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.
As far as the eval scaring him, it might not. You can just present it (or the staff can) as a routine thing. No one told my grandmother that was what they were doing, but she told us later that she could tell they were testing her memory and she was super proud that she showed them! One of those moments I just had to laugh at.
That little incident taught me something important: FACT CHECK EVERYTHING THE LOVED ONE TELLS YOU. Call the AL right away with ANY question you have, ANY claim that's made about anything that sounds in any way fishy. Get the real story from the staff and then you can let it go.
For those of you who insist there is 'no such thing as truth from the staff' at an ALF, that is false. There IS such a thing as the truth if you find the right ALF for your loved one. Not everyone is evil and out to hurt us. Not everything is a conspiracy. There ARE good and kind and loving CNAs, nurses and EDs who have devoted their lives to the care and nurturing of our elders. If you haven't found that, it doesn't mean you 'live in a small town' or that you're 'NUTSO' or that you're naive. It just means you need to continue the search for the RIGHT place for mom or dad.
As far as the cognitive eval goes, I have sat there and watched my mother go through no less than 8 of them. They're no big deal; they take about 15 minutes. They are not going to ask your father ridiculous questions like the square root of a number, or who was president in 1888. They ask a couple of memory questions; they will mention 3 words like cat, house, book, asking your dad to remember those words. Then, about 10 minutes later, they will ask him what those 3 words are? Then he'll be asked to draw a clock showing 4:00 or whatever. That is to test executive brain function, which is like the conductor of the orchestra. If the EB function is diminished, then the rest of the orchestra doesn't know WHAT to do, if you see the analogy. My mom drew some blob on the paper that had NOTHING to do with a clock at all. That's when I KNEW her EB function was gone and THAT was why she was having struggles with everyday life! The test is not designed to harm but to help. Laugh it off with your dad, sit there with him and smile. Don't turn it into a federal case and it won't BE one.
Wishing you the best of luck moving forward. This is not an easy disease to deal with. Allow common sense and above all, COMPOSURE to prevail. Hysterics and over-reactions are commonly advised here on this forum but rarely warranted.
Dementia and ALZ patients have this type of behavior. I know others who lie or put on a show without any dementia. They are attention seekers.
They know they are lying. They get caught in lies all the time. Personally, I think some people are bored, some love drama, some love the attention, etc.
Why do you think some people refuse to join in the available senior activities? Asking you because you see their actions on a regular basis so I feel you know more than most people.
Please tell us why some people stay in their rooms or stay at their homes and isolate themselves. Then they get bored and stir up crap to entertain themselves.
Even I, who was probably the closest person available who knew her, was somewhat shocked when objective assessment was undertaken, and her degree of loss was revealed.
See what happens during the cognitive test.
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.
I must add that after this aborted evaluation, her doctor said that at her age (91) she wouldn't be submitted to hard treatment anyway, so we let it at that. It's been 3 years, her decline is slow. I moved in with her and help with what needs to be done.
In our case, I sat behind my LO in a relaxed and somewhat familiar environment. I was able to signal the examiner if responses weren’t accurate.
The “text” was conversational and informal. I had not mentioned to my LO that she would be tested, and in my experience, and particularly with her particular difficulties, that was better for her. I wonder if your mother might have managed more comfortably if the same approach had been used with her.
Your point about collecting information for meaningful, practical reasons rather than demonstrating deficits is, in my opinion, VERY important. In our case, the examiner was able to determine that my LO was struggling in many social and life skill situations and needed much more support than we as her family, had suspected.
The exam results were interpreted to me immediately, and a follow up documented printable description of her test results and observed behaviors became a valuable tool in setting up what was needed for her new life in Assisted Living Memory Care.
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.
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.
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.
As far as whats happening with his meds in particular, we use an overhead camera for my mom mainly for just this, to make sure she takes and gets all of her pills. When we first set it up she was a bit more independent than now and still using the long weekly pill cases but it's even more important now. All her medicine is kept on the one table which sits next to her big main table and the camera is overhead. It is motion sensitive so every time there is motion under it, so she reaches for anything on the medicine table, it saves a clip and we can go back and watch when she took her pills for instance. If you can set something like this up in his room maybe and then be able to look back or peek in when he takes his pills to see hows he's doing it. This way you have some oversight and assurance without him feeling like he's loosing his independence. My mother by the way has known about the camera from the get go and it doesn't see the entire room we have it framed just over the tables and were careful about her privacy but she has become accustomed to it and comfortable about it all now, in fact she counts on it now so I am not suggesting to do this on the QT but you also don't need to bring it up after installing unless there is a problem. With your dad being in AL though I'm not sure if they will have something to say about it.
Or the staff wants to take care of the meds so they can charge the family for that service. Yes, but it may be helpful...
They will cover up for one another and misrepresent things to "pacify" the seniors advocate. Don't assume that they wouldn't lie or don't have anything to gain, how about a mew AL resident that has to pay thousands more monthly.
Do you own due diligence and confirmation of the facts, maybe test dad with some information, have blood work done to test for the levels of medication in his system.
Best of luck sorting fact from fiction.
Were any of the other examples less easily explained than those two?
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).
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.
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!