The Other Shoe Is Dropping
During the height of my caregiving years, I was thoroughly convinced every bad thing started with a phone call.
Ring... ring...
"Hi Maria... this is the administrator."
I already knew this wasn't going to be good. Then came the follow-up email documenting everything we'd just discussed.
Every call seemed to bring another fire to put out, another impossible decision, another clock that had suddenly started ticking.
One of the hardest parts of Alzheimer's I had to learn to navigate with Papa Kemp was the paranoia. He became convinced people were trying to hurt him.
It started with neighbors and then other residents. None of it was real to me, but every bit of it was real to him.
And when someone with Alzheimer's or paranoia truly believes they're in danger, they respond the way anyone would if they believed their safety was at risk. They try to protect themselves.
Seems reasonable, doesn't it? That's exactly what I thought.
If your loved one lives anywhere other than home, there may come a day when the phone call isn't about a medication change or a doctor's appointment.
It may be a request for you to come in for a meeting.
Buckle up. Clear your schedule.
Trust me... this isn't a conversation you want to have over the phone.
Care communities can issue discharge notices when they can no longer safely meet a resident's needs. Outside the healthcare world, most of us would simply call that an eviction.
What I didn't know was what could happen before that.
I didn't even know a geriatric psychiatric unit existed. Until those words slid out during a face-to-face meeting.
Suddenly, I was being told that if Papa Kemp was going to remain in his retirement community, he first had to be admitted to a locked geriatric psychiatric unit for evaluation and treatment.
And just like that...the clock was ticking again.
I remember sitting there wondering if I'd heard them correctly.
Can you imagine trying to explain to a father living with Alzheimer's and severe paranoia that strangers were about to arrive in an ambulance, take him to a locked psychiatric unit, and somehow convince him they were trying to help?
Or, if he didn't go, he might have to leave the only community he knew and move somewhere filled with unfamiliar faces while his paranoia came with him.
How do you convince someone who already believes everyone is against him that this time, the people trying to take him away are actually trying to help?
I felt suffocated by the weight of this decision because I knew how Papa Kemp would see it.
He wouldn't have seen a daughter trying to help him. He would have felt betrayed, tricked, or abandoned.
In his mind, the one person he still trusted would have become just another person trying to hurt him.
The trust we'd spent years rebuilding could have been obliterated the moment they wheeled him away... or the moment he realized he was in a locked psychiatric unit.
That thought shattered me.
I remember sitting there completely confused. The administrator explained that Papa Kemp had been telling people he would "jack anyone up" if they tried to hurt him.
My first thought was...
"But no one is trying to hurt him. No one is giving him secret shots in the middle of the night. No one is stealing his keys every day. So exactly who is he going to catch?"
From my perspective, these weren't violent threats. They were defensive statements made by a man who genuinely believed he was in danger.
What made it even more confusing was that we'd already dealt with medication-induced hallucinations before. Once his doctor adjusted his medications, the hallucinations stopped.
The paranoia didn't. To me, those were two very different things.
At the time, I couldn't understand why the retirement community couldn't separate the two. Here's what I wish someone had told me.
Whether your loved one lives in a retirement community, assisted living, memory care, or a nursing home, there's no guarantee they can remain there indefinitely.
If their behaviors become unsafe for themselves, other residents, or staff, the facility may determine it can no longer safely meet their needs.
And when that happens...the clock starts ticking.
Suddenly, you're making decisions you never knew existed. That's when families are faced with decisions they never imagined they'd have to make, often with very little time to make them.
I left that meeting with more questions than answers. I wasn't about to make a decision like this on my own. I called Papa Kemp's primary care physician, hoping he could help me navigate what felt like an impossible landmine.
His recommendation surprised me. As it turned out, Papa Kemp started having chest pains. He suggested taking Papa Kemp to the very same hospital that housed the geriatric psychiatric unit so we could work with the admitting psychiatrist and determine the best course of action.
Talk about God intervening! I rushed him to the very same hospital. Ironically, while he was admitted for his heart, the psychiatrist who had already evaluated him came by to see him.
He told me Papa Kemp didn't need to be admitted to the geriatric psychiatric unit. I remember feeling an overwhelming sense of relief.
Not because the journey was over. It wasn't. But because someone had finally helped me make sense of what had felt impossible just days earlier.
It finally dawned on me that they weren't answering the same question.
The psychiatrist was deciding whether Papa Kemp needed inpatient psychiatric care. The retirement community was deciding whether they could safely care for him in a community where dozens of other residents and employees also deserved to feel safe.
Those are two very different decisions.
Looking back now, I don't believe anyone was trying to make my life harder. I think everyone involved was doing the best they could with the information they had and the responsibilities they carried.
Caregiving has a way of surrounding you with experts, doctors, specialists, hospitals, and care communities. Everyone brings valuable insight, wisdom, and expertise.
But when the conversations end and you are left alone with your thoughts...
You're still the one who has to make the decision and be prepared to live with it.
No one hands you an instruction manual or AI prompt for moments like these.
Sometimes the hardest part of caregiving isn't choosing between a good option and a bad one.
It's choosing between two heartbreaking ones... and then logging onto Zoom for that 9:00 a.m. meeting with your boss.
Because until we understand what caregivers are carrying, we'll continue expecting them to perform as if they aren't carrying anything at all.
More to come,
Chef Maria
