Elderly isolated dad may not be coping - what should I do?
January 10, 2012 3:25 PM   Subscribe

Elderly father, living alone a long way away, may not be coping. I am trying to investigate & get him help if he needs it - please tell me if I am leaving something out or overstepping the mark.

My father is 80 and lives on his own about a 3-hour plane flight away from me (this is Australia; I'm in Melbourne, he is in regional Queensland). He has no family or close friends in the vicinity. He doesn't make much effort to see people. He suffers from health problems including a bad knee, prostate problems, hearing problems, diabetes and depression, and he's on several medications. He also smokes.

He's always been really independent but lately I've been worried. He's missed appointments and not rescheduled, and he consistently doesn't know what day it is. When he needs to remember something he's always written it down on a scrap of paper which I think then gets lost among other scraps.

His TV broke before Christmas and he hasn't arranged for it to be fixed yet. I thought at first he was just being vague with dates because he wasn't getting that outside stimulation. A few things have been happening that have made me wonder if this isn't the beginning of something more, though. For instance:

- Last week I got him to make a doctor's appointment; I called him last night since his appointment is today, and he'd forgotten he had an appointment. Once I reminded him, though, he remembered it wasn't with his regular doctor, and he knew which doctor it was with.
- He told me that he thinks he'll have to get a ribbon tied on the car aerial because it takes him a long time now to remember where he parked the car.
- His sleeping patterns seem to be all up and down. He's often just woken up from a nap when I call, whether it's 11 AM or 6 PM.
- He talks about things he has to do, but never does them (for instance, he can never find a pen that works but he won't throw out the ones that don't work).
- I've noticed that he's slurring his words a bit, especially when he's first woken up.

He's admitted he may be having memory problems, although he insists that he's all right and he seems to be eating, paying his bills, etc. He always knows who I am, who he is & where he is on the phone.

My partner and I are flying up there in a couple of weeks to see how he's going and judge for ourselves how he's going, what the house is looking like, what he might need, etc. I'm trying to get my brother involved as well, but he is fairly resistant to the idea that Dad might need help.

So my specific questions are:

- What should I be looking out for in the house? We'll be fixing the TV and seeing if he needs help with maintenance. I'll check his smoke alarm and locks and look out for the cleanliness of the house. Are there any red flags which might give me clues about whether he's coping or not?
- If his problem is only/mainly with dates and personal organisation, what kind of things could I get him that would help him with this? I've thought of getting him a single large notepad to avoid the scraps of paper. I also thought I'd get him one of those medication dispensers with compartments for each day (if he's losing track of dates, he may not be taking his medication right). Are there other things I should be looking for?
- If his problem is greater than this, he will probably need to move. I would prefer it if he was closer to me and my brother where we could visit him every few weeks, and also if he were in a retirement community where there were other people around. He was quite amenable to being closer to us when I mentioned the idea. He will almost certainly need help to sell his current house and move. Should I get power of attorney so I can help with it?
- I've asked him to give my phone number to his doctor; should I call his doctor? Is that acceptable? I know there are huge privacy issues but I'm worried he will not talk to the doctor about his memory problem and that therefore he won't get referred to the services he needs, and he'll never ask for help on his own - he's too proud.
- Is there anything else I am not thinking of that I should be doing? I am completely new to this.

He's always been self-reliant and I do not want to take away his dignity or autonomy; but he has a history of not seeking help so I want to make sure he gets it if he needs it.
posted by andraste to Human Relations (16 answers total) 5 users marked this as a favorite
All of my grandparents have suffered from dementia of various types (some alzheimers, some not), and it almost always began this way, with trouble only with dates and times, and finding things. If this is the beginning of something more serious, I'm sorry. In some cases it progresses quickly (months), and you might be looking for somewhere else for him to move to soon. In other cases it can take years from this point to where it gets more serious. It would still probably help if he were closer to you so you could check in on him in person more often.

When my most recent grandfather was getting close to not coping on his own any more, here are some red flags we found when we visited:
- food was almost always past its use-by dates. He was still eating stale bread from the bakery from a week ago, and hadn't realised. There were mouldy things in the refrigerator, some of which he was still eating.
- he was dressed quite inappropriately for the weather. Winter clothes in summer. Multiple layers of weird things, like underwear + shirt and trousers + more underwear + another shirt.
- he was taking naps in the morning or middle of the day not just because he was tired, but because he thought it was bedtime. Or he was waking up from a nap and thinking it was first thing in the morning, and going through his morning routine (shower, dress, breakfast) even though it was 6pm.
- he wasn't taking his medications consistently at all.

If you could get him a mobile phone or digital device of some sort that you can program with reminders to actually beep at him and tell him on the screen what to do, that would help with medication and appointments. One way to have some input with that is to get him even just a simple phone, and set up a google calendar that you have access to, and that has his phone number as the number to send reminders to. Then you can schedule things (including recurring things) for him in it, and it will message his phone automatically. That's a free service, by the way.
posted by lollusc at 3:37 PM on January 10, 2012 [1 favorite]

Here in the US you can call his doctor but the doctor can't talk to you about your dad. So you can relay your concerns- they just can't respond.

A lot of the hospitals around here have a medical advocate who can be a social worker for your dad- just check in on him, make sure his doctors are communicating with each other, make sure he gets to appointments, etc.

Good luck. I think I'm looking towards this for my own dad, who fortunately, is "only" 60 miles away.
posted by small_ruminant at 3:57 PM on January 10, 2012

might be an idea to ring the local hospital to see about services like a regular visit from a nurse, or maybe the local council has services for elderly people who want to stay in their homes. You could also maybe go to see his GP with him? Is that allowed? There are also services where the client has an alarm they can press ...around their neck, etc if they have a fall or get into difficulties...
posted by sparkle55 at 3:58 PM on January 10, 2012

When you are there, check on the freshness and viability and use by dates of all foods and medicines you can find in the house. Check on the freshness and viability of household and bathroom products such as toothpaste, shampoo, soaps, cleaning products, dish liquids, etc.

Check for strange and unpleasant smells. Elderly people generally have quite poor senses of smell so something can be dead or rotting or just generally yuck and they won't have noticed it. Check for pests, ants, fleas etc. Check his bedding, check that the washing machine is working properly, check the seals on the fridge, check the taps, check how clean everything is or is not. Check the yard. Does he have a shed or a garage? If so, then I'm sorry to say that it sounds like he doesn't need it. Get rid of anything in there that he could potentially injure himself on, or trip over.

Check for tripping hazards and sharp edges throughout the house generally. Check electrical cords on appliances. Defrost the freezer while you're there.

As sad as it is, television is a great comfort to the elderly and alone. Make sure it works and he's getting all the channels. Ditto for the radio, or "wireless" as he probably calls it :-)

I'm of two minds about getting him a simple mobile phone to use. On the one hand, sure, he can have his reminders and it's a very slight reassurance for you because it's another way to get in touch. But in reality it will probably be a source of great anxiety for him and in all likelihood it will never be recharged.

I don't know how regional it is when you're talking about regional Queensland. There's a difference between Toowoomba and Emerald. That said, you may want to check with the supermarket most local to him to see if regular deliveries can be arranged. The usual stuff like milk and bread, once every four days or whatever. It's another set of eyes on him, though irregular. YMMV, of course, but in my limited experience small town IGAs or whatever will be more inclined towards doing something like that for the local aged community.

Perhaps you could even clear out his pantry altogether and get in touch with Meals on Wheels, if they exist in the town/area. Then you can be assured that not only will your father be eating properly, but there will be somebody knocking on his door and checking in on him every single day. Make generous regular donations to that branch of MoW, of course.

Let him smoke. As harsh as it sounds, it's honestly not going to make much of a difference at this stage, and it gives him pleasure and comfort. BUT...identify the places that he smokes regularly. Does he mainly only smoke in his favourite armchair? Then fireproof it and the carpet around it. There are flame retardant and fireproofing sprays that can be had.

Does he have any pets? Like a bird or a dog or anything? Then something needs to be done about that as he is no longer capable of caring for it properly and that is unfair on the animal. However, you don't mention anything so my assumption is that no creature exists. Just putting it out there for the future, I guess.

The local medical authorities need to know about him. Go to the base hospital and ask to speak to somebody in geriatrics. There will be organisations around town or in the nearest city. They need to know about your father and his condition and where he lives and how to get in touch with him. You may like to speak to his neighbours while you are there, introduce yourself, and give them your contact details as well as getting theirs, if they're happy to do so. Get the details of the local police station as well...most coppers who aren't assholes are only too happy to go and knock on a door if you're worried about your dad.

Specific medical care I will leave to the experts. This is just some stuff from the top of my head. Good on you for looking out for him, but I have to say you might want to give some serious consideration to a relocation operation, either for yourselves or for him.
posted by tumid dahlia at 4:18 PM on January 10, 2012 [7 favorites]

So often lost, the signs are the arrival of this: one of you should give yourself to the care of him. Take him in; you will make this last chapter one of peace, for him and for you.
posted by Kruger5 at 4:27 PM on January 10, 2012 [1 favorite]

There may be an agency that will help you find someone to check on him every week or so; perhaps hiring a cleaner to visit, clean and cook every other week or so. You can call him every couple of days, mention the day and date, talk to him about world & local (to him) events. Memory problems are not uncommon in the elderly, esp. if they take a lot of medications and/or are depressed. Do an inventory of meds; take it to a doctor and have it assessed to see if there are complications. Sometimes, people just keep taking something, even if it's no longer needed, or conflicts with other meds./conditions. Tell him you'd like to have an appt. with him and his doctor, to review his meds and health status, and to make contingency plans if he were to become ill, have an accident, etc.

Respect his independence by being honest - you love him, and want to be sure he's doing well, and having a good life.
posted by theora55 at 4:56 PM on January 10, 2012

Thanks guys, great suggestions so far, especially on what to check for. There is no garage or storage shed, he has no pets, and he only smokes outside. He's been resistant to Meals on Wheels claiming that he's fine in his eating, which is one of the reasons I want to go & check how his eating is going. Great idea to get to know his neighbours.

I think the mobile phone would be more trouble than it's worth, unfortunately. He still has trouble using his DVD player. I think the mobile might not get recharged and would make him anxious.

tumid dahlia: it's Hervey Bay. Which is good because it's full of elderly people and so there are plenty of services, but I would still prefer him closer. But since my brother & I (and our mother) are both in Victoria (and this is where we originated as a family) he'd be OK with relocating. He'd probably just need help to do so, which I can do.
posted by andraste at 5:02 PM on January 10, 2012 [1 favorite]

Hervey Bay's a nice spot, the lucky old bugger. But yeah, relocation is the absolute best option. That will take a little while to organise, naturally, so get everything under control at his place while you're up there. Being back in Victoria near his loved ones will do him a world of good.
posted by tumid dahlia at 5:09 PM on January 10, 2012 [1 favorite]

One thing that should be emphasized is that this is a non-recoverable condition. He will not get better so the sooner you get him into a supportive surrounding close to hand the better for everyone. I would also recommend Susan Jacoby's Never Say Die if you would like some background about just what is going awry.
posted by ptm at 8:30 PM on January 10, 2012

Are his bills getting paid on time?
posted by metahawk at 11:00 PM on January 10, 2012

No one has discussed power of attorney yet. I watched my mother go through a similar situation with her mother. First, my grandma lived with us, then in a senior apartment building (where she managed herself but had help with things like rides to the grocery store and doctor), and finally in an assisted living facility where her Alzheimer's went into high gear and where she eventually passed away. My mother received power of attorney when she moved in with us and began the process of selling her house.

I would discuss the issue with your dad and make sure he fully understands what you're trying to do. Also discuss it with your brother and any other close family members, so there is no misunderstanding of your intentions or how things are going to proceed.

Good luck. Your dad is lucky to have you so concerned and involved.
posted by look busy at 10:57 AM on January 11, 2012

Update: I spoke to one of Dad's friends today, and we had a good chat. He thinks the situation is not urgent and Dad is still able to look after himself, but he needs some help with the garden maintenance and heavy housework. He also thinks it would be a good idea for Dad to be closer to us and that Dad just A) doesn't know how to get the ball rolling in terms of selling his place and looking for a new one, and B) doesn't want to be a burden on me and my brother.

Friend offered to get together with us when we visit Dad in a few weeks' time, to chat with him about whether he wants to move, about local services, etc. He also reassured me in the meantime that he visits Dad at least once a week or so, calls him several times a week, and he's going to get him to come more often to the local hobbyist club they both belong to.

Thank you all for your suggestions so far. It's been a real help in getting things clear. I have also talked to Dad about getting power of attorney with Dad - to be held jointly with my brother - and he's agreed in principle. I'm looking on this as the start of a process which will hopefully end in a happier Dad, living close to his family, and better looked after.
posted by andraste at 9:00 PM on January 11, 2012

I'm old and independent and I've had to get some help here and there, which hasn't pleased me, but it's nevertheless been necessary. I also live in a building with 150 apartments full of old people and we all have similar problems, so I have a couple of things I'd like to say.

Please step lightly here. If you're dead certain he isn't eating right or taking his medications or he has some medical problem that seriously impacts his ability to take care of himself at all - okay, then he may need to be "relocated" whether he's comfortable with the idea or not, but otherwise - if he needs help with housecleaning, hire someone to come in and clean every week or two, and that person can check the dates on his food and keep an eye on his physical condition also. If your Dad wants to go on fixing his own food, that's important to him, so if possible, let him have control over his food and food preparation. If you think he needs better nourishment, encourage him to drink a couple bottles of Ensure a day. But, seriously, the last bastion of personal control over our lives most of us have is our ability to eat what we want when we want - and that's not asking too much for an 80-year-old man if that's the way he wants it. Also don't be too fixated on dated food. I drink ultra-pasteurized milk which lasts for a considerable time after the date has passed and it's absolutely fresh. I have cereal which is past dates, but it's just fine, and bread also. I buy bread that's just at the end date and put a loaf or two in the freezer. I may not take it out for two weeks, but when I do it's just fine; however, if someone came into my apartment and looked at the date on the bread, they'd think I was eating garbage. Just be absolutely certain that you have to take control of this away from him if you do, because it's going to be a big issue over the long run. Remember he has to have some control over his own life just to keep his dignity. We may be old and beat up, but we've earned some right to do things the way we want in our "golden years," just as you're earning that same right now.

I'd really be edgy about the Power of Attorney bit. If he suggests that, fine, but as much as I love and cherish my children, I shudder at the idea of any of them "taking" Power of Attorney over my life; even under the best and most loving of circumstances, my life can be changed dramatically because someone else thinks it's what's best. Most everyone I know is very leery of giving up Power of Attorney.

If he's not particularly attached to his home, there are several different options for elderly housing; maybe he'd like to live in an all-elderly apartment building where he can still cook for himself but has other old people around to visit with and he can get help if he needs it. \
posted by aryma at 11:57 PM on January 11, 2012

One thing to consider is that if he is willing to move now, it would be easier on him to do it while he is still relatively healthy and mentally with it. The stress of moving is much worse on someone who is uncertain about their surroundings, having trouble remembering where things are, or slightly paranoid (which, sadly, is something that many people with alzheimers or other degenerative age-related mental diseases become). One of my grandfathers moved to live next door to his children when he was at the point of not coping alone any more, and he spent the next few months very confused and frightened, and often going wandering away from the new house looking for his old local shops, friends, etc.

If your dad moves while he is still coping okay, he will have time to build up a bit of a routine and social network in the new place before any more serious problems strike.
posted by lollusc at 12:12 AM on January 12, 2012

aryma; thank you for the reminders to tread lightly. I will try to keep it in mind.

I'm certainly not thinking he's at the stage of needing anything like a nursing home. I was thinking something like an independent living unit in a retirement community - where he could have his own unit with a couple of bedrooms, a car parking spot and a small garden. They're private and he would be completely independent as far as daily life and cooking goes, but all his neighbours would be other elderly folks, maintenance is provided, and there are buzzers in the units in case of emergency. But I have no desire to take away his autonomy if he's perfectly OK and just needs a bit of help with the heavier stuff - hence the visit. He's always played up the "silly old forgetful duffer" stereotype for a bit of a laugh, so it can be difficult to tell over the phone whether he's still doing that or it's becoming true! But your points are well taken.
posted by andraste at 2:29 AM on January 12, 2012

My Dad is 86, has "mild dementia" and issues with short term memory.

We had him living with us for 6 months (in Baltimore - which really did a number on our relationship, but that is an unneeded tangent here) and I am now negotiating getting him into an assisted living situation back in his home town (in the San Francisco Bay Area).

The only thing that I would say that you may wish to factor in, not now, but later, is that if you do get him to move to a care situation (however non-intrusive), think about what to do as he gets more absent-minded. Transfer trauma (which is harder of folks with memory problems) is a thing. Essentially they get more disoriented than folks with intact memories and faculties when they move residence from place to place.

Also, and I was not prepared for this (and every person is different), my father has severely compromised ability to know where he is and get from point A to point B. I mention this because in the U.S., one of the policing protocols I was not aware of for folks with dementia is that if one is reported missing and the time of going missing was 3 hours ago, the police in the U.S. do not treat the incident as a missing persons report but as a missing dead persons report. So if your elder is showing signs of location awareness and getting home-type problems, register that elder with a program like the Alzheimer's Association's Safe Return program.
posted by kalessin at 1:19 PM on January 12, 2012

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