drawing exercise - the act of drawing quieted him down. So I think you're onto something.

Yes, I'll definitely let you all know where I come out, and how the move works when it happens.


Best,
Alan

Alan:

If you are going to hire a car and attendant, why not go ahead and do the check in before he getst there. I have transitioned Mom at least 5 times to different locations and each time I either drove her there with an attendant who cared for her as I did the paperwork, or I went ahead and did the paperwork so that she was whisked up to the room.

My FIL always repeated 'I don't know where I am' and 'I don't know this road' but it seemed to reassure him when I said 'I know this road, it's okay'. The longest I ever drove him anywhere was an hour, though.

Does you Dad like TV? Do you or does anyone you know have one of those TVs you plug into the 12V in the car? I don't know much about how they are set up, I'm sorry to say, but friends with small kids swear by DVDs on long drives, so I know it's possible, I just don't know what it entails :-D Come to think of it, a laptop that plays DVDs would work just as well.

I agree with your Dad riding in the back seat, which I'm sure you'd already thought about. MIL will reach over and try to honk the horn if I let her sit in front, it's dangerous.

ytram - good thought, but I think I'm going to have to ride along with him during the trip from NY. I'm usually better at calming him down than the professionals are, only because I know him better and can pick up more of the cues. But I think I can work it out with the NH so that they move him in and look after him while I handle the paperwork once we get there.

Best,
Alan

crella - thanks. The TV is an interesting idea. The only thing that concerns me is that he has trouble distinguishing between the TV and real life. Putting one in the car might give him information overload - all the sights and sensations of the trip, plus the TV. Not sure. But I'll check it out with the care manager and the staff at his geriatrics center, and see what they think.

Back seat - yes, definitely. Less distraction for the driver, and less for him to see, too. Cf. "too much information," above.

Again, thanks to all for great advice.


Best,
Alan

Alan, I know your dad's ability to converse is pretty impaired.

Does he chime in if you start singing a song he recognizes (try childhood songs, like The Old Gray Mare or She'll Be Coming Round The Mountain)?

If you give him a bunch of beads or blocks to "sort", would it occupy him (doesn't matter if he really does sort them or not)?

Because if you can think of some little activity or stimulus that he responds to almost automatically, that could be a way to keep him occupied if he's not sedated.

Hopefully, though, you'll be able to get a sedative from his doctor ahead of time...

I'm wondering if maybe some big band CD's might be worthwhile - Glenn Miller, Artie Shaw, etc.

And yes, will also look into something he can do with his hands.

But the sedative definitely comes first.


Best,
Alan

you know what alan..i think this is going to be so much easier than you think....you have heard some great tactics to use with dad..i and trust that it will all work out..you know what to do..you know your dad..sideways and whatever....like I know my dad..it is all going to work out..but please know this...you have a ton of support before you and behind you...

God Bless,
kim

Thanks, that means a lot - most appreciated.


Best,
Alan

quote:

The only thing that concerns me is that he has trouble distinguishing between the TV and real life.

Oh my, I hadn't thought of that! We're not quite at that point yet (although we're not far behind you on this road...)and it did not occur to me.

quote:

I'm wondering if maybe some big band CD's might be worthwhile - Glenn Miller, Artie Shaw, etc.

Great idea.

And I think I mentioned this earlier, but definitely push the child-lock button so he can't open the door unexpectedly.