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My father, who has been a heavy drinker most of his adult life, lost his wife in 2017. His eyesight was failing before she died but is now is almost completely gone. His neighbor helps him by buying groceries for him and alcohol (she herself drinks heavily and has no issue supporting his habit), but as his mental status complicates the situation, I want to understand my options for assisted living. He is totally resistant to quitting drinking so please don’t recommend rehab - I’m asking could he still be in a care facility and continue drinking or does that not exist?

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Depends a lot on what you mean by AL. Regular AL likely has no restrictions on drinking in their own apartments, but if he wanders about drunkenly, they will likely not appreciate that!

That said, between dementia and eyesight, I should think it might be better for him to be in a MC, not just AL. It will likely depend on the facility.

I discovered when they were going through the 6 month review one time that they had doctor okay for X ounces of wine or beer per day on file. I would have to provide it and they would portion it out, but so long as the doctor okayed it, she could have some, maybe with her dinner.

She was not much for beers and I don't like wine, so it was hard to choose. I had to ask other people for help in selecting something, so I only did it for a short while. Mom wasn't a big drinker, so she didn't really miss it. Mom and dad used to drink mixed stuff when they were entertaining, but that was long over, esp after dad passed. Not much entertaining then!

In your dad's case, if it is hard alcohol, that may take more wrangling with the doc, but certainly everyone should know that he can't be cut off :just like that: or he'd go through withdrawals. If the doc is aware and can work something out with the facility, so that he gets only X amount X times/day, weaning him off by either reducing the amount allowed and/or extending the time between shots, they may get him off it completely or reduce it to a minimum.

So, you'd have to consult with facilities AND with his doctor, to determine if this is feasible. Again, the bigger concern I'd have initially is choosing between AL and MC. With dementia, bad/no eyesight, MC would be a better choice.
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My mother's AL allowed residents to have alcohol in their own rooms but not in the rest of the facility.
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It may depend on how your father acts when he’s drinking. If he is wandering around the facility and being offensive, I doubt if anywhere would take him. If he’s having a quiet drink or three in his room and then going off to bed, it may not be an issue.

My MIL was a regular drinker at home. Her nursing home was OK with her having a bottle of wine in her fridge, with family bringing in replacements. She liked to offer a drink to visitors. I’m fairly sure that she would have been ashamed if the aides who helped her to bed realised that she was the worse for drink. She certainly stopped drinking so much quite quickly, and eventually I think more or less stopped all together.

It would be a good idea to talk to him about how much, when and where would be enough for him, before you start asking facilities about their rules.
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Ahsam80: My late friend was a legally blind woman and also a consumer of alcohol. Towards the end of her life, she resided in an assisted living facility. She was allowed to have her glass or glasses of wine (per my late mother) daily. However, I question this mindset because most definitely the elder is on at least one, two or more medications, that would seem to be going against any physician's orders.
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You're going to have to ask some facilities what they can do about the alcohol. I'm sure a dr would have to write an order to allow him so much a day - no one is going to give free reign on all day or all night drinking. It can be done because I had a relative who was allow a beer or so a day.

If he has money for assisted living, you may want to use it for in home care for him and find a caretaker who will provide the alcohol - so much per day. The neighbor could be told not to come back since she might give him all he wants.
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I had a great aunt on my father's side, she was single all her life and dad's cousin was her POA. They moved her from California to Colorado to an AL living near dad's cousin. She told me one time when I was in northern CA that she drank vodka with raisins soaked in it to help I believe her arthritis. However, it was evidently more than that.

While in the AL living facility after getting drunk she called the police and told them she was being held hostage. No, she didn't get kicked out, but she did get warned. All I know is that she didn't call the police again. She died shortly after that. I will say that aunt was the spitfire of the family, she was under 5' and was a WWII nurse serving in Australia.

So they may let him drink to his heart's content, but if he causes too much trouble he may have to find other digs.
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mfrench37033 Apr 2021
I would have loved to have met her LOL
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Ahsam, leaving the drinking aside for the moment, is your Dad still independent in his home?

Cooks, washes, dresses, pays bills himself? Independent in my book also includes having help as long as he is able to arrange & manage it (eg cleaning service, grocery deliveries, or aides for bath assist).

To keep him at home but with more help may work?

Or is he not dependant & replying on you for daily care (or organising his daily care)?
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In this case, I feel this man needs to be in a facility. They will NOT allow drinking and if they know it is a problem, they will watch he does not get liquor. The neighbor must be told to stop and if that doesn't happen, is there way to stop the visits. I think no one can control this man so it should be somewhere where he is "more controlled" and the neighbor should NOT be allowed to visit him as he will bring liquor.
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lco
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I cannot wrap my brain around a Dr. writing a prescription for a patient to consume alcohol. My SIL is a liver specialist and trust me, half or more of his patients are unrepentant alcoholics. And extremely sick, too.

SO MANY medications interract badly with alcohol--for that alone, I think you'd have a hard time getting any doc on board.

Sadly, for people like your dad, moving to a facility that will take better care of him than he can for himself--also means he's going to lose some sense of independence, as far as the alcohol abuse goes.

If you really want to spend a wasted day, start calling ALF's and see what their policies on drinking are.

There is an ENORMOUS difference between a small cocktail before dinner and drinking all day long, until you're totally smashed.
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Bethanycares May 2021
My mother was in assisted living. One night an aide noticed my mother had a small glass of Southern Comfort --what she enjoyed before bed. The aide freaked, called the nurse, administrator, and me. I asked what the problem was, she's been doing that for years. It was just enough to bother everybody. Her doctor did write a prescription/order that my mother could use alcohol on an as-needed basis. What the aide didn't see was the bourbon above the refrigerator (too high for anyone but my 6'5" husband to reach) and when we visited her we each had a wonderful manhattan, and she loved being the hostess. (No, my mother --at 93-- was not an alcoholic). You need to work the system.
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well with dementia, the alcohol is not helping that because it does help to deteriorate the brain........and I do NOT know of any NH or AL that allows alcohol. he might in time forget about it, but IF he has been a heavy drinker, they might give him something to help ween him off of it, but it won't be alcohol. the last thing a NH needs is a drunk (sorry don't know any other way to put it) with dementia. it will makes things worse for them to handle. And shame on that other woman for supporting his habit. but things are what they are. I wish you luck..........
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Ahsam80--Does your father ever become belligerent, abusive, or combative when he drinks? Does he pass out in public places (or even in his room), or vomit? I figure that if ANY facility of any kind would be willing to accept him as he is, answers to questions such as these would be critical.
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NO! that is legal liability for the facility. He will have to "detox" before entering into a facility--Hospitals have medications to avoid alcohol withdrawals such as ativan and lithium (one or the other). Sometimes they also put dipsomanics on gabapentin as well to prevent withdrawals and seizures.

If he is competent you cannot force him to move unless you become his court-appointed legal guardian (if a POA is not already put in place). Even then you will probably have to put him in the hospital under involuntary act if you feel he is a danger to himself and others. Psychiatrist will evaluate his mental status, and go from there.

In my opinion he is going to drink himself to death or FALL and get a catastrophic brain bleed or broken hip from being drunk. If he refuses to listen to reason what do you have to lose but to TRY to help him. Different states have different laws regarding involuntary hospitalization. Call his doctor...or if he won't listen call 911 and tell them what is happening and, at least in Florida, a police officer has the power to Baker Act. Call your local law enforcement (non-emergency) and ask if they can Baker Act or do an involuntary placement. If you don't call you can expect him to die from a fall and you will have to live with that memory -- especially if you question his competency...you have to act on his behalf and do what is BEST for his safety and well being.

IF he is admitted to a psychiatric unit for detox, and the doctor deems your father incompetent--they have a visiting Justice and the Court can appoint a legal guardian right in the psych unit.

IF the doctors deem him competent at least you know you did what you could and he will be free to go home and drink himself to death and there is nothing you can do about it. Of course you could also seek legal advice about misdiagnosis and medical malpractice. Tons of lawyers out there you know who do just that.
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He's a senior, a person with disabilities and also has substance use disorders. This is not rare. Some localities may have facilities for people with these conditions, but they will most likely try to get him off the alcohol. Can he afford to hire an aide or more than one to help, if things get to be too much for you and his neighbor? Get connected with a social worker in his area to help explain his options.
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Any that I have been in or any other way the answer is NO alcohol is allowed in any medical facility, assisted living, NH,.
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Short Answer No!

If he wants to drink, leave him where he is.

He is doing what he wants and
The alcohol will kill him soon enough.

It would not be right, especially with his eye sight gone to make him move to unfamiliar surroundings, he would be totally miserable.

Let the drinking neighbor continue to help out with groceries and visiting.

At least he's not alone.

Don't put him somewhere just to ease your mind.
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Alcoholism makes it harder to care for a person with dementia and low vision. Most facilities will probably require him to attend an inpatient facility to detox before he can be placed into a facility.

Detox has it's own unique set of caregiving challenges during the process. He will need near constant nursing care for the first week or 2 of detox while he is weaned off, He will need access to immediate care by qualified doctors if he has a crisis - like seizures - while he detoxes. He will do better if he agrees to AA or similar program after he has completed physical detox. Facilities could probably make sure he can get to AA, but they do not have the other types of care your father needs during detox.
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I think what you are asking is can he stay at an assisted living and still drink heavily? If his drinking would cause problems for him or his fellow residents and staff, then he could be asked to leave. There is a difference between having a beer or a cocktail every night and heavy drinking.

As for nursing homes, I have known doctors to “prescribe” a small amount of alcohol for residents - like one beer at night or one 4-6 ounce cocktail with dinner. The family would have to purchase the alcohol. The staff would have to “dispense” it. But that would depend upon the facility and the doctor. Alcohol withdrawal can be very dangerous for lifelong drinkers and resident will sometimes elope in search of a drink.
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We discussed this issue with my father’s doctor and the doctor prescribed (facilities can’t give residents even a vitamin without a script) up to two shots a day. Dad was not happy with that amount and even more unhappy when his assisted living facility would only give him one shot a day but the promise of more if they found that he could tolerate it without falling etc was enough for him to accept it. We supply the vodka and it remains with the nurses locked up along with all medications.

Three years later; the nurses deliver him his shot and he doesn’t even ask for additional alcohol anymore.

Talk to your dad’s doctor. If your dad has been drinking every day for years like my dad...it would be unsafe for him to go cold turkey.

I wish you luck and peace during this difficult situation
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My dad was a heavy drinker as well had dementia. I had the same concerns you. I was actually surprised that once he was placed in memory care facility his need for alchohol actually diminished. Out of site out of mind. One blessing of dementia. Most memory care facility are equipped to handle most situations.
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My husband was a heavy drinker. In his younger days, he drank beer. Later, it was wine. As his dementia and anxiety got worse, so did his wine consumption. When we downsized to a condo, I refused to keep wine in the apt. But I’d get him beer and put a strict 2-beer a day limit on him. Surprisingly, some days he didn’t have any beer. Now he’s in a care and board home for people with dementia and I stock their fridge with non-alcoholic beer. Amazingly, he doesn’t know the difference. In the evening, when he sundowns and thinks his golfing buddies took his car, wallet, and golf clubs and left him at this “motel/hotel,” he calls all upset and tells me I need to come get him because he has no money, no car, etc. I tell him to stay there tonight and I’ll call him in the morning. He eventually calms down but remains upset that he has no money. What if he wants to go to the bar and get a beer? I tell him I’m familiar with that property and it’s all-inclusive and, yes, even tips are included. So he tells tells me he’s going down to the bar (the kitchen down the hall) for a beer and then going to bed.

I dont know how much your dad drinks, or if weaning him off alcohol with a fake drink is possible. If he’s alcohol-dependant, this won’t work. If he’s just a heavy drinker, dementia can work in your favor in getting him off it. In my husband’s case, I think he was self-medicating with alcohol as dementia ramped up the anxiety he’s always dealt with.
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Some counceling for yourself through Al-Anon may help to support you & help identify what pathways are available for him.
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This is a question to ask the facility. Most do not allow excess drinking, but DO allow drinking not in excess. Excess drinking is disturbing to others, and contributes to ill health and falls. Discuss with facility. He may have a better chance in a small Board and Care, dependent on his demeanor when drinking.
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No nursing home is going to put up with an active alcoholic. People can drink privately in their own apartments in an assisted living. No one in an AL will go and get alcohol for someone though. They will not allow a resident to stay if there is any incidents because of drinking. That person will get evicted. Your father won't go into rehab either as you say.
The best possible outcome will be that he'll end up drunk in the ER. They will see that he is an elderly alcoholic with dementia.
Then a social worker will contact whoever is his next of kin. If it's you then you must tell them that he is alone and you cannot and will not be his caregiver in his home or yours.
The hospital will keep him admitted there and he will be put into a nursing home. They will not allow him to have booze.
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Beatty Apr 2021
He will probably need alcohol withdrawal care, overseen & managed by medical team as withdrawl can be very traumatic for long time drinkers.

After that, transfer to NH is done. Sometimes with a Doc's order for one glass of something with dinner. Amazingly, this can be enough.

If physically able to leave NH (pay for taxi, get back home) sometime people do. Neighbours call the family, Police etc. Then off to court to ascertain in Guardianship is required & can he live alone IF he accepts & can pay for services to his home. A lot end up back in the NH, but not all.
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He may have to go through some kind of detox if you put him someplace where alcohol isn't allowed, and the facility would have to be on board with that. If it's memory care, he may have to arrive already dried out. I can't imagine they're going to want to deal with someone detoxing.
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Ahsam, have you checked into board and care facilities?

In my state they allow drinking as long as a doctor says it is okay. I imagine that would be the criteria just about any place, to ensure that they are not blamed if someone dies on their watch from alcohol related issues.

You have options to get him the care he needs, you just need the authority to intervene or wait for the crisis that makes the decisions for him.
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I think in most ALs one can drink all they want in the privacy of their own apartment, but what happens when they pass out in the hallway, vomit in the commons, pee themselves while in a chair in the dining room or become belligerent or violent to another resident? If I had a LO at that place and heard about it I'd be complaining in a heartbeat. I can't imagine they'd be allowed to stay. LTC and MC in my MIL's facility is no booze, period.
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When my mother lived in 2 different Assisted Living places, she and my dad were FREE to drink alcohol as they wished. In fact, both ALs had happy hours on Friday where wine and beer was served. There was one lady who would get drunk every week at happy hour and the other ladies would whisper nasty gossip about her behind her back. My mother kept several bottles of liquor inside her apartment in the cabinets to drink as she desired, even though she took medication. The goal in AL is to be fairly independent and not 'monitored' by staff 24/7. Help is available when needed and to a certain degree only.

My mother now lives in Memory Care Assisted Living where alcohol of any kind is completely prohibited. If a resident wants to drink, a prescription has to be written by their doctor ie: Mary Jones can have 1 beer per day. Honest to God. So, if your dad has dementia and belongs in Memory Care AL, then yes, they will prohibit him from consuming alcohol there. You'd need to make SURE of that before placing him, of course, but the 2 MCs I've been involved with BOTH prohibit alcohol w/o a doctor's written RX for the resident to have it.

Not sure how things work in Skilled Nursing.

Wishing you and your dad the best of luck with a difficult situation. I hate how alcohol can ruin so many lives.
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Ahsam80 Apr 2021
Thank you for the insight into other situations and my options, however limited.
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Honestly, I can't imagine any facility agreeing to allowing alcoholism to continue  in its facilities.    There could be severe legal ramifications. 

And, although I don't mean to be cruel, I think your father's refusal to quit drinking is a reflection of how he may or may not cooperate in a care facility.   

I wish there were better options for you.
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