The ALF May Dismiss Dad

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This has been a challenging week to say the least. Dad has been having more panic attacks due to his outright refusal to cool off his room. I'm not sure if it's the dementia or plain old stubborness, but whenever the weather gets warm, we start the thermostat battles. It happens in the winter as well, but not as badly. Dad is legally blind and can not see how to operate the HVAC unit in his room. As a result, he will often keep it turned completely off with the windows and doors closed. Needless to say, it gets very stuffy in his room which exacerbates his breathing which leads to a panic attack. This can go on for hours, and Dad will refuse to allow the AL staff to turn on the HVAC unit or give him a Seroquel to calm him down. He's equated the Seroquel to a "sleeping pill", and he accuses the staff of trying to drug him and he gets really combative. Now it's getting worse because he will get on his motorized scooter and ride up and down the halls of the ALF to "cool off". This often involves trying to engage disinterested workers in conversations (repetitive of course) or asking them to explain why he's so "uptight". I've tried to convince Dad to take the medicine when they offer it, but he's a tough old man and won't be made to do anything he doesn't want to do, including pulling the cord if he needs help with the HVAC. He's starting to get quite the reputation as the resident nuisance and some staff members are going to recommend him to be moved. How in the world am I going to explain this to Dad? Furthermore, where am I going to find the time or money to move him AGAIN? UGH! It's like I can NOT catch a break. This whole situation is literally sucking the life out of me. I just want it to be over if not for him, maybe for me. I'm just tired of it all.


Tinyblu, ah the battle of the themostat. My Dad had the same issue... any time I came into his Independent Living apartment I had to make it cooler... his private caregiver said she was ready to shed her clothes it was so hot. She would even crack open the windows in the bedroom and in Dad's den just to get some air into the place.

Turned out Dad's weekday caregiver had noticed when the A/C is on, it would blow out air from the ceiling vent which in turn would bounce off the wall and back onto Dad if he sat in his recliner. Boy, was she right. Moving the recliner wasn't an option as Dad really enjoyed looking out the window while he sat there. Maintenance was called in and blocked that side of the ceiling vent. That worked great.....

But Dad was in such a habit of making the rooms warm because my late Mom was always so cold. He just couldn't break that habit :(

When Dad lived at his house, he use to go around with a sleeveless undershirt and walking shorts. Mom was bundled like she was living in the Arctic. Dad felt he couldn't do that living in IL, which I understood.

As for the thermostat itself, the digital numbers were very tiny in that tinted lime green, even I had an issue reading them.... so whomever bought those thermostats for the facility wasn't thinking like an elder with poor eyesight.

Tinyblu, how long has your Dad been in this continuing care facility?
Your dad is legally blind yet drives a motorized scooter?

If he won't take a pill that he obviously needs and that you need him to take in order to remain there as a resident, perhaps you can crush it and feed it to him in some pudding or applesauce? Check with the pharmacist.

Also, if he is feeling rushed to take the pill that is likely contributing to his refusal. Make sure the staff understand that he needs a calm environment in order to take the pill and add it into his medication regimen. Check with his doctor first.

You need him to comply. His brain no longer works. You have to do what is best for him and a move is not what is best for him. Do what you need to do to prevent the ALF from dismissing him.
Dad has been at this facility two years total: He spent about a year on the Independent side and was moved to Assisted after being placed on 24 hour oxygen.

Hahaha! Yes, Dad drives a motorized scooter while legally blind. He has no tunnel vision. The optic nerve in his left eye was severed in the Navy and his right eye has declined drastically over the years. He now has cataracts to add to it. He can distinguish shapes and can make out features if he stands really close to a person and move his head from side to side to piece together several peripheral images. This kinda freaks people out so he tends to keep his eyes cast downward.

Reading is pretty much out of the question, but for a guy with limitations, he does well.

I may try to get the ALF to hide a crushed pill in soup. He's a picky eater and doesn't eat much at all. He's a sandwich guy because they are easy for him to handle. His diet literally consists of a bacon and egg sandwich in the morning, a hamburger and chips for lunch, and a cup of soup for dinner. That's IT.

He doesn't eat pudding or applesauce, so unless the kitchen can put the pill in soup, that won't work. He gets combative if they try to get him to eat at the ice cream social. He REALLY doesn't want to be forced to do anything.

I really don't want the ALF to dismiss him. He loves it there.

Also, sorry about the spacing. Something is going on with posting. All of my paragraphs disappear.
Tinyblu, does your Dad like chocolate ice cream after dinner [not at the social, my Dad didn't join in, either]?

My late Mom refused crushed pills in applesauce as she didn't like applesauce.... so the nurse tried using chocolate ice cream... bingo, we have a winner !!! What was amusing later on, my Mom wouldn't eat regular chocolate ice cream [without the pill crushed in it] as she thought it tasted funny :P

For your Dad's diet, he's doing the right thing not overloading himself on big meals since he's getting little exercise... good for him :) I always figure, let an elder eat what they want, at least they are eating.
Is your dad in a Memory Care unit? If not, I'd explore them for your dad. They are better trained to handle challenging behavior like your dad's. Resisting care, not cooperating is actually pretty common for dementia patients. I wouldn't bother with blaming him for being stubborn. It's not his fault. But, when the staff is not equipped to manage that behavior, they may just not be able to handle it.  ALSO, ask to have a team meeting at the ALF and see if you can put your heads together and devise a plan to help with dad so he can stay, but, I would ask them if they think Memory Care would be a better fit. 

I'd actually wonder if your dad would be able to regulate the thermostat, even if he could see it. I say this, because of all the LTC places that I have visited, those who have dementia, are not able to do it. They may be able to read the number 72, but, it means nothing to do them. And, they may cut off a switch and totally not remember doing it. If the regulation of the the temp was just visual, then he would allow someone else to help, but, I would question if he has the ability to pull a cord for help with the air. Eventually, there is a loss of initiative. I'd explore if that is what is happening and if so, the same thing would happen with other air conditions too in other facilities.

I'd also ask his doctor to review his medication. Your dad gets that the Seroquel makes him drowsy, So, he doesn't want to take it. That's actually understandable. Taking it at bedtime, is one thing, but, in the day? I'd ask a doctor or psychiatrist for a daily medication for anxiety that does NOT cause drowsiness. One that he can't even tell he took. It just takes the edge off things and the person is more content, yet not groggy. My LO takes Cymbalta and it did wonders for her, but, there are many options.

I would also reconsider the scooter. Is there some reason that Dad can't get himself around in a manual wheelchair? He's on oxygen, right? Maybe, that would be too much for him, but, I'd really evaluate the safety of the scooter, if he can't see well.

I hope you find some things that help and work for your dad.
I'm definitely going to try the chocolate ice cream idea. Dad does love his sweets.

...and I agree that the whole thermostat thing probably has more cognitive undertones than anything. I honestly don't think that Dad understands the numbers.

I have gone with Dad to Memory Care facilities and they are pretty grim. Dad really doesn't want to go there and I would feel awful if I had to place him there. Of the three we visited, there were people sitting in the halls in wheelchairs looking kind of out of it, or people randomly walking up and asking if I was their mother. One woman was dragging this doll around and talking to it... it was truly heart breaking, and I witnessed staff members yelling at patients. Unless I absolutely have to, I honestly don't want to put Dad in a place like that.

His psychiatrist flat out refuses to give Dad anything else outside of the Seroquel, and I can't afford a civilian doctor, so we're stuck. Each time I have presented documentation of Dad's increased anxiety , she just ups the Seroquel (which is actually contraindicated in dementia patients). It's frustrating that she won't even consider something else for him.

Without the scooter, Dad would not be able to get around. He can't walk more than a few feet without being completely out of breath. He wouldn't be able to operate a manual wheelchair, and the ALF makes Dad complete a "driving test" every six months to ensure safety. He can't see details well, but general shapes and REALLY large writing. Without the scooter, Dad would be completely bound to his room. I'm going to try to get the VA doc to do a referral for hospice. It's my understanding that they would most likely suggest something outside of the Seroquel for Dad, and if I have to work even more hours to pay for it -- so be it.

This can't go on...poor guy.
Hospice? Does your father show signs of being at the end of his life?
The VA psychiatrist won't put him on an antidepressant? Why is that? What is the mechanism to challenge her refusal to properly medicate his anxiety and depression?
Hospice and all the medications they provide are covered by Medicare.

Is your dad more apt to take an antidepressant or a drug from hospice than he is to take the seroquel?

Can't the ALF (with out permission) simply keep his room at a comfortable, safe level without asking him?
About the thermostat - I worked in an office where this was an issue and finally the maintenance staff quietly advised me not to worry about it - they disconnected the thermostat, set the temperature to be comfortable for most people - but left the thermostat itself on the wall and let people think they were altering it. They told me they saved themselves a lot of time and trouble that way.

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