Up until yesterday. I thought my 93-year-old father was quite sharp for someone his age. He lives in the Independent Living area of a facility. He listens to the radio & watches TV, keeps up with major current events & has maintained a dry sense of humor. Also neither my brother or my husband have noticed any changes in him. Recently, some repairs/adjustments were made to his apartment which had been requested months ago. When his bathroom vent fan was taken out in preparation for a modification, he told me that "the guy came in, took it out & said nothing", meaning he was not told why the fan was taken out, what would happen next, etc. However, during a spontaneous conversation with the director, I was told that dad WAS given a detailed explanation.
I also handle his pillbox, which lights up when it's time to take a particular med. I was told that housekeeping has found pills in his linen when doing the laundry. Dad has always been particular about his med regimen. I briefly discussed these things with him & he insists that no one gave him any info about the fan. He also said he takes his meds when the pillbox lights up. These are just a couple of examples that I've been told that are very disturbing, if true. I even asked the director if he had him confused with someone else! I spoke to the head nurse who is concerned especially about the meds. I requested that she set up a cognitive eval for him.
My concern is: who is telling the truth? As a retired RN, I'd like to think I would see these kind of changes myself. How do I tell him about the cognitive eval without scaring him? How should I proceed otherwise? I'm not sure who to believe.

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My late fil would have told you he had taken his meds. Each morning, he counted out the pills he needed to take and put them in his chest pocket. If there were no more pills in it at the end of the day, he "took them all."

When I found random pills on the floor, we realized what he was doing and had to have his medication supervised.

My Dad generally appears to be all there cognitively. He sits at the table and organizes his pills. He takes them as scheduled throughout the day. However I find them on the floor, tucked under the edge of his place mat or under a napkin.

The cleaning staff have no reason to lie about finding your Dad's medication in his linens. Dad is telling his truth, then the medication dispenser lights up, he takes the pills out. But he may not take them right away. He may put them down, while he gets a glass of water, then get distracted.

My Dad appears to be 100% all there. He is also very defensive if questioned. It is very hard to see the changes in our own parents. Even for a retired RN like yourself. You want to believe Dad is 100%, when the evidence clearly shows differently.
Helpful Answer (10)

I was shocked at how bad my mom had gotten and had no idea until I stayed in a hotel room with her.  We drove out of town for a family funeral so my mom was out of her "every day element".  She was nuts!  I sent her into the bathroom three times to change her clothes and every time she came back out and had no idea what she went in for.  I found the clean clothes I had given her to put on, tied in a knot around the grab bar in the shower and I found the clean underwear in the toilet.  My mom truly believes what she is telling me when she talks, but I know what she is saying didn't happen.  When my mom says things that I know are not true, I don't consider her to be "lying" I consider her to be sick...she has dementia.

No one in my moms extended family wanted to believe she was sick.  I am not sure why they thought I would make it up, but they would say to remember me giving you $100 for your birthday don't you?  And she would respond yes.  Or they would say don't you remember that kid Jimmy that lived next door to us when we were growing up and she would respond yes.  So they would say, see... she is fine.  Just recently though, my uncle asked my mom what his name was and she couldn't come up with it....he finally dug deeper than a yes or no answer.  He was shocked that she didn't know her own brothers name.

My point in telling you all of this is so you will dig a little deeper.  Take him to lunch and then ask him the next day what he had for lunch when you went out.  Ask him the name of the restaurant you went to.  Give him something to read and then ask his opinion on the matter.  

I can certainly see a worker knocking on your dads door and saying I am here to work on the fan that's broken...and not go into much more detail than that.  But I don't see why the workers would fabricate finding meds in your dads bedding.  What would be the point?

One of my moms neighbors in the Assisted Living Facility kept saying that the employees were stealing his things so his son installed a camera in his apartment.  So the next time he told his son that his bag of toiletries from walmart was missing, his son looked at the video, saw his dad hide the bag behind some things in a closet.  He looked in that spot and there were the items.  His dad had just forgotten that he hid the items. 

It is a horrible thing to accept that our parent is not the same and on the decline.  Your RN status does not change the fact that you you have been around this man your entire life and you expect him to act a certain way .... you are on auto pilot with him just as much as he is with you...  Just dig a little deeper...take him out of his routine and see what you see...

The cognitive eval is not a bad thing.  Just tell him the facility is going to have a visit with him to see how things are going.
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Believe the staff. They have no reason to promote an untruth. The bathroom fan is a non-issue. The meds found in his linens is serious. My sister, with dementia, adored her 7# dog and treated him as her child. Staff told me she was being mean to him. IMPOSSIBLE!! So I watched her (unannounced) and Bingo, true!! I found a loving home for him within days.
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my2cents Jan 2020
I would never just 'believe' the staff. This family needs to put their own eyeballs in the room to see what is going on. And observation needs to happen for at least a week every day.
The fact that there were some pills in the bed means that he DID open the pill dispenser when the light went off. It's possible he just needs to be opening the box at a table where you could easily find one that you dropped.
I would ask myself why would these other people lie? What do they have to gain?

Sometimes we are too close to the situation and do not see what is right in front of us. It is always harder to accept decline when it is someone we love, when at work, people are at a arms length away...totally different.

I just took my step mother for evaluation, she didn't want to do it, I told her that we need to know because we want to keep her in AL and not have to move her husband into into MC. She said ok. Although I do know when he passes that is where she will have to go.

Good Luck hope that he will agree to go!
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About the fan. I expect the idea is something like "all people working in our facility should take care to explain any work they are doing to the residents involved," and I expect everyone is given some kind of basic training to that effect. And I also expect that quite a lot of the time it doesn't happen: the worker won't have enough time allocated to the job, the worker starts work before the resident is in the room and explaining would get complicated, or the worker begins to explain, the resident doesn't immediately catch the thread, and the worker gives up and goes about his (legitimate) business. So I expect that the director was telling you what ought to have happened, rather than necessarily what did happen or what your father was able to pick up from what was said to him (how's his hearing, by the way?). Nobody's lying, they're more... thinking wishfully, perhaps.

Pills in the linen - how fiddly are they, and how easy is it to get them out of the dispenser? One thing I have noticed (mainly male) people doing is shaking all of their tablets (and it's sometimes as many as eight or ten) into the palm of their hand, and then clapping the palm to their mouths, whammo, just like that, to get the pills down in one. It makes my hair stand on end. If any one of those little tablets goes astray down a shirt front or between the chair cushions I have to track it down, identify it, and record the mishap on a chart, and it is a gigantic pain; but we're not allowed to tell people how to take their tablets if they're doing it themselves. The other thing that commonly happens (more with blister packs) is that the pills are tiny and the tray is deep, and one or two get overlooked.

So if possible, can you be there when your father takes his medications and just observe him without comment? You might spot where the problem is and be able to make a minor adjustment, nothing at all to do with cognition (unless you count not being as punctilious as he might be about his meds).
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Barbeem Jan 2020
Yep that how my 97 dad takes his meds! Cup the hand and all in the mouth! Then I found many in the floor. So I showed him where they ended and encouraged to take one at a time! He would only take them "the right way" if I stood by him. Lol
What benefit do you feel there is in their lying to you? I think you cannot know who is telling the truth, but I suspect that the AL is telling the truth, because I cannot imagine their fibbing about it. If you want to private message me I can tell you about a personal experience of mine I don't care to mention here, that taught me quite a lot. There is a reason that there is this "pill box that lights up" etc. There has been some recognition by someone that there is starting to be some failures, infrequent perhaps, in cognition needed to know when to take the pills. Perhaps things are getting a bit worse. As I said, I cannot imagine a reason to lie. Are you thinking they are wanting to bump your 93 year old Dad up in care level and there is a method to the madness? At 93, if Dad didn't have some forgetfulness going on I would be very, very surprised. I know I am 77 and I surely DO.
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nature73 Jan 2020
Not sure how to PM you. Will explore how to do this.
I would just be upfront about it. I'd let the part about the fan go; I can see how it's a little worrisome you're getting 2 stories, but there could be any number of pretty benign reasons for that. I'd go ahead and assume it was just miscommunication. But the part about the medication is more concerning for all involved.

So I'd just tell him that they've found pills in his sheets and under the bed and are worried he's having trouble with them, and that's why they are checking his cognition. Just let him know that you realize he may be dropping them inadvertently, and that you think he's very capable, but that you still need to help find a solution to the problem, and that besides, a cognition test is an important measure of how he's doing (can be used as baseline, as someone else suggested).

Reassure him that he's not "losing his grip" (as my dear, sharp, grandmother used to worry) and that no one is trying to take away his autonomy. You need him to feel he can trust you and the best way to do that is to assume the best of all parties involved and be as upfront and caring as you can. I'm sure if he's as sharp as you say he is, he will be able to reason through all this.
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You or someone needs to spend more time w/dad - perhaps about a week of being there all day long to observe.
The repairman came in and took the fan, but director says dad given detailed info. Unless the director was the one sharing the info, she has no idea what the repairman said.
As for the pills, dropping them can happen. My mom is very alert about her meds and knows each one to get out of pill bottles each day. However, there are times I'll find one under or around her chair. It dropped, she didn't realize it as it went from hand to mouth and she missed a pill that day. If he has a kitchen table to sit at, put the med box there and let him know it would be easier to find it if it dropped. Just let him know that if he accidentally drops one, it can cause him problems.
I wouldn't do an eval on him right now. You just told him a repairman explained something in detail (that may not have happened) an talked to him about missing medicine (which he is really not forgetting to 'try' to take if they were found outside the med box). First observe.
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lealonnie1 Jan 2020
Not only is it a bit unrealistic for a family member to spend all day every day with a resident for an entire week, but that will not guarantee anything ANYWAY! Cognitive decline is a real issue; it comes and goes without rhyme or reason, too. They can be fine one day, and out of it the next. I never blindly believe anything my mother tells me in AL. Why? Because she's made up stories CONTINUALLY for years now! I have to fact check EVERYTHING she says otherwise she'd have me in a tizzy 24/7.
As a family member who is close to him, you may not notice cognitive changes in him especially if they are subtle. I think a cognitive evaluation is a good idea. I wouldn't make a big deal of the evaluation just treat it it as routine. I don't think these events can be reduced to truth versus lies. Could be how dad remembers the situation compared to how the staff remembers. However, I don't think that the staff would enter the room unannounced nor do I think that they are misrepresenting the medication issue. In any event, what is best for your Dad should be the primary concern.
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My LO was pocketing her meds, but would look you straight in the eye and tell you she took them.
The SNF now crushes her meds and adds apple sauce.
i didn’t request the crushing of her pills but I’m glad they do it because
it assures she’s getting her meds, and one less thing for me to worry about.
Her dementia has gotten worse in the last year, and even though she’s on dementia meds, along with mood stabilizers it makes me wonder how would she be without them.
Good luck with your dad. Sounds like he has kept himself together for Many Years. My LO is only 67 years old.
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