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This psychiatrist preformed a mini mental health exam via telehealth on my 68 yr old husband, deeming my husband 'his own person' while my husband was in a skilled nursing home in Michigan undergoing physical and occupational therapy for his FrontoTemporal dementia. This treatment was supposed to be part of my husband's long term care stay. My husband's pcp is also the medical director of the facility and was instrumental in my husband's admission. The pcp is also one of the two Dr's who signed my husband's Patient Advocate form that states he's not able to participate in his medical treatment decisions. Due to Covid-19, Medicare waived the 3 day hospital stay prior to admission and I was able to directly admit him from our home. His condition has deteriorated both physically and mentally in the past several months with his contiual falling and having difficulty walking, showering and dressing. Do to several health conditions of my own, I am not able to adequately care for my husband at home. I have gotten home healthcare early on but my husband was not very receptive to their presence and tried ordering them out. Just prior to Covid, I stopped home healthcare as aides were constantly showing up late or were sick. Since my husband was discharged from the nursing home against my authority as his DPOA & Patient Advocate, he was admitted into a hospital two days later as a result of an infection he developed while in the facility. Also being a diabetic and deemed 'his own person,' he signed his own discharge papers after a six day stay. Only being home for two days, my husband was taken to the emergency room and admitted with cellulitis. After a six day stay in the hospital, he is now, once again, home. Home healthcare is to start soon along with physical & occupational therapy. I guess my husband's condition isn't 'bad' enough to be in a skilled facility yet but home healthcare can't be here 24/7 and I can't fully care for my husband by myself. To be honest, I'm not all that comfortable having people coming in our home with Covid-19 still playing a major factor.
I'm dissappointed with our pcp for not sticking up for my husband while in the skilled nursing home trying to find out why the psychiatrist would go against an advanced directive. It makes no sense to have advanced directives in place if the medical community will not comply with them. I feel my husband and I have found ourselves caught between the proverbial rock and a hard place. There's also my husband's brother who thinks I'm lying about most everything after I've tried to keep him informed as to my husband's condition. All I want is for my husband to be safe and well taken care of and our home is now clearly no longer the safest place and I'm clearly not able to provide the best care for him here at home either.
Any advice would be helpful especially in our state of Michigan. Thank you in advance.

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I wonder if perhaps either because of the way he was admitted to the skilled nursing facility or as part of the transition to LTC at the facility Medicare, Medicaid or his health insurance ordered this psychiatrist evaluation based on the reasoning for LTC or something. Basically hired a psychiatrist to try and find him “his own person” so they wouldn’t have to pay for his care in the facility long term. This might have taken the control out of the PCP’s hands even though he or she was trying to find a way to navigate him in. It is so irresponsible for any doctor to diagnose a stranger to them this way but it’s not surprising coming from bean counters (insurance) rather than health care providers and if this is the case there should be some sort of appeal process. I’m also sure things are turned upside down with COVID which could be an advantage or a disadvantage.

Either way even if you pursue an appeal or some legal push back based on the lack of real evaluation one thing you can do rite now as I’m understanding the situation is not try to do more that you know you can long term in caring for him. You have home care coming to evaluate and help care for him for the short term and part of that evaluation up front and ongoing (they are constantly evaluating for “release”) so while it probably won’t be easy and goes completely against your natural inclination don’t try to keep up with the mess and care. Let them find you struggling, talk about your health issues and how they are preventing you from caring for him, even if your overstating a bit at the moment. Think about it this way, give them an inch they will expect a mile. Leave dishes in the sink, a mess in the bathroom, let the laundry pile up, make efforts but don’t do more than you know you can long term and tell them what you can’t do and keep up with, be vocal about your fears for his safety and your health if he stays at home with you.
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Reply to Lymie61
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I live in California. My husband is diabetic also, and has heart and kidney disease, He also has MDS--a slow-progressing blood cancer. He was dx with Alzheimer's three years ago, although I noticed signs of his mental decline over the last 10 years. My goal was to keep him home until the last stage, But he kept falling, and each time my son and I had to call 911 because he weighs 270 pounds and we couldn't lift him.

This spring, he thwarted my plan when he developed an obsession/delusion, regarding his foot. He believed there was something inside (probably bones!) that needed to be removed. He began picking at his foot with his fingernails, in the process removing huge strips of skin, which he would hide. When I found out, I begged, pleaded, and even screamed at him to stop. I put a sign next to his bed that said, "Don't pick your foot!" In the space of three days he managed to burrow all the way into a vein. I discovered him sitting in the shower gushing blood. He could have bled out. He felt no pain because of diabetic neuropathy.

He spent a week in the VA hospital, The hospital had to station a 24-hour-a-day nurse next to his bed to prevent him from picking his foot. When he came home the wound was healed to the size of a dime, He promptly starting to pick at it again. Within three days he had developed sepsis and needed a blood transfusion. He spent a month in the VA hospital, then 20 days in a Medicare-paid rehab facility trying to learn to walk again. Then they wanted to send him home and have a PT come in twice a week.

I asked for an dementia evaluation. They didn't rely on one person's assessment. They assigned a social worker who interviewed his gerontologist, the psychiatric nurse, his PCP, him, and me.

My husband wanted to come home, and told them he was fine. The odd part about ALZ is that sometimes they seemingly snap out of it and can sound almost like their old serves. I suggested interviewing him in late afternoon, when Sundowner's kicks in. It was determined that, without me, there was no way he could care for himself--feeding, dressing, taking insulin shots and medicine, remembering his medical appointments, and--most importantly--not self-harming. There was no suggestion that I was obligated to do these things for him.

In early July, the VA placed him in a Memory Care Facility. I'm sad that, because of the pandemic, they're on lockdown, and I can't visit. However, I feel free from the constant stress and responsibility, and the sense of failure because I couldn't stop him from harming himself. Now we talk on the phone every day or two. Sometimes, he calls me at 3 or 4 in the morning, not realizing what time it is. But it's easy to be patient, because I'm no longer stressed out.

Tbh, he hasn't settled in yet, and pleads to some home. That breaks my heart. But he was unhappy at home, too. Of course, I have attacks of guilt, but everyone tells me I did the right thing. Having support and reinforcement is so important.

When the pandemic is over, I plan to visit at least once a week, have dinner with him, play games, sit in his room and read and talk to him.

I'm sorry you're having the opposite experience, even though our situations are similar. I would ask for another evaluation, this time with a social worker and a doctor who specializes in dementia.

I'm not a legal expert, but I believe a medical directive is only for end-of-life issues, or when the person is unable to make his own decisions. When my husband was still fairly lucid, he signed a notarized Durable Power of Attorney over to me, This allows me to make most decisions for him, as well as conduct financial transactions. They care facility won't even change his medicine without consulting me. This keeps me in the loop, and makes me feel like part of the caregiver team.

When you're dealing with both mental and physical issues, it's overwhelming! Don't let them bully you into being a caregiver if it's not right for you.
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Reply to Ziggi71
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If I am not mistaken your husband's condition and your care of him has been long ongoing? I cannot imagine, and agree with JoAnn, a brief teleconference diagnosis that figures in anything at all legally. Many suffering from dementia can be very very good short term at "confabulating", at making people think that they are absolutely normal. Being "his own man" doesn't honestly mean much of anything at all. Have you seen the complete diagnosis that the psychiatrist gave after the teleconference? What do you PCPs , who have been following your husband all this time have to say about this. And how exactly does this figure in things. Does this brief diagnostic thingy mean that your husband has control over placement, and other things?
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Reply to AlvaDeer
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I don't see where a Psychiatrist can give a good evaluation this way. Your husband must be able to put a good face on when need. Its call "showdowning"

Does your husband see a neurologist? If not maybe he should. Your husbands physical problems would make him 24/7 care. The next time he is hospitalized and enters rehab, refuse to take him home. Tell them you can no longer care for him. It is not a safe discharge.

In the meantime, see a lawyer versed in Medicaid. You need to protect your half of the assets, if DH ever needs Medicaid. Your assets can be split in half, his half going towards his care. When that is spent down, Medicaid can be applied for. SS and pensions will be split so u can pay your bills. His split going to offset the cost of his care. You will be able to remain in the home and have a car.
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Reply to JoAnn29
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Have you asked the PCP for his advice about this?

When you talk his ongoing care and treatment through with your husband, what does he say about it? The point here being that his making his own decisions is only a problem if what he wants is terrible for him.

If a person is, as you put it, 'his own person,' that means he decides. It doesn't mean no one is allowed to ask him to discuss it fully before deciding. So how come the discharge planners (or whoever) don't seem to be questioning his highly questionable choices?
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Reply to Countrymouse
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