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I don't want her knowing I'm speaking to him about this and don't know how to approach him while we are all there. She denies she's having any kind of memory problems. She has good memory in some areas, but she'll deny remembering certain details or conversations. Basically, I just want him to be aware and possibly offer some resources that we can avail her of. Her social worker who visited her once a week when she lived in Florida said she could probably have the same services here as she had there.

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Why not just go ahead with organising the services?

What sort of details is your aunt forgetting? What makes you concerned about anxiety and depression?

The thing is. I can certainly understand that you don't want to stir up trouble in your relationship with your aunt. But if you have substantial reasons for believing that there is a problem, then I think it's a mistake to go behind her back and risk adding the complications that arise from covert communications. It is much better to be open and straightforward, and specific about your concerns, while emphasising that you are on her side. If she'd broken a leg she wouldn't pretend there's nothing wrong, and you wouldn't be pussyfooting around being polite about it, and it's a pity to treat this any differently. Of course we are all aware that there is stigma and there is fear around mental ill health, but the stigma and the fear just make it all worse and harder to cope with.
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GIAGIA Jun 2019
Hi Countrymouse,

Past behavior dictates we do things with a "less is more" approach if that makes any sense? I have tried being nothing but transparent and straightforward with her and to no avail - she becomes emotionally reactive, angry and resistant to both big and small changes - and as would have it, no changes at all. Depression and anxiety is the result of aging, loss, and mental illness. These things combined, makes everything having to do with her care, tricky to do. The doctor's appointment went better than I had imagined it would today and am pleased that he recognized the need for additional help. Now, he said maybe he would be able to make the referral to Medicare for in home visits (1 X weekly) like she had with a social worker/therapist while she lived in Florida. He says that they don't always allow this....so we will see. I, myself am trying to figure how Medicare works, what it does and what it doesn't. This is my first go round.
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You could write him a note. Give it to the receptionist and ask that he read it before he talks to Aunt.

To receive any Medicare services you need a doctors order. U need a service that can bill Medicare too. If services in Fla were Medicare based u should have no problem. If they were Medicaid based, that will make a difference. Medicaid is a state thing and she will need to reapply.
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Judysai422 Jun 2019
I totally agree, write a note and give to doctor prior to appointment. I did this with my mom's new neurologist and it worked like a charm! Portal works, too, but sometimes there is a limit on the length.
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Many doctors have Portals where you can write notes or send secure messages to the office.
If you have her information you could set that up if she has not done so (I am guessing she would not have)
The other option would be to write a note and give it to the nurse and those notes would be entered for the doctor to review.
I would sent the note before the appointment so they have a chance to review it prior to the visit.
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Mom had an appt & I called ahead, asking if I could speak to him privately before he saw Mom. We spoke in his office. Many will let you make an appt to do same or use the patient portal if your mom has one.
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GIAGIA Jun 2019
Yes, exactly --- that's what ended up happening and it went well!
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I agree with some others. I wrote to mom's doctors with a list of my observed behaviors and concerns. I sent the notes in advance of appointments. All found the information useful and I believe she received better care because of the information I sent.
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GIAGIA Jun 2019
Thank you for your response, I feel lucky for all of the support here. The doctor has been very responsive and feel he understand the situation even better now that we've talked.
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Same answer here, the privacy thing only applies one way, you can call and write and tell the doc whatever you’d like beforehand. Good luck. You’ll slowly be in her business more and more, they don’t love it but just try to finesse it as you go.
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GIAGIA Jun 2019
True. Thanks for your response.
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I did the same thing that some others did: I sent my mom's doc a note a week or so before my mom's appointment, detailing some of my concerns, and the doc was able to steer the conversation a certain way.  In my case, it involved trying to convince my mom not to drive, so the doc was able to say how lucky my mom was to live with us and have a daughter who was willing to take her anywhere. Between the doc's kind words, and a car that stopped working, things worked in our favor. My mom, too, denied having any memory issues. I think it's a good idea to give the doc a heads-up regarding your concerns. Best of luck.
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GIAGIA Jun 2019
Thank you for your reply!
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Living with memory loss is depressive. Its awful ,I started a notepad so i would not forget things and guess what I cant find it. Ive tried Post its, medium size pads it doesn't matter it is still going to drive me crazy. I suggest that you write these ideas down and give her the tools to work with if she doesn't do better let's talk Helen Keller chalk board cause that is what I'm doing next. I hate telling people that i cant remember things also , mind you i am 53 .
I watch a movie and the next day i could not tell you what it was.
i have been fixing my grandmothers jewelry to hand down and i was talking to my cousin and I could not remember the word pendant. Its awful and scary, is it going to get so bad i cant remember where the bathroom is? Then its time for a home why on earth would we say our memory is going?
Sorry I thought you should hear it from the other side, it might help
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AlvaDeer Jun 2019
What I was trying to tell her, Bruceandtoby2. Normal to be depressed, anxious about all this. Changes at the end of life are not, as they say, for Sissies. I am 76. The amount of loss is apparent to me, and is, of course, accelerating. You are like my brother, able to discuss and describe changes you are going through and your feelings about them; you are invaluable as a teacher on a site like this. Wishing you good luck moving forward.
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Take a breath and relax. Our memories are strange things. Forgetting things is normal as we age I know you are younger but it can happen anytime. Are you having a lot of stress or taking medication that might be an issue. Don’t question yourself too much. If you are really concerned talk to your doctor. Blessings to you
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I called the doctor, left a message, he called me back. I told him everything that I was aware of, it helped tremendously, the doctor thanked me. My step mother is now in Memory Care, where she needs to be,
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GIAGIA Jun 2019
That's a good outcome. I'm sure you are relieved to have his support.
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I kept a list of things as I noticed them and just handed it to the Dr. when I visited with my husband. That way I could tell her what I was noticing without confronting him or seeming as though I was telling on him.
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GIAGIA Jun 2019
That's a good idea. It helps them to know more of what they are dealing with but also help you because it added support. Thank you for your response.
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My mom's cognition is going steadily downhill but she doesn't like me to speak on her behalf to medical people. So I write short notes and slip them to the nurse, doctor, or person at the check-in desk when we arrive at an appointment. You can write something like, “My aunt’s memory has declined sharply in recent months but she is unhappy when I bring it up. Can you start that conversation with her?” I just did this last week when my mom started PT on her shoulder. I gave the therapist a note letting her know that my mom would need ongoing reminders throughout her session to stay on task and help with counting repetitions of the exercises.
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GIAGIA Jun 2019
That's a really good idea! I'm glad it worked out for you. The doctor mentioned a medical group portal I could also use to email him and his staff messages, so I think I'll do that from now on. It's one less thing to provoke her anxiety over...and helps keep matters a little calmer.
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It is possible, since you do not mention being power of attorney for health care, that the doctor will not speak with you. Frankly, it is time for a social worker consult and to put power of attorney for health care in place. That person can warn doctor you are seeing changes; he can assess when she comes to him. But you mention that you are not there in saying "While we are here....". There is little you can do if you are NOT there, since your aunt is not in full dementia at this time. Denial is common as things start to slip, and doesn't help matters. Anxiety and depression is common as well, as can be imagined by any who can imagine "going there" near the end. It's time to talk to the aunt about "future things that could happen to ANY OF US as we age" and to get in place an advance care directive for her wishes, and the appointment of a power of attorney for health care, possibly for financial if the time comes. This doesn't even have to be a family member. Who is there for the aunt at this time.
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GIAGIA Jun 2019
Yes Alvadeer,

The POA and AD are in place. So it's not a matter of not being able to speak with him. It was being able to talk with him in private. As it turned out, I had sent him a message prior to the appt.. and I was able to relay to him the problems. He handled it by asking her to sit quietly alone so he could come back and do another BP -- as her high BP has been an issue and is being treated. We stepped out of the room and into his office. He has now added a low dose anti depressant to help replace the Trazadone she was taking and we'll see if that helps somewhat.
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Janner, I understand. That's pretty close to what I'm dealing with too. Fortunately, I was able to speak with the doctor privately and it went very well.
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if she is still competent and gives you permission to talk to him then there's no problem you just say it as plainly as you've done so here. if she's not competent to sign a release of info, then there may be a problem
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GIAGIA Jun 2019
In some ways she's competent but in others, no. She also doesn't tell the full truth when the doctor asks questions. I am her POA and have been handling her affairs, though I keep in mind that I want her to have a sense of dignity so I don't try to speak for her - I just fill some things in and then other things just have to be said private or else she reacts irrationally.
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Either write him/her a letter or make an appointment to see him/her yourself - if possible bring in a video or 2 to show how she is when not showboating for them - tell the dr that you want what is best for auntie but you want him/her to be aware of what you are seeing

These drs didn't just fall off the turnip wagon yesterday so many [but not all] are aware of these issues - even if you say that nothing will be done for some time as you don't want to upset the apple cart at this time but rather you feel that he/she should aware of some concerns .... if you can get more than 1 source to show then that can be important
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Write a letter to the doctor prior to the visit and state just what you said here. That will give him a heads up. Contact the old social worker and doctors that she had in Florida and ask them to send notes about her condition to the new doctor. That should take care of it. Gives the doctor a place to start and the conversation won't be so awkward when you do the first visit.
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Pass him a note detailing your concerns while you're there.
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I had the same situation a few months back. Noticed some cognitive changes with my mother.
I contacted doctors office and spoke with his nurse who made appointment for me to visit doctor with my mother. The nurse made arrangements for me to speak with doctor prior to doctor seeing my mom.
Once I explained to doctor my concerns he was surprised he had not picked up any signs during their visits. During exam he started asking questions where he was able to see my concerns. He ordered tests and made referral to geriatric doctor where mom was diagnosed with Dementia. Moms primary care doctor was so thankful that we stepped in to make him aware of what we had been noticing with mom.
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You either set up a one on one appointment with you and the doctor only or have a private phone conversation. You should NOT be the one who tells your aunt - there will be problems. Let her argue with the doctor. Then later you can refer to the conversation and say you have noticed, etc. Also have him prescribe the proper RX.
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Just go talk to the doctor and explain this to him. He'll keep a secret.
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I see that your problem has been addressed. I am posting in case anyone else needs help. When I took mom for an appointment, she became unruly and I left the room. Doc chatted with me while the nurse did her usual. He agreed to provide a letter so that I could proceed with taking over financials (note, we already had all the necessary documents in place, but Federal entities do not honor any kind of POA - they have their own rules.) After SIX months of back and forth through the portal, staff was useless and we NEVER received the letter. I provided POA and they asked for it again. I gave them the requirements from the federal pension and pleaded with them for this letter. Nothing. We changed doctors, primarily because the place we chose was nowhere near that doctor office - it still took time to get the right letter!!

Even that doctor, despite initially thinking she was the right one (I had switched to her when I had moved) was clueless in many respects - I changed over to another just in time as she decided to retire! I just had my first physical with this new doctor and guess what? They gave ME the mini-test!!! Thankfully I passed. If I didn't, we would both be in trouble. I have two brothers, but I manage everything for mom, me and payments on my cards for my daughter's debts that she pays for (long story) - I cannot afford to start down that nasty path! I don't think either brother would be able to manage what I take care of (one is not listed as POA for anything and cannot be now, plus he isn't local. The other seems to live in another world!)

So, be sure you have a doctor who is on board and has a clue AND will work with you! As everyone has noted, it never hurts to contact the doctor office and see what will work - portals are good, but personal contact first might be best.
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