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I have DPOA, and dad has dementia. I want to respect his wishes, but I take him to his cardiology and neurology appointments. (He thought he might be able to get his drivers license back from one of them) I noticed a 1.5 cm crusty skin cancer lesion, and his teeth (which he hasn’t brushed since August) are now starting to fall out. He often takes his pills incorrectly, even though he has a pill organizer. I’ve mentiined getting a new pill dispenser but he gets angry and argumentative. I’ve showed him how he took too many days worth of pills, and I’ve begged him to let me get someone to help me to help him. He thinks that caring for him only involves bringing him a “hero sandwich” every other day! I’ve mentioned that I’d like him to see a dentist and a dermatologist, and he gets furious and verbally abusive with me. Do I LET him fall apart? I’ve stopped nagging him to shower, so he stopped showering. I figure I need to pick my battles, but where do I draw the line? I am the only person taking care of him because he refuses help from anyone else. The neuropsychologist suggested adult day care and assisted living- but Dad just sits in his apartment smoking cigarettes and watching tv. He refuses to go anywhere! I am fully responsible for him, so I’m not sure if I can step back and do nothing for a week and “see what happens.” He could die if he doesn’t take his pills, or has no food to eat. He has 3 heart issues, and I’m afraid that when his teeth fall out he could get an infection that would affect his heart. I don’t know if the skin cancer can kill him, but he makes things so difficult that I’m losing my mind! I work full time, have my own family, and I have my own serious health issues to deal with. Any advice?

It is challenging when they are stubborn and have dementia.

How do you pick your battles? Depends on how bad Dad’s dementia is.

If he is willing to see the cardiologist again perhaps have a chat with the doctor ahead of time and have the Doc tell Dad he needs to have his teeth seen to to prevent his heart worsening?

Skin cancer? My Dad is fastidious about having his skin checked after his first round of skin cancer 20 years ago. But he will not go to the dentist anymore. Like I said which battles to pick?

There will come a time when Dad can no longer live in his own. Perhaps start looking into options now, but do not tell him.

Dad will die at some point. Perhaps ask him if he would rather die of cancer, heart disease, stroke, malnutrition, COPD or some other malady? Then tell him you will not facilitate his death by neglect.

Remember you do not have to ask him about a new pill dispenser, just go buy it, load it up and take the old one away.

It is crazy making when they refuse help, then expect others to clean up the mess they create.

Sorry no real answers, just someone who understands the challenges.
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Reply to Tothill
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There's a difference between allowing a competent adult to make their own ruinous choices and allowing the same behaviour in someone with dementia - your father no longer has the mental capacity to understand long term consequences or to adequately care for himself. Sometimes a family member isn't the best choice as a caregiver because the elder resists or the caregiver finds it difficult to "disrespect" their parent, maybe it is time to enlist some outside help.
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He is not your dependent. Having DPOA is not the same as having guardianship. All you can do is try your best to keep him safe.

Because he has dementia and is a smoker, he is at high risk for setting his home on fire. Where does he live? What is the risk of a fire burning down other structures?

His health is poor. Perhaps it's time to discuss prognosis with his doctor and prepare for giving your father the best quality of life for whatever amount of time remains. If that means hero sandwiches every day or two, then enjoy that time.

Rather than mentioning things to him like getting a new pill dispenser, just do it. That is something that is within your control. Get him an automatic pill dispenser and reorganize his pills for him. They are expensive - $60-$75 - but they work for seniors with cognitive decline. Lock it and you keep the key in order to prevent him from taking extra medication.

What is his financial situation?
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Reply to NYDaughterInLaw
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Dadsakid Jan 4, 2019
Oh, he lives in a senior apartment complex. I also fear that he will start a fire with his smoking, but at least he isn’t drinking any more. He drank heavily for over 65 years, and he smokes 1.5 packs a day of unfiltered cigarettes. When he detoxed from alcohol he was in the hospital, and they gave him s nicotine patch. The highest dose did nothing! They had to keep him drugged and sedated to prevent him from getting up and trying to leave in his gown out the front door to get cigarettes.
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I'm learning that as contributors with responses, we can only help you with what has worked for us. There are always nuances to each situation that won't fit in this little box!

My sister and I are co-caregivers to our mother with fairly advanced Alz and now, a debilitating knee injury so she can't even walk. We decided it's time to get her into a place where they can at least keep her fed, showered (she hasn't had a shower in 2 years), and relatively safe. To help us navigate the ins and outs of an incredibly complex world of elder caregiving, we have contracted with an elder advocate who also works with a senior housing specialist.

The $1,325 we have paid so far for this out of Mom's accounts has already helped. They are also willing to be the "bad guys" when it comes to explaining to Mom that she can't live by herself anymore. The worst is yet to come - we've just started this journey - but to help you see things more clearly, prioritize which battles to fight, and remove some of the guilt that comes with the child/parent dynamic, consider an elder advocate in your area. Just google that phrase and see what comes up. Mine came highly recommended to me by a friend who went through something similar. We are lucky in that we have the most fabulous geriatric physician on the planet (we're in Fla.), too.

They can help with alternate sources of financing, veterans benefits if that's an option, and so much more. The short answer to your question is yes, it would be to everyone advantage to step in and override your father's poor decisions.

I wish you luck.
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Reply to shb1964
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If you are really his POA then you have to override what he is doing to himself and get him into a Assisted Living Facility asap. If his health has diminished past that point, then you should get him into a nursing home.
You may think that you are breaking a promise to him but the real promise is that you care for him and his health. Don't feel guilty about this transition because you will be taking care of his health and the staff at these facilities will care for him and deal with his stubbornness. You have a family and yoyr own prpblems to deal with. Take the strain off yourself. You need professional help at tjis point.
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Reply to Maude69
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Yes.

My dad died about 18 months ago and I had been estranged from my family for about 10 years leading up to that point. When I came back home I realized my mom was not the person that I remembered. She wasn't taking care of herself in any way, she was living in filth, and despite having been an accountant she let her finances fall into a state of disrepair (including attempting to purchase a property with excessive earnest money) such that it took a year for me to clean up the mess and prevent her from going bankrupt.

In the beginning I had no idea that it was Frontotemporal Dementia. We thought maybe she was just depressed. We argued with her to let us intervene, but she was completely obstinate.

Eventually I took action, got DPOA, fixed everything, etc. But I realized that she needed even more than what I could provide with just DPOA. I hired legal counsel and petitioned the local probate court for guardianship and today am in the final stages of having her placed in assisted living.

The best advice I can give you is this. Start the process ASAP.

If you don't intervene now, the damage caused tomorrow could be much more costly than what's required to get things under control today. The sooner you get the guardianship process, the sooner your dad will have the care he *needs*, even if it isn't something he necessarily wants.
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lynina2 Jan 8, 2019
How expensive was it to obtain guardianship and how long did it take?
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Even if you get him in an AL or NH they cannot force him to do anything, even with Dementia. By the time I placed Mom, she was pretty out of it so excepted everything. An AL will not take Dad if he is going to be combatant. They aren't set up that way. POA does not mean you are physically responsible for him. It means you can handle his finances and take care of his wishes concerning medical. Guardianship is another thing but he has to be found incompetent.

Maybe you should get APS involved or Office of Aging. Let them evaluate the situation. They may tell you that there is nothing you can do. By doing this, it will show you didn't abandon him, it was his choice and APS said you can't do anything legally.
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anaiqpn Jan 8, 2019
Is there someone or a place we could call when the person gets combative and will not listen to us? My mom has dementia and she have tried 2 times to overdose on pills. is their a place that would take her temporarily when shes feeling overwhelmed. She has medicare and when she goes to the hospital they only keep her for a few days then release her. i was told in order for medicare to pay for the stay at a facility she has to go straight from the hospital to facility and they will keep her for up to 100 days. What other options do I have for a temporary facility to accept her and let medicare pay for it? i'm referring to only when shes feeling like overdosing.
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You’re right! I will let the cardiologist talk to him about his teeth. Thanks for understanding.
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Reply to Dadsakid
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just a quick note, My dad died from skin cancer - however, he had a hole you could put a pencil thru in his jaw. stage 4 skin cancer. he refused to see dentists and doctors until it was too late
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Dadsakid Jan 8, 2019
I’m so sorry you had to go through that! It must have been very difficult.
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Introduce caregiver, possibly male, as a ' friend or company' for him.  If he smoked all his life he won't give up now. Good luck deciding.  It is tough.  You are in our thoughts.  Hugs.
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Dadsakid Jan 8, 2019
Thank you! You’re right about the smoking... I’ve joked at the tobacco shop that he is the “last human alive who smokes Lucky Strikes.” He doesn’t want to quit. It makes him happy.
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