My father is 84 years old. He has dementia. His internist has given him a diagnosis of Alzheimer’s but didn’t mention which stage. From my father’s history and current state, I’d say that it’s actually mixed dementia - primarily multi-infarc (small strokes leading to cumulative damage) and Alzheimer’s. Reading the criteria, I’d judge him to be at Alzheimer’s Stage 4 (moderate).
I’ve been his primary caregiver over the last three years. My mom works full time plus 90 miles away, so on the days she works, she’s gone all day long. On the days she’s here, she takes care of Dad, except for the rare occasion when we can do something together.
In January, my older brother was laid off and moved in with us. In February, Dad’s mood became more erratic. In late February, he had a trans-ischemic attack, spent two days in the hospital, another two weeks being followed up, and his doctor has declared him unsafe to drive. Knowing that we couldn’t trust Dad not to drive, Mom took his car keys.
Since then, he’s become extremely hostile towards me - refusing to take his medications, refusing to let me get his blood pressure, accusing me of stealing or hiding things, and today he announced that I was no longer welcome in his house. Luckily, older brother has been able to step into my role and jolly Dad into taking his meds. However, the progression of his dementia has accelerated so rapidly, that there’s no telling how long that will last. (Two hours after telling me I wasn’t welcome, he included my brother in this and said if we are here in the morning, he’ll call the police. An hour after that, he was fine with us, but implied that he would be divorcing our mom.)
This is what we’re working with.
His short term memory is toast. He does not remember conversations from the previous day, sometimes from the previous hour. He does, however, seem to retain some sense of emotional context, so if the conversation did not go his way (“Give me the keys.” “No.”), he is angry for days afterward, even though he doesn’t know why.
Because he doesn’t know why, he’s started to confabulate reasons (she stole my wallet, she stole my keys), and he becomes uncooperative, hostile, and mean as a snake. Last night, he destroyed a dry erase board I put up months ago to track where family members are. Will he become physically violent towards me or someone else? A week ago, I’d have said no. Now, I think it’s quite possible.
His ability to read, write, and do math have taken a big hit. He can’t focus on simple tasks like dialing a phone number or using the tv remote anymore. It takes him multiple tries to get what he wants, and he often gives up out of frustration. He can still get showered and dressed, but it takes longer and longer. He can feed himself, but we do everything we can to keep him from cooking, as he’s nearly caused a fire on two occasions.
He has sabotaged medication by pretending to take it and then setting it aside or throwing it away. If alcohol is available, he will drink it, often up to a bottle of wine a night. He’s become restless at night, getting up, checking all the locks, wandering through the house.
Because of his complete denial regarding the severity of his health problems, he never agreed to a durable power of attorney or an advanced directive. So, there’s no easy route to have Mom take over. There’s absolutely no way he will agree to one now, as Mom is “The Enemy”.
Medical incompetency and legal incompetency are two completely different creatures. According to his doctor, Dad is now incompetent. According to state law, he is competent until and unless someone files for conservatorship through the probate court. That requires a fee that may be outside my mom’s financial means at this time, then a doctor’s report, then a court investigator interviews both Dad and Mom and anyone else involved, court investigator makes a report to all involved parties, the judge holds a hearing, and a decision is made. It’s even possible to have a jury trial.
Dad is retired military, gets Social Security, and is on Medicare. For acute medical problems, he’s completely covered. Nursing home is another matter and one that would financially wipe Mom out, and she’s not even retired yet.
And that’s where we are. Well-intentioned advice and fellow experiences are welcome.
