Father has Alzheimer and Alcoholism

JessClip

My father's girlfriend/caregiver has informed me she is leaving.  My father will be on his own. He does not remember to take his meds, cannot cook a meal, and has almost no short term memory what so ever.  However, he did pass his last driving test.  His drinking has gotten much worse, probably because he can't remember how many drinks he has had.  He lives about 700 miles away (in a different state). I don't think he can live alone, but he would most likely not willing come live with my family. But, I am considering this option in the hopes that he might be accepting of it. I am his POA. He will not willingly stop drinking, but I am hoping that if he lives with my family we could slowly replace his alcohol and non-alcoholic options.

Any recommendations or suggestions on how to deal with this situation is greatly appreciated.

Thanks!

Nerdyblond

Wow, JessClip...

Okay, he definitely needs someone there full time. He probably is not willing to come live with you but you could always tell him your family wants to visit with him...thennnnn mayyybeee liiike kinda forget to bring him home??? "Hey dad, the family wants to see you! Let's go visit them!"

Couple days later: "Oh shoot dad! I just got a call from your neighbor! Your house was destroyed by a microburst! They're trying to fix your house but it will be a few weeks."

Couple of weeks later: "Uh, dad...you know...we really like having you close by...and your house is not done yet..."

You get the idea, yeah?

Jo C.

JessClip, I am sorry for what is happening and can well understand the concern.  Has your father been seen by a dementia specialist?  I ask that because of the alcoholism.   He would need to be checked for Warnicke-Korsakoff syndrome which can also be separate from one another and is different from Alzheimers; it is caused by alcoholism - treatment is very different.

It appears you have a crisis situation waiting to become far worse if he is alone.  He will need someone to be with him, or to be in a care facility whether an ALF if he is a candidate for that or in another setting.  To leave him alone sounds as though it would be a possible disaster.  He is blessed to have such a caring adult child.

You could ask him to come for a "visit" or "vacation."  Then once there, you can continue to keep him centered.  However; that being said, it would have to be with a deep understanding that this plan, in all probability, would not be an easy transition.  There may well be much emotion, resistance and even anger possibilities.  You plan to taper the alcohol; he may well know the difference, he would have to do this with medical supervision - if he is a heavy alcoholic especially of long term use, he may have to be detoxed so he does not have severe side effects which can be dangerous.

In any case, if he does come to live with you, it would be good to have a, "Plan B," for a possible change if it does not work out.  That would be quietly finding a facility willing to accept him as a resident if he cannot manage in your home.  At least then he would be close enough for you to monitor his needs.

Let us know what you decide and how it is going,  it is a difficult position and I wish you well; we will be thinking of you as you make the best decisions for all.

J.

Quilting brings calm

If your family includes children in your home, please do not move your alcoholic father into it.  My mom, my sisters and I lived with my grandparents from when I was almost 3 until I was 5 1/2.   My grandfather was an alcoholic. He died  when I was 12.  There was numerous times he passed out in the doorway between the rec  room, kitchen  and living room. We would have to step over him to go to the bathroom and bedrooms. It was a traumatic time of my life.  

I know you need him to be in the town you are in.  I know it will be difficult to get him moved directly to an AL from out of state.  The facility will want to evaluate him.  They may not accept an active alcoholic or they may him  to leave if there are issues.  I suggest you rent an apartment in an over 55 community  for a short term lease to get him to your state.  After all, he’s living alone now.  Then you can work on a permanent placement for him.  

How you get him there?  Well, in our  case we had a crisis and we  took advantage of it to move my parents  back to our home state on an emergency basis. We took my mom straight from the interstate to the local hospital when we got back to our home town. 

harshedbuzz

JessClip-

Hi and welcome. I am sorry for the reason you are here but very happy you found us. 

I am an adult only of an alcoholic dad who was living a distance away. He was married to my mom who was not only a classic enabler but also working counter to my suggestion that he be evaluated for dementia until her inaction nearly killed her. 

The girlfriend situation complicates things. That she signaled leaving him so you can assume responsibility for him is great, but you will need to do a deep dive into his finances to be certain she has not exploited him financially. Sadly, this is not uncommon. And often a SO who has been acting in the role of caregiver feels a justifiable sense of entitlement to walk away with some compensation. And then there's the notion of common law marriage to be ruled out if that might apply. 

If your dad doesn't already have a POA that allows you to act on his behalf, you will need to get legal paperwork in order. If he won't cooperate with this, you may need to obtain guardianship in order to step in and keep him safe. A CELA is your best choice here as they are the experts in elder law.

National Elder Law Foundation (nelf.org)

Your dad needs to be evaluated. Ideally, this should happen at a university level medical center memory clinic. It is my experience-- sadly-- that PCPs and even the small-town ER missed my dad's alcohol-related dementia entirely. Dad had Wernicke-Korsakoff's Syndrome which is treatable and can be reversible if treated promptly with IV Thiamine and lifestyle changes. When he was finally diagnosed and treated, he did return to a significantly higher baseline for a time. 

WKS is one possibility, but he could also have one of the more typical dementias like Alzheimer's, Vascular or even a FTD-behavioral variant. Or, like my dad, he could have mixed dementia. Dad had Alzheimer's and WKS. 

WKS has some symptoms that overlap other dementias but I've been told they are either more prominent or appear more early on. Dad had a PET scan as part of his workup which showed a specific pattern of glucose uptake. The symptoms that leaned into WKS were-

intolerance to cold-- he was setting the thermostat to 85F in July in MD, his body temperature was also abnormally low.

a roiling gait even when sober

strange eye-rolling movements

conflated memories-- this is where a person retains the gist of a story but can't recall the specific details and back-fills them with random people or places that might make sense but aren't true. When dad did this it was as if he was re-writing family history.

no short-term memory at all.

This is some background on WKS because there isn't a whole lot of information out there.

Korsakoff Syndrome: Clinical Aspects, Psychology and Treatment | Alcohol and Alcoholism | Oxford Academic (oup.com)

Is the drinking new? How much is he drinking?

WKS can take some time to develop. In my dad's case, he became a highly functional alcoholic in the time after my sister died in 1994. There also seems to be a genetic piece involved. My sister likely developed it in the last months of her life related to an HIV infection, my dad's nephew also died of complications of WKS just before my dad did. His son had set him up in an in-law apartment and was able to help him remain sober so I don't know if he was able to access alcohol or if the disease progressed despite abstinence as it sometimes does. 

In your shoes, I would visit him in his home for a week or so and observe his behavior through the day. I did this when my mom was hospitalized for liver failure and almost died (oh the irony, she's not much of a drinker it was an autoimmune thing). The hospital called me as an emergency contact as the sensed dad wasn't up to making decisions. Dad, meanwhile, was telling me my mother was mean to him. No mention of her being the color of a school bus or being hospitalized and near death. When I got to their house dad was hosting neighborhood happy hour wearing nothing but a bath towel. 

This short read helped me understand how dad might be thinking and helped me fine-tune my approach to taking steps to keep him safe.

12 pt Understanding the Dementia Experience (dementiacarestrategies.com)

I would also urge you to contact Al-Anon for yourself. It's very helpful in the context of alcohol use disorders though not every strategy will apply given your dad's memory issues and the impact dementia has on executive function. 

Dad was prescribed an abstinent lifestyle upon diagnosis. This was a challenge. He didn't want to not drink. He couldn't always recall that he was not supposed to drink. Swapping out a non-alcoholic wine or beer didn't work. His brain was damaged, but his palate was as discriminating as ever. YMMV.

Trying to keep dad sober meant my mother and I were the Alcohol Police and that is not an easy role to maintain. It comes with abuse and threats of violence. YMMV. Dad was detoxed during a hospitalization and follow up stay in a SNF for PT and OT. This is not a safe DIY project, btw. After we did look into a geriatric alcohol rehab program. The director would have accepted him but didn't expect that he'd be able to learn the strategies to become sober so we didn't do it. 

Because of dad's aggressive behaviors and anxiety, we did get him a geriatric psychiatrist who prescribed an antipsychotic to relieve the anxiety and behaviors it caused. He also added Wellbutrin to help overcome his apathy (common in dementia). It didn't help that, but it did seem to curb his desire to consume a bottle or two of wine daily. The geripsych was kind of surprised, but this medication is also prescribed for smoking cessation and some eating disorders. 

I did move my parents closer to me which was a lot of work. I would not have moved dad into my home. Ever. Quilting makes some valid points. I initially moved both my parents to a 55+ apartment and then into a home in a nice 55+ community about 7 miles from my house. I also had a Plan B in my back pocket should my mom become unable to provide care either because or death or illness-- I had toured a dozen MCFs and found 2 I liked, the SNF where he stayed after the hospital would have taken him on-the-fly until I could get the MCF thing lined up. 

In your shoes I would be looking at a secure MCF. A hospitality AL might not be ideal here although I suppose you can trial it to see how it goes. No short term memory means the other residents will likely shun him and being able to come and go means you won't be able to control access to alcohol if that is a goal for you.

I wish I could be more positive, but this is really hard stuff.

HB

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