My father is 78, living alone, fell and couldn't get up. He was found 3 days later dehydrated and septic from his calf injury blood flow, clot?
Sepsis causes mental confusion.
He spent 2 weeks in hospital to get infection treated then he was transferred to nursing home for rehabilitation/physical therapy. He needed to learn to trust his legs again.
My sister (his POA) and I knew that living alone with no safe guards was no longer an option for him...We were scrambling to find safety measures for him when he got back home.
Then the nursing home social worker said he had advanced dementia and could not live alone anymore. One doctor signed his POA and a 2nd doctor refused to sign. My sister and I stopped looking for ways to live safer art home and started touring assisted living facilities.
The nursing home justified the advanced dementia (undiagnosed) but in their experience is advanced dementia. The scores they referenced were:
MoCa 15(out of 30)
SLUMS 8(out of 30)
We went to aging and disability for advice and to learn how to communicate with him. Now that he has Dementia, never say NO, always redirect, just never say the word no! Talk like a politician answer something different than was asked or discussed. Watch politician interview to learn how to do it.
AGDR center advised we get another doc to sign his POA. So we went doc shopping, it was a disgusting feeling. His PCP refused to sign said he could continue to drive.
Long story short. He is back to living at home alone and just how we started, we r looking for ways for him to live safer at home which he refuses. He is isolating a great deal now, before fall he was a very social person.
I got him a jitterbug phone which he refuses to use and a fall alert necklace that he also refuses to use.
He loves driving, just driving...he's going to have mind blank and not be able to get home or tell us where he is. His cell phone has become too difficult for him to use and he won’t touch a smart phone or his new fall alert necklace.
We have taken a picture of him to use in a silver alert, but if he would just use the phone or fall alert necklace the silver alert would never happen.
My sister and I split the week, we are determined he will never lay on the floor for days ever again. One of us stops in every day, on my days I wear the fall alert necklace hoping to normalize it for him.
Since my sister is his chosen POA, she has final decisions about everything--she listens to me, we brain storm she just has final decision.
As far as my days to visit him. I am the daughter not liked. He yells at me a lot. I kind of do my days for my sister so she doesn’t get overwhelmed. I'm the one who footed the bill for the fall alert and jitterbug. It is very irritating that he dislikes me so much.
But if I met your Father PRIOR to the bad fall & sepsis how would I have found him?
- Memory ok?
- Coping with his daily tasks?
Activities of Daily Living (ADLs): bathing, dressing, shopping etc
- Able to manage/take his medications?
- Having insight to his limitations?
- Risk taking not too bad? Eg driving safely?
Maybe an older man set in his ways? A little stubborn?
But being stubborn does not mean dementia. Neither does avoiding change or making bad/poor decisions.
Sepsis is a big deal. It can take a person down & they don't come all the way up again...
Sepsis (like other infections) can cause delerium in the elderly. It would be tragic to have him diagnosed with DEMENTIA if this is a temporary DELERIUM.
"social worker said he had advanced dimentia"
A social worker is not trained to diagnose this.
Dementia is a progressive life limiting condition. While delerium can look very similar & also show deficits on a screening score - it CAN lift. (But not always sadly).
Not wanting 'strangers' & 'stuff' eg housecleaner, alarm pendant is human nature. Some will adapt & accept as they age. Others hang on to their independence with a firm hold. Depends on personality.
I suppose I would advise to keep checking in.. share with sister sounds good. Introducting a 'friend' as a housecleaner will be better. Sneaking in the housekeepers 'friends' to help even better 😁
But regardless of label (dementia/delerium, even depression) increasing the safety is what to focus on now. As you have done.
Keep reassuring your Father he can choose, he does have control. But choices have consequences.
- Choosing home help may help him stay home longer.
- Refusing home help may increase his chance of an adverse event having a more serious result.
My LO is also shall we say 'a change avoider'. Would not accept personal care until too many bathroom falls. Would not accept chaperone until falls using taxi. Would not accept falls alarm until left on floor for hours. And on it goes.. even the most stubborn CAN change their minds!
Regarding the driving... please understand that him getting lost is the least of the worries. If he is physically compromised and not as alert, and his reaction times are slower -- he can cause an accident. My 90+ yr old uncle should have had his driving skills retested but his children didn't want to "anger" him. He went through a red light and got t-boned by a car, killing his wife of 60+ years who had survived cancer. Thankfully the other victims weren't seriously hurt.
You can anonymously report him to his state's DMV online. They will send him a letter informing him he needs to come in for a retest (eye test for sure, maybe behind the wheel). No one shoud take him for this test. Let his license expire. Then cancel his car insurance and disable the car so he can't drive. Many seniors continue to drive because they are angry and in denial. Make sure he has rides to his appointments and to do errands.
Also, I found this guideline helpful:
Rules for engaging our loved ones with dementia:
1) Agree, do not argue
2) Divert, do not attempt to reason
3) Distract, do not shame
4) Reassure, do not lecture
5) Reminisce, do not ask “Do you remember…?”
6) Repeat, do not say “I told you”
7) Do what they can do, don’t say “you can’t”
8) Ask, do not demand
9) Encourage, do not condescend
10) Reinforce, never force
The overall goals should be to:
1) keep them as calm and peaceful as possible
(because they are less and less able to bring themselves to this state on their own)
2) keep them physically protected in their environment and from predatory people
3) keep them nourished with healthy foods that they will accept without fighting or forcing
4) keep them in as good a health condition as is possible, that their financial resources will allow and within their desires as expressed in a Living Will (aka Advance Healthcare Directive)
5) keep them pain-free as possible and within their desires as expressed in a Living Will (aka Advance Healthcare Directive)
The caregiving arrangement needs to work for both the receiver and the giver. If it is onerous to the caregiver, then the arrangement is NOT working. Alternative types of care must be considered to avoid caregiver burnout.
I wish you clarity, wisdom and peace in your heart as you help him through these times.
Google Understanding the Dementia Experience by Jennifer Ghent-Fuller and download the 33 page booklet. It'll help you understand dad's world and also give you some useful tips to help you deal with him.
Best of luck to you
Did he have a stroke?
Can continue to trial aging at home as Plan A.
However, behind the scenes keep working on Plan B. Tour some places with your sister. Find out costs, entry criteria etc. Be 'ready to roll' as one Social Worker told me.