update after VA appointment for FIL

It’s difficult as the in-law. I think sometimes it’s easier to see the reality of the situation, being a bit less attached. My mil had dementia and now my mom has it. When mom was finally diagnosed there was so much work to do. She had let things go for the last few years and refused help with anything. I didn’t feel comfortable stepping in until after the diagnosis. Her cpap was 25 years old and had not worked in years, but mom insisted someone should be able to fix it. She had tape holding her glasses together. She had lost a lot of weight and only had just a few things that fit her. She hadn’t been to the dentist, because it was too expensive. I have never seen her hair so long and straight. It’s a lot of work getting everything back in order and often with the pwd fighting everything you are trying to do for them. Is there a plan to move him to a facility? There can be a waiting list. I will attach the dbat just in case you haven’t seen it yet. I found moms doctors used the 3 stage model, which I didn’t find very helpful. You and your husband can probably use the dbat and come up a more specific stage. Usually someone is considered in the last stage they show symptoms. I will attach it just in case you have t seen it yet.

Hi,

Maybe this will help your husband? When you say "There are some circumstances that was brought about by his mother and sister that keep us at a distance for the last 6 years, so he is very hurt by that and the fact that prior to his fathers dementia, his father just went along with whatever his wife said, even when it meant he wasn't sticking up for his son." Keep in mind that If he's showing stage 5/6 behaviors now, then he was probably already having issues 6 years ago, and a limited capacity to evaluate situations correctly on his own. If they used to have a good relationship and things changed, then it can often be the disease driving the changes.

@ajzjmsmom said:

No, no DPOA can be appointed at this time, it will require getting a lawyer and establishing guardianship. I can see how it is perceived that the assumption is that she will take care of it all, that is what her mother would have wanted and she is determined to do what her mother wanted despite how it could and does affect her health and how it might potentially affect my FIL.

Have you actually spoken to an elder law attorney? The bar for capacity to sign is pretty low and generally established by the attorney— not a physician. I was shocked that my own dad— in the stage you are describing was considered ok to sign. This would not only be less expensive, but it would also spare FIL being part of the court process and potentially a court ordered 5-hour geripsych exam.

As long as she is treating my FIL well, my husband won't step in because his mother wanted his sister to continue caregiving for them, we help as we can. My SIL is hesitant to allow a caregiver into the house to help with ADLs for my FIL, most days he needs assistance with dressing himself and normally getting dressed and his shoes on results in cussing if he doesn't get help.

Often, even the most dedicated caregivers break when their LO become doubly incontinent and/or develop disordered sleep patterns.

While my FIL checks many of the boxes for a late stage 5, he doesn't check all the boxes all the time so all the medical that the geriatric doctor will be doing is so needed. At least my husband or I go to all doctors appointments with my SIL and usually both of us go. She tends to be a "I am going to trust God and pray about this situation" type of person and while I think it is good to trust God and pray, we also need to be wide eyed about what is happening with him.

You may be disappointed by the geriatric doc's assessment. Sometimes doctors use a medical 3-stage model based on what treatments are appropriate rather that the level of care a PWD requires daily. It's also possible that he may showtime during appointments by temporarily seeming more with it than he actually is. TBH, his caregivers probably have a better sense of his current baseline than any doctor does. Another piece to this may be cognitive reserve. You mention below that he was intelligent and well-educated, sometimes this can mask how impaired a PWD is. My dad was also quite bright and maintained the ability to have conversations at times (they were crazy conflated but to outsiders seemed "normal"— he faked out a SLP testing his swallowing with a story about my sister's visit earlier the day he died. My sister had been dead 25 years at the time— she was shocked when I shared that). He also did freakishly well on the quick in-office assessments; I saw him get a 24 on a MMSE 6 months before he died. He was unreliably continent at the time and got into a random women's car when I turned my back at the valet stand.

The saddest thing is my FIL has his doctorate, was a brilliant speaker, very outgoing and personable and was the life of the party, he is so quiet now and that has been something I have noticed for the last several years. My MIL had gotten to where she spoke for him but I wasn't there for their daily living and I can only imagine how hard it was for her to take care of and deal with his dementia by herself. The social worker did say this is something she sees quite often with my in-laws generation, the secrecy and unwillingness to accept help. As you say a tough situation all around.

My parents were also secretive. You mention SIL has some health issues. Does she have eyes on her daily? I mention because mom became ill in the time before the feces hit the fan. She developed liver failure and almost died. Fortunately, a retired nurse neighbor recognized how sick she was and transported her to the ED over dad's objections. The woman was the color of a school bus and dad either didn't notice, didn't care or didn't know what to do for her.

HB

You and your husband are so on the ball—hats off to you. Having gone through this with your mother must make the current situation like watching a slow-motion car wreck. It must be so frustrating, but you're doing as much as you're being allowed to do. It's a shame that your SIL is struggling and not able to be open to your own experiences. As you note, there's not much you can do but wait to see, and setting clear boundaries for the future is a great step.

My mom is stage 4. At first I was concerned about getting her on a healthy diabetic diet. It took me a while to finally accept I that its just not that important. One of the problems I have had is that she has become a very picky eater (probably dementia related). She knows she is diabetic and would get mad at me if I brought her a snack that had too many calories. It’s ridiculous, I buy her sugar free candy, but when we go to lunch she will ask if she can get an ice cream sundae. It’s probably one of the few things that make her happy, so I don’t worry about it.