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Hubby took his dad to his neurologist appointment at the office for the first time in a long time because of the pandemic. Turns out that the neurologist had been doing Facetimes with FIL every 3 months or so and hubby had no idea that he wasn't actually being seen and examined by the neurologist, who came highly recommended by a family member.


Neurologist did the mini mental and FIL's score dropped from 26/30 two years ago to 21/30 now.


FIL moved into the assisted living wing of his building! (Yes, forum friends, we got it done and the charade of independence finally came to an end.) But the neurologist said that he should have the full-time aides he had in indy living and that "all assets should be liquidated" to pay for "this time that he still knows where he is" because, once he doesn't, "it won't matter what sort of nursing home you stick him in".


My husband is his dad's POA both medical and financial and manages all of his father's affairs because he can't do any of that for himself anymore. FIL's primary care doctor agrees with assisted living.


What say you about what the neurologist said?

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For a so called "professional doctor" to say, "it won't matter what sort of nursing home you stick him in" once his dementia advances, is beyond out of line in my opinion and a sign of ignorance and cruelty to boot. My mother knew damn well she didn't live in some third rate nursing home when her dementia was advanced bc she loved "her girls" in memory care who treated her with love and respect. She always knew that I was working my butt off to keep her OUT of a warehoused care situation and comfy where she was at, not sharing a room and a toilet.

So many people seem to think once an elder gets dementia that they have no feelings, no mind at all left, that they're just incapable of emotions and have no idea what is going on, which is a fallacy.

Your FIL belongs in memory care AL where full time aides are not required due to the better ratio of caregivers to residents. Why would this doctor not recommend such a placement and suggest FT aides at exorbitant costs instead????
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NeedHelpWithMom Mar 2023
Absolutely, all of our parents deserve to have respect by their caregivers and be able to maintain their dignity.

I will always be grateful to the caregivers who cared for my mom in her ‘end of life’ care home.

The nurses and aides treated her and our entire family with warmth and kindness.
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Neurologist’s comment was completely out of line. Doc needs to stay in his lane, which is to provide care. Your FIL is still a human in need of compassion and care, and will be until his last day. It absolutely matters what kind of care he receives. Wonder if doc would be content for his family member to be stuck just anywhere
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NYDaughterInLaw Apr 2023
Thanks, Daughter. I think that's the right approach to dealing with him i.e. "Stay in your lane". This neurologist strikes me as very cold and not at all genuine with his whole "Hey, buddy" and "Hi, champ" schtick with my FIL.
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A lot of doctors are horse's patoots in my opinion. The nurse or P.A. is who you want to make friends with.

That reminds me of my first OB who, when I told him the anesthesia was wearing off and I could feel him putting in stitches told me, "OK, I'll sew faster." 😡
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NYDaughterInLaw Apr 2023
I agree completely that most docs are worthless. The ones who actually provide valuable insights are worth holding onto.
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I think the neurologist was out of line telling your husband to liquidate all of your FIL's assets to pay for his care now while he still knows where he is because it won't matter what nursing home you stick him in.
I don't know your husband but I'm pretty sure he's an intelligent man who doesn't need to be snidely talked down to like that. Doctors know better how to talk to patients and their families because they are taught how to when they are being educated.
I remember when my first husband was sick. One of his doctors sounded very much like your FIL's doctor.
One day I took him to an appointment. By this time he couldn't drive anymore. I had to tell his doctor that the 'Dr, House' persona works for Hugh Laurie on the tv show which is entertainment. In real life a doctor who treats his patients and their people with zero compassion and empathy is just an a$$hole. Sometimes doctors need to be reminded that they not God. That they are just the same as their patients.
Now, I know something about caregiving because I did it for a very long time.
It matters what kind of nursing home a person gets placed in even if they are completely out of it with dementia. They still need to be decently cared for. This means proper hygiene, nutrition, and socialization. To me these are basic human rights for all people. In many nursing homes residents don't get any of the three. So it matters.
Your FIL's doctor is a tool. Your husband should tell him not to be. He's also not a social worker or accountant. So, it wouldn't be for him to tell anyone when to liquidate assets or that quality of care doesn't matter in a nursing home doesn't matter.
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NYDaughterInLaw Apr 2023
Thanks so much, Burnt, for your thoughtful reply. It means more to me than you know!
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Think he was being a little unfeeling. There is no need for additional aides. There will be enough at AL. But be aware that Dad will need Memory care eventually. I would want a diagnosis of what type of Dementia he has for medication sake. Then no need for a neurologist because the Dementia will just worsen. Will not matter what # he is at.
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againx100 Mar 2023
It's hard to know if AL will really do enough. Depends on his level of need. My mom has mild/moderate dementia and I've had to coach the staff on the fact that they have to help my mom more cuz she is not going to do X, Y and Z. Like get her trash ready. Or put away her laundry. She'll say she'll do it herself but she just won't.

I kind of like what the doc said - I have been considering getting an aide to help mom at AL but also think about wasting her money. If it makes her happier when she is still pretty cognizant most of the time, maybe it is money well spent.
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I seen this could be interpreted two ways,
Yes, very insensitive of dr to say it does not matter where he ends up at the end of his life.
But, as I and my husband’s neurologist promote his independence and encourage him to do and live right now I can see the meaning of doing or having better life at this point of his life, with better care and companionship. But, not to discount his needs in the future.
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NYDaughterInLaw Apr 2023
My FIL has been living in the same senior living building for almost a decade. Until recently, he was in the independent living part and he did not make use of most of the amenities. He would sit in his apartment with his two private helpers watching TV, go down for dinner, and maybe watch the evening's movie. Even though he's now in assisted living, he can still use all of those amenities but chooses not to. If he wants companionship it's there in abundance but he stays in his room. Wasting money on companions he doesn't need will only reduce the amount of money available for when he does actually need actual help. And as you point out, his future needs cannot be discounted. But neither FIL nor this neurologist seem to be taking those needs into consideration. And it's not like the doctor is going to reach into his own pocket if FIL's money runs out.
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Sounds like one of those learned but blunt people. Like Sheldon from The Big Bang Theory.

It's common to hear many surgeons lack a warm bedside manner.. but can cut people up well, which is what you need. Maybe Neurologists are similar?

Comment seemed harsh but maybe he thinks blunt honestly helps families prepare better?

I expect the video visits were just a Covid thing - over now.

"But, once AL is no longer working, we want to bring FIL home and hire agency help".

Your future plan jumped out. I'll be the blunt one now! That can be Plan A. a dedicated & loving plan. Just have plan B. ready too.
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BurntCaregiver Apr 2023
@Beatty

The doctor isn't lacking a warm bedside manner. He is lacking basic manners. He is lacking the professionalism he was taught when he was being educated.
He doesn't have to be all warm and fuzzy with a patient or their family. Just show them basic respect.
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He was rude if the question is about how he put what he said.

I don't know your FIL so I don't know how much he needs one on one supervision and care, so I can really assess whether he was right or not.
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NYDaughterInLaw Apr 2023
He doesn't need one-on-one supervision.
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NY,

Do you trust your FIL’s neurologist? Are you satisfied overall with his care of your FIL?

Personally. I don’t think that a FaceTime interview is enough to see his overall progression. My mother always saw her neurologist in person.

I am not saying that your FIL’s neurologist isn’t a good doctor. Only you can make that call. If you desire a second opinion on this matter then you can always consult with another physician.

I am glad that your husband took your FIL into the office to see the neurologist to get a better look at him.

Doctors have a responsibility to prepare us for what they feel is needed now and in the future.

So, it’s possible that he was only giving you a ‘heads up’ on what lies ahead regarding needing more supervision (hiring additional aides.)

I am curious, did he mention memory care at all in his future? Do you have that option down the road in his present facility? Do you feel that he is approaching the memory care stage?

Does the neurologist plan on doing further testing on your FIL?

As far as money goes, your husband has always been a wonderful advocate for his dad. I’m sure that he will continue to do what he considers best for his dad.
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NYDaughterInLaw Apr 2023
Thanks, Need. I do not feel FIL is approaching memory care. And I doubt that is the route we would choose for him. When that time comes, I believe we will bring him home and hire agency help. The assisted living nurse and director both agree that he is doing well in ALF.

I do not trust this neurologist but FIL still has enough say to insist on continuing with him. He likes him because he allows him to showtime and calls him things like "champ" and "buddy" and says "you're looking well" and other flattery.
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Were you actually there? Could hubby be frustrated and made the conversation sound so cold and unfeeling? If this is hubs interpretation, then he understood that it is time to liquidate and get dad the care he needs. It will new like that was the point of the conversation and doc visit.
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NYDaughterInLaw Apr 2023
What do you mean "It is time to liquidate and get dad the care he needs"? He is in assisted living. He does most things for himself or with minimal assistance.
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