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He really needs it and wants it.

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Short and sweet: Make an anonymous phone call to the county Social or Human Services in the county they live in and report them to Adult Protection Services. They will have to come out and do a home visit and file report. That should start the ball rolling without them knowing it was you. The statement that your Mom is keeping your father captive should elicit a pretty quick response.
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You tell your attorney that you need a psychology eval. on your parents.
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What sort of specialist, Fred?

If in fact you believe your father understands his own medical condition, and he is still refusing treatment, the short answer is that you don't. You just keep hoping he'll change his mind.

If you think he has become mentally incompetent, your options are as Beechgirl suggested; or you could try calling the specialist and asking for advice.

It kind of depends on what the situation is now, one week after your original post, and what you're hoping to achieve.
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You call 911. Tell them mom/dad has beenacting strangely and is refusing to see a doctor. When you get to the hospital tell them you are requesting a psychiatric evaluation. If 2 psychiztrists agree they cn be held for 72 hours without the patients permission to access them and get proper treatment for them.
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How do you get them to a specialist for diagnosis when they refuse to go?
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You know what you need to do. It won't be cheap and your parents will be angry, but the best thing is to see an attorney to get guardianship and conservatorship. Also, it has been my experience that most primary doctors won't diagnose dementia. You should take your Mom & Dad to see an elder psychologist or elder neurologist to get an accurate diagnosis. The memory test that most PCP's do won't give you an accurate diagnosis. I know because everyone in the family knows my Mom has dementia, as well, as my Dad, but I couldn't get a diagnosis from their PCP. It took a psychologist to give us a diagnosis of dementia. With that I went to court and got guardianship over my Dad and conservatorship over both Mom & Dad, so I can now pay for the care they desperately needed and Dad can no longer take Mom home from rehab after her falls AMA, against medical advice. Yes, they were angry, yes both my brother and my husband didn't think I should go to court, yes it was expensive, but if I had it to do all over again, I still would have done it. IT WAS THE RIGHT THING TO DO.
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I have been through a similar situation. Get legal advice. There is a site online called AVVO. You can ask precise legal questions and a few lawyers from your area will answer. It also has a rating system on lawyers. I found a wonderful one Some will.give you an hours consultation for free, some you pay for. There are so many issues involved that no lay person is going to be able to give you the exact information you're looking for. I spent months under such stresd I thought they'd bury me. Once I put it in the handsof a good attorney, I could breathe again.The tension in my neck and shoulders disappeared. You need someone who is not emotionally involved. A side note if dad's name is on the joint accounts he can withdraw money without mom being there. He can sign both a Health Care Proxy and Power of Attorney naming you without needing mom's permission. Check that website AVVO.
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Fred, I am confused as is GardenArtist. Are you caring for both mom and dad? In the profile area you can list two or even more as I have on my profile by adding another person.
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Fred, I think if you'd explained from the outset that your father is 89 and has both congestive heart failure and renal cancer your mother's refusal to co-operate in trying to get him into AL might have sounded less stubborn and selfish and a lot more realistic. I am sorry to learn that he is in so much pain: codeine or other opiates would suppress respiration, presumably that's why he can't be given those while he has pneumonia. But at some point pain relief must become the priority. I should do what you can to get his medical team to focus on his physical comfort. I'm sorry for all that you and your family are going through.
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Fred, the AL question is probably moot if your dad has MRSA; they wouldn't admit him, from what I understand/remember from my mom's application process.
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Fred, I'm so sorry to hear about your dad's other physical problems. Maybe it's time to call hospice?
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Kazzaa we cannot do not have geriatric specialists in our area. She would refuse to go anyway, as we had to force her to go to the last appointment and then she insisted on going alone so we couldn't hear what was said.
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I'm so sorry to read about your dad's difficult diagnosis. Be sure to call in hospice to help him and the rest of your family.

If your mom understands the implications of what is going on, she'll probably be pretty devastated since this is something she can't control. Hugs to you.
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Thank you ba8alou. We have had an infectious disease specialist on the case for the last 5 months. He is the one who wants him to have surgery, but none of the surgeons will touch him. They say it's too high risk due to him having fluid retention, congestive heart failure, he's 89 years old, MRSA has invaded his entire body, he has kidney cancer, etc. He is in so much pain right now but they said they cannot give him pain killers other than Tylenol because they said the pain killers will cause his pneumonia to overtake him.
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Fred, so sorry to hear about the MRSA. From my experience, doesn't have to be a death sentence. PLEASE seek out an Infectious Disease specialist and get a second opinion. It may be the same opinion, but you're going to feel better down the road that you knocked at a second door.
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Sorry but as long as your mum is scoring in the memory tests they will not deem her "incompetent" she sounds like early stages and this could take forever to diagnose i would take her to a geriatrician they are the best and the most helpful!
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Fred, I echo CM's inquiry as to whether you're comfortable with the explanation, including of options for your father's MRSA. My father had MRSA twice, cured by Vancomycin, and then VRSA, also cured, I believe with Vancomycin. This was when he was also intubated and on a ventilator, so he was severely compromised.

What protection did he offer for your mother and family? This is an infectious disease, although I don't know about repeated episodes.

If you want a second opinion (which I would get given the dire prognosis), see an infectious disease physician.

I'm sorry to learn of this sad situation; your family has certainly had a rough time.
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FarmerFred I'm so sorry to hear that, that's terrible news. Are you completely comfortable and clear with the medics' explanation? - don't forget it's a perfectly reasonable and courteous thing to seek a second opinion, if you're not. Not for surgery, no, he'd be traumatised; but where is the infection, what treatment is he being given, all the rest of it.

Oh God your poor mother. I know, poor you too; but poor lady. Please let us know how things are going. I'll keep my fingers crossed in case of better news.
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Well now it looks like we may not have to do anything. Dad's illness is due to MRSA and whenever he gets off antibiotics, it comes back. They said the only was to get rid of it is by surgery, but he is too high risk for anyone to operate. The docs just called and said since they can't operate, there is nothing they can do but stick him in a nursing home and wait for him to die. I doubt if he could get into AL with such a highly infectious disease and he can't go home due to the amount of care needed to manage his pain. So now it's a waiting game. I have no idea what it will be like to deal with mom when he's gone but I guess well cross that bridge when we get to it. Thank you everyone for your words of wisdom and encouragement.
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The more I read the more I begin to envision your mother like a trapped, cornered animal, reaching out and fighting for whatever it is she wants to preserve. I most certainly don't mean that facetiously or critically but rather that she seems to feel she's under seige and is reacting so strongly that to me it seems it would be frightening. She must really feel threatened and as if her control is being taken away from her. I wish there were some way she could let go and just have some peace and solitude to calm down and move forward with more comfort in her family's care and concern.

A ramp in some ways is better as a wheelchair lift is electrically dependent. Have a power failure and you're without the lift. Just make sure the ramp meets code - there are specific pitch requirements for ramps. And don't forget the railings with posts that can help the person hold on if anything happens.

I don't recall if I suggested this earlier and don't feel like rereading my own posts so I'll post the question now. Have you contacted the Alzheimr's Assn. to see if they're offering the Creating Confident Caregivers course in your area? I took it in Michigan and it was excellent.

My father has never been diagnosed with dementia (I might already have it!) but the course deals with elder behavior which extends well beyond the dementia diagnosis so it was helpful for me. There's an excellent manual that provides very basic and more complex information on dealing with a variety of elder behaviors, including the challenge to one's control of one's perception of life, actual life changes, and situations like that you're facing. If you can get a copy of the manual and the hand-outs, I think they would really be helpful.

Sounds like you're making some progress though. Maybe that's the key - present her with a costly alternative and eventually she'll agree to what you're proposing.
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She has a harder time getting into the house than dad does, so yes it would be beneficial to both of them. She said if we build it she will chop it down with an axe! But she did finally come around to agreeing to the ramp after she found out a wheelchair lift will cost $10,000! (That's what she wanted instead of a ramp)
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Start with the ramp. Just commission it. Unless she's prepared to lie down in front of the digger or stand in the concrete she can't physically prevents its being done. And then, all being well, she will see that it is no threat. Hey! - might even have its advantages for her. Once the work is done your father can insist on its being paid for - help him do that, but don't be the one who defies your mother on your own.

She is afraid, I agree. But she's not wrong, is she?
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"I think she's a control freak and now she feels she's losing control."

Got it. I think that's the crux of the whole issue.

Now the challenge is how you let her feel she's still in control while you're trying to ease in to help? How can you make her feel your advice and decisions are hers?

Perhaps the ramp will be the test. Talk to the building inspection department to find out what code is in your area, start getting estimates. This is a safety issue for your father. It might even be possible to get a ramp that's detachable and can be removed if they do go into AL. And it might be that if her control can be moderated they might not need to go to AL.

Again, wishing you success.
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Mom and dad are both 89. She has always been the controlling one. Growing ups if dad said "hey, let's all go do this together " mom would always say "no, were going to do this instead." And he would be obviously disappointed but say "yes, dear." She controls all the finances, decisions, everything. I think she's a control freak and now she feels she's losing control. We have tried to politely explain the situation but she will act like a little kid and throw a temper tantrum and cry until she gets her way then carry on like nothing happened. Dad doesn't care if they live together or not. I think she drives him crazy. He even told her he wants a ramp built and if she doesn't like it she can file for divorce!
We don't want to be forceful and go over her head. We want her to see what is needed and some around. But she has always been stubborn and bull headed and it only seems to be getting worse.
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There may be something else going on with your mother, specifically, the fear that accompanies the hard cold recognition that they're aging to the point that life isn't going to be easy from now on.

It seems she's fighting to control everything, maybe because that's her nature but also perhaps because she senses and feels that control over their life and their bodies slipping away.

Somehow she needs to understand that what you're doing is trying to move forward with plans in place to ensure good care for both of them, but right now she seems to view that as a threat, perhaps to her own stewardship of herself and her partner.

Tough situation - wish I had some good answers for you. Hang in there. Sometimes you may have to take a Russian approach - two steps forward and one backward, regroup, then try again.

As you probably know, the more you raise the issues, the more she'll dig in her heels.
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Woah woah woah…

Can we pedal back a bit?

Ok, Dad has sampled and really likes the convenience and ease of living in ALF. It would suit him at his time of life, and allow his health to continue to improve. So: big tick to ALF there.

So what is Mom's problem? Has anyone asked her WHY she's dug her heels in so hard?

At a guess, this is to do with her not wanting to abandon her way of life, her family home, their shared history as a couple… Well, when you look at it, it's not a small thing that's being asked of her, is it? She must be very afraid of the plans that everyone else seems to be making. Perhaps that's why she's having none of it when it comes to sensible precautions like drawing up POA documents and finding a better environment for their old age.

FarmerFred, is it correct to assume that they do want to stay together as a married couple?

I think, actually, that the first thing you need to do is regain your mother's trust. It sounds like she's barring the gates and stocking the moat with crocodiles - and the more you push her, the more she's going to resist, right up to the point where something dangerous or horrible could happen.

I agree it's frustrating, and that she's being (probably infuriatingly) stubborn and obstructive; but she's not wrong to feel threatened - she's looked ahead to the choice of: either she lives alone in the family house, or she moves whether she likes it or not to ALF with her husband. She's not keen on either, to put it mildly.

I expect that if you discuss with her what she *would* like to happen in the future, she will say things along the lines of leave us alone and we'll be fine, we'll manage, go away. Now not knowing your mother I don't know how you get this point across to her; but somehow you have to remind her that the best, most effective way for her to stay in control of her life is to make practical plans. Age and infirmity come to us all. If she doesn't want them to beat her, she needs to take preemptive action.

If you can just get her to think about that, she might then make the next important step of considering her and her husband's comfort and quality of life. All kinds of things are possible. She can't prevent change, but she can choose the option that she likes best and that suits both of them.

You may end up having to go the legal route anyway; but given that that means seeing your parents' interests as conflicting I think it would be a pity to start out on that path without giving alternatives your best shot. Does your mother have any friends or relatives she confides in? Any allies you can get on your side?
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Fred, listen to Jeanne. From experience, I can tell you that you are stuck in the fog that comes with being around a situation that appears hopeless when in fact that are doors that you can walk through.
1. Find an eldercare lawyer and take your Dad
2. Find yourself a good mental health professional and go have a chat. These situations are wearing to the human spirit and psyche; sometimes talking them out with a therapist or counselor helps. sometimes medication helps.
3. Understand that mom is who she is and is going to be angry at you. You will survivie that. Our parent's anger is something that we ALL are terrified of, but with some support, you will get through this.
4. PLEASE understand that I'm not suggesting that you're weak, mentally ill, stupid or anything negative. You are simply a human being who loves his parents and who doesn't want them hurt. As parents age, it can be a gargantuan and painful task to shift our own (and their) thinking about what "proper" behavior of one generation to the other is. Godspeed, my friend.
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Time to see a lawyer.

Dad has access to a joint bank account. He could simply take all the money out. Or after he is in a facility Mom could take all the money out. What the facility should need to know is can be make any required down payment and can he continue to pay the monthly fees. Does he have enough income to make the monthly fees?

Really, see a lawyer. There has got to be a straight-forward way to resolve this so that Dad can have the environment he wants and can afford.
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The senior center I talked to said that if they have any joint accounts in the last five years, they need that info, and whoever has their name in the account will have to sign the papers to verify the information is true.
Yes the NH scheduled a "walk through" of their home a week and a half before his scheduled discharge. They took him to the house and observed him going into the house, walking around, getting in and out if bed, and using the bathroom. They said it would be helpful if he had a ramp, he is unable to step into the tub because it is too high, but he could work on that, furniture needed to be moved around to make room for his walker, they recommended he get a fall alert button.
About a month ago, after months of nagging, mom finally allowed us to call a lawyer to meet us at the NH. They filled out papers for medical surrogate but the only way she would do it was she was dad's surrogate and he was hers. Next in line would be me, and then my brother who lives 9 hours away. But the surrogate can only make decisions if the person needing medical attention is not able to say yes or no or nod or shake their head.
We finally got mom a doctor appointment because we suspect alzheimers or dementia, but she said she would only go alone. My sister from several states away was in town for the week and we convinced mom that she had to take me or her along. She chose my sister so since I'm around her more, I made a list of unusual behaviors and concerns we had. I'm not sure if my sister gave them to the doc or not, but I did call the nurse the day before to let her know some of our main concerns. After being gone for 2 hours my sister said mom passed her memory test but we had to wait for the lab results. We do not know what tests they did and mom will not tell us the results, so we don't know if she has a problem or not. If she does has a problem we can declare her incompetent and it will be easier for us to take care of dad's situation. But we have no way of knowing, so we are back where we started.
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Another thought; If you have a joint checking accont, say, one person can write a check, yes? Does Dad have a pension or social security? If it's being deposited into a joint account, then stop that and redirect it to a new account that you open in his name. No one should be held hostage like this.
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