Frustrated and conflicted

Call them directly, you don’t need a referral. You can ask first a referral for home health to come to your house and evaluate. That could be an option. Also, I would change your doctor if at all possible. Do you have POA for his medical?

@RetiredTeacher
Anosognosia can make advocation very tricky for the caregiver.

Yes, you can ask for a hospice referral independently of his medical team.

In your shoes, I might start calling around looking for a geri psych who will do appointments over Zoom. You may have to pay out-of-pocket, but it may be the easiest way to access the help you both need right now. You could communicate via the patient portal or email to report symptoms and behaviors with video clips to give the doc a sense of what you're seeing.

Even if you did need to do an initial appointment, IME with several psychiatrists, it's not like a traditional clinical setting. There typically isn't the usual vitals check-in, folks in scrubs, and the office will have a different almost cozy feel. I've never met a psych who wasn't warm and engaging. My dad, who spent a lifetime denigrating mental healthcare (oh, the irony), adored both his geri psychs and enjoyed the attention. YMMV.
HB

In my opinion your husband is not a reliable reporter of his condition and a doctor should know that! It shouldn’t matter that your husband doesn’t think there is a problem, he has anosognosia (that’s common). I would make sure his doctor has all the facts and knows how difficult this situation is. The doctor should be listening to you! If your husband doesn’t want medication for the problem then just tell him it’s vitamins. The person with dementia can’t dictate the care. Good luck .

A lot of the effective treatment for your husband will be non-medical. If you are going to be the primary caregiver this will mean a lot of education.

The good news is that an enormouse amount of education is at your finger tips. Two required readings are The Thirty-six Hour Day and any of Naomi Feil's books on validation.

Additionally are videos by Teepa Snow…just a google away.

How the VD was diagnosed and by what kind of specialist?

Sleep disturbances/lack of sleep are never something you should try to cope with. This is a serious health risk for you, and needs to be addressed. If his provider is refusing to see a problem, you need another provider, whether it is hospice, geri psych, a new primary or something, but you need a provider that can address your dh's real health issues, not just the ones the provider prefers to see. I also recommend reaching out to a couple of hospice companies to do an evaluation. This is no charge to you, but even if your dh is not accepted they can provide valuable information during the evaluation visit.

I too felt that my dear wife was still too functional, not bed ridden, could feed herself, etc. to qualify for hospice but once a couple of her doctors realized she would no longer attend office visits or even video visits the suggested hospice. Surprisingly, when they did their evaluation she did qualify. Also, they may be able to see and judge better the actual status and likely progression. As it turns out they were very accurate and in short order I did see the changes start to occur, faster and faster. My learning was that I was not good at doing an objective assessment but hospice is remarkably good at it. It is not cost to you but I admit the emotional toll in making that call we huge. It was the right thing for us to do.

I did need a referral for hospice (hospice did not want to schedule an assessment until they had one), and DH's PCP was reluctant to provide. I insisted on a referral to at least get him on their books for later. While she was filling out the form she was surprised that his weight loss, double incontinence, and lack of coherent conversation would be sufficient for a hospice referral with alzheimer's. Ask again, insist that you want them to assess to be ready in the future. They seem to be more willing to do that.

Dh did qualify and hospice has been a lifeline for me.

Could you find some way to give all your concerns to the pcp before this appointment. It’s going to be difficult to convey your concerns with your husband there. Maybe you could bring a note to the office, email the doctor. If you called the office you could ask the best way to get this important information to the doctor prior to the appointment. If he doesn’t have all this information he is not going to be able to prescribe the needed medication. But talking about your concerns openly, without holding back, with your husband present is going to cause problems between you and your husband.