Next steps for elderly relative showing signs of mental decline

[Anonymous]

Our family member had a stroke 6 years ago, with occupational therapy they were able to return to "almost" normal. They need a lot of support to get them through each day - help with meals, bathing, bills etc. They don't live alone. During a recent family visit we noticed they are starting to show signs of confusion - time, day etc. We are not the primary support system for the relative so want to tread with caution but the person in charge is also on the older side so we aren't entirely sure they fully understand what to do. It sounds like the relative regularly sees their primary care physician - what are next steps ? Can the primary help to identify cognitive issues? Should they see a neurologist?

[Anonymous]

The next step is more hired help, and figuring out an eventual move.

[Anonymous]

See a neurologist, but there isn't much to be done. It's a normal part of aging. Can they go to memory care?

[Anonymous]

Goal would be to go to a primary care doctor who can outline next steps; maybe a referral to neurologist for further testing, perhaps a diagnosis (could be general like cognitive decline). Maybe a social worker gets involved if nothing else but to discuss available resources like adult day care, transportation services, home health aide visits or plan, etc.

A general plan should be outlined: are they going to stay in current home? If so, how practical and most importantly, safe is their residence? How are medicines managed? Home delivery? Very important to critical that meds - all-even OTC are supervised.

Are doorways wide enough to get a walker or wheelchair through? Where are primary bedrooms?

How will home maintenance be handled? Lawn care?

Is there a DNR in place? If so, this must be out and visible -make copies and distribute. Also discuss power of attorney. Who can write checks, pay bills if one partner is hospitalized or unable to do so?

Plan to have a responsible adult accompany the patients to any doctor appointments. This person will take notes, clarify, ask questions.

[Anonymous]

Anonymous wrote:The next step is more hired help, and figuring out an eventual move.

OP here: As you can imagine they don't a lot of resources and live in an early with limit support options. While we were visiting they did mention they had reached out the council on aging -which could assist with meals on wheels, driving to appointments etc. But day-to-day care seems more relevant at this point. I guess part of my question should have been - do they need the primary care physician to note these declines in order to gain access to a memory care facility?

[Anonymous]

Anonymous wrote:

Anonymous wrote:The next step is more hired help, and figuring out an eventual move.

OP here: As you can imagine they don't a lot of resources and live in an early with limit support options. While we were visiting they did mention they had reached out the council on aging -which could assist with meals on wheels, driving to appointments etc. But day-to-day care seems more relevant at this point. I guess part of my question should have been - do they need the primary care physician to note these declines in order to gain access to a memory care facility?

It probably doesn't matter too much if they can't afford it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The next step is more hired help, and figuring out an eventual move.

OP here: As you can imagine they don't a lot of resources and live in an early with limit support options. While we were visiting they did mention they had reached out the council on aging -which could assist with meals on wheels, driving to appointments etc. But day-to-day care seems more relevant at this point. I guess part of my question should have been - do they need the primary care physician to note these declines in order to gain access to a memory care facility?

It probably doesn't matter too much if they can't afford it.

If they need memory care, they would spend down their existing assets and medicaid would kick in after that.

[Anonymous]

^ this
Find a place they can afford w/eventual medicaid. The diagnosis is the least of your problems.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The next step is more hired help, and figuring out an eventual move.

OP here: As you can imagine they don't a lot of resources and live in an early with limit support options. While we were visiting they did mention they had reached out the council on aging -which could assist with meals on wheels, driving to appointments etc. But day-to-day care seems more relevant at this point. I guess part of my question should have been - do they need the primary care physician to note these declines in order to gain access to a memory care facility?

No, there is no need of a track record of decline. Memory care is for people who don't have good memories, regardless of how fast or long the decline was.

[Anonymous]

Anonymous wrote:Goal would be to go to a primary care doctor who can outline next steps; maybe a referral to neurologist for further testing, perhaps a diagnosis (could be general like cognitive decline). Maybe a social worker gets involved if nothing else but to discuss available resources like adult day care, transportation services, home health aide visits or plan, etc.

A general plan should be outlined: are they going to stay in current home? If so, how practical and most importantly, safe is their residence? How are medicines managed? Home delivery? Very important to critical that meds - all-even OTC are supervised.

Are doorways wide enough to get a walker or wheelchair through? Where are primary bedrooms?

How will home maintenance be handled? Lawn care?

Is there a DNR in place? If so, this must be out and visible -make copies and distribute. Also discuss power of attorney. Who can write checks, pay bills if one partner is hospitalized or unable to do so?

Plan to have a responsible adult accompany the patients to any doctor appointments. This person will take notes, clarify, ask questions.

OP Here: These will be very helpful to ask the current caregiver, thanks. It seemed like they were already doing a lot of this (one-story house, yard service,medication management with pill boxes, wills/power of attorney is all up to date, they have a joint account to pay bills) - but since they are also of advanced age - so how much they can handle is also a concern.

[Anonymous]

PP 7:47 back to say that you are most welcome. I’ve become an expert on elder care starting with my grandparents, then my parents - all now deceased. Now back at square one with my “forever young” local ILs who have done very little to help themselves.

Also learning the hard way that unless these people are your parents, all of your work, advice and suggestions might be ignored. Be prepared to only make suggestions if asked. No unsolicited advice.

Here I am with notes, experience, ideas but because these are NOT my parents, DH and his siblings are slowly (agonizingly so) talking about their plan and I’m staying in my lane.

[Anonymous]

^ this is so true. And I've seen it when the DIL was a Generic Physician or Nursing Home Administrator, or Elder Law Attorney

[Anonymous]

PP: here’s what the elderly parents should NOT do:

“Wing it” or “decide when that time comes”… to plan/move/make decisions/have an Advanced Medical Directive/Durable Power of Attorney/DNR order/Will/Trust/Burial/Funeral Plans etc. Claim repeatedly that these are uncomfortable conversations and…

Assume your adult DC will “be able to help” (with transportation, med reminders, filing your taxes, do your banking, general house maintenance, etc.) and therefore defer critical decisions

Dismiss any and all suggestions to de-clutter

Make grand pronouncements that you will never leave current home, or ask your adult DC to pledge NEVER to “put you away”

Assume that you can simply “age in place” without making ANY changes or adjustments

Bank 100k and earmark this for “elder care” with the idea that you’ll hire an aide to come over for a couple of hours every once in a while to help you with…stuff.

[Anonymous]

Anonymous wrote:PP: here’s what the elderly parents should NOT do:

“Wing it” or “decide when that time comes”… to plan/move/make decisions/have an Advanced Medical Directive/Durable Power of Attorney/DNR order/Will/Trust/Burial/Funeral Plans etc. Claim repeatedly that these are uncomfortable conversations and…

Assume your adult DC will “be able to help” (with transportation, med reminders, filing your taxes, do your banking, general house maintenance, etc.) and therefore defer critical decisions

Dismiss any and all suggestions to de-clutter

Make grand pronouncements that you will never leave current home, or ask your adult DC to pledge NEVER to “put you away”

Assume that you can simply “age in place” without making ANY changes or adjustments

Bank 100k and earmark this for “elder care” with the idea that you’ll hire an aide to come over for a couple of hours every once in a while to help you with…stuff.

This has been the approach of my mother and its chaotic, draining and a financial burden on those remaining. Add to all the guilt for removing her from her home, making health decisions that were in her best interest but she blames us for making. I really do wish this stage of live could be better managed earlier on and there were better options for our elders.