Up until yesterday. I thought my 93-year-old father was quite sharp for someone his age. He lives in the Independent Living area of a facility. He listens to the radio & watches TV, keeps up with major current events & has maintained a dry sense of humor. Also neither my brother or my husband have noticed any changes in him. Recently, some repairs/adjustments were made to his apartment which had been requested months ago. When his bathroom vent fan was taken out in preparation for a modification, he told me that "the guy came in, took it out & said nothing", meaning he was not told why the fan was taken out, what would happen next, etc. However, during a spontaneous conversation with the director, I was told that dad WAS given a detailed explanation.
I also handle his pillbox, which lights up when it's time to take a particular med. I was told that housekeeping has found pills in his linen when doing the laundry. Dad has always been particular about his med regimen. I briefly discussed these things with him & he insists that no one gave him any info about the fan. He also said he takes his meds when the pillbox lights up. These are just a couple of examples that I've been told that are very disturbing, if true. I even asked the director if he had him confused with someone else! I spoke to the head nurse who is concerned especially about the meds. I requested that she set up a cognitive eval for him.
My concern is: who is telling the truth? As a retired RN, I'd like to think I would see these kind of changes myself. How do I tell him about the cognitive eval without scaring him? How should I proceed otherwise? I'm not sure who to believe.
When I found random pills on the floor, we realized what he was doing and had to have his medication supervised.
My Dad generally appears to be all there cognitively. He sits at the table and organizes his pills. He takes them as scheduled throughout the day. However I find them on the floor, tucked under the edge of his place mat or under a napkin.
The cleaning staff have no reason to lie about finding your Dad's medication in his linens. Dad is telling his truth, then the medication dispenser lights up, he takes the pills out. But he may not take them right away. He may put them down, while he gets a glass of water, then get distracted.
My Dad appears to be 100% all there. He is also very defensive if questioned. It is very hard to see the changes in our own parents. Even for a retired RN like yourself. You want to believe Dad is 100%, when the evidence clearly shows differently.
No one in my moms extended family wanted to believe she was sick. I am not sure why they thought I would make it up, but they would say to her...you remember me giving you $100 for your birthday don't you? And she would respond yes. Or they would say don't you remember that kid Jimmy that lived next door to us when we were growing up and she would respond yes. So they would say, see... she is fine. Just recently though, my uncle asked my mom what his name was and she couldn't come up with it....he finally dug deeper than a yes or no answer. He was shocked that she didn't know her own brothers name.
My point in telling you all of this is so you will dig a little deeper. Take him to lunch and then ask him the next day what he had for lunch when you went out. Ask him the name of the restaurant you went to. Give him something to read and then ask his opinion on the matter.
I can certainly see a worker knocking on your dads door and saying I am here to work on the fan that's broken...and not go into much more detail than that. But I don't see why the workers would fabricate finding meds in your dads bedding. What would be the point?
One of my moms neighbors in the Assisted Living Facility kept saying that the employees were stealing his things so his son installed a camera in his apartment. So the next time he told his son that his bag of toiletries from walmart was missing, his son looked at the video, saw his dad hide the bag behind some things in a closet. He looked in that spot and there were the items. His dad had just forgotten that he hid the items.
It is a horrible thing to accept that our parent is not the same and on the decline. Your RN status does not change the fact that you you have been around this man your entire life and you expect him to act a certain way .... you are on auto pilot with him just as much as he is with you... Just dig a little deeper...take him out of his routine and see what you see...
The cognitive eval is not a bad thing. Just tell him the facility is going to have a visit with him to see how things are going.
The fact that there were some pills in the bed means that he DID open the pill dispenser when the light went off. It's possible he just needs to be opening the box at a table where you could easily find one that you dropped.
Sometimes we are too close to the situation and do not see what is right in front of us. It is always harder to accept decline when it is someone we love, when at work, people are at a arms length away...totally different.
I just took my step mother for evaluation, she didn't want to do it, I told her that we need to know because we want to keep her in AL and not have to move her husband into into MC. She said ok. Although I do know when he passes that is where she will have to go.
Good Luck hope that he will agree to go!
Pills in the linen - how fiddly are they, and how easy is it to get them out of the dispenser? One thing I have noticed (mainly male) people doing is shaking all of their tablets (and it's sometimes as many as eight or ten) into the palm of their hand, and then clapping the palm to their mouths, whammo, just like that, to get the pills down in one. It makes my hair stand on end. If any one of those little tablets goes astray down a shirt front or between the chair cushions I have to track it down, identify it, and record the mishap on a chart, and it is a gigantic pain; but we're not allowed to tell people how to take their tablets if they're doing it themselves. The other thing that commonly happens (more with blister packs) is that the pills are tiny and the tray is deep, and one or two get overlooked.
So if possible, can you be there when your father takes his medications and just observe him without comment? You might spot where the problem is and be able to make a minor adjustment, nothing at all to do with cognition (unless you count not being as punctilious as he might be about his meds).
So I'd just tell him that they've found pills in his sheets and under the bed and are worried he's having trouble with them, and that's why they are checking his cognition. Just let him know that you realize he may be dropping them inadvertently, and that you think he's very capable, but that you still need to help find a solution to the problem, and that besides, a cognition test is an important measure of how he's doing (can be used as baseline, as someone else suggested).
Reassure him that he's not "losing his grip" (as my dear, sharp, grandmother used to worry) and that no one is trying to take away his autonomy. You need him to feel he can trust you and the best way to do that is to assume the best of all parties involved and be as upfront and caring as you can. I'm sure if he's as sharp as you say he is, he will be able to reason through all this.
The repairman came in and took the fan, but director says dad given detailed info. Unless the director was the one sharing the info, she has no idea what the repairman said.
As for the pills, dropping them can happen. My mom is very alert about her meds and knows each one to get out of pill bottles each day. However, there are times I'll find one under or around her chair. It dropped, she didn't realize it as it went from hand to mouth and she missed a pill that day. If he has a kitchen table to sit at, put the med box there and let him know it would be easier to find it if it dropped. Just let him know that if he accidentally drops one, it can cause him problems.
I wouldn't do an eval on him right now. You just told him a repairman explained something in detail (that may not have happened) an talked to him about missing medicine (which he is really not forgetting to 'try' to take if they were found outside the med box). First observe.
The SNF now crushes her meds and adds apple sauce.
i didn’t request the crushing of her pills but I’m glad they do it because
it assures she’s getting her meds, and one less thing for me to worry about.
Her dementia has gotten worse in the last year, and even though she’s on dementia meds, along with mood stabilizers it makes me wonder how would she be without them.
Good luck with your dad. Sounds like he has kept himself together for Many Years. My LO is only 67 years old.
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