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I have an appointment with a different Dr. this week regarding some paperwork for my 89 year old father. We are seeing this Dr. instead of his regular primary because I was informed by a county dementia expert that I needed a supporting statement from a 2nd Dr. stating that my father cannot live alone in his house, and I live with him. We have Joint Tenancy, the house is deeded to me with a 5-year lookback so it is complicated.

Anyway, his primary Dr. didn't seem like she was very interested in how things were going with him. I am hoping that this Dr. will be more willing to talk about his dementia, recent renewed interest in consuming alcohol, inappropriate anger responses, social ineptness (when I take him on a drive or to a restaurant I always regret it, yet he pressures me to take him often). But, since she isn't his primary Dr. she might not help either.

It is awkward and usually futile trying to discuss all of this when he is present. And since I am his healthcare POA I would think that they could talk to me privately, unless they require guardianship but he has not yet been declared mentally incompetent. When we are with the Dr. he is usually on his best behavior. And I know that he will deny or try to justify his actions. Like when he tried to strangle my neck recently during an argument, and I resisted, then he lost his balance and scraped his elbow, he will have a selective memory and deny that he had tried to strangle me.

He will also claim that his dizziness is due to a concussion rather than his prior alcoholism which I have heard can cause it. He denies the years of alcoholism.

Any ideas on how to handle these awkward Dr. visits so you can have your say? It seems like everyone is so busy and rushed these days and the Drs. bolt for the door without asking if there were any other issues to talk about. I was thinking about making an appointment for myself with his Dr. under my own insurance but I don't know if it is allowed and as I said she gave me the impression that she didn't want to get involved in the mental or behavioral problems. I don't have a Dr. myself because I have had bad luck when it comes to my own health issues and finally decided that it was a waste of time and money. In fact, accompanying my father to his medical appointments always reminds me why I stopped going to them for myself!

I might try calling the clinic before we go and ask if I could PLEASE even just talk to the nurse privately. We live in a small town and don't have any specialists nearby. But I just know that if I try to say everything that I want to say in his presence, it won't go well and like I said, he doesn't display the same kind of behavior that he does at home when I bring up unpopular subjects. And I will probably pay for it after we leave the appointment.
I am thinking that it is time to start trying some meds, which he might not take if he knows what they are for. Again, some things can only be discussed in private with the Dr.

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Thanks for all of the excellent advice! The medical system really does not make it easy for us to manage these situations. I did talk to a very nice dementia specialist who works for the Aging and Disability Resource Center and she agreed that I could be dealing with a very difficult case because my father has had anger management issues his whole life but he would always deny it. My late mother tolerated it. And now you have dementia, a concussion caused by a fall due to alcoholism, and losing his wife two years ago. I agree that he needs a cognitive reassessment, and apparently it is up to me to push for it. Can't expect his Dr to take the initiative.
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What I used to do is to type out all the things that I have observed about about my LO, such as won't bathe, wears dirty clothes, won't take medications, denies they have a medical condition, bills piled up, mail unopened, confused about driving, having delusions, repeating a lot, no insight into condition, neighbors worried, family members worried, multiple calls to 911, obsessions, anxiety, crying, pacing, etc. I also listed a general history of their employment, our relationship over the years, social contacts, medical history, etc. Try to be brief, but, include them in a easily readable form. I took that by the doctor's office the day before and asked the doctor to read it. They don't have to give you info, but, you can give them info. I'd confirm the doctor has read it, before the consult starts. That way, the doctor has the heads up and can conduct the examination fully informed.
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I tried to do the thing you mentioned cwillie, but because of insurance issues, they would not make an appointment for my mom unless my mom was present. Otherwise, how would they bill insurance? Or they would have to bill my own insurance, and what code would that be for insurance purposes? That would be good to know, if someone has done that and could tell us.

What I HAVE done is just what you say, wrote it all down with bulleted points, short and sweet, one page front side only, and gave that to the aide who came in to take the vital signs before the doc came in. Told her to make sure the doctor read that BEFORE she came in. That seemed to work fine. The doc then just talked around the bulleted points. This worked because the doctor was considerate and kind and concerned about my mom's feelings, so she didn't blurt stuff out that would cause mom concern.

One doctor and aide just didn't have a clue and wanted me to explain the paper in front of my mom.... we didn't stay with that practice long. They couldn't understand why I thought my mom had a UTI, when she said she was fine and she didn't have the traditional symptoms of a UTI, so they kept asking her and wanted me to explain in front of my mom why I thought she had a UTI. It was very awkward. But I stuck to my guns and said, "read the paper, it will explain". The aide says, but this doesn't make sense, and she starts to read it out loud. I stop her and say, "just give to the doctor please".

So the moral of that story is to just be prepared for some awkwardness, and be prepared to cut someone off who is starting to read the paper out loud.

Another option: Check with your area's Agency on Aging, if they have such a thing. Ask who they would recommend for a cognitive assessment. We had a phd psychologist who spent an hour or so with mom and wrote up a detailed report for my lawyer and the judge for a guardianship hearing. Medicare paid for that assessment, but even it it hadn't I would have considered it money well spent. If you have this cognitive assessment that actually shows the cognitive decline and possibly aggressive tendencies, it may be easier for you to get the other help you need. You can tell your dad it's just another doctor's appointment with a new doctor. This person did the assessment with just my mom. I had to go into another room and wait. Your dad might see that as less threatening.

Trust me, a good psychologist/psychiatrist will be able to get past the charming good behavior in short time. People with dementia are only good at fooling people who want to be fooled. People who want to see the best in others will discount any discrepancies and in the short window of a doctors appointment that is possible. With a psych professional given an hour or more of interaction, they will easily be able to see your concerns. I would do this even if I had to drive an hour or more to get it done!

A copy of something like that in your dad's medical records might help whoever is her primary care doc realize what is needed.

Ah, also, see if you can get a referral to a neurologist. That is who is really able to handle dementia. Give the neurologist the findings of the cognitive assessment. Gives them a place to start and an idea of what another professional has seen from a different angle. Again, it might be worth it even if you have to drive an hour or more.

Another route to consider is a behavioral health hospital. The next time your dad becomes violent and that doesn't have to be against you (In my mom's case she threw a chair across the room - I kid you not!) either call 911 or take him to the ER yourself and explain what happened. If you tell them you are afraid for yourself or that he might hurt himself, then they will keep him there and in all likelihood send him to a behavioral health hospital, aka psych hospital or psych ward. I know you said you live in a small town but it might be worth taking him to a bigger city that has one of these and check it out.

For my mom, I was able to convince her to go with me to the hospital and she checked herself in for a voluntary stay where they reviewed her meds and basically just started all over with her meds until they found the combination that would help her feel better and her behavior to even out.

It is really dangerous for you right now. He could have killed you! When my mom lived with my brother, he just called 911 when she hit him with her cane and the cops came and then the ambulance and they hauled her away to the ER. She was so mad that he called 911 that she was violent with the cops just because of that. Not something I would recommend, but it was all he could think of in the moment and I don't fault him for that.

Anyway, I feel for you. I know that I'm fortunate that I live somewhere where all these services are readily available. I wish you the best.
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I think the way to start is to give the doc a heads up when you make the appointment about why you are seeing them, hopefully they can go from there.
Or, some on the forum have mentioned writing specific concerns in a letter delivered before the appointment.
Because it was very difficult to take my mom out something I was able to do with my mom's doctor was to make an appointment where the doc and I could discuss her care needs without mom present, a similar strategy might work for you.
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Write down the bullet points you want to make, hand it to the receptionist when you check and and tell her it is vital the doctor review this before the exam. Better yet, get it there a day or two ahead of the appointment and bring extra copies that day. Be prepared for an awkward session anyhow.
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