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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
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V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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You can call your dad’s primary care doc. While dad’s information is HIPPA protected, docs are allowed to listen to information about their patients Expree your concerns and request the doc give dad a mini cognition test. I did this with my moms doc….
If you do not have POA or other legal documents authorizing you to accompany him to MD appointments, then you do not go.
You do not tell us why YOU 'deem' him at risk?
I have witnessed these MD visits first hand. With alcoholism and dementia, the MD / nurse (?) will ask questions and take whatever answer is given - no matter what the truth is. [As my client would say she drinks 1-2 drinks occasoinally when she goes through a quart of hard liquor a week or less]. I am sitting there thinking "I am the care provider ... I know what's going on ... why don't YOU ask me?" No. They do not.
I believe the key is calling the MD ahead of time to discuss your concerns (medical / dementia).
If you are not listed in his medical records as the person to be called in case of an emergency, you need to be. - Likely only your dad can authorize this. - If your dad refuses, then you need to let it go.
Likely your dad is scared and wanting to hide what is going on with him. He wants to maintain the independence he is both used to and perceives he still has. My client who is now 104 still wants her independence. This is perhaps human nature. No one wants to be dependent and ACKNOWLEDGING that they is declining in various ways (emotionally, cognitively, psychologically) - and physically.
You do what you can and then let it go. "Do" talk to your Dad about how he FEELS about his life, what he can and cannot do, and ask / encourage him to talk about his fears. Opening up to you will bring him closer (possibly) to you and trust you more. Or, conversely, it may alert him to keep quiet as you will want to make changes he doesn't want. Tread lightly and compassionately. Really listen. Active listening. Reflective listening. Let him talk and you say as little as possible.
And, as MD supports you to be present at his MD appts., you tell your Dad the 'doctor asked me to come with you - just this one time.' ... Or say that anyway if you think it would work out.
There is NO lying in dealing with trying to provide the best care possible for our loved ones. Coupled with dementia / confusion / fears - we try to keep the person as calm as possible. It definitely is a tight rope. No doubt about it.
What is that phrase about a turnip? You can't make XXX out of a turnip. In other words, you do the best you can with an open, caring heart and then you need to (realize that you need to) let it go.
I was shocked when I saw you question because I went through the Exact same situation. My dad wouldn’t let me go to appointments with him and actually told his care team Not to talk to me! It was the first stages of dementia, (paranoia). Almost two years later we got a diagnosis, vascular dementia. I am still caring for him but as his condition progresses I am not equipped to keep him safe at all times. We are having to make the hardest decision of our lives to put him in a War Veteran home. Anyway, to answer your question I would say give him time, don’t be too overbearing. He may know that he’s starting to forget things and the first instinct is to hide it. Like everyone said you could possibly write a letter with your concerns but what I did was keep a log of all of his behaviors that were concerning. Things that he was forgetting, hallucinations, him getting lost going places he’s frequented for years. Things like that, although he was going to the VA clinic several times a week without an appointment so when I went up there in person the staff said they were very familiar with him and admitted to his behavior being strange but they wouldn’t do anything about it. I finally talked my dad into a POA which his clinic still wouldn’t honor because he told them not to talk to me. I talked to his social worker several times. I was basically relentless until they finally started working with me and his doctor recommended that he should always have a caregiver or family member accompany him to his appointments. I think after a while my dad saw that I was truly concerned about his health and all I wanted to do was help. He was letting things slip away like bills and other financial obligations which I took care of for him. I’m afraid patient’s care teams are weary of adult children or family members trying to take advantage of the elderly. Elder abuse, extortion, and exploitation happens more often than you’d think and mostly by family members or neighbors. Key thing is to let him keep his dignity. Explain that you are only wanting to help, but you won’t have a say in his healthcare without a medical POA.
Are you the POA for your father? If not, who is? If no one is named POA, I suggest the family get this addressed ASAP. Or, at minimum who is named on his medical records at his PCP as person who can get health information about him, who can physician release info to. If you fit one of the above, then you should be able to at minimum contact his PCP and, share your observations and needs re your father and his safety. If your father is cognitively appropriate, perhaps you could try to have rational conversation with him about the necessary needs to address his health for safety reasons and, to help you and the family be at peace about providing his needs. It sounds like he may surely be in denial about his health status, perhaps grieving his health status, or maybe trying to be " protective" of family still..... There could be any number of things contributing to his refusal to allow family to go to PCP with him. However it does come down to safety issues. You can always confer with an Elder Law Attorney about the dynamics to be more informed about the circumstances around caring for aging. The PCP should be able to provide the family with a " level of care needs assessment" for your father, assign a Geriatric Case mgr or Licensed SW to him , to further determine what level of care is needed to provide safety, medical, emotional care for him. Does he live alone now? If so( or if he is living with someone ) and, you feel he is unsafe and being non compliant or in denial about his condition, you can as last resort ( or sooner if you choose) make a call to APS , Adult Protective Services, and report the situation , APS, will follow up and go from there. If your father is A/ O, cognitively appropriate and able to follow and retain a conversation, you can also inform him that if he continues to deny you or other designated family member access to go to PCP with him to be a part of his health care, then you may have to call APS, and let him know what the potential ramifications of that could be. Maybe that would get his attention.
If your dad is getting himself to these appointments and the doctor is not making this assessment, (both independently), why would you want this determination made?
Do you have appropriate and pure motives?
If you don’t, and you write such a “letter” you better believe it will be part of the permanent “record.”
You make a valid point. Our OP has given us absolutely no information her, as to what, in her estimation, is going on here. Of late I find that the Forum is getting some questions that look a bit like the entrance to the rabbit hole, and many of us are jumping right in and have long, repetitive discussions, and even argument, as to what the "possible problems" and "motivations" are. And we cannot know this without a good solid question, and without good responses from our OP.
You are correct that a letter to an MD would be noted in his files as to who wrote it, when, and what their major concerns were. And the MD would almost certainly DISCUSS such a letter with his/her patient (if competent).
I think I was "first responder" on this question, or close to, and honestly I just asked a few more questions of our OP. As you will not, he/she didn't return to answer, nor to comment on thread.
You do not need to be in the room to express concerns to your dad's doctor. When my husband turned paranoid after starting a new medication, I called his doctor before a scheduled physical and told someone on the staff what was happening. I said I thought the medication should be discontinued. It was and he returned to his regular self in a few days.
What I did was to write a letter to the doctor ahead of time so that when my BIL was seen they had my concerns and that is when my BIL lost the right to drive because of his dementia.
Notifying the doctor ahead seems like the right thing to do. Who wants to see anyone get hurt? However, most doctors have some training in eliciting all kinds of information from their elderly patients. I had a friend whose doctor was obligated by law (in California) to report her to the DMV and she lost her license. She never told her family and continued to drive. While she didn't have any accidents after she lost her license, she had three before and injured her chest on the steering wheel. She's now in a lovely nursing home.
There's more to this "I'm safeguarding everyone's" story. Was the License Loser provided with a list of "Senior Ride Services, cabs in the area, bus schedules and/or given phone numbers of friends (yours and hers) who might provide a ride in case of a minor emergency. Some seniors become pretty upset when a pet becomes injured. Did you provide a Life Alert gadget to wear? Have you checked the senior's home for impediments to their leaving quickly? Do you have the phone numbers of her neighbors? Do they have yours? Is there a list of important phone numbers on the back of the front door? What about a POLST sign (bright pink) which tells firemen whether or not to resuscitate? They will do that if you are unconscious. Think possible cracked ribs. Investigate, be proactive and get prepared for a number of scenarios. It could happen to you one day.
Just had another friend (86) tell me that driving was the last bastion of her "Personal Freedom." I've heard that one before. I was telling her that I can ride with the various services every day of the week for less than my monthly car insurance. Add in gas and maintenance and it doesn't make much sense to me. She said her $146 a month was worth her "Personal Freedom." If you don't live in an area that has these services, maybe you could have someone be "On Call." for a fee.
Good luck with your family's journey. It's just beginning.
Most medical providers have a Patient Portal that you can use to communicate with the doctor. If your dad has not set up his you could probably do so and use that to communicate and actually see what is going on. (It would be best if you are listed on his HIPAA form as one that can get information from the medical office. Without the signed HIPAA form YOU can communicate but they can not inform you of any information. (Having you or someone listed on HIPAA forms is important as the hospital could give no information until he gives permission if he is brought in as a result of an accident)
In a lot of cases, unfortunately, it is a matter of waiting for an event that would require your input. It is important to be ready for that moment to "get your foot in the door" with at least a discussion of future plans.
The simple thing is to send a note to the doctor saying what you are concerned about and why. A ‘good’ doctor will take it from there to check things out. Many many parents will take advice from their doctor, rather than from their own family. If the doctor doesn’t follow through, consider recommending a different doctor.
Does your dad make his own appointments and take himself to his appointments? Handle his own finances? Pick up any prescriptions prescribed and take them appropriately?
My experience is that a primary often will not assist. Rather than spend your time trying to get in to see the primary, I might forward him a note for a referral to a neurologist where he could possibly get the correct evaluation and medication for his condition.
This is a tough one. On the one hand, his doctor is bound by law to honor HIPPA (laws that protect patient privacy). On the other hand, you want to make sure your loved one is mentally competent or when he/she needs your assistance - especially if you are the one designated as POA or health care surrogate. The best option is to contact the doctor about your concerns. Ask him/her to contact you when he deems there is a problem you need to address. Most states have laws about who can act as a proxy for decision-making for somebody with cognitive issues. Look up your state laws or ask the doctor to suggest who to talk to about this (social services comes to my mind).
Explain, please. What do you mean by "at risk". What symptoms are you seeing? If you are not Medical POA you have no right to communicate with your dad's MD. That is to say you are welcome to communicate if you see CLEAR SIGNS of something; but don't expect an answer. The MDs ALL evaluate any seniors mentation on any office visits and have clear ways of doing so without seeming to.
The doctors are so clever! The questions seem innocuous. “Where did you grow up?” And “What did you do for a living?” And “Where does your son live?” Geriatric specialists are amazing.
At risk for what? As a driver? Living by himself? Are you hoping to get him a memory/cognitive test? Even if his doc gives him this test and it shows impairment, your doctor can't force anything to happen if no one is your father's PoA. No PoA = no power.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
You do not tell us why YOU 'deem' him at risk?
I have witnessed these MD visits first hand.
With alcoholism and dementia, the MD / nurse (?) will ask questions and take whatever answer is given - no matter what the truth is. [As my client would say she drinks 1-2 drinks occasoinally when she goes through a quart of hard liquor a week or less]. I am sitting there thinking "I am the care provider ... I know what's going on ... why don't YOU ask me?" No. They do not.
I believe the key is calling the MD ahead of time to discuss your concerns (medical / dementia).
If you are not listed in his medical records as the person to be called in case of an emergency, you need to be.
- Likely only your dad can authorize this.
- If your dad refuses, then you need to let it go.
Likely your dad is scared and wanting to hide what is going on with him.
He wants to maintain the independence he is both used to and perceives he still has. My client who is now 104 still wants her independence. This is perhaps human nature. No one wants to be dependent and ACKNOWLEDGING that they is declining in various ways (emotionally, cognitively, psychologically) - and physically.
You do what you can and then let it go.
"Do" talk to your Dad about how he FEELS about his life, what he can and cannot do, and ask / encourage him to talk about his fears. Opening up to you will bring him closer (possibly) to you and trust you more. Or, conversely, it may alert him to keep quiet as you will want to make changes he doesn't want.
Tread lightly and compassionately. Really listen. Active listening. Reflective listening. Let him talk and you say as little as possible.
And, as MD supports you to be present at his MD appts., you tell your Dad the 'doctor asked me to come with you - just this one time.'
... Or say that anyway if you think it would work out.
There is NO lying in dealing with trying to provide the best care possible for our loved ones. Coupled with dementia / confusion / fears - we try to keep the person as calm as possible. It definitely is a tight rope. No doubt about it.
What is that phrase about a turnip? You can't make XXX out of a turnip.
In other words, you do the best you can with an open, caring heart and then you need to (realize that you need to) let it go.
Gena, Touch Matters
If you fit one of the above, then you should be able to at minimum contact his PCP and, share your observations and needs re your father and his safety. If your father is cognitively appropriate, perhaps you could try to have rational conversation with him about the necessary needs to address his health for safety reasons and, to help you and the family be at peace about providing his needs.
It sounds like he may surely be in denial about his health status, perhaps grieving his health status, or maybe trying to be " protective" of family still..... There could be any number of things contributing to his refusal to allow family to go to PCP with him. However it does come down to safety issues.
You can always confer with an Elder Law Attorney about the dynamics to be more informed about the circumstances around caring for aging. The PCP should be able to provide the family with a " level of care needs assessment" for your father, assign a Geriatric Case mgr or Licensed SW to him , to further determine what level of care is needed to provide safety, medical, emotional care for him. Does he live alone now? If so( or if he is living with someone ) and, you feel he is unsafe and being non compliant or in denial about his condition, you can as last resort ( or sooner if you choose) make a call to APS , Adult Protective Services, and report the situation , APS, will follow up and go from there. If your father is A/ O, cognitively appropriate and able to follow and retain a conversation, you can also inform him that if he continues to deny you or other designated family member access to go to PCP with him to be a part of his health care, then you may have to call APS, and let him know what the potential ramifications of that could be. Maybe that would get his attention.
Practice self care!
Do you have appropriate and pure motives?
If you don’t, and you write such a “letter” you better believe it will be part of the permanent “record.”
Our OP has given us absolutely no information her, as to what, in her estimation, is going on here.
Of late I find that the Forum is getting some questions that look a bit like the entrance to the rabbit hole, and many of us are jumping right in and have long, repetitive discussions, and even argument, as to what the "possible problems" and "motivations" are. And we cannot know this without a good solid question, and without good responses from our OP.
You are correct that a letter to an MD would be noted in his files as to who wrote it, when, and what their major concerns were. And the MD would almost certainly DISCUSS such a letter with his/her patient (if competent).
I think I was "first responder" on this question, or close to, and honestly I just asked a few more questions of our OP. As you will not, he/she didn't return to answer, nor to comment on thread.
Prayers
There's more to this "I'm safeguarding everyone's" story. Was the License Loser provided with a list of "Senior Ride Services, cabs in the area, bus schedules and/or given phone numbers of friends (yours and hers) who might provide a ride in case of a minor emergency. Some seniors become pretty upset when a pet becomes injured. Did you provide a Life Alert gadget to wear? Have you checked the senior's home for impediments to their leaving quickly? Do you have the phone numbers of her neighbors? Do they have yours? Is there a list of important phone numbers on the back of the front door? What about a POLST sign (bright pink) which tells firemen whether or not to resuscitate? They will do that if you are unconscious. Think possible cracked ribs. Investigate, be proactive and get prepared for a number of scenarios. It could happen to you one day.
Just had another friend (86) tell me that driving was the last bastion of her "Personal Freedom." I've heard that one before. I was telling her that I can ride with the various services every day of the week for less than my monthly car insurance. Add in gas and maintenance and it doesn't make much sense to me. She said her $146 a month was worth her "Personal Freedom." If you don't live in an area that has these services, maybe you could have someone be "On Call." for a fee.
Good luck with your family's journey. It's just beginning.
If your dad has not set up his you could probably do so and use that to communicate and actually see what is going on. (It would be best if you are listed on his HIPAA form as one that can get information from the medical office.
Without the signed HIPAA form YOU can communicate but they can not inform you of any information.
(Having you or someone listed on HIPAA forms is important as the hospital could give no information until he gives permission if he is brought in as a result of an accident)
Not sure I understand what your aim is?
For the Doctor to observe what you observe?
To hear your concerns?
Or for some type of action to be taken?
My experience is that a primary often will not assist. Rather than spend your time trying to get in to see the primary, I might forward him a note for a referral to a neurologist where he could possibly get the correct evaluation and medication for his condition.
What do you mean by "at risk".
What symptoms are you seeing?
If you are not Medical POA you have no right to communicate with your dad's MD. That is to say you are welcome to communicate if you see CLEAR SIGNS of something; but don't expect an answer. The MDs ALL evaluate any seniors mentation on any office visits and have clear ways of doing so without seeming to.
Without having medical POA, you will not be able to receive feedback from your father’s doctor about his condition.
Best wishes to you.