Dad’s 1st neuropsych appt

Quilting brings calm

I’m drained, sad and angry.    Picked stepdad up for his 1st neuropsychologist appointment.  50 minutes from their  AL.  5 minutes of him telling me not to make any more appointments for him and denying he knew about this one ( he did) and 45 minutes of awkward ‘the farm fields look nice’. 30 minutes of paperwork.  The questionnaire didn’t go well as I read it to him. 

30 minutes of  the doctor ‘getting to know him’. The doctor asked me a few questions about my childhood and about a letter  I had dropped off the day before.  The letter detailed Dad’s  behavioral issues and paranoia,  Dad calling me a liar all the while and making snide comments.  About 25 minutes of testing.  The MMSE type test, the clock test, and some additional testing that involved clapping when hearing the letter A and mirroring the doctor pointing to shapes, and so forth.  Plus a series of questions meant to quickly screen for depression.  He is supposed to go back for 3 hours of testing in July.   

The doctor told me as I left ( I let Dad walk out first)  that he scored low on the test ( I asked, and that’s what he answered - no specific number yet).  Did well on recognition memory, but not so good on ‘other stuff’.   Appears to be depressed and that can manifest as anger and  aggression.  He had to have hints to answer the 3 words, the day of the week, season, couldn’t get past 93 on the subtract 7 from 100.    So I don’t know what we are dealing with.  He only has an 8th grade education, can’t read or write well and is 82. 

I thought we would have an argument on the way home, but he was quiet.  He saved the argument for their AL apartment.  I placed their pharmacy bill on the table and told him the check needed signed.  I went into Mom’s bedroom and figured out how to set up favorite  channels for the new tv so that she only sees the ones for the cable, not all the Roku ones.

I came back out to the table.  Dad had not signed the check and went into an accusation  that I was stealing their money and using it to pay my bills.  I’m not.   I don’t have access to the account that I had handed him the check from  in the first place.  It’s the account he opened and transferred almost half their savings( all the money he had access to that day) to.  I expect him to pay their bills out of it as needed.  He denied moving the money.   He just doesn’t understand that the monthly bills and spending is more than their monthly income.  Therefore their  savings is dwindling.   The account in mom’s name ( she  transferred the savings that was in a different account after he took the other money) is also paying part of their bills.  The joint account gets the monthly income  and  pays some of the automated bills. 

I got so mad at him that I finally said,  I’m done.  Pay the bill, don’t pay the bill.  I left. 

Mom has called me about 5 times  and left me about 7 text messages in the 90 minutes since then.  I texted her we would  discuss it later.  She has mild dementia, anxiety and depression.  

May flowers

Wow, quilting, what a difficult day! I feel for you! I’m sorry you didn’t get concrete answers on where he is. At least it’s a start. We went through a stage where whenever we had to pay a bill, we got the third degree every time he had to sign a check. He didn’t accuse us like your dad did but he wanted to see the bill and what it was for, then he’d argue that he had paid it, then he’d say the bill wasn’t right, then he’d walk away and we’d redirect him back to the bill and it was the same thing all over. SO frustrating. We had to just leave it alone many times! 

What a mess dealing with the different accounts too. Sheesh. And I’m sure it’s a concern that the lack of judgment makes them vulnerable to scams or overspending on non-necessities.

harshedbuzz

Quilting brings calm wrote:

I’m drained, sad and angry.  

I read this last night but didn't have time to respond in my typically long-winded manner. My first reaction was that I was sort of shocked it went so badly. But then I recalled my early interactions with my son's neuropsychologists and recalled that some of them, in retrospect, were stressing both of us to get a sense of family dynamic and to verify accuracy of the reporter-- i.e. getting past "showtiming" to get a sense of what a real baseline is. It's like when you bring your car into the shop because it's making a funny noise-- you want it to make the noise for the mechanic so he can fix it. 

 Picked stepdad up for his 1st neuropsychologist appointment.  50 minutes from their  AL.  5 minutes of him telling me not to make any more appointments for him and denying he knew about this one ( he did) and 45 minutes of awkward ‘the farm fields look nice’. 30 minutes of paperwork.  The questionnaire didn’t go well as I read it to him. 

That would be my dad too. What helped me was framing the appointment as seeking the top- notch doctor in the area as a second opinion to make sure dad was getting the best care possible. Sometimes lunch of a treat after can improve the emotional temperature of the outing. For dad, I used to do as much of the paperwork without his input as possible. I always blamed it on his vision vs small print. 

30 minutes of  the doctor ‘getting to know him’. The doctor asked me a few questions about my childhood and about a letter  I had dropped off the day before.  The letter detailed Dad’s  behavioral issues and paranoia,  Dad calling me a liar all the while and making snide comments.  

Yikes! I had one of dad's neurologists opening discuss symptoms and behaviors after we met with him without dad. It did not go well. He withdrew and sent a social worker in to cool things down. But it did him a taste of how volatile dad could get and validated my request for Seroquel. It was a 90 minute drive in traffic and $25+ tip to park-- a total waste. I always made sure to sit in the chair behind dad where I could signal the doctor as to the veracity of dad's answers. The subtle head shake "no", the exasperated eye-roll, etc. 

About 25 minutes of testing.  The MMSE type test, the clock test, and some additional testing that involved clapping when hearing the letter A and mirroring the doctor pointing to shapes, and so forth.  Plus a series of questions meant to quickly screen for depression.  He is supposed to go back for 3 hours of testing in July.  

Hopefully, he'll largely have forgotten and you can keep the appointment. In the meantime, is there a plan to treat the depression. If you could get that improved before his appointment in July it could help determine what is mental health and what is cognitive. 

The doctor told me as I left ( I let Dad walk out first)  that he scored low on the test ( I asked, and that’s what he answered - no specific number yet).  Did well on recognition memory, but not so good on ‘other stuff’.   Appears to be depressed and that can manifest as anger and  aggression.  He had to have hints to answer the 3 words, the day of the week, season, couldn’t get past 93 on the subtract 7 from 100.    So I don’t know what we are dealing with.  He only has an 8th grade education, can’t read or write well and is 82. 

Age and level of education do factor into how these tests are scored. That said, I have seen my own dad do surprisingly well on parts of these tests even when I considered him to be in stage 6 with mixed dementia. He did a quick screening with his geripsych 6-9 month before he died and scored slightly lower than average for a man his age/education level. The pattern of deficits can be suggestive of what is going on. Dad's spatial stuff tanked, his clock was a mess, he couldn't remember the 3 things even with prompts (one was a rose- his mom's name- I was surprised he said "Lily" when prompted with "it was a flower") but darn* could that man do serial subtraction like there was a paycheck in it. He'd minored in math in college so maybe that's not surprising. The geripsych commented on that strength and dad bragged on himself the whole way down to the lobby and valet stand where he got into some random lady's car scaring the daylights out of her. TL;DR. The tests are useful, but I still think families and caregivers have a better sense of how a person is doing.

I thought we would have an argument on the way home, but he was quiet.  He saved the argument for their AL apartment.  I placed their pharmacy bill on the table and told him the check needed signed.  I went into Mom’s bedroom and figured out how to set up favorite  channels for the new tv so that she only sees the ones for the cable, not all the Roku ones.

I came back out to the table.  Dad had not signed the check and went into an accusation  that I was stealing their money and using it to pay my bills.  I’m not.   I don’t have access to the account that I had handed him the check from  in the first place.  It’s the account he opened and transferred almost half their savings( all the money he had access to that day) to.  I expect him to pay their bills out of it as needed.  He denied moving the money.   He just doesn’t understand that the monthly bills and spending is more than their monthly income.  Therefore their  savings is dwindling.   The account in mom’s name ( she  transferred the savings that was in a different account after he took the other money) is also paying part of their bills.  The joint account gets the monthly income  and  pays some of the automated bills. 

This would have been a great exchange to record on your phone and email to the geripsych. 

I got so mad at him that I finally said,  I’m done.  Pay the bill, don’t pay the bill.  I left. 

Mom has called me about 5 times  and left me about 7 text messages in the 90 minutes since then.  I texted her we would  discuss it later.  She has mild dementia, anxiety and depression.

I'm so sorry. This is all such hard stuff. You are good people.

HB  

Quilting brings calm

Thank you Mayflowers and HB. 

I was actually impressed with the neuropsychologist. I understood why he asked me what he asked me, it was just hard trying to answer with my stepdad in the room denying it all.  However as you said, it gave the doctor a feel for dads temper.   I had been told ahead of time that this appointment would be an hour and the next one up to 4 hours.  So I was not surprised by not getting complete answers yesterday.  I did not see the parts of the test that involves drawing and pointing at things as I didn’t sit close enough.  I heard everything he answered verbally 

Patient portal is a wonderful thing though and  a check last night showed two ‘problems’ listed with ICD codes.  Unspecified dementia without  behavioral disturbance and adjustment disorder with depressed mood.  No detail behind those yet in terms of scores, etc. So I know the doctor sees the problem.  I don’t think there  will be any medication until after the July appointment.  Hopefully that unspecified dementia will have a dementia category after that. A diagnosis and medication would make my life  and mom’s a little easier.  

At some  point in the future a guardian will have to be appointed for him as he is too paranoid to give me a financial POA, although I have the medical one for him. Mom has given me both for her. 

May flowers

I don’t know how the financial POA works but can it give you a way to keep him from taking any more money out of the joint account?

Quilting brings calm

Mayflowers -

I am on the remaining joint account  but there’s not much in it.  The pensions and  social security payments  come in, and the automated bills go out.  The income tax refund comes in annually.  When he transferred  that money, he only left $1000 in there. There isn’t much extra in there at the end of the month.  Mom already did what she could  by transferring the rest if their savings  into a new account here locally  and adding me( and  my own debit card).   It was a good thing because a couple months after she did, covid restrictions started and  left them restricted to the AL  and  that was how I paid for their groceries and other supplies for a year.   The joint account is out of state, my name is  not on the checks themselves. I wasn’t going to attempt to  write a check on it at the grocery store. 

Multiple calls about an assortment of things again this morning.  A medicine snafu for her, which I had already  straightened out, .  Then An ache that has already been checked out once.  I told her they  could call the doctor for  an appointment and dad could take her.  Tough love right now.   They go places whenever they want  anyway.  He wanted to know when his next  appointment was.  It’s on the reminder card that I gave you.  

jmlarue

Quilting - It occurs to me that you may be able to work around the idea of appointing a guardian for your Dad by cancelling the current DPOAs and making new ones for both mother and father. For you father's benefit, you can explain that they need to be re-done so that he and your mother are automatically able to speak for one another if anything should happen. You could explain that it should give him peace of mind that some court appointed stranger wouldn't get control of their assets down the road. Your dad's DPOA should appoint your mother as his Agent, with you as the Alternate. Your mother's DPOA would list you as Agent with your dad as Alternate. That way, when it becomes necessary for you to take over the financials for your dad, all you'll need is a notarized letter from your mother stating that she can no longer fulfill the duties as Agent for your dad and that his named Alternate (you) will have full authority to act on his behalf.

To be sure I'm not steering you wrong here, you'd be smart to get a brief consultation from a CELA to make sure this is a legal and workable solution in your State. He/she may have another idea that would be more effective (like setting up a family trust with you as trustee). Personally, I'd walk through broken glass to prevent a third-party guardian from being appointed. Our family had to stand by helplessly when that happened for my Grandmother and my folks had to stand by and watch the guardian bleed a lot of money from her estate from the management fees they are permitted to charge. Contesting any decision of the guardian came with additional court fees on top of that.

SusanB-dil

Oh, my QBC - yes, that makes for a tough day! ((hugs))  not to mention the complications on the finances... whew!

Quilting brings calm

Jmlarue.  

I understand your points about the state appointed guardian.  There is no ‘estate’ for one to run through the money on.  There is just enough money to keep them  in an AL for about 3 more years. After that, we will have to apply for Medicaid for them.  

He’s not going to give my mom POA authority over him either.     He would automatically assume she was trying to steal ‘ his money’.   

I really don’t want any legal authority or legal responsibility for him because he wouldn’t be cooperative and I would have no way to make him.  If, for example,   the doctor eventually  tells him to stop driving, he will ignore him and me.  He would not surrender the keys  or the car to me  in a million years.  My state  does not investigate ability to drive on the request of anyone but a doctor or law enforcement.  So I couldn’t even notify the state that I thought  he shouldn’t drive.  There is a new post on the spouse forum about a driving accident of A PWD living in an AL.  Makes my blood run cold. I’ve put some thoughts down on that post.  

My spouse refuses to allow him on our property and I will never allow him or my mom to live with me.  He was very abusive mentally, physically,  verbally,  etc  beginning when he married my mom when  I was 5 and continuing until now 58 years later   When my mom  dies, I’m done with him.  

jmlarue

Message understood. I can see why you want nothing to do with the man.  Since there are limited assets to try to preserve for your mother's care, there's really no good reason not to allow the State to appoint an independent guardian for him. Sounds like you have some of the bases covered for your Mom and you're not a miracle worker. Just know that I have the greatest empathy for what you're having to deal with.

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Quilting brings calm

I’ve contacted the PCP and  looped him into the situation, gave him info about the appointment  and  the upcoming one.  

I do not have any examples of bad driving.  No dings on the vehicle at all. No tickets in decades. The only accident he’s had in years was last year, in front of a police officer, who ticketed the other driver.   He is virtually unchanged in all aspects from then. 

abc123

Dear Quilting, I am so sorry you have to deal with him! It’s a shame. He’s a very lucky man to have you and he’s too stubborn and mean to realize it.