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My father has always been difficult to talk to, to work with on anything. He always knows more than anyone else. It gets worse as he gets older. He even gets violent. He has minimal dementia. He would not stay in a home. He qualifies for hospice and my sister and I will be sharing responsibilities over his care simply because neither of us can handle him by ourselves. We're not even sure that he will leave his rural home to move to my sister's home for hospice care. He is becoming unable to care for himself primarily because of extreme pain from an accident that happened years ago. He will be on morphine for the rest of his life. He simply doesn't like nor trust people, including his family. What would you suggest and how would you suggest we carry it out. Neither of us can stand being around him for long. He becomes very abusive.

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Frank, this is one tough question. One of my uncle's was like this, undeniable dementia, but there was nothing wrong in the mind of this big strong WWII vet! Except that whenever he saw war, violence or 911 footage on TV, it was happening right now and he had to go out and save people...an admirable sentiment , to be sure.

Eventually, my cousins had to gain Guardianship and force place him in a VA nursing home with a dementia unit, where by all accounts, he WA the life of the party.

Can you pursue guardianship? That gives you the right to force place him.

I guess the other option is to leave him be. What is the downside to that? Has he talked, ever, about end of life choices? Does he want to be left to his own devices until he's dead?
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Hospice is for the dying. It doesn't sound like your father is within 6 months of death.

When someone becomes unable to remain safe by themselves, it's not up to them where they go anymore. They may have vocal opinions, but that doesn't mean they get what they want. There are safe facilities for elders who will wander. They are purpose built for that exact situation and it's called Memory Care.

Take him to a neurologist and have a cognitive evaluation done. Then he probably needs to be in a memory care unit, not alone at home or living with one of you. Crotchety parents tend to behave better for people in medical uniforms and for people who are not their children. They'll be fed, cleaned, given medication at the right time of day every day, have activities, and looked after around the clock. It might change & improve your relationship with him not to have to be the caretaker.

A lot of the paranoia is probably coming from his dementia, and there are meds for that. My mother is on just enough Risperdol that she no longer tries to fight the care takers who need to move her, bathe her, dress her, exercise her. She's convinced 90% of nurses & doctors are frauds. Everybody is trying to kill her. That people swing her around by her arms all night or they toss her around. (She's 200 pounds and 63 inches tall, so I doubt it.) Moving her into memory care was one of the best things that ever happened to her. She probably would have died in her house if I hadn't moved her fall of 2013 (which still feels like last year to me!)
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If you can get the pain under control, he may calm down. Use enough morphine to control the pain or ask for Tramadol, which relieves pain and anxiety. Add in a stool softener to prevent constipation, because that can make him grumpy too.
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Morphine does very odd things to behaviour. My ex husband has to take it for a chronic condition, and you can always tell when he's had some recently: he's not normally the chatty type but honestly you can't get a word in edgeways. It's always mystified me why abusers - I don't mean my ex or your father, who have a legitimate need - would opt for it: aren't there nicer things to take?

Anyway. Given that quite major factor, and that your father has never found it easy to accept help from you or your sister, would it perhaps be a good idea for the two of you to work on your own expectations of how much you're going to be able to do for him? Concentrate instead on building relationships with his care team so that you can be involved at a safe distance. Your father may be sincere in his preference to stay in his own home; and while emotionally I can understand why your sister would want to assist with his hospice care I think she might be setting herself up for a fruitless ordeal. What qualifies him for hospice, do you mind my asking?
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Frankk: Hospice will come in every 1-3 months to re-evaluate the patient to see if he still needs hospice. So, my answer to you is: Let Hospice decide as to whether or not your father is Hospice ready. He may have underlying factors that you have not shared with us about your dad's health. Honestly, they will let you know - Period.
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My dad was very grumpy, he was losng control of his life to cancer, and it was a battle all the way to the moment of his last breath. Understand, be patient, and hold on tight. It's going to be a very bumpy ride, and if you can find humor somewhere, use it, and show your dad - Love,patience, humor.....
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Make sure your sister is in complete agreement with everything before you do anything and ferret out any feelings she may be concealing. Is there an estate involved? The shared "not able to stand much time with him" won't be enough to keep you in agreement as the financial burdens of his care start to mount. You'd be surprised how many siblings turn on each other when dealing with extremely difficult parents with dementia. My parents made the same kind of shared POA arrangments for our extremely difficult mom, and my sister went out of her way to undo it all when she smelled the money and it came time to write the checks. Prior to that, she claimed to be in agreement with everything, and we've had nothing but trouble since, and mom is suffering because of it. Shared POA never works out the way you think it will.
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Oversee his care. Don't do it yourself. Can he go to a hospice house? Can he remain in his own house? Does he have financial resources to hire some help?
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He should not be in extrem pain. he should be getting enough morphine to control the pain but will he take it ? If he has not been declared incompetent he can and probably will refuse hospice. Have they met with him yet. Old men tend to be far more difficult to place in care than old ladies. They would rather rot in their own filth than agree to a move. if things are getting really bad you could try calling adult protective services but i wouldn't guanentee he will open the door. As far as moving in with your sister is concerned again he wont be willing he will see it as someone controling his life. I can not really offer advice and you just may have to wait for an emergency and get him placed from a hospital stay. Not the best or kindest way but stubbon suspicious old men often have to find out the hard way what is best for them. Apart fron the pain what do you see as making him close to death?
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You want the best maybe secured home that is close to you and your family they have retirement/ nursing homes check out some regional small homes
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All great answers, some of which I shall discuss with my sister. That we cannot change his life by co-sharing responsibilities is a very good comment. He will never be a happy man. As for placing him in a "home," if it comes to that, will probably be cost prohibitive. I'm still waiting for updates from my sister.
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Have you applied for Medicaid? This might be the time to do it. Do you have poa for health and finances? Who brought up the idea of Hospice? Sorry for the many questions, they will get you more substantial answers.
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