What type of in-home care for people with dementia and anger management?

We did see his primary care Dr last month when he had a bad cold and his night time cough was concerning. That was a day or so after he had brought the first bottle of wine home. He asked me if I knew where the bottle opener was. He said that he thought that having some wine would help him feel better. I told him that it wasn't a good idea. And I did tell his Dr about that, awkward as it was, and I said that I didn't think that it was a good idea for someone with dizziness issues to be consuming alcoholic beverages. She did tell him that she thought the same, but I wish that she would have been a little more aggressive about it and maybe lecture him a bit. I felt like she didn't want to get involved.

I don't know about his mental diagnosis. I believe that it is agreed that he has memory issues, and he has not been diagnosed with Alzheimer's. I know that when I spoke to the county dementia specialist (she is not a Dr, just an advisor for families who are dealing with memory issues), she said that that didn't really matter because they all have many similarities, even though they are different. So I don't know if the word dementia is appropriate or not...I know that he has short-term memory issues that seem to be getting worse, yet at the same time he can remember certain things like when he was in the military for a few years after graduating high school. He has so many different issues that I guess that I don't know what to call it. Should I refer to it as multiple mental issues instead of dementia? Or cognitive issues? It really is hard to know just what is responsible for his symptoms.

So maybe I had better re-type the letter that I was going to give to the Dr tomorrow- we will see her on Wednesday. She works in the same small clinic as his primary Dr. The dementia specialist/advisor said that this other Dr had been at some of her meetings so she thought that she 'might' be more familiar with these things.

I am a lot stronger than he is and he loses his balance easily. I did not push back at him- just put my hands up so he could not get at my neck. Still, the fact that he 'tried' to do it is bad enough. It is the only such incident in the two years since my mother passed. Normally I walk away but when it comes to bringing alcohol in the house after not doing so for 4 years, I absolutely will not put up with it. Even though he already has anger management issues, the alcohol probably exacerbates it. My late mother had a horrible time with him when he was drunk but didn't want to confide in anyone outside of the house about it. Their generation was like that. I worry about him passing out with a cigarette, even though we have fire detectors. And his driving.

My brother did give him a good talking-to last Friday and so far my father has been pretty quiet and leaving me alone. I told my brother that if I had talked to my father that way, he would have come at me but since he is a guy my father didn't do the same to him. But he was still argumentative and kept saying that he didn't want to talk about it just like he is when I want to establish ground rules and boundaries about his behavior. My brother told him that they HAD to talk about it, otherwise I would have no choice but to move out. I have always considered my father to have a sexist attitude towards women, but that was probably pretty common in his generation.

BTW, many caregivers in my support group carry business style cards that say something like, " Thank you for your patience. My loved one has dementia." I sincerely hope you won't be together long enough to need these, but I pass it along for what it is worth.

AVOCADO1, you say your father has dementia. Is that a medical diagnosis or your own observations? If he has been diagnosed, I think you need to get back to that doctor or whatever doctor is following his dementia and report this angry behavior. If he has not been medically diagnosed, I'd address that as soon as possible.

Almost every symptom on that list of dry drunk could also apply to dementia! Poor Dad. He has so much going on with his health, and very little control over all of it. Poor you, having to deal with a person you love but who is seriously impaired so that he behaves very badly toward you.

I am afraid at this point that any anger management will have to come via medication. He isn't going to learn anger management. This is why input from a doctor qualified to deal with dementia is critical.

Living with this man, regardless of how much you may love him and wish him well, is dangerous. No one should put up with abuse, whether it is caused by dementia, past alcoholism, a concussion, overuse of Vicodin or any other condition. Regardless of what causes his anger you would be equally dead if he strangled you.

I think you and your father need to separate as soon as possible. Get medical attention for him. Also see your lawyer as soon as you can. They can go over the POA documents with you and explain them paragraph by paragraph. Exactly what authority you have under what circumstance depends on how the documents are written. Ask the lawyer about about calling 911 the next time Dad is headed toward violence, and then using the Baker Act to have him evaluated. Ask them about what measures you can use to protect yourself. But do this very soon! That environment is not only toxic, it is dangerous to the point of being life-threatening.

I think you are right that finding a suitable placement for him is going to be difficult. But if he is appropriately medicated and the staff is experienced, it could work out. Perhaps if you are only a visitor and not the person prohibiting alcohol you could reestablish a cordial relationship.

Do update us on this as it progresses. Many of us will be worrying about you!

She is considered a dementia specialist for area counties- it is called the ADRC- Aging and Disabilities Resource Center. One of the things that she gave me was a list of eldercare attorneys, and the one that we dealt with, who drew up the POA documents, was on that list. I have heard that when it comes to $$$, homes and other assets, that the state will try and make things very difficult. And I have heard that POA documents can vary from case to case, and until I get a chance to speak with the eldercare attorney, it is hard to know who is right. And I need to find out what the consequences are if my father goes into a facility, or if I move out and get him in-home care. The dementia specialist encouraged me to stay in the home with him until at least the 5-year lookback period regarding the house is met. But that means that I would have to possibly endure almost 4 more years in this toxic situation.  My brother said that he would not tolerate it if it were him, and he is right. And the house would need a lot of work before it could be sold anyway, and there are about 46 years of accumulated stuff inside. I wish that parents would start getting rid of things when they are getting on in years so as to not leave a mess for their children to clear out. But whenever I talk about getting rid of anything, my father disagrees and I will not give him a reason to be abusive to me. It would really be better if he went to a facility so I could get to work on the house, assuming that it wasn't going to be taken away immediately. I do not know what would happen.

You may want to consult another Eldercare attorney and see if his/her opinions agree with the first Eldercare attorney that you talked with. What are the qualifications (nurse, social worker, doctor, lay person) and duties of the "county dementia specialist"? Is the person elected or appointed to the position and how much authority does he/she have in determining the future of your father's care? I am unfamiliar with this specialist.

SueC1957

That does sound like it could be the case. Because of the fall in the parking lot and the concussion, and then being in the hospital and nursing home afterwards, he never did go through proper detox. He was forced into it. And I am not aware of anyone ever speaking to him about addressing the alcoholism afterwards. My late mother insisted on having no more alcohol in the house after the incident. And he is still in denial about ever having had a drinking problem, even though his blood test showed that he was intoxicated at the time. My late mother also told me that they were once stopped by the police when he was driving erratically. She said that the cop told him that he was drunk and scolded him for endangering his wife's life. But the cop let him go with just a warning, and I am sure that my father has no recollection of the incident.
And he definitely has a selective memory. Ever since his recent attempt to strangle me, his version of the incident is that I pushed him for no reason and it is all my fault that he fell and scraped his elbow. I am sure that this is what he will tell the Dr that we see this week. I have a 2-page letter written up and hopefully I can get it to her tomorrow, a day before our appointment.

Avocado,
I'm not sure if you're familiar with this. Maybe your dad has Dry Drunk Syndrome (defined by alcohol rehab.com) as;
The term 'dry drunk' is believed to originate from 12 Step recovery groups. It is used to describe those who no longer drink alcohol but in many ways behave like they were still in the midst of addiction. The dry drunk may be full of resentment and anger.
Dry drunk is a slang expression infamously known in the sober community. It describes a person who no longer drinks or abuses drugs, but continues to behave in dysfunctional ways.

From americanaddictioncenters.com;
Symptoms of a dry drunk include;
Resentment toward friends or family.
Anger and negativity surrounding recovery.
Depression, anxiety, and fear of relapse.
Jealousy of friends who are not struggling with addiction.
Romanticizing their drinking days.
Being self-obsessed.

It's horrible to have alcoholic parents. Please be concerned for your safety. If he can't live alone, apply for Medicaid and get him into a facility.

Yes, I agree that it is obviously a very toxic situation. And lately, all I hear from people, including my sister who conveniently lives halfway across the country, is that the solution is in-home care so I can get breaks. What kind of in-home care?! And would they put up with him for very long? It is on record that he cannot live alone, and so far, he agrees with that. He cannot pay bills or deal with finances- my late mother handled all of that. And the Joint Tenancy with a 5-year lookback is confusing...my late mother wanted me to inherit the house and it would need a lot of work done before it could be sold anyway. Every room is full of 50 years of accumulated junk and my father becomes argumentative when I talk about getting rid of things. It would need painting, maybe new carpets. I would like to get started on clearing things out because, at age 58, I am not getting any younger either. But he would have to get out of the house before I could even get started. It will be a major chore.

If it were up to me, I would like to see if he could be put in a local assisted living place where I see there is a men's memory care unit. I don't think that he would last very long in regular assisted living because of his insensitivity and lack of consideration for others. He was in a nice rehab place earlier this year after being in the hospital for heart issues. Just in the short time that he was there, he had managed to alienate some of the other patients and they didn't want to talk to him. He also had found part of a cigarette in a pocket and had smoked it in the bathroom. They called me about that...like it was my problem, even though I had told my father that smoking wouldn't be allowed.

Oh, and the inappropriate joking and interrupting other restaurant diners is something that he does while I believe that he is sober. He is bad enough already, even without the alcohol.

After the fall that caused the concussion, he had agreed to have no alcohol in the house. He could only have occasional drinks at restaurants, but I think that that is a mistake. And recently, he was wanting to go to restaurants more often, even though he eats very little. And I am sure that he wants to go to restaurants more often just so he can drink. And as I mentioned before, he has been bothering other diners and causing scenes so I don't plan on taking him out to eat anytime soon.

When he brought the wine home, he has said different things about what the wine was for. One time he says that he just wants to have it on hand for visitors (which we rarely have), another time he said that he thought it would help his cold feel better. He will say that he would never consume alcohol in the house, but then said that he could drink at home if he wanted to. So he was pretty good for 4 years, but lately he has had a renewed interest in alcohol.

He will tell anyone who will listen about his fall, the concussion and dizziness to try and get sympathy because now he can't do things like gardening due to it. But he of course always leaves out the fact that his blood alcohol levels showed that he was intoxicated. He also had been given inappropriate amounts of Vicodin by his Dr at the time.

Is your dad secretly drinking also? 

My dad was an alcoholic too. He would do anything to get booze. My ex-husband felt sorry for him and would sneak it into the board and care home!

You must remove either him or yourself from this situation NOW.  You know it's not going to get any better. My dad was Jekel and Hyde too, a wonderful man when sober but a son of a * when drunk. He threw a lead crystal ashtray at me as I was running out the back door. Made a good dent in the wood (thank God not my head). You are not safe. 
You say your father can do his own care. Then let him. 

You owe him nothing. Don't buy into guilt. One of you has got to go. It's not abandonment, it's safety.

The dizziness and memory "issues" are a result of the alcoholism. My dad had those too. Directly related to booze, not the concussion.
Please report back soon.

 I am also kind of fuzzy on how much authority I have because I have had conflicting opinions between the Eldercare attorney that I dealt with and a county dementia specialist who told me that I could only make certain decisions if my father was declared mentally incompetent and I became his guardian.

He also has ALWAYS, his whole life, had a Jekyll and Hyde thing when it comes to how he treats his family (verbally abusive, inappropriate anger responses), but was always much more civil when in the presence of neighbors and at Dr appointments. The Drs do not see his angry outbursts and inappropriate behavior at restaurants. They think that he seems fine and rational when we go to appointments. They don't see the REAL person.

He actually did try to come at me physically recently when I kept telling him that I absolutely did not want any alcohol in the house. He had brought a bottle of wine home for the 2nd time in a month. He got up out of his chair and his hands were just a few inches from my neck...he was going to strangle my neck if he could. I put up my hands to resist him and he lost his balance and fell on the carpet, scraping his elbow which bled because he bleeds very easily. 

We do have an appointment with a Dr this week about some paperwork. And since the recent incident, he is telling everyone that I pushed him, and totally denying that he had attempted to strangle my neck. I am sure that he will do the same with the Dr this week.

You need to get him evaluated. My Mom hit her head needing stitches and staples to repair the wound. She also had a concussion. It started her journey with Dementia. Still having dizzy spells should be questioned. Was your Dad like this before? If not, than definitely needs to see a doctor. If worse than his normal self, needs to see a doctor. He could get violent to you.