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Medical Forum / Diseases and Disorders / Alzheimer's / June 2007New Member Here - Greetings!
Hello group. I meant to join in by introducing myself first but I needed some quick help earlier so I've already jumped in with both feet. I was so glad to have a place to go. I'm dreading what's coming and I can't change it. Last week we had our first big crisis so now it's time to get in gear. Maybe I can learn how to avoid the next one. I will find a local support group I'm sure. One of you gave me a link to check on that. I can tell though that this group is going to help me a lot. I mostly just read the seniors groups plus gardening and needlework. Just recently I've been learning how to help manage my type 2 diabetes with another very knowledgeable group. Diabetes is a new complication in my life. I find the stress of what is happening to us right now is really messing with my control. Anyway, that's another fine mess I've gotten myself into! I am 61 years old and alone by choice and I was able to happily retire almost 10 years ago. I have a brother and his wife helping and we are all in the same town together so I guess for what is about to happen to us all we have the best possible circumstances going for us. It seems my 82 year old father has very quickly gotten worse. He has shown increased memory loss, confusion, angry outbursts and accusations plus some paranoia. Last week, in anger, he took his car and drove nearly 600 miles. He was gone for 14 hours when the police in a neighboring state found him. It was dark and he was driving on the highway, 40 MPH , on the rim of a blown out tire. He didn't know where he was and he couldn't tell them how to call us. We had filed a missing persons report so when they entered his name they were able to reach us. I keep a cell phone in his car but he couldn't remember to use it or to tell them it was there. He never turns it on so we couldn't call him and he can't hear well enough to know its ringing. In the past when he's needed me he has always been able to call me from his car. Oh well, those days are over. The police were so good to him and we are so lucky he wasn't hurt nor were any citizens he passed along the way. This is so unexpected. He has driven a few blocks just a couple of times in the past year. Just up to his neighborhood grocery store. He doesn't like to drive and he prefers to have one of us take him everywhere. We are always happy to do this for him. He does like to have his car in the garage though. Right now, we have kept his car away from him. He is having a hard time with this. I was able to get him to the doctor this week and he's just had an MRI and a quick memory testing session. His MRI revealed a recent injury (he fell about 4 weeks ago) that caused some bleeding in the brain and according to his doctor could have definitely contributed to his behavior changes. He also has had a small stroke sometime in the past. He scored 22 of 30 on the memory test. The doctor told him that was not good. I can't find any guidelines on what that actually means. Anyone know? His doc explained all of these things and told him he had early stages or mild memory impairment. He never used the "A" word. I'm not sure why. On the way home dad asked me if they had gotten his test results back yet. He didn't remember from 10 minutes back what he'd been told. I showed him the Aricept pill pack his doc had given him and he read the header and looked at me and asked "is that what I have? Alzheimers?" I feel so bad for him. I just said "maybe". I'm hoping that with the medicine and once the blood in his head is absorbed and dissipates maybe he will have more lucid moments. I just don't know what to expect. Any recommendations will be appreciated. Sorry for the long rambling post. At this point I can't find a short version in my head! I'm glad to have found this group. Thanks for the earlier answers. I learned something in each one. Barbara H > Hello group. I meant to join in by introducing myself first but I needed > some quick help earlier so I've already jumped in with both feet. I was so [quoted text clipped - 59 lines] > > Barbara H Hi Barbara, There are a lot of different causes that seem to manifest in the same way, with memory loss and such. Hardening of the arteries, mini strokes, head injuries, and of course, alzheimers disease and probably a lot more I haven't mentioned. Having one of those doesn't necessarily mean that they can't have one or more of the others too. It sounds like your dad may be working on a couple of them at the same time. Of course, you know he shouldn't be allowed to drive anymore. Not only for his sake, but the people he might encounter out there. Once someone starts to lose their faculties like that, it is probably a good bet he shouldn't be alone anymore. I am glad you found this group too, it was a real help to me and to many others over time. My mother in law is gone for a couple of years now, but the caregiving experience was a very powerful one in our lives. I stay here to pass on the favor of all the good advice I received here, when we were totally clueless. I am also glad you are looking for a real life support group in your area. Our local group and this one got us through the worst of it all :-) Again.... welcome.  SignatureBest Regards, Evelyn Barbara, I am very sorry to hear of your situation. I'll first mention some standard advice. If you haven't already done so, make sure that you and/or your siblings have good financial and medical powers of attorney for your father's affairs. You should see a lawyer who does a lot of this kind of work. I found here in Baltimore that an attorney would do a complete setup of will, trust (if he recommends that) and powers of attorney for about $2,650. I don't know how that compares to others, but it may give you a ballpark estimate of what's involved. You want to get started on the legal and financial technicalities as soon as you can because they take time and they are vastly easier to do if you can get your Dad to participate - which it sounds like he may still be able to do. Getting a bank to change the names on an account, getting a power of attorney, etc., is easy when your Dad can sign the papers in front of a witness. It's much harder if he can't or won't. You may find it necessary to use some manipulation on your Dad. The need for this will increase over time. Don't feel bad about it. When you know you're protecting him and that his own position is unsafe, it's a far better thing to manipulate him than to allow him to hurt himself or someone else. The car is an obvious problem. My brother and I talked to our father and told him that my brother's car had died and he couldn't get to work. We asked that, since my Dad hardly ever used his car, would he give his to my brother, who couldn't afford to buy a new one at the moment. Instead of seing this as having his car taken away, our Dad saw it as his giving a helping hand to his son. It worked well. If your Dad lives alone, that too is a problem. There may come a time when he walks out of the house, or when he turns on the stove, or when he gets hurt and doesn't know how to use his cell phone or his regular phone. You'll need to plan for this for the future. Having him move in with one of you is an option - but be aware that it's a big responsibility and often leads to a very high stress environment for you. If your Dad can afford it, assisted living can be ideal. This can be easier to do when your Dad is still functioning at a relatively high state than later on. In the first place, it allows him to move into a higher functioning unit and to stay there longer. In the second place, it allows him to make an adaptation to the change while he is better able to do it. You asked about why the physician never used the "A" word. I'm guessing first, that he doesn't know for certain what the cause of the problem is. AD is not easy to diagnose. Secondly, he may have hoped to spare you or your Dad's sensibilities and not take away hope since, in fact, he couldn't confirm that it is AD. However the fact that he prescribed Aricept indicates that he probably considers AD to be the most likely diagnosis. As for what to expect on Aricept - it varies from patient to patient. I'm not a doctor or any kind of expert, so what follows is just a layman's poorly informed opinion. Your Dad's doctor may know more and a specialist will know a lot more. I think that many patients get zero benefit from Aricept. Others get a modest benefit. It can improve mental functioning to a degree in some patients for some period of time, but will not slow the progress of the disease. Even if your Dad benefits from the drug, at some point down the road, maybe in a year or two, your Dad will be in exactly the same place at the same time that he would have been in without the drug. Although it happens, I suspect it is rare to actually perceive a difference in a patient after he starts Aricept. More likely there will be a small improvement in test scores, or a slower decline - but only for some period of time. Look out for side effects. My mother-in-law experienced severe tremors after starting Aricept. The drug prolongs neuronal stimulation. It can do that in the nerves that activate muscles as well as the nerves that participate in thinking. If that happens, cutting back the dose is probably a good idea and stop altogether if that doesn't work. My best wishes to you, your Dad, and the rest of your family. Alan > snip..... > The car is an obvious problem. My brother and I talked to our [quoted text clipped - 6 lines] > snip .... >> Alan Hey Alan - My brother and I used your example above and Dad was eager to help his son. I'm so happy he was positive about this. We've kept his car out of sight for the whole two weeks since the "run-away" and I guess he's somehow resigned to not driving again. He has always had a giving heart and this was the perfect approach. The only thing he asked my brother in return was to be taken on country drives. Of course we will make sure he gets to do that any time he wishes. Now we've got to get the paperwork done so that he doesn't have a sudden change of heart. Thanks again for a very helpful idea. We wanted to keep his mini van because its so easy for him to get in and out of but not if it was a constant reminder of his being prohibited from driving. - Barbara H >> snip..... >> The car is an obvious problem. My brother and I talked to our [quoted text clipped - 19 lines] > because its so easy for him to get in and out of but not if it was a > constant reminder of his being prohibited from driving. - Barbara H :-) It is wonderful to hear of a good outcome of some iffy situation! Thanks for sharing it here. SignatureBest Regards, Evelyn Hi Barbara Your dad had the MMSE test - which is the mini-mental state exam. A score of 24 or less out of 30 indicates global cognitive impairment. Here is a good link http://www.health24.com/medical/Condition_centres/777-792-798-1565,17559.asp I hope you realize now that he cannot drive again. Period. No wait and see. Its done. You should talk to the doctor about getting his license pulled, but also take definitive steps to prevent him from driving ever again, whether that means selling the car, permanently disabling it, whatever. I'd also be getting him put on the local wandering persons registry, get him a medic alert bracelet that says memory or cognitively impaired, and iron name tags into his clothing with name and contact phone number. Your dad may not have Alzheimer's. The second most common cause of dementia in the elderly is called multi-infarct, or vascular dementia. It is also progressive, incurable and results in dementia, but its from small strokes, small bleeds, blockages etc. in the vessels in the brain. There are also other causes of dementia. It is absolutely worthwhile to see a neurologist or pyschiatrist with a specialty in dementias to get him fully examined, and have a good talk with them about diagnosis and what to expect etc. A good assessment will more fully explore his deficits - in order for YOU to get your head around this, you need a real picture of what he can or can't do mentally at this point, so you can be realistic (i.e. if he lives alone, that has to change and soon). M > It seems my 82 year old father has very quickly gotten worse. He has shown > increased memory loss, confusion, angry outbursts and accusations plus [quoted text clipped - 41 lines] > > Barbara H Barbara this latest incident means you have reached crisis time. You need to find out what medical problems might be complicating your father's mental status. If he has a hematoma he may need surgery to relieve the pressure on his brain. My elderly neighbor had a brain hematoma and he did not improve until after surgery. Your father's driving needs to be stopped today - by any means necessary - including disabling his car. Ask his Dr to tell the licensing bureau to require retesting as a means to getting his license permanently revoked. Get a medical and regular power of attorney. This can be done very easily and is not expensive. Buy and read the book "The 36 hour day" that is a standard guide for all dementia caregivers. Don't expect too much from Aricept - possibly some minor improvement. Expect the next few months or years to be very time consuming with many difficult choices ahead for you. You must stop your father from traveling on his own. In my part of the country there is about one person a week who has dementia found dead each week during the winter months who has gone on a short errand and ends up dead hundreds of miles from home. The kids always say "we knew he had problems but did not know he was this far along". Often there have been prior incidents but nothing was done. This incident is your wake up call. Welcome to the group no one wants to join. good luck. AW http://www.amazon.com/exec/obidos/ASIN/0446610410/bookstorenow57-20 > I was able to get him to the doctor this week and he's just had an MRI and a > quick memory testing session. His MRI revealed a recent injury (he fell [quoted text clipped - 6 lines] > His doc explained all of these things and told him he had early stages or > mild memory impairment. He never used the "A" word. I'm not sure why. to echo what others have said: have your father sign durable power of attorney for health care, and one for his business affairs, sothat you can make medical decisions for him and manage his financial affairs, which are probably already a mess. have his primary care doc refer him for a full neuro and psychiatric exam, preferably at a hospital or clinic experienced in geriatric dementias. you need to have them eliminate possible physical causes like low thyroid, normal pressure hyrdocephalus, side effects of statin medications like lipitor, overdoses of meds (because he didn't remember taking them he might take them more than once), etc.). you also need to know what kind of dementia it is, since frontal lobe dementias can cause paranoia, anger, & sudden changes in behaviors, and medications that can help alz patients often don't work on frontal lobe dementias. don't let his doc tell you this is "normal effects of aging" because there is no such thing. and once you get the power of attorney, don't just accept whatever the doc says --- if you feel you aren't getting answers, or that the doc really isn't up to date on dealing with dementias, find another doctor, one that actually wants to support families in taking care of their LOs. fyi, i often found it useful to fax a note to the doctor the day before my mother's visits, to give her a heads up on what was happening because my mom would either be totally vague, or she would lie about not smoking or about staying on her meds. finally, you need to ask your father's doctor to write to DMV and have your father's license revoked. period. if the doc balks, tell him that because you have asked him to do so, if does not and your father ends up driving and killing someone HE (the doc) will be liable. once his license is revoked, the best thing is to sell his car. welcome to the club no one wants to join. feel free to come back. FYI, much of what i and the others have said is available in the group archives on google groups. like you and evelyn, i ended up here during a crisis, and have stayed to help others even though my mom's been gone for over 2 years. >> I was able to get him to the doctor this week and he's just had an MRI >> and a [quoted text clipped - 53 lines] > ended up here during a crisis, and have stayed to help others > even though my mom's been gone for over 2 years. Evelyn, Alan, Mary, August & Dennis. Just read your replies and I truly appreciate the wealth of knowledge and information you are able to share through this group. Some of the uncertainty and helpless feelings are beginning to lift a little. While I'm able to recognize some of the things we've done right or are at least working in our favor I also now see many things that need tightened up and accomplished soon. We will begin the process this next week to get proper power of attorney while dad is still able to participate. I'm sure we will have to do some manipulating so that he will not misinterpret what we are doing. I especially appreciate knowing that its okay to do this. I am already an owner on his bank account and have kept his finances in order now for several years. When our mother died my father had never even written a check. He would describe himself as a people person, not a numbers guy. Anyway, I also invested in his home about 12 years ago so that he could do some updates and be able to keep it. He put me on the deed as a co-owner at that time. I guess I need to know what impact that will have on both of us. His health care expenses may require the eventual sale of his home. Oh well, questions for the attorney I guess. I feel like I'm able to protect some of his assets right now and financially he is fine. However, I know now not to leave any of this to chance. I have actually taken his files home with me for now. Most urgent seems to be the car situation. You all were quite clear on that topic. It's like you've all "been there & done that". J A small part of me wants to just give it back to him and stop the bitter feelings he has toward us right now. But, since his run away trip we have kept his car out of sight. We do not plan to give it back to him. That's been a terrible ordeal for us all. We would like to keep it to help shuttle him around for now but if that turns out to be a problem we can sell it. It's a mini van and he just can't get in and out of a low car any more. I have a van also so we'll make do with mine most likely. He's still not speaking to my brother and I'm barely back in the door. But, that's okay we didn't have time to ease him away from his car. This episode forced us to act quickly and to firmly tell him that he won't be allowed to drive unless a doctor tells him it is safe. Which brings up another problem because his doctor refused to answer my direct question regarding his being allowed to drive. Fortunately dad doesn't remember that and we have told him the doctor says absolutely no driving. Like you said Dennis, I will insist that he write to the DMV and request dad's license be revoked or replaced with an ID only type registration. The past few days dad has calmed down a bit and doesn't ask for the car back. As to the living alone problem. We will begin searching for a good assisted living center and I believe we have time to ease him into that idea. If his head injury was contributing to his erratic behavior maybe he will go back to his mild stage of dementia as that continues to heal. I just don't know. For now we've told him that he is at high risk for additional bleeding and for the next month must be very cautious. I'm not so sure I could handle him moving in with me. I guess if there were a really good diagnosis that said he wouldn't be a threat to himself or others I might consider that. My brother and his wife still work so that's not an option. Well, we have lots of bridges to cross and I thank you all again for your advice and support. I'll order the book August recommended. I'll be adding the other items recommended to a new list of things to check out or do now. I feel like I'm walking into the fog he is living in! We've lived through other family crisis and sad times but this is so much more frightening. I did find a local Alzheimers group, I guess they are a support group. They don't meet again until June 27th but I'm going to be there and find out what I can. Best, Barbara H >>> I was able to get him to the doctor this week and he's just had an MRI >>> and a [quoted text clipped - 91 lines] > quickly and to firmly tell him that he won't be allowed to drive unless a > doctor tells him it is safe. Hi, Barbara; As others have said, welcome to the club no one should be a member of. Your dad sounds similar to my FIL. The mini stroke (TIA) is a vascular problem, which points to vascular dementia being part of the equation (there could be more factors). The anger and paranoia, but otherwise decent skills says the frontal lobes be more affected than the rearmost lobes. The difference between alzheimer's and frontal lobe dementia is that AD starts in the rear of the brain first, affecting memory and some cognitive skills first. FLD affects executive functioning first - how to organize a task, how to control emotional responses, how to maintain self control.... Does your dad have trouble retrieving specific words while speaking? Will he talk around a word he can't grasp (You know, that thing you use to cut with; that place we went when your mother did....) and will often continue by saying, "well, anyway...." and be able to continue the sentence or thought without the word. If yes, this subtle loss of verbal retrieval and oral planning skills is a hallmark of frontal lobe issue. A neon arrow, if you will. The best test for what part of the brain is affected is a PET scan. As others have said, a full neuro-psych workup by a geriatric neurologist gives the fullest picutre of your dad's state and abilities. > Which brings up another problem because his doctor refused to answer my > direct question regarding his being allowed to drive. Fortunately dad > doesn't remember that and we have told him the doctor says absolutely no > driving. With a FLD, this could be problematic if he asks the doctor about driving. Your dad will remember your telling him its the docs orders not to drive and if the doctor denies it, it will fuel your dad's paranoia towards you. Ask the doctor to write a letter to the DMV in your area reporting your dad as someone whose medical condition indicates he should lo longer drive. If the doctor balks, others here have reported that asking the doctor if they want to be driving down a road and have your dad driving towards them, has proven successful in changing a doctor's attitude. My MIL needed a somewhat raised car to get in and out of that she liked; I think it was a Vista. She traded it for a crossover car a few years ago, also slightly raised. And people report the Toyota Scion and Honda Element are also easy to get in and out of. Once you have an enduring POA and a diagnosis of dementia, you can sell Dad's car and put any proceeds towards his care. > Like you said Dennis, I will insist that he write to the DMV and request > dad's license be revoked or replaced with an ID only type registration. [quoted text clipped - 11 lines] > others I might consider that. My brother and his wife still work so that's > not an option. Just something to keep in mind as a 'just in case' - If you have a loved one with FLD (if that turns out to be the issue) and a tendency to get angry, there are issues with having him in assisted living or anyplace that isn't equipped to or willing to put up with agressive, antisocial behavior. My FIL only got aggressive when we was wandering late at night and was confused, but the minute you tried to guide him anywhere or get him to the correct place, he could become very physically aggressive. He needed specific medication (were never told precisely what by MIL) to keep the aggression in control and it needed to be ingested on a very precise schedule. Assissted living won't do that level of care, and aren't equipped for aggressive people. They need to protect the other residents who are also very frail and vulnerable. And to be honest, a woman living alone is also not equipped to deal with a male when he gets aggressive, which my MIL tried to do, but wound up compromising safety to do so. While it may be the one thing you swore you'd never do, please start looking into Nursing Homes in your area, what level of care they will provide, what kind of patients they'll accept. Maybe even get on a list at the one you like best. Our family had to make the decision while in crisis mode and wound up with what we could get. It wasn't a good fit, and he spent 6 weeks on a psych ward (not set up for dementia patients) until we found another placement. Wishing you good luck! Adelle > I feel like I'm walking into the fog he is living in! We've lived through > other family crisis and sad times but this is so much more frightening. I [quoted text clipped - 5 lines] > > Barbara H I'm not sure how this is suppose to work .... I snipped a whole bunch of good stuff ... hope I did this right. B > Hi, Barbara; > > As others have said, welcome to the club no one should be a member of. Does your dad have trouble retrieving specific words while speaking? Will he talk > around a word he can't grasp (You know, that thing you use to cut with; > that place we went when your mother did....) and will often continue by > saying, "well, anyway...." and be able to continue the sentence or thought > without the word. If yes, this subtle loss of verbal retrieval and oral > planning skills is a hallmark of frontal lobe issue. A neon arrow, if you > will. That's exactly what is happening with his word skills. The other day he referred to his "little pieces of medicine" not being able to come up with the word "pills". > The best test for what part of the brain is affected is a PET scan. As > others have said, a full neuro-psych workup by a geriatric neurologist > gives the fullest picutre of your dad's state and abilities. I will pursue this recommendation and insist on a full neuro-psych workup. His doctor now is a geriatric specialist so he should be able to refer us to a geriatric neurologist. > others here have reported that asking the doctor if they want to be > driving down a road and have your dad driving towards them, has proven > successful in changing a doctor's attitude. Excellent suggestion. Can't argue with that logic. > Just something to keep in mind as a 'just in case' - If you have a loved > one with FLD (if that turns out to be the issue) and a tendency to get [quoted text clipped - 18 lines] > > Adelle I know this is good guidance. I'm just not at a point where I can accept that we may have to go the Nursing Home route. I've ordered a new book ..... (along with The 36 Hour Day) it's called ..... "Old Age in a New Age: The Promise of Transformative Nursing Homes" by Beth Baker I'm hoping I will get a better insight into what kind of care we can expect and maybe hope to find. Being a baby boomer myself these things have been on my mind for some time now. Having dad's crisis has pushed the urgency up on my calendar for sure! Thank you so much for sharing your knowledge with me. I feel better prepared to start the discovery work needed to determine how best to help dad. Best regards Barbara Dear Barbara; You did the snipping just right. I'm so glad you wrote back. That thing about losing words is a big clue to what's up with your dad. And unfortunately, it will impact slight differences in the course of his progression. While "the 36 hour day" will give great insights into caregiving, FLD presents unique issues. As it progresses, oral skills issues will be lost faster than if he had AD. Please spend a bit of time researching Frontal Lobe Dementia on the web. You will see names like Pick's Disease and Dementia with Lewy Bodies. Your dad probably doesn't have those. But vascular dementia can strike any part of the brain, depending on which blood vessels wind up being affected, so your dad's dementia may mimic these named dementias. One thing to remember is that your dad's memory and ability to recall things related to an emotional response will remain more acute. He will be able to use logic and reason to some extent, often to try to get his own way (can be very manipulative). He will seem like himself far longer than AD patients do, even when he also presents with very similar deficits. He will be able to maintain cogent conversation, talk about hobbies, even some long standing issues in the news (though new, small details will become confused). This will present itself as being able to seem 'normal' during shorter medical visits, and medical personnel perhaps not being able to accept/give credence to symptoms that you say he presents at home. It's very frustrating. An example is Your dad will be unaware that he has deficits, impairment in judgment, of distance, etc. He will develop compulsions. FIL entered contests and continually did those 'send a dollar to the person on top of the list schemes' until MIL just started hiding all the cash, convinced that he'd miss a chance to win if he didn't. He also kept buying screwdrivers, his mind stuck on the fact that he might not have the precise one he'd need when he'd want it. He will also have problems with following a sequence in *new* things, but may retain ingrained habits a long time, as long as he remains in familiar surroundings. SO he will seem like he is coping well, but faced with new or uncommon experience (new appliance, even if it works exactly like the old one, new street sign put up in familiar place, emergency event like a grease fire or water heater leak) he will be completely unable to cope and figure out what to do (call you, call plumber, take same route...). Like in AD, he cannot learn new things. Unlike AD, he will retain some functionality longer, provided he has all familiar prompts. So taking new meds will mean new, unfamiliar things. He may be able to do them if combined into existing familiar habit. Or not. In AD, its mostly 'or not.' My FIL, a lifelong woodworker, lost his ability to follow directions of a woodworking project, but could still perform household chores correctly without supervision, even long past becoming delusional. He washed dishes, and maintained hygiene (remembering the sequences involved in how to bathe and shave). The latter he was able to keep until moved to a nursing home; the unfamiliar somehow meant he lost whatever prompts his brain used. But the paranoia, the anger and negativity may affect his willingness to take his meds. My FIL 'forgot' he had congestive heart failure and was convinced he had no need of medication and that the medication was a waste of money and some sort of conspiracy between the docs and MIL. Of course, it resulted in a medical crisis which then exposed how bad the dementia was - he just couldn't hide it over 72 hours in a hospital like he could for two hours in a doctor's office. I 'hear' you aren't ready to consider nursing homes. Just keep it in the back of your head. Also, it might be a good idea to have plans in place in case the paranoia and anger combine into aggression. The frontal lobes are where the 'brakes on antisocial behavior' are located. Some people get aggressive, some lose inhibitions (undress, touch people inappropriately), some lose appropriateness (angry when not warranted, wrong choice of clothing for weather, saying rude things). Let local law enforcement know that any aggression will be mental health related and not criminal in case you need help if he gets out of control. Or in case he decides you are keeping him prisoner, or stealing from him and calls police to report you or get help. MIL never did this. She couldn't keep him from driving long past the time he should because he'd become belligerent when he couldn't find the keys and she took the path of appeasement as opposed to being proactive. She felt unsafe several times, with his reactions to keys and medication, but lived in the situation, preferring to try to defer to the semblance of his dignity, than treat him in ways she thought were disrespectful. Not always good choices. Take it a day at a time. But please try to make good choices that protect everyone's health and well being - including your own. Wishing you all good things Adelle > I'm not sure how this is suppose to work .... I snipped a whole bunch of > good stuff ... hope I did this right. B [quoted text clipped - 70 lines] > Best regards > Barbara Barbara, It sounds like you have already started the process and are doing the right things. As far as putting your name on the bank accounts and house, we had not done that in my mother-in-law's case and our lawyer told us that we had to. It was the right thing to do. Having your name on these things will make it easy for you to act for him. My Dad thought the world of me, and I of him. When he got dementia, I was able to briefly convince him to give me full control over his finances. I took his bank account, stocks, credit cards, and checkbook. I acted much too late. He had already put almost two thirds of his life savings into terrible investments that crashed and became completely worthless. He allowed me to take control because he trusted me, but afterwards, it tore him apart. I had horrible sessions with him where he told me I was killing him, he felt like a nobody without any money. He begged me to give it back. I would go away crying, feeling like I was killing him if I took his money and killing him if I didn't. I eventually found a solution to that problem. I opened a joint checking account for the two of us and put $200 in it. I gave him a check book. I told him, look, you've got money. If you need to buy something, you can write a check. If you need some cash, you can cash a check. If the account gets low, just call me and I'll put some more in it. In fact, he never spent the whole $200, but he felt better. I wrote earlier about what my brother and I did with his car. That worked for us. I found that the best thing to do was to try to find a solution that satisfied my Dad's emotional needs while minimizing the risk to him. Another thing I did with my Dad was to tell him, Look, you've got money (the $200 checkbook), if you need to get somewhere it's easy, just call a cab. I went through calculations to show him that he seldom used a car (he was living in assisted living by then), and it was much cheaper to take cabs than to pay for license, insurance, and maintenance on the car, and easier to because he didn't have to worry about keeping up the car, parking, etc. He had always been a practical person and liked the idea that he was saving money. In fact, I don't believe he ever did call a cab. But knowing he could made him feel a lot better. He no longer felt that he was stuck and with no options. Alan > Anyway, I also invested in his home about 12 years ago so that he could do > some updates and be able to keep it. He put me on the deed as a co-owner at > that time. I guess I need to know what impact that will have on both of us. > His health care expenses may require the eventual sale of his home. Oh well, > questions for the attorney I guess. that's why folks should consult an elder care attorney *before* doing what you did. you definitely need to consult one ASAP. > Most urgent seems to be the car situation. You all were quite clear on that > topic. It's like you've all "been there & done that". J A small part of me > wants to just give it back to him and stop the bitter feelings he has toward > us right now. But, since his run away trip we have kept his car out of > sight. We do not plan to give it back to him. That's been a terrible ordeal > for us all. the best strategy is one *i* used --- let his doc and the DMV be the bad guys. that was the first time i asked the doc in advance to write directions and instructions on a prescription form, so i could point to it and say "see, right here the doc says 'NO DRIVING"" or "see, the doc said 'at least 30 minutes of exercise every day!'". works wonders if they're the type that always obeys doc's orders... rule 1 when maneuvering a demented person to do what she/he needs to do: always blame it on someone else: the doc, DMV, medicare, the hospital, the garage that's waiting for car parts... > As to the living alone problem. We will begin searching for a good assisted > living center and I believe we have time to ease him into that idea. if he's already upset, DON'T WASTE YOUR TIME. it will result in tremendous anger and resentment. don't even think of mentioning it any time he could possibly overhear you! especially don't mention it UNTIL YOU HAVE THE DURABLE POWERS OF ATTORNEY SIGNED. if you do, he will obsess on it and not let go of his anger for months. get the full medical evaluation, and have all of you kids sit down with the geratric social worker to have a no-denial discussion of whether he can live safely alone any more, or needs to be in a secure facility. then choose the place you want him to live, which will probably have a waiting list --- so get him on it. as soon as they have an opening, do as i suggested in another thread --- take him for a drive while you move him, and deliver him to the new place, and then don't visit for a week or two. that is my summary of what has been repeated here over and over based on experience, especially when the LO has no insight into his disability (they rarely do, that's the nature of the disease), and is paranoid, angry, and mistrustful. it sounds cruel, but it truly is the kindest thing you can do, to put him in a place where he will be secure and safe. far better that than have him wander off and get mugged or lost, or set his house on fire. On Jun 11, 12:28 am, NO_SPAM_TO_dphar...@gci.net (Dennis P. Harris) wrote: > ... as soon as they have > an opening, do as i suggested in another thread --- take him for > a drive while you move him, and deliver him to the new place, and > then don't visit for a week or two. ... That is what has to be done at a certain point in the disease process, but it may be that Barbara's father hasn't gone that far yet. My Dad actually checked himself into assisted living. My Mom had died several years before with advanced AD. He saw signs of it developing in himself. He sold his condo and moved into AL on his own accord. My brother and I were seeing early signs of problems, but they were still very early and he had been living independently with considerable success. Barbara's Dad might still be rational enough to see the advantages of AL - no more cooking and cleaning, lots of companionship from same aged folks, activities, three decent meals a day, a nice facility, help always at hand if needed. It would be ideal if he chose that for himself. Of course it has to be a nice place to be attractive in that way - but who would want to move a parent into a place that isn't nice? There are lots of Assisted Living facilities that have the ability to help both non-demented and demented residents. If a person is able to function at a reasonable state - which Barbara's Dad may still be able to do, he can move into such a place and be in the non-demented section unless and until he deteriorates badly. It's a more desirable option than a locked down AD unit where all the folks have serious trouble. Alan At one point early in the illness we took my mother in law to check out an assisted living place very near where her sister lived. It was just a beautiful place - and it offered graduated care and many options and services, from your own independent apartment right the way to a heavy care nursing home. My mother in law could afford it, it was very convenient to her sole surviving sister whom she was very close to, near all kinds of amenities, never mind what was offered "in house". Heck, after the tour, I was ready to go live there myself. My mother in law actually rejected it as being "too nice", if you can believe it. Argh!! M. On Jun 12, 7:52 pm, Mary_Gor...@tvo.org wrote: > ... > My mother in law actually rejected it as being "too nice", if you can > believe it. Argh!! Ouch! Hi Alan, Dennis & all I know I'm not very experienced and probably being overly hopeful right now. But, I do think we have some time with Dad. Not a lot but hopefully enough that he will settle into his old routine and be safe and comfortable for now in his own home. Maybe just a month or so but that will help us get organized. I would love to have a year or more and maybe that will happen. He knows what he did but he doesn't understand the danger he was in. I had home health care in this morning for an evaluation so I'm anxious to hear their recommendations. He was very hospitable and even charming with the nurse they sent. His health review was quite good as he has very few health problems and takes very little medication. His bp was 116 over 64. That seemed to impress the nurse a lot! He actually signed the car over to my brother this morning so that hurdle has been cleared. We discussed getting proper power of attorney with him and he was very agreeable. Dad has a grandson he helped put through law school and is just starting his career as an attorney so he has helped Dad know how important our help will be with these kinds of documents. So that's headed the right direction too. I'm feeling pretty good right now although I know things can turn on a dime. I'll probably never feel completely at ease again but I do finally feel like I have time enough to implement the very helpful advice given here and to accomplish these things without a dark cloud hanging over us. It's still a cloud but it's not so ominous as before. Thanks again, you're such a good group. - Barbara H > On Jun 11, 12:28 am, NO_SPAM_TO_dphar...@gci.net (Dennis P. Harris) > wrote: [quoted text clipped - 34 lines] > > Alan > I'm feeling pretty good right now although I know things can turn on a dime. I'll > probably never feel completely at ease again but I do finally feel like I have time [quoted text clipped - 3 lines] > > Thanks again, you're such a good group. - Barbara H I'm really glad things are under control, and very glad we could help. Best of luck to all. Alan > Hi Alan, Dennis & all > [quoted text clipped - 26 lines] > > Thanks again, you're such a good group. - Barbara H Wow, it is so good to hear of things going in a positive direction. It is good that your family is close, and to be so cooperative and helpful with one another. SignatureBest Regards, Evelyn > I had home health care in this morning for an evaluation so I'm anxious to > hear their recommendations. He was very hospitable and even charming with > the nurse they sent. His health review was quite good as he has very few > health problems and takes very little medication. His bp was 116 over 64. > That seemed to impress the nurse a lot! but if he hasn't had a full neuro-psych evaluation, you need to have that done ASAP once you have the durable POA so that his docs will discuss his condition with you. if he has AD, there are meds that can slow the deterioration. if it's due to some other cause, and it's treatable, you need to know that too. in addition, the cognitive skills assessment can alert you to deficits that could put him in danger, and give you a better idea as to whether or how long he should be left alone. i'm glad to see that he's being cooperative, and that you were able to deal with the car problem so quickly. be sure to start looking for the next place he'll be living right away, though, and get him on the waiting list without worrying about his approval. one tip --- while it's great that his grandson is starting to practice law, your family really needs to have an attorney experienced in your state's elder law if you have to start dealing with anything to do with his assets, since there are lookback periods for medicaid for institutional care once his assets are spent down. for stuff like a living will and durable powers of attorney, those are often set in state statute (in my state, the actual forms, with checkboxes, are part of the law). <snip>> > but if he hasn't had a full neuro-psych evaluation, you need to > have that done ASAP once you have the durable POA so that his [quoted text clipped - 8 lines] > i'm glad to see that he's being cooperative, and that you were > able to deal with the car problem so quickly. Hi Dennis - I certainly hope and plan to do all of these things to whatever extent is needed. Dad has agreed to both types of POA's and has from the beginning always signed a release for the doctor to talk to his children. Now that this has taken a turn for the worse though I realize how important POA is .... both medically and financially. I'm glad I came here and learned so much so quickly. > be sure to start looking for the next place he'll be living right > away, though, and get him on the waiting list without worrying > about his approval. We're all still a little shell shocked but so much more hopeful than before because he has been so cooperative. I do plan to start visiting local centers as soon as I can. We would love to get him in to our Veteran's center here. It's brand new and is very nice. I know two people who have had parents there and they were both happy. That's where I plan to start since he is from that "Greatest Generation". We'll find the right place though. I know it. > one tip --- while it's great that his grandson is starting to > practice law, your family really needs to have an attorney > experienced in your state's elder law if you have to start > dealing with anything to do with his assets, since there are > lookback periods for medicaid for institutional care once his > assets are spent down. We would never consider using his grandson as our attorney in this matter. Much too close to the situation and he is now practicing in another state. It's just nice that he is making good recommendations to his Grandfather and he has helped us find three local attorneys who are all qualified in elder law. We think we've narrowed it down and by the weekend will have that process in motion. Without his input I think my Dad would have balked at the idea of needing to assign POA. I know that for right now he trusts us and he understands that he won't have to worry about taking care of any kind of business or paperwork at all. That's one of his big fears. > for stuff like a living will and durable powers of attorney, > those are often set in state statute (in my state, the actual > forms, with checkboxes, are part of the law). The forms you refer to sound very similar to what we've been provided for review. Lots of boxes to check and options to accept or reject. State specific of course and all very proper. I'll be so glad to get that piece of this action in place. Thanks again for your helpful suggestions and tips. Barbara H > The forms you refer to sound very similar to what we've been provided for > review. Lots of boxes to check and options to accept or reject. State > specific of course and all very proper. the nice thing about the ones for our state (which i believe is based on a "model law" put together by one of the interstate law compacts) is that the boxes prompt you for almost every possibility. this can give you an opportunity to discuss those issues with your LO while you are filling out the form, so they can express themselves as clearly as possible. my mother, who had been caregiver for her mother and two aunts *before* there were living wills, had definite ideas about end-of-life issues (no resuscitation, no hydration, no tube feeding). when she woke up in the hospital with a hydration drip in her arm, she ordered us to get rid of it, call hospice, take her home, and obey her living will so that she could die at home with only palliative care. of course, we obeyed. |
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