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Expert Topics

Alzheimer's, Dementia, and Parkinson's Disease

- Douglas Scharre, MD

Asset Protection & Financial Management

- John Greener

Cancer Care

- Richy Agajanian, MD

Caregiver Challenges

- Sue Salach-Cutler

Communication Through The Generations

- David Solie, MS, PA

Diabetes

- Joy K. Richardson, RD, CDE

Elder Care at Home

- Ethan Kassel, MSW, LCSW, C-ASWCM
- Steve Barlam

Elder Law

- Howard S. Krooks, JD, CELA, CAP
- Ellen Morris, Esq.
- Shana Siegel, Esq., CELA

End-of-Life Issues

- Vincent Dopulos, MA, LPC, RDT

Fitness

- Deborah Quilter

Geriatrics

- Robert A Murden, MD

Home Care Solutions

- Emma R. Dickison

Home Health Care & Palliative Care

- Pamela Fishman, LCSW

Home Health Modifications

- Connie Hallquist

Senior Housing Solutions

- Tiffany Wise
- Mike Campbell

Incontinence Issues

- Brian Christine, MD

Integrative Medicine

- Rashmi Gulati, MD

Live In Care

- Kathy N. Johnson, PhD, CMC

Managing Medicare

- Ross Blair

Memory Care

- AnnaMarie Barba
- Crystal Roberts

Mobility Issues

- Nick Gutwein

Nutrition Know-How

- Dr. Gourmet, Timothy S. Harlan, M.D.

Quality of Life

- Joan Garbow, MSW, LCSW, CCM

Safety and Hospitalization Concerns

- Martine Ehrenclou, M.A.

Senior Healthcare

- Archelle Georgiou, MD

Senior Medical Issues

- Chris Iliades, MD

Senior Transitions

- Mary Kay Buysse, MS

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  • My 72 year old mother was diagnosed with Parkinson's 18 months ago after experiencing mobility issues and a fall. She is very mobile and has only a slight hand tremor. Her mental health, however, has significantly declined since the diagnosis. She is now often confused, can no longer do her own banking, has very little short-term memory and sometimes makes no sense when she speaks. She is confusing her medications and forgetting when and if she has eaten. She recently had a psychoneurological evaluation, which I was told was "inconclusive." I am now wondering if the Sinemet she is taking is somehow causing all the cognitive issues? 

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  • My 86 year old father has Alzheimer's and is immobile. He's deaf, and he cannot feed himself or get out of a chair. He believes that he sleeps for a long time, but in actually, he sleeps around 5 minutes. The same thing happens when he's awake—after about five minutes, he believes he is awake for a long time. This happens repeatedly, so he is awake all night. With the sleeping pills he only sleeps a few hours. What should we do to help him? 

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  • I recently had an MRI and the diagnosis was the beginning of memory loss or dementia. I am 66 years old. I walk two miles a day and am in good physical condition. I also ride horses. My mother and grandmother both had Alzheimer's. Is there anything I can do to slow down the memory loss and stay ahead of the game? I am also diagnosed with depression. The medications they put me on are Namenda 10 mg twice daily, escitalopram 20mg once daily and Lorazepam 0.5mg once daily. 

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  • My father was recently diagnosed mid-level Alzheimer's. He still exercises, is 88 years old and lives with me at our home. He does have trouble walking, but uses a walker. He is having trouble speaking at times, and his doctor is aware of his issues. But at night, usually after 8 pm, once it is time for him to get ready for bed, he starts getting totally confused. He forgets how to use the bathroom, he does not even know where it is. He is very confused and agitated. He is unsure how to get into bed, and I can tell he does not really know what is going on, but he knows me. His wife has been gone nearly 5 months in a rehab, and I know that is a factor. Should I play music or is it sundowner's syndrome? We hope to get him on some meds soon, and he is scheduled to get a scan on his brain soon. Please advise. 

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  • My mother, near 60, is suddenly having problems while drinking or eating. Whenever she tries to bring something to her mouth, her hand just gets disoriented and goes to the side. What could the reason be? 

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  • My father is 89 years old and sleeps constantly. I cannot get him to eat or drink anything. He is in the early stages of dementia, according to his doctor. I wake him up to take his pills and give him a glass of water to drink. He will only drink about half of it, and only twice a day. He will sometimes drink a High Protein Boost and will eat a half bagel with cream cheese occasionally, sometimes a little ice cream. He will not bathe, although he can still go to the bathroom by himself. I moved in with him a few months ago and he has seemed to go downhill rapidly since I did this. It seems like he has given up and is trying to die now that he has realized that he can no longer be alone. Any suggestions on how to get him to eat and bathe? 

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  • My dad is 87. Two years ago he received a pacemaker, defibrillator and new valve. Recently he just sleeps. He eats a bit, doesn't like to go out and thinks 15 minutes is hours when he does go out. He's taken care of by my 85 year old mom. What can we do? 

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  • My Father, now 94, was severely injured in the Philippines during WWII. He was sent back to the US and was in hospitals for years. He still sets off metal detectors due to the shrapnel in his body and he is profoundly deaf. When the VA finally decided to test him for Alzheimer's, they discovered he had lost much of his frontal lobe way back in 1943. It explained a lot of his past behavior to our family. We've had Dad at home with my brother and my mother for years. It's a huge struggle and it's time to find a capable place where he would feel safe. Would an Alzheimer's unit be adequate or do we need something different considering the additional factors? I should say Dad is in outstanding health and until recently played 18 holes of golf three times a week and 36 on Saturdays. 

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  • I need some help with caring for my parents. Two years ago they moved to be near me and my sister due to health issues, mom's dementia, etc. The first year was spent in and out of hospitals. They were in independent living, which was my dad's idea since my mom no longer cooked and it seemed the ideal situation. That lasted about 6 months and he hated living there. He is not at all a social person and does not want to dine with strangers. Mom rarely went to meals or got out of bed. My sister and I were there 3-5 days a week to put out meds in boxes, do laundry, doctor appointments—Dad would not use their transportation. He said, what if they move out to a regular apartment and then I can "help them out." It turned out to be far more than a little help. In August of 2012 mom broke her hip and was in rehab for 2 months. This happened while they were with me at our cottage in northern Michigan. I was there as well for two months. I could not leave because my dad does not drive. When we got them back to their new apartment in Fall 2012 there were many followup doctor appointments, PT, more appointments. Also, while mom was at rehab, dad ended up in the hospital for a week. I have missed special events with my college age children, have not been able to get away and when I do it is a week of planning meals, meds, and then my sister who works full time has to fill in for me. My dad calls every day about mom not getting out of bed and not taking meds. He is very demanding and needy and seems oblivious of how he is consuming my life. This is my "empty nest" time and I have become resentful of having to do everything for them. We have caregivers three days a week, 5-7 Tues and Thurs and 3-5 Fri. That is it ! He does not want to pay for more help. My sister and I know we need help—we just have no family time at all. Weekends are consumed by our parents. I just do not know how my dad cannot see all of our time is with them. When they were our age and empty nest they traveled, mom went with dad on business trips. Neither one had to care for a parent. I do not know what to do and feel guilty when I want out or when people tell me I am such a good daughter. I want to be that daughter not a caregiver. My husband and children have been angry and upset because they take all of my time and also because they see what it is doing to me. Help ! 

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  • I would like your opinion on how to handle an upcoming event. We have a big birthday—99 years young—in a couple of months for my Mom. The family wants to throw a party at a hall and have all the relatives and friends that she has not seen for years and years to attend. This is nice, but I have my concerns about the stress and confusion this may give to Mom. She has moderate dementia and sometimes she does not recognize the family that is taking care of her daily. It also seems that when there are more than a couple people talking around the dining room table she gets confused and remote. If there is such a big celebration in her honor, is this the right thing to do for her? I suggested that we contact the relatives/friends and let them know about the birthday and they can send her cards/messages of their wishes and keep a small family celebration for Mom. Some days are good, some are not. I would appreciate your insight or suggestions on how to handle this, especially with the family members. It is definitely something to celebrate, but how we should do it is my concern. Thank you for any information you can send. 

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  •  My 93 year old mother had an ischemic stroke 9 month ago. She recovered miraculously, she eats right and exercises, but she lost a lot of weight and muscle mass. Her medications for heart are monitored, and all seems OK. Still she's losing a lot of weight and strength. What could be causing the rapid weight loss?

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  • How can I tell my 89 year old father-in-law that he needs to pay better attention to cleanliness and hygiene? He seems to not be showering and wearing clean clothes anymore. Is this a sign of dementia? 

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  • My dad is 77. He is relatively fit and healthy. He has never drank alcohol or smoked. Lately his voice is weaker and strained at times. He is stubborn about seeing a doctor. Have your any ideas why this might be happening? 

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  • My 93 year old father does not have a serious medical condition. Due to his age, he has age related medical issues. He no longer can drive. His doctor is pulling his license Thursday. I am the only caregiver left around to take care of him. He needs me and my hearing (he does have hearing issues and already wears hearing aids) to drive him to his appointments. Do you know if I can take FLMA for this type of assistance? If so, I'm unclear what to put on the FMLA paperwork for his "medical reasons." Any information you can provide will be a big help. 

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  • My 86 year old dad has a foley catheter and has a UTI infection. The problem is he has been on antibiotics for two weeks and the infection has not cleared up. They have taken two cultures and have changed the antibiotics, but nothing seems to work. What could be the problem? 

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  • My father is 86 with dementia and in a wheel chair. He's also diabetic, but not on meds for it--diet helps him. UTI infections are ongoing. He has had prostate issues for over 30 plus years, and he's currently on Flomax. The problem is that the pill form of antibiotics isn't working anymore and he has to have IV meds. His UTIs are happening very 6-8 weeks. He's had what I call the "rotor rooter" surgery for the urethra—they found over 200 jewels was the term I remember 2 years ago. Now it seems his UTIs are coming more frequent. He just got out of hospital for one 3 weeks ago and we think he's got another. He had a culture taken today to find out for sure. We just can't get him to drink enough fluids. He's on cranberry pills 3 times a day. I give him Crystal Light a lot because he hates the taste of water--at this point anything to change the taste of water! My question is this, does it seem or sound like he's spiraling down in his health, that his final days are coming sooner then later? 

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  • I am writing as I suddenly found my feet and ankles were quite swollen. The swelling has gone down to normal. I read the article regarding Peripheral Edema, especially that the most common cause is heart failure. Although the swelling has gone down to normal, should my doctor request the tests, especially heart, kidney and liver tests. 

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  • What's with these Medicare "Observation days"? My 90 year old dad was in the hospital after a bad fall at his assisted living. Apparently he got confused because he had a urinary tract infection and lost his balance. Nothing broken, but the physical therapist recommended sub-acute rehab. The discharge planner told us that although had been in hospital getting care, he could not qualify for his Medicare rehab days. Apparently he was not in an acute level bed, but in an observation bed after he was admitted from the ER to his floor. He was in the hospital 2 nights. During that time they had to figure out if he had a stroke. He got intravenous antibiotics on his first day plus some IV hydration. After the first day, they changed my dad to an antibiotic that he took by mouth. We ended up paying for his care at a local nursing home. It wasn't cheap, considering the costs of paying for his rehab bed while maintaining his assisted living apartment. The hospital discharge planner wasn't the problem. It seems as if Medicare's criteria for hospital level of care was rather difficult to meet. Any thoughts about trying to impact Medicare and their ageist regulations? This was a very stressful time for my dad and me. Also, I think it will only get worse with all the talk and plans regarding trimming and containing health care costs. Feeling hopeless in Boston. 

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  • My 84 year old dad and his 86 year old companion live 45 minutes away. In the past 6 months, he has experienced some memory loss and other health issues, the latest resulting in 2 trips to the ER within a week for dehydration. My brother and I have been traveling back and forth at all hours, requiring us to, at times, leave work and family. We discussed the possibility of assisted living, but as of now, my dad is opposed. Can you recommend a service that would come in 2-3 times per week to help with organizing meds, shopping and doctor appointments? I've spent hours searching, and your site was recommended by a friend in a similar situation. 

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  • My mom has been in the hospital for 3 weeks. She had to have a feeding tube inserted and since then she hasn't been awake. The doctor is trying some kind of medicine to bring her out of the sleepy state. What is the name of the medicine he is using? 

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  • My 90 year old mom had a stroke and can't swallow. She has a feeding tube in her stomach. How do I keep her mouth moist? 

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  • My mother in law is diabetic and keeps falling out of bed at night and not remembering it. What could cause this problem? She is also on dialysis. 

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  • Under sound mind my uncle bypassed his children and made me his DPOA and healthcare proxy. He also made me a joint holder on his bank accounts and stated it was a gift to me because he did not want his children to have it. To his children's dismay and dislike he advised his children of "his decision." They waited until after his stroke when he could no longer speak for himself and applied for guardianship. Guardianship was awarded to them, and they later came after me for the gift. Am I obligated to return the gift? Do I have any legal standing to keep what my uncle wanted me to have? 

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  • Both my parents are elderly (87) and have recently had health issues. They have about $150K in savings and own their home worth about $125K. They planned to give money $2,500 to my daughter (their granddaughter) to help with college tuition. Recently they granted power of attorney to my older brother and he is concerned about causing an issue with Medicaid when their money runs out. Can he give the $2500 as a gift or as a loan from my parents to me or my daughter and if a loan to be paid back with interest within the next 2 years without causing Medicaid fraud issues? 

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  • I am trustee, Social Security payee and P.O.A. for my father's 87-year-old widowed and childless sister. She is a resident of Florida and is currently in a dementia facility there. I live in California and all of her mail comes to my California address. Are there steps that I can take so that when she passes away, the state of CA will not be able to tax her estate? Or should I not even worry about this? 

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  • My mom is 88 and has been having UTIs for some time. She seems to be getting them one after the other. She has been on so many antibiotics that some no longer work on her. How does the UTI affect the rest of her organs since she has them so often? 

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  • Four weeks ago our 88 year old mother sustained a broken arm from a fall. Prior to the injury she was living alone and oriented. Now she has 24-hour aides due to nighttime disorientation and confusion, which we presume is due to the fact she is not sleeping at all. The aides say she is up 50 times a night. Sleeping pills do not help. Her healing is not going well. In the daytime she is lucid, awake and oriented. She takes a few naps of 20 minutes duration only. Pain was contributing factor early on, but that seems managed now, but still no sleep. Suggestions? We fear she is on her way to SNF because she can no longer afford the aides, which cost $3000 a week.  

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  • I take care of my 91 year old mother who has advanced Lewy Body Dementia, where she is hallucinating days and nights and is quite delusional. She does not recognize me or where she is, and is very repetitive with basic questions. At night, usually all night, she yells and calls out my deceased family members' names very loudly, as well as reliving past episodes of her life like "Frankie, shut off the stove before the food burns!!" as well as the occasional "Police help!" and two-sided conversations with imaginary people. Her nighttime drug protocol now is Trazadone 37 mg, also Seroquel 25 mg and Namenda 2.5 mg at about 8 PM when we put her to bed and later melatonin 10 mg at 10 PM. The medicine is not really effective for any decent length of peaceful, restful sleep (six hours would be wonderful). Could there by any success with Galantamine for reduction of hallucinations or sleeping issues? She does not sleep during the day and has no other medical conditions besides glaucoma. 

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  • My mother recently died. She had seven children, and one daughter died before her, leaving a daughter of her own. Would the granddaughter then take the place of the sibling who died, as far as the estate and inheritance go? My five siblings feel like the estate should be divided 6 ways instead of 7. I feel like the daughter of my deceased sister should be the 7th part of the inheritance. 

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  • I have been a caregiver for a now 92 year old gentlemen for 9 years. I just terminated my employment with the agency because I am moving. I will be moving hundreds of miles in a few weeks. Is there any way I can visit even though I signed a paper stating that once my employment with that agency was over I was not to have contact with the client? He is in the last stages of life and I just want to visit my friend while I still live close by. 

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  • Mother and father entered hospice care within a day of each other. Mother then passed within 4 days. She prepaid all funeral expenses and has a death insurance policy payable to father of $10,000. Medical and durable POA has passed on in succession to their daughter. The insurance benefit has not been applied for. There are no other assets such as real estate. Is that cash benefit owed to the nursing home for the father's hospice care? 

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  • I have 2 questions: 1) My mother has cerebral degeneration and has a PEG tube placed. She takes nothing by mouth. She is homebound and bedridden. She can no longer speak. What is Arkansas's law regarding removal of PEG tubes once one is placed as her condition will never improve—it will only continue to worsen with time. 2) My father needs to get a Financial Power of Attorney done so that I can assist him with his finances, should he no longer be able to. I live in Ohio, he lives in Arkansas. Are there any issues with this arrangement since I live out of state? 

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  • My mom did not earn enough money to pay for her assisted living and nursing home the last few years of her life. She has three daughters, and two helped pay the expenses with the understanding of all siblings that when she died and we sold the house or leased it, that we would be paid back first and then all siblings would split the rest equally. She did die and we leased the home and have been paying off the equity line. Then we started to pay the two loans to the siblings. Do those two have to pay taxes on this reimbursement since they loaned the money with after-tax income? If so, wouldn’t they be paying taxes on this money twice? The home is in the Atlanta, GA area. One sister from GA, the other from MI. 

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  • My father and mother were living independently in a bungalow unit in an assisted living facility in Oregon. My father became ill and they were moved into an "apartment" unit in the hospice area of the main building of the facility. My mother has dementia, but this was not a problem while my dad was alive. However, he died over Christmas and now my mother is alone. The facility manager says she needs to be in the Memory Care Unit, but they have no room. Since they cannot properly care for her, they just gave her a 30 Day Move-out Notice and are telling me I have to find a place for her. I have no resources, I live in Virginia, I am an only child and I have Parkinson's disease. Plus, my parents were not on Medicaid when my dad died. My mother would qualify for Medicaid, but I'm still working on getting the application finished. Can they really just throw her out? What are my options? I can't afford an Elder Care attorney. 

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  • My husband has Alzheimer's disease. He is 56 years old. This is his 2nd marriage. We have a 3 year old son and he pays child support to his ex for his two other sons, who are 18 and 20. If we apply for Medicaid to get him in a nursing home, will they take into consideration that he has a family and that he still pays for support? Will we lose our house if he has to go to a home? 

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  • My mother has Alzheimer’s. My sister became POA, I think, through my uncle who was my mother’s original POA. My mother does not remember picking my sister, who is 3 years younger than me. My sister put her in an assisted living facility and my mother is very upset. Mom had been living by herself for 4 years and is still able to take her own shower, get dressed on her own, fix her breakfast and take her medicine. I think she could still live on her own, but I do not have much say about that. My mother's attorney told my sister that she should take my mom's bank card, health card, ss# card and her checkbook. She also has both sets of keys to mom's car. This same attorney is also my uncle's attorney and, honestly, I don't trust him and think there is a conflict of interest. My sister and uncle put mom in there because they don't want to have to take care of her. I'm the one who has been taking care of mom since my dad passed away 4 years ago. Mom’s Alzheimer’s is getting worse I do believe, but she is still capable of taking care of herself. When she can't remember in the evenings, I'm always there. What can I do to get her out of the assisted living facility and take her back to her condo? Can I take her out of the assisted living place on my own? I am the oldest daughter. Mom has been begging me to take her home.

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  • In NY my mother signed a will in 2009, but was unwilling to sign a POA at that time. The lawyer gave us the POA with instructions so my mom could sign it at a later date. My mom finally signed this original POA in 2012. Recently she was hospitalized and so we brought the POA to the bank so we can pay her bills. The bank will not accept the POA because it does not include signatures of the two POAs that she assigned. It seems the form was changed after 2009. What do we have to do to make this form valid? Can a lawyer just put an attachment to this POA or do we have to start all over? 

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  • My mother is 96 years old. She is blind, cannot hear well and cannot walk due to deterioration of her spine and hips. She has been under hospice care for the past 18 months. I must be here most of every day to help with her care. Can I receive $50 per week from her funds for the care I provide her? My sister is her power-of-attorney for financial matters. We are in discussions about this and want to be clear on what is allowable. Thank you.  

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  •  My sister has power of attorney for my mother who is in a nursing home, Can she prevent me and my other sister from asking about my mother’s health and welfare from the nursing staff? We don't want to interfere with her care, but we have been refused information because we are not on some kind of list. When I asked the nursing home administrator about this list she told me I had to speak to my sister.

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  • I have an 88-year-old female friend, a diabetic, who keeps her sugar levels very well regulated by insulin. Up until several days ago, she had no problems with her vision. She has had an eye examination within the last year and was told that her eyes were fine. She does wear bifocals. Up until this problem with her vision, she has been able to do crafts, read and navigate on her own. She also has had cataract surgery in the past. Can the lenses become blurry over time? This is a question she has asked me. I told her that I would go online to do research. I told her that she should get to her eye doctor asap. 

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  • What is a supplement to help with lack of energy in the elderly?  

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  • My doctor of several decades quit because of health care reform. Now we cannot find a doctor. Yesterday, Peacehealth Hospital and our Providence Medicare insurance tried to find us a doctor. No one will take us as patients because of Medicare. What are we to do? 
 

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  • My mom is in the mid stage of dementia. She has been living with my family (husband and 2 elementary age children) for a year and a half. Her condition has deteriorated enough that I can no longer provide a safe, secure environment for her, and keep my family sane as well. Because she will have to be on Medicaid very soon, our living options are very limited. We are considering a memory care facility (up to 80 residents) and I know she will fight like mad to avoid it. She has times where she is higher functioning. What is the best way to approach this? I don't know what to say to make it less scary to her and also to make sure she will move in there asap.  

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  • My 93 year old Mother is complaining that her eyesight is getting worse. She had cataract surgery 8 years ago. She is completely chair confined, incontinent, and takes pain meds for arthritis, blood pressure and allergies, and stool softeners every day. She is starting to say that her vision is getting worse. Is this age? We try and watch about her becoming dehydrated. 

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  • My 75-year-old mother-in-law lives on her own. She is having visual, auditory and olfactory hallucinations. She believes the neighbors are persecuting her and trying to get into her house. She is repeatedly bothering the police. She has always been secretive and rather difficult to get along with. We suggested security cameras for her house, but she is still afraid and lives in fear of the “people” who live on her roof and are drilling holes into it, etc. The symptoms have been going on for a couple of years and are getting worse. My husband and I can't get her to go in for a medical checkup as she states that she is not crazy and there's nothing wrong with her glasses or her hearing aid. We do not know who her doctor is. She says she's been taking care of herself all these years and doesn't need our help. She clearly does. 

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  • My mother in law whom is 96 no longer knows when she is going to have a bowel movement. Therefore, she is going in her pants. We took her to a urologist and he gave her an antibiotics however, it did not help her. We have started to give her fiber. However, this has not helped yet. What can we do? The doctor said he could not help her because he only deals with urine problems. She seems to be in good health and goes out with friends. However, we are afraid they will not want to take her out if she continues to mess in her pants. Please help! 

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  • My father is 67 years old and had a quadruple bypass 6 years ago. He has had diabetes for 15 years and a recent amputation, as well as 6 small strokes. He has dementia—I’m not sure at what stage it is, but is recently hallucinating and saying weird things at night. He wants to get out of bed 10 times a night, then sleeps a lot during the day. He takes ambient and nortriptyline at night and has body tremors as well. My question is how can we know if he has Parkinson's or dementia? We aren’t sure how to care for him. My mother is in denial and says he can do more for himself than he does. 

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  • I help my grandmother who is 83 years old and lives in a LLC facility in Maryland, where I live as well. My 67-year-old mother lives in Florida, and both of them have the same health issues and both of them ask me for help. I think my grandmother’s memory is getting worse, but my mother calls her to drive her crazy! What can I do to prevent this, but at the same time help them both? 

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  • I have been living with my grandmother for 15 years. She has always been an upbeat person. She has been under a lot of stress because her son (my uncle) is in the ICU. This morning she just was not herself. Her speech was impaired a little. I knew what she was trying to say, but she just was scrambling her words and all mixed up. Do you think it could be stress or should she be tested? 

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  • My dad is 87 years old. He has had Parkinson's disease since he was in his early 70s. The doctor told him that if he could tolerate PD medication it would be 15 years before it got bad. My mom passed away in April 2010. They were married 63 years. At the time dad's doctors said he would probably live only 6 months (according to statistics). He continued to live in his own home. We hired someone to stay with him during the day and my sister and I took turns staying at night. He was never alone. In January 2012 he fell and broke his hip. After surgery he was sent to a nursing home for therapy. He has been there ever since. His PD and his mind have gotten worse. Recently, he has been very agitated, does not sleep at all some nights and has been somewhat aggressive to the caregivers, which it not like him at all. We can't figure out if it's his medication, progression of his disease or something else. He was this way at home before he went to the nursing home, just not as often and it didn't last as long as it does now. We go see him every day and talk to doctors almost daily. I know it is common for people with PD dementia to be aggressive, but we just can't stand to see him like this. Is there anything you might suggest to help with this? They keep changing his medication but nothing seems to help. 

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  • My father-in-law has dementia. He’s 89 years old and is bedridden— he can only get out of bed with help. He has caregivers during the day and evening. When they leave at night, they lock up the house. My worry is what could happen in case of a fire since he can't get up and get out. I think he needs to be put in a home where he can get 24-hour care. He could have that at home, but refuses for anyone to be in the house at night. We can’t make him understand that he needs someone there all the time for his safety. He has money, but he says he can't afford it. When we show him that he can afford it, he agrees, then changes his mind. What can we do? Can we be held responsible for his safety? 

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  • My mom is 88 and on hospice, diagnosed with dementia. She has had muscle spasms for about a month that affect her entire body nonstop. Her spasms keep her mouth opened and cannot swallow very well. Hospice doctors have her on Ativan (lorazepam) and just started Neurontin (gabapentin). But it is not working. It mainly just puts her to sleep, but she wakes up in a spasms. Is there anything else we can try to help her? 

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  • My mom is 80 and underwent a breast cancer operation. She also has Parkinson’s disease. My brothers are not taking care of her. She is always sulking when thinking of them. How can I bring happiness in her life and a smile on her face? 

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  • Mom has a blockage in the back of her head and has been doing things that aren’t like her. She tried to adopt a 67-year-old woman and her son. And mom thinks I'm after her money and things. I don't want her stuff. I'm tired of people taking advantage of her. Could this be dementia? 

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  • My father is 87 years old and has dementia. He is totally incontinent and is on coumadin for an irregular heartbeat. He lives in a very nice memory care facility. Lately his heart rate has been fluctuating. He wore a 24-hour monitor and his rate varied from 40 to 187. His cardiologist is recommending a pacemaker. We're leaning toward that because if he were to fall due to the low heart rate and become lightheaded, he might bleed out due to the coumadin. So Of course there's always the chance he could just fall just because of getting older. He still walks on his own. Wondered what your thoughts are on this. Pacemaker or not—I am torn and not sure what's the best thing to do. 

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  • My grandmother just turned 100 and was very active until around 8 months ago. Since then she has experienced multiple behavior changes. She is now in an assisted living facility. She has lost a great deal of weight, refuses to eat or take medication so they are not giving her anything. Just recently they started Ativan because they did not bathe her or change her clothes for two weeks because she would not let them or even me. What stage does she appear to be in and what does the assisted living have to do when a patient refuses meds, water, food, to change clothes or any real care? 

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  • My mother is 94, suffering many health issues and getting direct care solely from me, her son, with the exception of 2 hours per day personal care from a private-pay agency. I have no participating siblings or support. My mother's pension income is approximately $5500 a month. She lives in my home. All bank accounts are jointly held by her and me. The original deposits were from the sale proceeds of a home seven years ago that we also held jointly. Should she go into a nursing home in our area, she would run a deficiency of about $3500/mo if using just her income. Can the joint accounts be attached? Should I close those accounts and place them in my name only? What other ramifications are there in doing that? Would she

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  • My parents are living together, but are not married. They are currently renting a home in Port Saint Lucie, FL. My question is, if one parent passes away, is the other party held liable for the reminder of the lease?

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  • My wife has been diagnosed with Lewy Body dementia by two different doctors. Her condition has been deteriorating rapidly over that past few years. She is currently bedridden for most of the day and night. I am now at a point where I can no longer give her all the help she needs. We get some help, about 6-7 hours a week from a local agency, but have had to hire additional help, 12 hours a week, at a cost to us of $144 per week. I am a disabled veteran, but get very little help from the VA. Are the new expenses, about $7,500 per year, deductable?

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  • My brother and I were informed that my 62 year old stepmother put my 82 year old dad in a nursing home. We were shocked that she did not discuss this with us, and I would like my dad to live with me. We called the nursing home and she has full power of attorney, so we aren’t able to get any information about his health or his condition. We asked to have a meeting with his doctors and caseworker, but were told my stepmother would have to set that up. She says she will, but keeps giving us the runaround. Now she is claiming he was abusive to her and he has Alzheimer’s. What can I do? They live in New Mexico.

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  • My father was taken to the hospital Friday January 18th and is doing extremely poorly after a massive stroke and bleed on the brain. The next day my stepsister (theonly child for my father’s second marriage) emptied his house without informing me or anyone else. I am the sole executive if anything happens to him. Is she allowed to do this?

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  • My mother-in-law is in a nursing home (she will not be getting out). We have been paying her mortgage for the last four years because we have been told when she passes, we can sell the house and split the money among her four kids. Her $600 social security check goes straight to the nursing home. When she dies, will the nursing home take the house? Or we will in fact be able to sell it? We live in South Carolina. I don't want to be throwing money away if we can't sell it afterwards.

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  • My mother in law fell on the 15th of November. The house we live in is safe—the bathroom, living room, her bedroom and the kitchen-dining room are all on one level with easy access. She has a walker and a personal toilet in her room for her convenience. When she fell she got a bruise right on the side of her right eye, she lost mobility and couldn't get around by herself so we took her to the hospital. The next day we went to go get her and she did not feel ready to come home—they took it that she was scared to come home and told us they wanted to put her in a home. It would be devastating to her to take her away from the family, and we want her around as long as possible to see her grandchildren grow up. There is always someone her with her and willing to get her food and help her. Two days later, she was ready to come home and they let her have a physical therapist come over and a nurse who looked at the house and thought it was great and safe. Today we took her to her doctor who asked her some questions and she said she has dementia without giving her a proper test. The doctor was very rude and said she wants mom in a home and is not capable of making her own medical decisions. She wants to take my mom away from us when we have done everything to make sure she was safe and happy. What do we do? 

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  • My mother, 89, and father, 90, still live in their home, which is paid off. They live in NY state. About 20 years ago, my parents put their home and all stocks in an irrevocable trust in my and my two sisters’ names. If they were to go into a nursing home, what assets would the facility take to pay for their care? Would the facility be able to access the money from the trust? 

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  • My brother and I are concerned about our grandmother who lives with our parents. She fell for a second time and broke her left hip this time, and is now in a rehab/nursing home. She fell before and broke a bone in her face and arm. When she goes to the hospital they ask: is anyone at home miss treating you? She always says no. She has dementia and in her head she thinks everyone is nice. I had to ask the doctor to check her blood, check her bladder, see if she is dehydrated because no one else did—she needed 2 pints of blood, she had a UTI, she was dehydrated, and she got a bed sore. This woman was good to my brother and me, and my parents treat her like crap and do not care. They sold her home for nothing and do not want her anymore. After her hip gets better, how can we get her if our father has POA (she gets SSI and disability)? 

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  • My father had a serious motorcycle accident in 1991 with head trauma and brain injury. My mother took care of him from then until she passed away in 2011. My dad is on disability and unable to make important decisions on his own because of his head injury. Since my mom passed, I have moved in with him to care for him. He is easily persuaded by anyone and can be convinced of anything. I have tried to talk with his doctor about his mental health, as he has become increasingly violent since my moms’ passing. His doctor refuses to speak with me because my dad told him not to. He is about to lose his house and vehicles because he refuses to let me help him with his bills anymore. He has met a woman who has talked him into giving her all his pain and anxiety medication each month. Therefore he is not taking part of his medication to help keep his mind balanced. Is there a way I could legally get POA over him to get his mind and life back in balance? 

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  • I have been living in my elderly mother's home for the past 2 years to care for her. She has chronic illnesses that would make it unsafe for her to be alone. My sisters have informed me that when my mother dies, all of my belongings will become part of my mother's estate, since they are in my mother's house. Is this legal? What can I do to protect my belongings from being taken by my sisters after she dies? 

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  • My mother, age 66, has Alzheimer’s and lives with my 86 year old father. I went through Florida’s access application and applied for Medicaid for them. They live off social security and make roughly under $1700 a month combined. They pay a mortgage and are receiving some food stamps. However, they were denied for Medicaid. There was nowhere on the application to state that she has Alzheimer’s. How do I proceed? I can't even get a counselor from children and family on the phone. 

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  • My Mother's assets are extremely low at this point so she is trying to apply for Medicaid. She has a term life policy that has a cash surrender value of about $3500, which is standing in the way of her Medicaid eligibility. She has signed the beneficiary over to the funeral home, thinking this would satisfy Medicaid's requirements. Given that she is applying for Medicaid we understand that as her children, we cannot touch this asset and put it in our names even though we are her POA. It appears to us that this is best choice at this point. Are there other options that make more sense? 

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  • My 75-year-old mom is still in very good physical and mental health. She's had type 2 diabetes for 20 years, but it's under control. However, she had a medical scare last year, a side effect from a medication. At that time, she added me to her bank account, though I have no direct access. She says she has a living will, but I'm not sure where it is. And, as far as I know, she hasn't given anyone a power of attorney. Is that the next step? 

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  • My Grandfather (84) passed on 12/21/2012. My Grandmother (80) was told she must apply for Survivors Benefits (SSI) to match what his monthly SSI was. Why is she unable to collect both SSI accounts? In effect, she is losing $900 a month, which was just enough to keep the house running. 

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  • My husband and I are living with his mother in Florida due to her decline in health and dementia. She is 89 years old. She only has Medicare insurance. It is coming to the point where she will have to be placed in a nursing home. She has $20,000 in stocks and she owns her home. My husband’s name has been on the house since it was bought 20 years ago and he has POA. Can the nursing home/Medicaid force us to sell the house? Thanks for your help. 

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  • My Mother has been diagnosed with Lewy Bodies Dementia and told me she is "losing it" and asked me to take over. She has been living with us for 5 years now and I do have POA and I am the only named person in her will. But she has a very large sum of money in investments, two houses and a vehicle. How do I go about getting all of this in my name? 

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  • My father is living with my sister. He’s 83 and had a stroke on a Friday. She didn't call an ambulance or take him to the hospital. She let him lie in bed for 4.5 days while she was going all through his paperwork, did not call me until Tuesday evening 7 pm to tell me he was admitted to hospital and put on morphine. Is this considered a crime of negligence? 

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  • My grandmother has dementia/Alzheimer’s and has been dating a man for about 4 to 5 years. This man came along right when her signs and symptoms began to appear. Also, he lives in California; we live in Delaware where her house is. He takes her to California for months and months and only comes back to Delaware for a few weeks. We now know that she is not capable of making her own decisions and she relies on him to make them all for her. However, he is not making these choices based on what is best for her. In a sense, she is brainwashed. In fact, she is not "allowed" to see any of the family unless he is around, a rule he made. We know he does not take good care of her—she has been in the hospital a few times because she has not taken her medicine or forgot she had already taken it and overdosed. She needs a supervisor. Is there a way to legally make him go away and in a sense take custody of my grandmother? Anyway to prove she is incapable of making her own choices? We know she does not like having to choose between the family and this man, but what kind of person would take someone away from their family when they are losing their mind? 

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  • My Dad is 74 and was diagnosed with frontal temporal dementia in August 2012. Since the diagnosis and various visits to psychiatrists and social workers, it is suspected that he may also have undiagnosed bipolar disorder. We are trying to request further evaluation to confirm this and properly administer medications. Mom is his main caregiver and they live with my sister and her family in WA and visit with my family and me in BC. It has become painfully evident that Dad is requiring too much care for Mom to provide 24/7. They are on limited income and have a small amount of proceeds from the recent sale of their home. I need to ensure that Mom has money to live on once Dad is in care. Do I instruct Mom and Dad to buy a house? How do I calculate WA state Medicaid? I cannot get a straightforward answer anywhere...I look forward to your help!  

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  • My father-in-law is in a memory care unit for dementia at a skilled nursing/assisted living facility in Seattle. He became difficult and "unresponsive," and they sent him off in an ambulance to the hospital. The ER said there was nothing wrong with him physically, he was just angry. The ER doc evaluated him and there was no reason to keep him. We then heard that the facility where he is a resident refused to take him back! This was at 10pm on a Friday night—no warning. What can we do? Is there any recourse? Don't they have to give written advance notice? The hospital said this is called “patient dumping." We are stunned by this revelation. Any advice you can lend would be appreciated before we contact the facility. 

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  • Five years ago my grandma, now 97, asked me to take care of her and never put her in a home, and I moved her into my home. We started getting hospice care in a year ago as we thought she was going to pass. She is in better health now and we want to take her off hospice, but they keep finding a reason to keep her as a patient. We live in a beautiful home and she is well cared for by my wife and me. Hospice now wants us to move her out because they think she needs more care. We have an hour gap when grandma is alone (she is bed ridden) and we hired a nurse to come for two hours a day to cover that time frame. Hospice still wants her out and is threatening to call adult family services if we don’t. We think they have a hidden agenda. Can they do that or can we deny their services instead without consequences? Thank you. 

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  • My dad has been moved to a rest home so that he can get physical therapy on his ankle. He is 78, has lots of medical conditions and cannot take care of himself, let alone walk. He is insisting that he goes home even though he can clearly not take care of himself. My mother is beside herself with worry. He could fall and hurt himself and her. She is not able to fully take care of him in his present situation. He is too heavy for her to lift or even help him up. But he will not listen and the facility says they cannot hold him if he wants to leave. I don't know what to do and I’m worried sick for both my parents. 

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  • How do I go about finding a home healthcare agency that is Medicare funded? 

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  • Over the past year or so my mother’s health has been gradually decreasing and she is still pretty young at 69 years old. She gave up her independent living apartment that was based off of her income to move in with one of her sons, who soon realized she was too much work and kicked her out. We rented her an apartment near our condo 1 mile away so that we could help her if need be. The issue now is that she is in and out of the hospital every couple months for high blood pressure and UTI infections, and cannot walk on her own anymore. Her health continues to decrease and she is no longer taking proper care of herself. I do not believe she is able to live on her own anymore—she cannot get up to use the bathroom, cannot shower herself, falls asleep while she is cooking something and makes irrational decisions. Her only source of income is her Social Security, which is not much, so we end up paying everything for her. I know of assisted living facilities that are willing to take her based on her income requirements, but she is unwilling to go. This last time she was in the hospital she started to show signs of early onset dementia. She was having very vivid dreams of things that never happened, for example she thought her son and daughter in law had a newborn child and she called the entire family telling everyone about this kid that never existed. We asked the hospital to do a neuro psych consult while she was in there, and the neuro-psych questioned her and suggested she get a full psych report. She will not seek any medical advice that might allow her son to get power of attorney to put her in assisted living where she needs to be. Is there anything we can do to get power of attorney from her? The situation keeps getting worse as time goes on, and she is so unwilling to let us help her.  

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  • Our 87 year old father suffers from dementia and a significant eye disease and is noticeably declining. He lives in the family home with my younger sibling who works during the day. Currently, dad continues to drive short distances to the store and back, and is quick to let you know that his driver's license is legal for 3 more years. In anticipation that his driving days are numbered, we have hired an aide, three times a week for six hours each time, to do activities with him as well as drive him to the store. During Dad's recent visit with his PCP, I spoke to her privately. She absolutely noticed his deteriorating awareness and agreed it was time to stop driving. I requested she contact the eye specialist to ask him to tell Dad he needs to stop driving due to his eye condition and must have his license revoked. We felt it would be easier for him to accept that his sight is no longer safe for driving rather than that his faculties have reached a point unacceptable to retain his driver's license. We hope to keep his dignity intact as much as possible. Next week is Dad's appointment with this doctor. I anticipate he will not accept this well at all! How should I prepare for a possible inappropriate outburst of anger? What can I do to console him during the 45-minute ride home? What can we do to minimize the depression he will experience moving forward?  

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  • I am so confused. My mother was diagnosed 13 years ago with Parkinson’s. The past five years have demanded constant one-on-one care, but recently my mother has been acting very strange. She started complaining about headaches in the back of her head about a month ago. She was taken to the emergency room and had extremely high blood pressure, thought to be based on food she ate that day. She has started talking like a baby and saying things like "Me see you, you see me?" over and over. She has complete knowledge that she is doing this and makes a point of making sure we notice this—she says that it is due to a stroke and that she has read that your speech is affected after a stroke. She has been acting very childish, actually pulling a tantrum if we don’t pay attention to her and getting upset when I go college, even going as far as to call me and insist that I not go to college anymore. My first day of college was when she actually claimed she had a stroke and told me I needed to miss school and take her to the emergency room—doctors didn’t find any evidence of a stroke. Is she acting out or perhaps experiencing dementia? How can I approach this without causing resentment? 

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  • My mother, 85, is taking medication for Parkinson's and has a level 6 Alzheimer's. She as been doing very well on the medication, but the other day she fell and hit her head and was knocked unconscious for a few minutes. She has been admitted to the hospital as a small spot of blood was found in her brain after a CT scan was done. The doctors are monitoring her and watching to see if the blood spot changes. I have a concern with her behavior now as she can answer your questions but then goes off in her own little world and talks about “golfing and it’s your turn.” She also gets up and goes to the table in her room and starts folding the bedding and towels, piles them neatly and then goes on to say it’s your turn play a card. She has never been this confused. Has the fall made this happen? Is there anything I can do to stop this? 

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  • Q:

    I’ve already been diagnosed with hearing loss. What should I do now?


    A:

    When people cannot hear well, activities they used to enjoy, such as meals with friends or family, become challenges. They can become frustrated, skip social activities and start to feel isolated. By contrast, people who seek treatment for hearing loss report significant improvements in relationships, self‐esteem, overall quality of life, mental health and safety. That is why it is so important for people with hearing loss to seek treatment, such as using digital, custom-programed hearing aids.

    For family members or caregivers, there are several steps to keep in mind. When speaking with someone with hearing loss, make sure to face him or her, avoid covering your mouth while speaking and speak slowly. Also, select hearing-friendly settings, such as a quiet room without background noise. Finally, people with hearing loss can benefit from effective communication strategies, such as watching lip movements, facial expressions and body language during conversations.

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    Q:

    How long is it safe to be exposed to loud sounds without the risk of damaging my hearing?


    A:

    People should limit their exposure to loud sounds, such as loud music, power tools or lawn mowers, to no more than 20 minutes at a time. Studies have shown that consistent exposure to loud sounds above 100 decibels, as compared to a normal conversation of 60 decibels, can permanently affect hearing. If you anticipate being in a loud environment, such as a music concert or sporting event, it is best to consider wearing hearing protection. Also, when using ear bud headphones, follow the “60/60 rule,” which means limiting the use of ear buds to 60 minutes at a time and at 60 percent of the player’s maximum volume.

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    Q:

    Is there an alternative to catheterization for urinary retention?


    Suzanne from FL
    A:

    This depends on the cause of the retention. Retention can be due to a physical blockage, like a large prostate in men, to the bladder muscles being stretched so much from a prior blockage that they do not work anymore, to medication that blocks the bladder muscles from working, or to the bladder muscles not working to empty the bladder caused by the nerves to the bladder not working. Most commonly the latter comes from a disease such as diabetes.

    If it is due to medications, the medications causing it can be stopped and sometimes the retention will resolve.

    If it is due to a prior blockage stretching the muscles, initially it is treated with catheterization, but sometimes it improves with time and the person no longer needs a catheter.

    If it is due to the nerves not working from a disease like diabetes, there are medicines that help sometimes, but other times they are not enough and a catheter is still needed.

    If it is due to a physical blockage, then a catheter is needed. If a catheter is needed, it can be either an indwelling catheter that is there all the time, or intermittent catheterization when the person puts one in 3 or 4 times a day to drain the bladder, and then removes it. This works in some cases and reduces the chance of infection if done properly.

    You would have to find out the cause of the retention and whether an intermittent catheter would work from the person’s physician.
     

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    Q:

    My father is 94 years of age living in his home in New York State. Two weeks ago he had a Foley catheter placed due to strictures in his urethra. He drinks some water but not enough. This morning his balance was so poor that he was unable to get out of bed without help. I feel that he is severely dehydrated. Should we get him medical attention? Is the catheter causing dehydration? 


    Linda from CO
    A:

    You have two questions. The second one is easy—the catheter is not causing dehydration. It can be uncomfortable and lead to infections, but not dehydration. The first question is tougher. There is a long list of problems that could cause him to have poor balance. At the least you should call his physician to discuss whether he should go in for a visit to evaluate this problem. 

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    Q:

    My grandmother is 77 and has dementia. I take care of her 5 days a week. My question is why can't my grandmother tell the difference between something feeling cool and something being wet? I will hand her a pair of panties or a jacket that feel cool to the touch and she thinks it's soaking wet. Is this normal? 


    Ashley from NC
    A:

    The normal functioning brain is able to differentiate cold from wet. However, both sensations can be similar. In the patient with dementia, there is damage to parts of the brain and this distinction may be harder to make for them. I would consider having her touch the clothes before putting them on so she can tell they are not wet. But warn her that they will feel cool or perhaps wet when she puts them on, but that she now knows they are not wet.  

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    Q:

    My stepmom is thinking about doing a few overnight stays with my dad who is getting ready to be moved to assisted living. My dad has dementia and I'm concerned that if these overnight stays have to be stopped it will confuse him even more. Is it best she not even start any overnight stays? 


    Denise from NC
    A:

    It entirely depends on your father and his current understanding and behavior issues. If there would be safety issues with overnight stays with your stepmom for her or for your father, then it would not be a good idea. However, if he has significant memory loss, then he may forget after a short time that your stepmom had an overnight stay. Is it possible that he could continue to have overnight stays with your stepmom at her place even if he goes to assisted living? Perhaps the overnight stays have significant meaning to your stepmom and would be worth it. In general, I would not typically plan or not plan events just in case it may, in the future, confuse the patient. If there is a known history of a patient being greatly bothered by an event, then you can use this information to avoid similar circumstances in the future.  

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    Q:

    My father has been diagnosed with dementia and Parkinson's. He does not take medication for neither because he has angina and was told by the doctor that they cannot prescribe anything. Surely this is wrong. If only something to stop my father from shaking would he be able to carry out some day-to-day tasks. 


    Jude
    A:

    There are many patients with Parkinson's disease and dementia who also have angina and are able to take medications for their memory loss or for their tremors. These medications can be very helpful in some individuals to help with their day-to-day functioning. I would suggest getting a second opinion from a neurologist.  

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    Q:

    My 83 year old mother-in-law recently was in the hospital for pneumonia. She has COPD and could walk well and was functioning quite well with a cane. She has had slight hand tremors for the past couple of years. When she came home from the hospital she fell going to the bathroom and hit her head and we do not know how long she was unconscious. When we arrived at the house that next day she was extremely confused, agitated and her shaking was remarkably worse. Her short term memory has gotten worse out of nowhere. She seems to be deteriorating at a fast rate. She lives with my brother-in-law and he did not think that we needed to take her to the ER and he blamed her actions on the recent hospital visit. If the fall did cause some type of brain bleed is it to late to go through the motions of a CAT scan etc since it has been wo weeks? I keep pushing to take her to a neurologist. 


    Jack from NJ
    A:

    Normally if someone had a bleed or hemorrhage in their brain, they would not only be more confused, but often would have one-sided weakness or numbness, facial droop, gait issues, or something that was worse on one side of the body from before. You would be able to see any bleeding for weeks on a CT scan after an event in most cases. Medication changes are common causes of confusion, so be sure to check if the hospital changed any medications she is taking. Nevertheless, if you or others have noted a significant and sudden change in her behaviors or memory, she should see her physician ASAP. They can evaluate and let you know if a neurologist is required.  

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    Q:

    I take care of a patient with Parkinson's disease and muscular dementia. She is spitting out her food and medicine. I crush her meds and put them in applesauce. It worked for a while, but now she is spitting everything out after a bite or two. What can I do to help her continue to eat and receive meds?  


    Terri from AL
    A:

    Patients with Parkinson's disease dementia or vascular dementia develop many problems with motor control. Sometimes this can extend to trouble figuring out how to chew or swallow at the end stage. If the patient is still able to swallow, then try placing the crushed medications in foods, puddings and ice cream, that have strong flavors that may camouflage the taste of the crushed pills. Some medications have liquid or solution formulations that can be switched to and then placed in liquids. There are medications that may help with appetite if she is losing weight. Nutritional supplements may keep the weight up as well.  

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    Q:

    My grandfather has had Parkinson's and Alzheimer's for many years and was fine until one night when he fell and banged his head. They cannot do an MRI because of his shaking. Now he is in a rehab center and barely eats and sleeps. He has extreme shaking in his body. He is 82. Is there anything we can do—anything?  


    Mike from FL
    A:

    Individuals with Parkinsonism and progressive cognitive loss may have Alzheimer's disease plus Parkinson's disease or may have another neurodegenerative disorder like dementia with Lewy bodies. Head trauma can cause concussions or even bleeding in the brain (subdural hematoma, subarachnoid bleeding, or bleeding in the brain itself). A CT scan could usually diagnose any bleeding. A CT scan is not so much affected by someone shaking in the scanner like an MRI scan would be. There are many medications that may help sleeping issues (mirtazapine, trazodone, zolpidem, gabapentin, melatonin). Mirtazapine may improve appetite as well as help sleep. Valproate may help with sleep issues associated with excessive restlessness. Quetiapine may help with sleep issues if the individual also has false beliefs or suspiciousness symptoms. Megestrol, mirtazapine, or valproate may all help with appetite issues. In regards to his shaking, there may be treatments, depending on the cause. Other medications he is on may also cause shaking, appetite loss, and decreased sleep. His physicians can try to sort out the causes of his symptoms.  

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    Q:

    Do you think a 92 year old should have to stay awake after 5:30pm to 10pm? Do you think at 92 you should be able to eat the food she likes? 


    Judy from NY
    A:

    This is a very interesting set of questions and the answers are not at all straightforward. It would be interesting to know if this question is from a 92 year old who is being pestered, or by a caregiver who is uncertain what to suggest.

    In terms of bedtimes, there are no recommendations for people in general for their health. There also are no generalities for aging and bedtimes. Once people stop working, so that their bedtimes no longer are controlled by outside demands, people tend to revert to their natural tendencies of being either early risers or night owls. I have many older patients who stay up until 3am and sleep until noon, and others who go to bed at 7pm and arise at 4am. No one pattern is preferred.

    Why is the question being asked? If the 92 year old is in a nursing home, he/she often have limited options as to when to offer food and medicines, which can alter people’s natural bedtimes and are often unavoidable. If the person is in the community and living with others, there may be issues of noise or other people’s bedtimes that need to be negotiated, as neither the older person nor the people he/she lives with have the right to absolutely dictate bedtimes to others, so it becomes a negotiation. If the older person lives alone, they can go to bed whenever they want.

    In terms of foods, it depends on the person’s overall health and priorities related to that, and on the person’s specific health conditions. For older people who are losing weight, not from a specific correctable cause, the important need is calories more than good nutrition, so ice cream all day is often great. For people with a very short remaining life span they should eat whatever makes them happy. For 92 year olds who hope to and expect to live several more years, choice of food may be much more important. Cholesterol- lowering diets and medications take up to three years to make any real effects so someone who does not expect to live longer than that need not worry about fats. However, someone with severe diabetes could die in a few days from eating the wrong foods so if they want to live many years they should not eat what they want if that is food high in sugar. It all comes down to a person’s health problems, and their personal desires as to how to live their lives.
     

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    Q:

    My 82 year old father had prostate radiation in 2008, then was diagnosed with a low grade bladder cancer in January 2013 that was successfully removed. Since then, he has suffered urinary blockage followed by catheters for periods varying from three or four weeks to three months. When the catheter is removed, he is partially incontinent for two to three weeks and hardly gets any sleep during that time. One urologist suggested a TURP intervention because the blockage was due, in his opinion, to prostate scar tissue related to the radiation, but his own urologist refuses to entertain this because of his age. The only medications he takes are Flomax and a baby aspirin, both daily. Should he ask his own urologist for a referral to another specialist? 


    Pierre
    A:

    It would be hard for me to say what the cause of this is, but since it does bother him a lot I would suggest a referral to another specialist. At 82 he is not old at all for minor surgery and that should not limit him if the procedure will help. 

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    Q:

    My grandmother is 77 and has dementia. I take care of her 5 days a week. She has incontinence. Her doctor has told us that she's not drinking enough water. Part of it is that I believe her train of thought is that if she drinks more she will go to the bathroom more often. Another issue is that she is just not thirsty—she will complain about being dry all the time (mouth, eyes, skin), but says she's not thirsty. Is there any way I can get to increase her water intake for her health? 

     


    Ashley from NC
    A:

    As people get older one of the changes everyone goes through is that the thirst response gets worse, meaning that if older people are dehydrated they still do not feel thirsty so do not drink enough. There is no treatment for this so all we can do is tell people they have to drink more than they think they should, and to drink regularly throughout the day even if they do not feel thirsty. It is often a struggle to get older people to comply with this, and it is even worse when they have dementia. The best suggestion is to find a tall drinking mug and tell her she have to drink a specific number of those mugs with liquid every day (to get about 80 ounces a day).

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    Q:

    My 68-year-old father recently had open heart surgery (he had to have a heart pump put in prior to surgery). He has diabetes and is on dialysis 2x a week. Two or three days following the surgery, as my children, husband, and I entered his hospital room, he shouted that he hoped we all died and that I got cancer to the bone. It was very upsetting. I stuck with him, and he has not repeated this kind of behavior, but he is surly and demanding. He is sapping all of my energy. Recently, he had me take him to the emergency room, and his blood pressure was 260/126. They re-admitted him, and he is back in rehab. I am dreading him coming home (he lives with us now). His short-term memory is shot (they think he had a series of undiagnosed strokes following the surgery). I get physically ill when I visit him. Help! 


    Kayla from KY
    A:

    I am sorry for what you and he are going through. If he was not like this before the surgery, the advice you got is likely correct, he had one or more strokes and that often changes a person’s personality. Unfortunately that cannot be corrected. There are medicines that can help with behaviors such as sudden outbursts, but not the surly and demanding nature. It is very difficult for caregivers, family or medical personnel, to deal with such behaviors at times, and it is understandable if it is too much for you. I suggest you talk with his doctor, or with a social worker at the hospital, and discuss your frustrations. For many families, they need to come up with alternative living arrangements because it will not be good for him, not to mention you, if you are seriously stressed out by his behavior. 

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    Q:

    My husband had a stroke 8 years ago and was taken off Coumadin because he falls so much. The last of August he had a knee replacement and had a blood clot in the lungs. They put him on Coumadin. I am confused as how much vitamin K he can have a day. I have read anywhere to 40 to 120 mcg. Can you give me the correct amount? 


    Margie from GA
    A:

    The important things about Vitamin K are to avoid high doses and to take the same amount every day. As long as he does not eat a very large dose of vitamin K, the Coumadin dose can be adjusted for the amount he does eat. Some people eat very little to none, others a modest amount, and the dose can be adjusted for that. We tell people who like salads, for example, to have a small one every day, just not a huge one ever and not salads on some days but not others. 

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    Q:

    My mom is 84 and of sound mind and body. She's always been very healthy and strong. She still does a lot of the cooking and kitchen work, plus the laundry and taking care of my brother's two sons, 7 and 10. I'm concerned with the amount of work she's doing. She's having trouble with her legs. She has pain when standing up and difficulty to start walking. Once she gets going, she's ok. I notice she has trouble with the stairs. My brother believes the work keeps her healthy and sharp. What is causing her leg pain and what can be done to help her?


    Luisa from FL
    A:

    Without actually seeing her, all I can use is clinical judgment about the cause of your mother’s problems. It sounds more like arthritis than anything else. There are lots of medicines for arthritis such as Tylenol, ibuprofen, and arthritis creams, but some of them are dangerous when used with other medicines or with certain medical problems so she would have to ask her doctor if they are safe. Heat such as a heating pad or warm water also helps. Modest exercise and activity is good for arthritis, overdoing it is not. For any one person, overdoing it is defined as when she feels pain or stiffness. On the other hand, too much rest makes the stiffness worse. I hope this helps. 

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    Q:

    My 72 year old mother was diagnosed with Parkinson's 18 months ago after experiencing mobility issues and a fall. She is very mobile and has only a slight hand tremor. Her mental health, however, has significantly declined since the diagnosis. She is now often confused, can no longer do her own banking, has very little short-term memory and sometimes makes no sense when she speaks. She is confusing her medications and forgetting when and if she has eaten. She recently had a psychoneurological evaluation, which I was told was "inconclusive." I am now wondering if the Sinemet she is taking is somehow causing all the cognitive issues? 


    Jennifer from TN
    A:

    Patients with Parkinsonism can have gradual cognitive decline due to a neurodegenerative condition. The most common ones are dementia with Lewy bodies or Parkinson's disease dementia. Since her hand tremors are slight, dementia with Lewy bodies may be more likely. Those individuals often may have issues with visual spatial processing, fluctuating symptoms, increasing sleepiness in the day or more closing their eyes, visual hallucinations and/or talking or thrashing out in their sleep. Cholinesterase inhibitors may help these individuals. As you point out, medications can cause cognitive issues. Sinemet may increase the likelihood for false beliefs, paranoia or hallucinations. If the Sinemet was never very helpful, it may be useful to lower the dose after a discussion with her doctor. Infections (urinary and others) strokes, and metabolic conditions may cause cognitive issues as well. These must be sorted out by her doctor.  

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    Q:

    My 86 year old father has Alzheimer's and is immobile. He's deaf, and he cannot feed himself or get out of a chair. He believes that he sleeps for a long time, but in actually, he sleeps around 5 minutes. The same thing happens when he's awake—after about five minutes, he believes he is awake for a long time. This happens repeatedly, so he is awake all night. With the sleeping pills he only sleeps a few hours. What should we do to help him? 


    Lalita from NY
    A:

    There are many medications that may help sleeping issues (mirtazapine, trazodone, zolpidem, gabapentin, melatonin). Mirtazapine may improve appetite as well as help sleep. Valproate may help with sleep issues associated with excessive restlessness. Quetiapine may help with sleep issues if the individual also has false beliefs or suspiciousness symptoms. Also the use of good sleep hygiene is very important. That is, try to keep his rise times and sleep times the same every day, including naps. Try to increase activities if possible—perhaps watching slapstick comedy that he can see visually, review family pictures, picture books of topics that may interest him, crafts and more.  

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    Q:

    I recently had an MRI and the diagnosis was the beginning of memory loss or dementia. I am 66 years old. I walk two miles a day and am in good physical condition. I also ride horses. My mother and grandmother both had Alzheimer's. Is there anything I can do to slow down the memory loss and stay ahead of the game? I am also diagnosed with depression. The medications they put me on are Namenda 10 mg twice daily, escitalopram 20mg once daily and Lorazepam 0.5mg once daily. 


    Rebecca from KS
    A:

    It is to your advantage that you are trying to be aggressive to keep your brain and body healthy. Physical and mental exercise seem to possibly slow down the cognitive decline with Alzheimer's disease. In addition to the Namenda for your cognitive loss, have your doctors consider the use of a cholinesterase inhibitor (such as donepezil, rivastigmine or galantamine). One of those medications works very well in combination with the Namenda. There is some literature that suggests vitamin E for its antioxidant effects can help slow down the course. I suggest 200 units daily. There are also many clinical trials looking at new potential treatments for Alzheimer's disease that you may qualify for. Most will have part of the study group be on a placebo and the others on the active treatment. Go to http://www.clinicaltrials.gov for a listing of current clinical trials. Note that there are some warnings about higher than 10 mg escitalopram if you are over age 60 related to heart concerns; these concerns do not seem to be seen with some other antidepressants like sertraline. Also, lorazepam can cause cognitive issues and so ask your doctor to see if you can avoid those types of medications.  

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    Q:

    My father was recently diagnosed mid-level Alzheimer's. He still exercises, is 88 years old and lives with me at our home. He does have trouble walking, but uses a walker. He is having trouble speaking at times, and his doctor is aware of his issues. But at night, usually after 8 pm, once it is time for him to get ready for bed, he starts getting totally confused. He forgets how to use the bathroom, he does not even know where it is. He is very confused and agitated. He is unsure how to get into bed, and I can tell he does not really know what is going on, but he knows me. His wife has been gone nearly 5 months in a rehab, and I know that is a factor. Should I play music or is it sundowner's syndrome? We hope to get him on some meds soon, and he is scheduled to get a scan on his brain soon. Please advise. 


    Bill from TN
    A:

    He may have some elements of Sundowning syndrome, which is common in many dementia conditions. If some of his behaviors involve suspiciousness or false beliefs or paranoia, antipsychotic medication like quetiapine or ziprasidone may be helpful. If he is packing or wanting to leave and excessively restless, valproate may be helpful. If he is anxious or depressed, an antidepressant may help these symptoms. Sometimes a mild medication to help him sleep, like trazodone, may take the edge off. Any medication should be given at least 45 minutes prior to when his symptoms usually occur to try to prevent or reduce these symptoms. Please talk to his doctor to see what they recommend. Keeping the house lit with lights prior to bedtime may reduce sundowning. Music may help.  

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    Q:

    My mother, near 60, is suddenly having problems while drinking or eating. Whenever she tries to bring something to her mouth, her hand just gets disoriented and goes to the side. What could the reason be? 


    Lubna
    A:

    If only one side (one hand) is involved, an MRI scan of her brain may be recommended by her physician to look for focal brain conditions or strokes. If she has normal strength and sensation in that hand, it may be a type of apraxia. Parkinsonian conditions like corticobasal degeneration can cause severe one-sided apraxia. Shoulder or neck issues could cause hand problems as well.  

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    Q:

    My father is 89 years old and sleeps constantly. I cannot get him to eat or drink anything. He is in the early stages of dementia, according to his doctor. I wake him up to take his pills and give him a glass of water to drink. He will only drink about half of it, and only twice a day. He will sometimes drink a High Protein Boost and will eat a half bagel with cream cheese occasionally, sometimes a little ice cream. He will not bathe, although he can still go to the bathroom by himself. I moved in with him a few months ago and he has seemed to go downhill rapidly since I did this. It seems like he has given up and is trying to die now that he has realized that he can no longer be alone. Any suggestions on how to get him to eat and bathe? 


    Carole from PA
    A:

    You are doing the right thing in adding ice cream and Boost or similar supplements. Anything that he likes to eat that has high protein or high calories would be good. Milkshakes with protein powder and ice cream can be considered. Medications may help his appetite. Be sure to have his doctor look at his medications and get a metabolic panel on him to evaluate for other causes of poor appetite. An antidepressant should be considered if you feel his mood is low. Increasing pleasurable activities may also help.  

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    Q:

    My dad is 87. Two years ago he received a pacemaker, defibrillator and new valve. Recently he just sleeps. He eats a bit, doesn't like to go out and thinks 15 minutes is hours when he does go out. He's taken care of by my 85 year old mom. What can we do? 


    A:

    Make sure you tell his doctor about his sleeping and appetite. At age 87 he will metabolize all medications more slowly. Check for medications that can cause sleepiness. Is he depressed? An antidepressant may help. He may be bored. A senior center, daycare facility or just increasing pleasurable activities may help keep him interested and would tend to reduce his excessive sleepiness.  

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    Q:

    My Father, now 94, was severely injured in the Philippines during WWII. He was sent back to the US and was in hospitals for years. He still sets off metal detectors due to the shrapnel in his body and he is profoundly deaf. When the VA finally decided to test him for Alzheimer's, they discovered he had lost much of his frontal lobe way back in 1943. It explained a lot of his past behavior to our family. We've had Dad at home with my brother and my mother for years. It's a huge struggle and it's time to find a capable place where he would feel safe. Would an Alzheimer's unit be adequate or do we need something different considering the additional factors? I should say Dad is in outstanding health and until recently played 18 holes of golf three times a week and 36 on Saturdays. 


    Victoria from MO
    A:

    I would look for a place that you have visited and feels right, probably one that is not too far away from you so you can visit. He seems very active and so look carefully at the activities program to see if it would be a good fit. Activities would be very important for his quality of life. It will not matter so much that he has had brain injury from WWII and Alzheimer's disease as long as you choose a place that is comfortable with residents with behaviors associated with dementia.  

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    Q:

    I need some help with caring for my parents. Two years ago they moved to be near me and my sister due to health issues, mom's dementia, etc. The first year was spent in and out of hospitals. They were in independent living, which was my dad's idea since my mom no longer cooked and it seemed the ideal situation. That lasted about 6 months and he hated living there. He is not at all a social person and does not want to dine with strangers. Mom rarely went to meals or got out of bed. My sister and I were there 3-5 days a week to put out meds in boxes, do laundry, doctor appointments—Dad would not use their transportation. He said, what if they move out to a regular apartment and then I can "help them out." It turned out to be far more than a little help. In August of 2012 mom broke her hip and was in rehab for 2 months. This happened while they were with me at our cottage in northern Michigan. I was there as well for two months. I could not leave because my dad does not drive. When we got them back to their new apartment in Fall 2012 there were many followup doctor appointments, PT, more appointments. Also, while mom was at rehab, dad ended up in the hospital for a week. I have missed special events with my college age children, have not been able to get away and when I do it is a week of planning meals, meds, and then my sister who works full time has to fill in for me. My dad calls every day about mom not getting out of bed and not taking meds. He is very demanding and needy and seems oblivious of how he is consuming my life. This is my "empty nest" time and I have become resentful of having to do everything for them. We have caregivers three days a week, 5-7 Tues and Thurs and 3-5 Fri. That is it ! He does not want to pay for more help. My sister and I know we need help—we just have no family time at all. Weekends are consumed by our parents. I just do not know how my dad cannot see all of our time is with them. When they were our age and empty nest they traveled, mom went with dad on business trips. Neither one had to care for a parent. I do not know what to do and feel guilty when I want out or when people tell me I am such a good daughter. I want to be that daughter not a caregiver. My husband and children have been angry and upset because they take all of my time and also because they see what it is doing to me. Help ! 


    Kathy from MI
    A:

    This sounds like a "tough love" situation. I suggest you and your sister unite and have an intervention with your father. Explain how this is affecting your lives, relationships and stress levels, which will lead to health issues for yourselves. Be honest and factual in your presentation. Use "I" statements such as "I need to spend more time with my family, they are upset I am not there for them" and "I am struggling with the stress this is causing me and am worried about my health. Therefore we need to come up with another solution to your care needs. Here are some options…"

    Then I would lay out some options for them, such as hire a professional geriatric care manager to oversee and coordinate all the things you are doing. Explain they need to pay a professional to do this since you are not going to continue, it is overwhelming and consuming your life. In addition, caregivers can do some of the tasks you are doing, and a driver could also do some of the things you are doing. The other alternative is assisted living, which has already failed.

    I do not think much will change unless you and your sister find a way to pull back and stop doing all that you are doing. There might be some short-term family strife over this, but hopefully your father will accept it eventually. You need to decide to make the change in order for this to shift. I always recommend to adult children to be careful not to damage their own family relationships with partners and children over the care for elderly parents. If this is happening, it is a red flag to get some professional help.
     

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    Q:

    I would like your opinion on how to handle an upcoming event. We have a big birthday—99 years young—in a couple of months for my Mom. The family wants to throw a party at a hall and have all the relatives and friends that she has not seen for years and years to attend. This is nice, but I have my concerns about the stress and confusion this may give to Mom. She has moderate dementia and sometimes she does not recognize the family that is taking care of her daily. It also seems that when there are more than a couple people talking around the dining room table she gets confused and remote. If there is such a big celebration in her honor, is this the right thing to do for her? I suggested that we contact the relatives/friends and let them know about the birthday and they can send her cards/messages of their wishes and keep a small family celebration for Mom. Some days are good, some are not. I would appreciate your insight or suggestions on how to handle this, especially with the family members. It is definitely something to celebrate, but how we should do it is my concern. Thank you for any information you can send. 


    Beth from IL
    A:

    I think you are very much on target with your gut instincts here. A large family event would probably not be the best way to celebrate this birthday if it would at all be confusing and distressing for your mother. Given her level of functioning now, I would keep it small and simple. Follow her lead during the gathering, and if she is getting confused, then that's your cue to end the party.

    Your idea of having family members send her cards is lovely. You can share some with her during the party, and make a scrapbook perhaps that she can look at, at other times with you. It's important to explain to family members that this decision is based on what is best for her. If everyone wants to gather since you have not seen each other for a long time, then maybe a Family Reunion is a better venue for this than a party for your mother.
     

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    Q:

     My 93 year old mother had an ischemic stroke 9 month ago. She recovered miraculously, she eats right and exercises, but she lost a lot of weight and muscle mass. Her medications for heart are monitored, and all seems OK. Still she's losing a lot of weight and strength. What could be causing the rapid weight loss?


    Hanna from CA
    A:

    First of all you said she is eating right now. Does that mean consuming a good amount of food, or that she is eating very healthy? If you meant that she is eating healthy now and was not before, she could be consuming a lot less calories than before, which might explain the weight loss. Also if she is exercising a lot and was sedentary before, that could explain some weight loss. On the other hand, if you meant she is eating the right amount now and exercising modestly now and still losing weight, that is a concern. I would first look at her medicines and see if any could cause weight loss. Otherwise a doctor would need to evaluate her for any of a large number of other conditions that could cause weight loss and may be completely unrelated to her stroke.

    If she lost the weight shortly after the stroke and is no longer losing it, the weight loss could all be related to the acute illness and poor intake at that time.

    At age 93, a major problem like the stroke will always cause some loss of strength and muscle mass and it is very difficult to return to normal strength at that age without vigorous exercise. I would worry less about the strength loss than the weight loss.
     

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    Q:

    How can I tell my 89 year old father-in-law that he needs to pay better attention to cleanliness and hygiene? He seems to not be showering and wearing clean clothes anymore. Is this a sign of dementia? 


    Sheryl from CT
    A:

    There can be many causes for reduced hygiene with aging. Dementia is certainly one of the most common and his doctor could investigate that possibility. A second issue is loss of smell and vision with aging—he could honestly not notice that his clothes are soiled. In addition, showering or bathing becomes physically more difficult for some frail elderly individuals, and doing the laundry also may be difficult or even expensive if using a laundromat so some people may choose to decrease the frequency of these activities. Finally if he is having some incontinence that might be contributing to the poor hygiene and he might be embarrassed about it.

    In terms of how you can approach him on this topic, be as gentle as possible. Ask him if he needs help with his laundry. Go to his house and see what the conditions are—is there a working laundry, a safe shower or tub, are there piles of dirty clothes lying around or evidence of incontinence?

    If there is evidence of incontinence you could offer to take him to the doctor for that, or for a dementia evaluation if you suspect that. You might have to be a somewhat honest though if he does not recognize the need to improve and state what you are noticing.
     

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    Q:

    My dad is 77. He is relatively fit and healthy. He has never drank alcohol or smoked. Lately his voice is weaker and strained at times. He is stubborn about seeing a doctor. Have your any ideas why this might be happening? 


    Susan
    A:

    There are multiple things that could cause this. He could be getting silent acid reflux with no symptoms other than the voice change. He could be developing a benign polyp on his vocal cords. He could be developing a neurologic problem such as myasthenia or any of a number of other neurologic conditions that affect the voice muscles. There are undoubtedly other possibilities, but these are the first that come to mind. The first ones are benign conditions so maybe telling him this would allow him to feel comfortable going to the doctor. 

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    Q:

    My 93 year old father does not have a serious medical condition. Due to his age, he has age related medical issues. He no longer can drive. His doctor is pulling his license Thursday. I am the only caregiver left around to take care of him. He needs me and my hearing (he does have hearing issues and already wears hearing aids) to drive him to his appointments. Do you know if I can take FLMA for this type of assistance? If so, I'm unclear what to put on the FMLA paperwork for his "medical reasons." Any information you can provide will be a big help. 


    Cheryl from NJ
    A:

    Most FMLA forms include sections where you are taking off time for yourself, and sections where you are taking off time to care for someone else. In either case, you can take off for one episode or request time off periodically (such as to go to visits once a month). Only your HR person can say if your organization will allow that, but the spirit of FMLA would allow that up to a certain frequency of time off and the standard FMLA forms have a section for just such a request as you have. 

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    Q:

    My 86 year old dad has a foley catheter and has a UTI infection. The problem is he has been on antibiotics for two weeks and the infection has not cleared up. They have taken two cultures and have changed the antibiotics, but nothing seems to work. What could be the problem? 


    Rose from NJ
    A:

    First of all, he could be colonized with bacteria. This happens to older people sometimes, more often if they have a foley catheter, and it means that there is always bacteria in his bladder but it is not causing an active infection, meaning it is not bothering him. If he is not having signs or symptoms of a UTI such as abdominal or back pain, an elevated white blood cell count in the blood or fever, this is a possibility. We suggest that the doctor check a urinalysis for white blood cells. If those are absent it is not an active infection and they can ignore the colonization. It is often impossible to get rid of this colonized bacteria, but again it is not bothering him if this is the case.

    If he is having symptoms of a UTI and they have checked cultures and given antibiotics that are supposed to work according to the cultures, it could be due to the foley catheter, which makes it more likely to get and harder to get rid of an infection. If possible, they should remove the foley catheter, give another round of indicated antibiotics, then recheck a culture.
     

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    Q:

    My father is 86 with dementia and in a wheel chair. He's also diabetic, but not on meds for it--diet helps him. UTI infections are ongoing. He has had prostate issues for over 30 plus years, and he's currently on Flomax. The problem is that the pill form of antibiotics isn't working anymore and he has to have IV meds. His UTIs are happening very 6-8 weeks. He's had what I call the "rotor rooter" surgery for the urethra—they found over 200 jewels was the term I remember 2 years ago. Now it seems his UTIs are coming more frequent. He just got out of hospital for one 3 weeks ago and we think he's got another. He had a culture taken today to find out for sure. We just can't get him to drink enough fluids. He's on cranberry pills 3 times a day. I give him Crystal Light a lot because he hates the taste of water--at this point anything to change the taste of water! My question is this, does it seem or sound like he's spiraling down in his health, that his final days are coming sooner then later? 


    Jo
    A:

    You main question seems to be is he spiraling downhill, and in responding to an email without seeing your father I cannot even make a wild guess about that. I can only comment on the frequent UTIs.

    Many older people have bacteria in their urine often or always that is not causing symptoms and should not be treated, so the first thing to decide is if these are real infections or just positive cultures. If they are true infections each time, the second thing to check is if the infection truly goes away, so someone needs to check urine cultures about a week after finishing the antibiotics each time to see if it does become normal in between. If the culture is still positive, either it is not a true infection or the antibiotics need to be changed or given for a longer period. If the culture becomes negative in between each time he should see a urologist to see if something is causing the repeated infections, and to consider whether he should take a low dose of antibiotics every day to prevent them.
     

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    Q:

    I am writing as I suddenly found my feet and ankles were quite swollen. The swelling has gone down to normal. I read the article regarding Peripheral Edema, especially that the most common cause is heart failure. Although the swelling has gone down to normal, should my doctor request the tests, especially heart, kidney and liver tests. 


    Jayne from CA
    A:

    There are a large number of causes of swelling like that. Generally the doctor will look at your medications, your known problems and your risks for certain problems, and examine you for other signs in addition to the swelling, then decide what tests are appropriate. These would include heart and kidney tests in some people, but not everyone. You should bring these concerns to your doctor. 

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    Q:

    What's with these Medicare "Observation days"? My 90 year old dad was in the hospital after a bad fall at his assisted living. Apparently he got confused because he had a urinary tract infection and lost his balance. Nothing broken, but the physical therapist recommended sub-acute rehab. The discharge planner told us that although had been in hospital getting care, he could not qualify for his Medicare rehab days. Apparently he was not in an acute level bed, but in an observation bed after he was admitted from the ER to his floor. He was in the hospital 2 nights. During that time they had to figure out if he had a stroke. He got intravenous antibiotics on his first day plus some IV hydration. After the first day, they changed my dad to an antibiotic that he took by mouth. We ended up paying for his care at a local nursing home. It wasn't cheap, considering the costs of paying for his rehab bed while maintaining his assisted living apartment. The hospital discharge planner wasn't the problem. It seems as if Medicare's criteria for hospital level of care was rather difficult to meet. Any thoughts about trying to impact Medicare and their ageist regulations? This was a very stressful time for my dad and me. Also, I think it will only get worse with all the talk and plans regarding trimming and containing health care costs. Feeling hopeless in Boston. 


    Ellie from MA
    A:

    I agree, the Medicare Observation status is problematic for people who need sub-acute rehab and do not have the 3-day qualifying stay. There is currently a push by various advocacy groups to make changes to this to allow for sub-acute rehab coverage when needed. We will have to wait and see what happens though. Meeting criteria for acute hospitalization under Medicare is more and more stringent. 

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    Q:

    My 84 year old dad and his 86 year old companion live 45 minutes away. In the past 6 months, he has experienced some memory loss and other health issues, the latest resulting in 2 trips to the ER within a week for dehydration. My brother and I have been traveling back and forth at all hours, requiring us to, at times, leave work and family. We discussed the possibility of assisted living, but as of now, my dad is opposed. Can you recommend a service that would come in 2-3 times per week to help with organizing meds, shopping and doctor appointments? I've spent hours searching, and your site was recommended by a friend in a similar situation. 


    Karen from CT
    A:

    You can contact a homecare agency to help you with this. There are many agencies now that service clients with these needs. Just make sure they are licensed agency, and insure their caregivers and cover worker's compensation. You might want to ask the social worker at the local senior center or department of social services for names of agencies in your father's town that are known and reputable. Or contact a Visiting Nurse Agency. Home Health Aides or Certified Nurses Aides cannot handle medications by putting them in a medication box, but they can remind the client to take their medication at the right time. The VNA could have an RN come to organize and pour the medications for a fee. 

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    Q:

    My mom has been in the hospital for 3 weeks. She had to have a feeding tube inserted and since then she hasn't been awake. The doctor is trying some kind of medicine to bring her out of the sleepy state. What is the name of the medicine he is using? 


    Jennifer from KS
    A:

    I could not know what medicine the doctor is giving your mother. There are medicines that counteract sleepiness side effects from other medicines, antibiotics for sleepiness if it is due to an infection in the brain, or psychiatric medicines that are designed to activate, or wake up, the brain in anyone, so it could be any of these medicines.

    PG Note: In these situations, you need to talk directly to the patient's doctors and ask questions. The floor nurses should be able to give you an idea of when they will make rounds and visit patients.
     

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    Q:

    My 90 year old mom had a stroke and can't swallow. She has a feeding tube in her stomach. How do I keep her mouth moist? 


    Jack from GA
    A:

    The best way to keep the mouth moist in people who cannot or should not swallow due to risks are to get mouth swabs. They frequently come in a lemon-glycerin formula, but there are other types of swabs are soothing and are moisturizing. You can find them by clicking here: http://www.parentgiving.com/shop/oral-swabs-380/c/
     

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    Q:

    My mother in law is diabetic and keeps falling out of bed at night and not remembering it. What could cause this problem? She is also on dialysis. 


    Reba from TN
    A:

    The initial worry in the problem you describe is whether she gets low blood sugar at night, which would affect her memory. Her sugar should be tested if she falls out of bed again to see if that is the cause. If her sugar is normal, however, she should be evaluated for general causes of memory loss, such as early dementia. That could happen to anyone and may not be related to the diabetes or kidney failure. She could fall out of bed more easily due to nerve damage from diabetes, but that would not prevent her from remembering the fall. 

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    Q:

    Under sound mind my uncle bypassed his children and made me his DPOA and healthcare proxy. He also made me a joint holder on his bank accounts and stated it was a gift to me because he did not want his children to have it. To his children's dismay and dislike he advised his children of "his decision." They waited until after his stroke when he could no longer speak for himself and applied for guardianship. Guardianship was awarded to them, and they later came after me for the gift. Am I obligated to return the gift? Do I have any legal standing to keep what my uncle wanted me to have? 


    A: Answered by Howard S. Krooks, JD, CELA, CAP

    As long as your uncle had capacity to make the gifts to you when they were made, the gifts may be upheld by a court. However, you must be prepared to prove that your uncle made a knowing and voluntary gift to you, and that you did not unduly influence him in making the gifts. If you are unable to sustain this burden of proof, then it is conceivable that a court would order the return of the gifts. 

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    Q:

    Both my parents are elderly (87) and have recently had health issues. They have about $150K in savings and own their home worth about $125K. They planned to give money $2,500 to my daughter (their granddaughter) to help with college tuition. Recently they granted power of attorney to my older brother and he is concerned about causing an issue with Medicaid when their money runs out. Can he give the $2500 as a gift or as a loan from my parents to me or my daughter and if a loan to be paid back with interest within the next 2 years without causing Medicaid fraud issues? 


    Timothy from NY
    A: Answered by Ellen Morris, Esq.

    A gift will create problems for Medicaid eligibility and create a penalty period during which time your parents will not qualify for Medicaid in New York. However, if this is a one time only gift, then the penalty period would be less than one month and would only be once either parent is residing in a nursing home. A loan evidenced by a promissory note is the better way to approach this situation, provided that it is an arm’s length transaction and a reasonable rate of interest is charged. 

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    Q:

    I am trustee, Social Security payee and P.O.A. for my father's 87-year-old widowed and childless sister. She is a resident of Florida and is currently in a dementia facility there. I live in California and all of her mail comes to my California address. Are there steps that I can take so that when she passes away, the state of CA will not be able to tax her estate? Or should I not even worry about this? 


    Gary from FL
    A: Answered by Ellen Morris, Esq.

    She is a Florida resident and the state of CA will have no reason to tax her estate. However there are steps you may take to avoid probate here in Florida, which will save time and money. Contact a certified elder law attorney for specifics. 

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    Q:

    My mom is 88 and has been having UTIs for some time. She seems to be getting them one after the other. She has been on so many antibiotics that some no longer work on her. How does the UTI affect the rest of her organs since she has them so often? 


    Adele from GA
    A:

    The UTIs primarily affect her kidneys, although with any one infection an older person can have trouble with confusion. She should have cultures taken in between infections to see if there is always an infection present, she should always get cultures when she has symptoms to make sure she is getting the right antibiotics, she should get kidney tests regularly, and she should only be treated for UTIs if she has symptoms and her urine white blood cells are high, as people sometimes have persistent organisms in the urine that are not causing true infections and repeated antibiotics for this issue are dangerous. 

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    Q:

    Four weeks ago our 88 year old mother sustained a broken arm from a fall. Prior to the injury she was living alone and oriented. Now she has 24-hour aides due to nighttime disorientation and confusion, which we presume is due to the fact she is not sleeping at all. The aides say she is up 50 times a night. Sleeping pills do not help. Her healing is not going well. In the daytime she is lucid, awake and oriented. She takes a few naps of 20 minutes duration only. Pain was contributing factor early on, but that seems managed now, but still no sleep. Suggestions? We fear she is on her way to SNF because she can no longer afford the aides, which cost $3000 a week.  


    EC from CA
    A:

    There are many possible issues going on. First, there could be an undiagnosed problem such as low oxygen, abnormal electrolytes or undiagnosed infection, which could be causing this. These possibilities need to be addressed. Otherwise, the two likely causes are poor sleep or reaction to her medicines. Trying to figure out why she is not sleeping would help as if there is an obvious cause that can be addressed. If there is not an obvious cause the usual strategy is to prevent daytime naps so she is sleepy at night, use sleeping medicines, and make sure she is comfortable. Additionally, many medicines can cause confusion so someone should review her medicines for this possibility. 

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    Q:

    I take care of my 91 year old mother who has advanced Lewy Body Dementia, where she is hallucinating days and nights and is quite delusional. She does not recognize me or where she is, and is very repetitive with basic questions. At night, usually all night, she yells and calls out my deceased family members' names very loudly, as well as reliving past episodes of her life like "Frankie, shut off the stove before the food burns!!" as well as the occasional "Police help!" and two-sided conversations with imaginary people. Her nighttime drug protocol now is Trazadone 37 mg, also Seroquel 25 mg and Namenda 2.5 mg at about 8 PM when we put her to bed and later melatonin 10 mg at 10 PM. The medicine is not really effective for any decent length of peaceful, restful sleep (six hours would be wonderful). Could there by any success with Galantamine for reduction of hallucinations or sleeping issues? She does not sleep during the day and has no other medical conditions besides glaucoma. 


    Louis
    A:

    Is it possible she is talking in her sleep? Talk to her doctor about medication adjustments. I would consider changing only one medication at a time. Trazodone can often be used at 50 to 100 mg dose at night (even higher if helpful). Seroquel can often be increased to 50 or 75 mg at night. If that is not working, her doctor could consider very low dose 0.25 mg lorazepam. Other choices might include zolpidem or gabapentin. Galantamine is not known to cause sleep issues, but it would not typically get rid of them either.  

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    Q:

    My mother recently died. She had seven children, and one daughter died before her, leaving a daughter of her own. Would the granddaughter then take the place of the sibling who died, as far as the estate and inheritance go? My five siblings feel like the estate should be divided 6 ways instead of 7. I feel like the daughter of my deceased sister should be the 7th part of the inheritance. 


    Lisa from OR
    A: Answered by Shana Siegel, Esq., CELA

    The answer to this question depends on whether your mother left a Will and, if she did not, it depends on the laws of intestate distribution (distribution of an estate where there is no will) of the state in which she died domiciled. It is a common rule for the heirs to take “by representation,” which would result in your niece inheriting her mother’s share, but this is a matter of state law, and you need the advice of an attorney who is expert in the laws of the relevant state. I always recommend hiring a certified elder law attorney (CELA) as CELA certification is only given with proof of at least five years of practice in the area of elder law, and after the attorney has passed a rigorous day-long exam.

     

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    Q:

    I have been a caregiver for a now 92 year old gentlemen for 9 years. I just terminated my employment with the agency because I am moving. I will be moving hundreds of miles in a few weeks. Is there any way I can visit even though I signed a paper stating that once my employment with that agency was over I was not to have contact with the client? He is in the last stages of life and I just want to visit my friend while I still live close by. 


    Pamela from RI
    A: Answered by Shana Siegel, Esq., CELA

    The answer depends on the contract that you signed, the agency and the client. These contracts limit contact for several reasons, such as to protect a client from having an employee intruding on their personal life and to prevent private contracts where the client hires the employee and eliminates the agency’s role and income from the placement. Your situation seems as if it would fall outside those two parameters, and the Agency would likely allow an exception to their policy. You are leaving employment not because of a situation which reflects badly on your relationship with the client, but you are moving far away, so that it is highly unlikely that you would be taking away their business through a private care contract with the client. Furthermore, it would likely be a comfort for the client to have the opportunity to have you visit. The best approach would be to discuss with the agency your wish to visit the client and to ask for a specific, written release from the no contact clause of the contract.  

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    Q:

    Mother and father entered hospice care within a day of each other. Mother then passed within 4 days. She prepaid all funeral expenses and has a death insurance policy payable to father of $10,000. Medical and durable POA has passed on in succession to their daughter. The insurance benefit has not been applied for. There are no other assets such as real estate. Is that cash benefit owed to the nursing home for the father's hospice care? 


    Dan from OH
    A: Answered by Shana Siegel, Esq., CELA

    It depends. If the care was covered by Medicare or another insurance coverage, then the policy benefit is not owed to the facility. It is possible that Medicare paid for hospice care but not for room and board, in which case the facility may have an outstanding claim. I recommend consulting an Elder Law attorney in the state where they reside.  

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    Q:

    I have 2 questions: 1) My mother has cerebral degeneration and has a PEG tube placed. She takes nothing by mouth. She is homebound and bedridden. She can no longer speak. What is Arkansas's law regarding removal of PEG tubes once one is placed as her condition will never improve—it will only continue to worsen with time. 2) My father needs to get a Financial Power of Attorney done so that I can assist him with his finances, should he no longer be able to. I live in Ohio, he lives in Arkansas. Are there any issues with this arrangement since I live out of state? 


    Linda from OH
    A: Answered by Shana Siegel, Esq., CELA

    These are questions which are specific to Arkansas law. You should consult with an expert in Arkansas Elder Law, preferably a Certified Elder Law Attorney (CELA), regarding end of life decisions in that State. As you must know, decisions regarding life extending measures are an important aspect of end of life planning. This issue is part of the “right to die” discussion, which is so politically charged yet so personal and poignant a decision for an individual and their family. How these decisions are made can be influenced by ethical rules of a particular hospital, and can even result in families bringing the matter before the Courts to assist them in effectuating their plan for their loved one.

    In many states this decision can be assisted by the individual preparing a living will and a healthcare proxy when they are still competent to make decisions, so that the wishes of the individual are clearly stated and the authority to make end of life decisions is delegated to a trusted individual to be able to make the necessary decisions if or when necessary. A CELA is an attorney who is certified in their expertise in advising individuals to prepare planning documents that reflect their choices and that will be honored by medical professionals if possible under the laws of a particular state. Without such a document, each state has a different rule regarding who makes the decision to allow or withdraw life sustaining treatment. 

    With regard to managing your father’s finances while residing in another state, again, an Arkansas Elder Law attorney will be able to help you prepare a financial power of attorney. Your out of state residence will not be an insurmountable problem, but banks have rules regarding which forms they will honor in order to allow access to an individual’s accounts, no matter what the state laws say should be valid, and it is sometimes necessary to prepare additional forms for a particular financial institution. There are also estate planning tools associated with access to bank accounts, naming beneficiaries, and titling of assets which your father may wish to explore. An Elder Law Attorney can help your father with setting his affairs in order so that he can plan for who and how his finances will be managed.

     

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    Q:

    My mom did not earn enough money to pay for her assisted living and nursing home the last few years of her life. She has three daughters, and two helped pay the expenses with the understanding of all siblings that when she died and we sold the house or leased it, that we would be paid back first and then all siblings would split the rest equally. She did die and we leased the home and have been paying off the equity line. Then we started to pay the two loans to the siblings. Do those two have to pay taxes on this reimbursement since they loaned the money with after-tax income? If so, wouldn’t they be paying taxes on this money twice? The home is in the Atlanta, GA area. One sister from GA, the other from MI. 


    Linda from GA
    A: Answered by Shana Siegel, Esq., CELA

    The answer is, it depends. You are asking if the income from rent received from your mother’s estate must be counted as income, or if it can be credited as reimbursement of past loans and is therefore not income. This is a question to ask an accountant and a tax lawyer, and cannot be answered without examining the loan documents and the estate finances and distribution. 

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    Q:

    My father and mother were living independently in a bungalow unit in an assisted living facility in Oregon. My father became ill and they were moved into an "apartment" unit in the hospice area of the main building of the facility. My mother has dementia, but this was not a problem while my dad was alive. However, he died over Christmas and now my mother is alone. The facility manager says she needs to be in the Memory Care Unit, but they have no room. Since they cannot properly care for her, they just gave her a 30 Day Move-out Notice and are telling me I have to find a place for her. I have no resources, I live in Virginia, I am an only child and I have Parkinson's disease. Plus, my parents were not on Medicaid when my dad died. My mother would qualify for Medicaid, but I'm still working on getting the application finished. Can they really just throw her out? What are my options? I can't afford an Elder Care attorney. 


    Ron from VA
    A: Answered by Shana Siegel, Esq., CELA

    This is a situation where it would be helpful to have the expert assistance of an Elder Law Attorney. Your mother needs an advocate. With her memory issues she is vulnerable even if she does have rights which aren’t being honored. Her rights may stem from Oregon Standards for Discharge from long-term care facilities, or from a contract with the residence which gave her more rights than mere statutory minimums.

    I recommend you call the Oregon Long-Term Care Ombudsman’s office and ask them to advocate on your mother’s behalf. The Ombudsman may be able to settle the problem or to direct you to legal services for the indigent which can help in advocating for her needs. The Oregon State Bar Association may also be of help in finding a pro-bono attorney for your mother.
     

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    Q:

    My husband has Alzheimer's disease. He is 56 years old. This is his 2nd marriage. We have a 3 year old son and he pays child support to his ex for his two other sons, who are 18 and 20. If we apply for Medicaid to get him in a nursing home, will they take into consideration that he has a family and that he still pays for support? Will we lose our house if he has to go to a home? 


    Jean from NY
    A: Answered by Shana Siegel, Esq., CELA

    You are right to be concerned. The good news is that Medicaid regulations do provide for certain resources to be kept for the “community spouse” (you), for minor children and for a carefully defined set of protected categories of resources and allowable expenses. It is important to have an expert go over your options with you and to set a plan for the future with a disabled spouse. Medicaid planning involves a set of interdependent decisions based on an individual’s specific medical and financial needs and resources.

    You need to consult an expert in Elder and Disabilities Law. Attorneys who are expert in this set of decisions can be recognized by their Certified Elder Law Attorney (CELA) certification by the National Academy of Elder Law Attorneys, (http://www.NAELA,org). CELA certification is the only certification of this expertise recognized by the American Bar Association. I recommend you find a CELA in New York to advise you on how to proceed.
     

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    Q:

    My mother has Alzheimer’s. My sister became POA, I think, through my uncle who was my mother’s original POA. My mother does not remember picking my sister, who is 3 years younger than me. My sister put her in an assisted living facility and my mother is very upset. Mom had been living by herself for 4 years and is still able to take her own shower, get dressed on her own, fix her breakfast and take her medicine. I think she could still live on her own, but I do not have much say about that. My mother's attorney told my sister that she should take my mom's bank card, health card, ss# card and her checkbook. She also has both sets of keys to mom's car. This same attorney is also my uncle's attorney and, honestly, I don't trust him and think there is a conflict of interest. My sister and uncle put mom in there because they don't want to have to take care of her. I'm the one who has been taking care of mom since my dad passed away 4 years ago. Mom’s Alzheimer’s is getting worse I do believe, but she is still capable of taking care of herself. When she can't remember in the evenings, I'm always there. What can I do to get her out of the assisted living facility and take her back to her condo? Can I take her out of the assisted living place on my own? I am the oldest daughter. Mom has been begging me to take her home.


    Jo from OH
    A: Answered by Shana Siegel, Esq., CELA

    This sounds like a very upsetting, but very common, situation. Different members of a family often disagree about the care of an elderly relative with Alzheimer’s. The progressive nature of the disease and the uneven progression of different aspects of the dementia make it hard to be certain about how to keep a person as independent as possible while protecting their safety at the same time.

    The primary issue is whether your mother still has sufficient capacity to revoke her power of attorney and to appoint a new power of attorney. That is a legal question whose answer is based on a medical assessment. I would start by hiring an elder law attorney to represent you, and arranging to have a doctor’s evaluation of your mother’s capacity or to see her treating doctor’s evaluation of her capacity and of her remaining ability to perform the activities of daily living. If she has capacity, she can simply revoke her existing power of attorney and appoint you, putting you in charge of decision-making.

    Because there has been a change of POA already, and your mother doesn’t recall agreeing to the change, it sounds as if she may not have capacity to appoint a new power of attorney. The next legal issue then becomes the appropriateness of petitioning the Court to appoint you as your mother’s guardian or conservator. You would present an argument to the Court as to why you would be a better guardian for your mother than your sister. You would likely point out to the Court the conflict in her current counsel’s representation of your uncle and your mother, and it is possible that the Court would assign new counsel to represent your mother. All of her immediate family would be notified and given the opportunity to participate in the Court proceeding. The Court will hold a hearing and make a determination in your mother’s best interests as to who should be her guardian.

    All along the way, you will be getting more information about your mother’s health. That information might help you, your uncle and your sister come to some agreement about how best to care for your mother. If it doesn’t, the Court can be asked to intervene and determine what is best for her.
     

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    Q:

    In NY my mother signed a will in 2009, but was unwilling to sign a POA at that time. The lawyer gave us the POA with instructions so my mom could sign it at a later date. My mom finally signed this original POA in 2012. Recently she was hospitalized and so we brought the POA to the bank so we can pay her bills. The bank will not accept the POA because it does not include signatures of the two POAs that she assigned. It seems the form was changed after 2009. What do we have to do to make this form valid? Can a lawyer just put an attachment to this POA or do we have to start all over? 


    Lori from NY
    A: Answered by Shana Siegel, Esq., CELA

    Yes, New York changed its form in September of 2010. And New York is very picky about the language in its form. You have to start all over if possible, using the right form. If it is not possible for her to execute a new POA because she lacks capacity to do so, your lawyer will advise you as to how to apply for a guardianship. Guardianship law is a specialized field, and I recommend consulting an attorney with expertise in the area of Elder and Disability law. 

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    Q:

    My mother is 96 years old. She is blind, cannot hear well and cannot walk due to deterioration of her spine and hips. She has been under hospice care for the past 18 months. I must be here most of every day to help with her care. Can I receive $50 per week from her funds for the care I provide her? My sister is her power-of-attorney for financial matters. We are in discussions about this and want to be clear on what is allowable. Thank you.  


    Rita from PA
    A: Answered by Shana Siegel, Esq., CELA

    Hospice is a Medicare-funded service that is available for palliative end-of-life care. When hospice care begins, life-saving skilled medical measures end. Though part of qualifying for hospice is a physician’s assessment that the patient is expected to live no more than six months, it is not uncommon that palliative care is so successful that the patient lives on longer than the six months required. A hospice reauthorization is usually available.

    The issue of payment from your mother’s private funds relates to her directions to her power of attorney, and also relates to her eligibility for government benefits such as Medicaid. If you are contemplating being paid from your mother’s private funds, there are situations in some states where it is permissible for a caregiver-child to be paid from the patient’s own funds and for those payments to be deemed an authorized transfer of funds should the patient ever apply for Medicaid. There are restrictions on the hourly rate, and you are required to keep careful timesheets.

    It is worthwhile to consult with a local elder law attorney regarding whether there are restrictions on you entering into a family caregiver contract with your mother or with her Power of Attorney on her behalf.
     

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    Q:

     My sister has power of attorney for my mother who is in a nursing home, Can she prevent me and my other sister from asking about my mother’s health and welfare from the nursing staff? We don't want to interfere with her care, but we have been refused information because we are not on some kind of list. When I asked the nursing home administrator about this list she told me I had to speak to my sister.


    Barbara from IL
    A: Answered by Shana Siegel, Esq., CELA

    It is difficult when family members lose competence. Rather than the natural family relationships governing situations such as access to your mother, legal forms and nursing home rules of privacy come into effect. Legally, simply being someone’s child does not give you access to their private information. Each person has the right to determine who is told about their health. When they are no longer able to manage their own affairs, or simply wish someone else to protect them, they can indicate who they wish to share what information with by designating a power of attorney to make certain decisions for them.

    The nursing home is required to protect their patient’s privacy, and it sounds like they are careful to keep a list of who they are allowed to give information to. You don’t say you are on a list of people who are not allowed to have information, merely that you have to ask your mother’s power of attorney to give permission for the release of your mother’s information. Depending on the terms of the power of attorney, your sister may have the right to control information regarding your mother. Your mother may have otherwise given control to her, as well.

    If there is some difficulty regarding obtaining information from your sister, I recommend hiring an attorney to help negotiate an arrangement between you, your sister, your mother and the nursing home.

    If you are concerned that the care your mother is receiving is neglectful, contact the Ombudsman for long term care in Illinois and ask for an investigation.

     

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    Q:

    I have an 88-year-old female friend, a diabetic, who keeps her sugar levels very well regulated by insulin. Up until several days ago, she had no problems with her vision. She has had an eye examination within the last year and was told that her eyes were fine. She does wear bifocals. Up until this problem with her vision, she has been able to do crafts, read and navigate on her own. She also has had cataract surgery in the past. Can the lenses become blurry over time? This is a question she has asked me. I told her that I would go online to do research. I told her that she should get to her eye doctor asap. 


    Esther from VA
    A:

    If the vision truly changed significantly just a few days ago that would suggest an acute problem and she needs to see the eye doctor. In regards to your question about the blurriness over time in relation to diabetes, diabetes can affect the vision in two ways. It can cause damage of the retina, which accumulates over time, or it can cause the lens to change and cause blurriness. Lens changes causing blurriness are due to changes in blood sugar level, and either recent high sugar levels if they were previously good or recent good blood sugar control if it was previously bad for a long time can cause the blurriness. This is related to fluid moving in and out of the lens as the sugar moves in and out. Usually these lens changes causing blurriness are reversible when the sugar level finally stabilizes and no longer changes much from day to day. 

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    Q:

    What is a supplement to help with lack of energy in the elderly?  


    Ruth from NC
    A:

    A strategy to Improve a lack of energy in an elderly person would need to be individualized to that person and what the cause of the poor energy is. Poor energy can be due to multiple issues including inadequate sleep, depression, anemia, medication side effects, poor nutrition, heart problems, lung problems or any of a number of undiagnosed medical problems. The person would need to see a physician first to determine the cause. If there truly is no specific cause, a program of exercise and proper nutrition (including reduced carbohydrates, which can cause sluggishness) would be the best. There is not good evidence that supplements are helpful in general and most physicians do not recommend them. 

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    Q:

    My doctor of several decades quit because of health care reform. Now we cannot find a doctor. Yesterday, Peacehealth Hospital and our Providence Medicare insurance tried to find us a doctor. No one will take us as patients because of Medicare. What are we to do? 
 


    Joyce from OR
    A:

    Usually your insurance company is the best source to help find you a new doctor as they usually know which doctors in your area take your form of Medicare. In addition, if there is a local Medical Association, either a county or a state medical association, they are also often a very good source to find a new physician. This is often more difficult in small towns or rural areas unfortunately, if that is your situation.

    As an aside, health care reform is very beneficial to primary care practitioners and increases Medicare payment to primary care physicians to help keep them in practice. Even with this increase in payments, however, Medicare does not pay physicians as much as private insurances. As a result some physicians unfortunately decide to not accept Medicare patients. This should happen less often under the Affordable Care Act, but still can be an issue, which can be worse in a small town with limited numbers of physicians so the decisions of 1 or 2 of them can make a major impact.
     

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    Q:

    My mom is in the mid stage of dementia. She has been living with my family (husband and 2 elementary age children) for a year and a half. Her condition has deteriorated enough that I can no longer provide a safe, secure environment for her, and keep my family sane as well. Because she will have to be on Medicaid very soon, our living options are very limited. We are considering a memory care facility (up to 80 residents) and I know she will fight like mad to avoid it. She has times where she is higher functioning. What is the best way to approach this? I don't know what to say to make it less scary to her and also to make sure she will move in there asap.  


    Sara from WA
    A:

    Since I do not know your mother very well, this may be hard. Many times they will adapt very well after a honeymoon adjustment period. However, I would consider telling her that TEMPORARILY she will be staying at a new place where they will be providing activity therapy to help with her brain, that you will be coming to check in on her frequently and that you will be getting assessments of how the therapy is going. It may be helpful to ask her doctor if he/she would also recommend this place to your mother as a place than can help with her brain condition.  

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    Q:

    My 93 year old Mother is complaining that her eyesight is getting worse. She had cataract surgery 8 years ago. She is completely chair confined, incontinent, and takes pain meds for arthritis, blood pressure and allergies, and stool softeners every day. She is starting to say that her vision is getting worse. Is this age? We try and watch about her becoming dehydrated. 


    JoAnn from TX
    A: Answered by Douglas Scharre, MD

    There are many potential causes for decreased vision, but it would not just be old age. She should be seen by an eye doctor to identify the cause of her vision complaints and to suggest a management plan.  

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    Q:

    My 75-year-old mother-in-law lives on her own. She is having visual, auditory and olfactory hallucinations. She believes the neighbors are persecuting her and trying to get into her house. She is repeatedly bothering the police. She has always been secretive and rather difficult to get along with. We suggested security cameras for her house, but she is still afraid and lives in fear of the “people” who live on her roof and are drilling holes into it, etc. The symptoms have been going on for a couple of years and are getting worse. My husband and I can't get her to go in for a medical checkup as she states that she is not crazy and there's nothing wrong with her glasses or her hearing aid. We do not know who her doctor is. She says she's been taking care of herself all these years and doesn't need our help. She clearly does. 


    Kelli from WA
    A:

    This is a difficult situation. First, to clarify, this might not be hallucinations. Many people have delusions, which are false beliefs. They believe people are getting into their houses by "evidence" they find, but they do not actually see or hear people who are not there. You should find out if she sees or hears them, or just "knows" that this is happening.

    Actual hallucinations can be due to dementia (such as Alzheimer’s or other dementias), can be due to psychiatric disease such as mild schizophrenia, can be due to problems in the brain such as strokes or even tumors, or can be a side effect of medications. If she is having hallucinations, nothing will help other than getting her to a doctor for an evaluation. I don't have any magic tricks for getting her to agree, other than saying you are concerned there might be an undiagnosed physical problem.

    If these are delusions, there tend to be two most likely causes. People with longstanding paranoia (you described her as always secretive) can get worse with age. Additionally, a specific problem with aging is something called paraphrenia. It is when people act suspicious because they believe things are happening like people spying on them or getting into their houses, but the cause is very poor hearing and vision so they misinterpret things they see and hear. Again, deciding which is the problem would require a medical evaluation.

    As a last resort, if this gets to be a dangerous problem for her you can take her to an ER and get her admitted to sort things out, but she would have to be having enough problems to be considered unable to make her own decisions. Good luck with this difficult situation.
     

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    Q:

    My mother in law whom is 96 no longer knows when she is going to have a bowel movement. Therefore, she is going in her pants. We took her to a urologist and he gave her an antibiotics however, it did not help her. We have started to give her fiber. However, this has not helped yet. What can we do? The doctor said he could not help her because he only deals with urine problems. She seems to be in good health and goes out with friends. However, we are afraid they will not want to take her out if she continues to mess in her pants. Please help! 


    A:

    I have two suggestions for this. In terms of trying to treat this, the body has a natural tendency to have a bowel movement in the morning after breakfast. One option is to have her eat a big breakfast and use a mild laxative in the morning, then sit on the toilet for awhile. Sometimes this is successful every morning and there are no worries about accidents later. The second suggestion is to see a gastroenterologist. The problem can be due to damage of the rectal muscles or nerves, or to rectal diseases, and an examination including rectal and colon exam can find a treatable cause. 

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    Q:

    My father is 67 years old and had a quadruple bypass 6 years ago. He has had diabetes for 15 years and a recent amputation, as well as 6 small strokes. He has dementia—I’m not sure at what stage it is, but is recently hallucinating and saying weird things at night. He wants to get out of bed 10 times a night, then sleeps a lot during the day. He takes ambient and nortriptyline at night and has body tremors as well. My question is how can we know if he has Parkinson's or dementia? We aren’t sure how to care for him. My mother is in denial and says he can do more for himself than he does. 


    Elaine from TX
    A:

    If he has cognitive changes and cannot perform his usual activities of daily living because of thinking problems, then he fits criteria for dementia. He may have vascular or stroke related dementia given his medical history. Parkinsonism, or tremors, stiffness and slowness, can be due to strokes. Parkinson’s disease and dementia with Lewy bodies are distinct neurodegenerative conditions that can also cause these same clinical features. His sleep disturbance may be related to REM sleep behavior disorder, often but not only seen in dementia with Lewy bodies. Parkinsonian conditions also often disrupt the circadian rhythm (sleep and wake cycles). Both nortriptyline and Ambien can cause confusion at times. Ramelteon (Rozerem) 8 mg nightly often helps the circadian sleep wake cycle dysfunction common in those with PDD. Over the counter melatonin is another choice. Trazodone nightly can safely be used for sleep issues. Seroquel at night might help both with sleep and hallucinations. If you wish further information regarding the best behavioral treatments for these conditions, you may wish to purchase my book, "Long-Term Management of Dementia" (Informa Press) through Amazon or click on the icon next to my picture.  

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    Q:

    I help my grandmother who is 83 years old and lives in a LLC facility in Maryland, where I live as well. My 67-year-old mother lives in Florida, and both of them have the same health issues and both of them ask me for help. I think my grandmother’s memory is getting worse, but my mother calls her to drive her crazy! What can I do to prevent this, but at the same time help them both? 


    Kim from MD
    A:

    It is hard to answer your question without knowing more about the conditions they have. There are also possibly personality traits that are coming into play as well. Perhaps there are limits that can be placed on calls by the LLC from your mother to your grandmother. 

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    Q:

    I have been living with my grandmother for 15 years. She has always been an upbeat person. She has been under a lot of stress because her son (my uncle) is in the ICU. This morning she just was not herself. Her speech was impaired a little. I knew what she was trying to say, but she just was scrambling her words and all mixed up. Do you think it could be stress or should she be tested? 


    Angel from IL
    A:

    Hopefully you took her to the emergency room right away. These symptoms could be a sign of a stroke. If it is a stroke, every minute you delay getting to the ER typically means more loss of brain function. If a stroke is ruled out than other causes can be evaluated including stress issues. 

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    Q:

    My dad is 87 years old. He has had Parkinson's disease since he was in his early 70s. The doctor told him that if he could tolerate PD medication it would be 15 years before it got bad. My mom passed away in April 2010. They were married 63 years. At the time dad's doctors said he would probably live only 6 months (according to statistics). He continued to live in his own home. We hired someone to stay with him during the day and my sister and I took turns staying at night. He was never alone. In January 2012 he fell and broke his hip. After surgery he was sent to a nursing home for therapy. He has been there ever since. His PD and his mind have gotten worse. Recently, he has been very agitated, does not sleep at all some nights and has been somewhat aggressive to the caregivers, which it not like him at all. We can't figure out if it's his medication, progression of his disease or something else. He was this way at home before he went to the nursing home, just not as often and it didn't last as long as it does now. We go see him every day and talk to doctors almost daily. I know it is common for people with PD dementia to be aggressive, but we just can't stand to see him like this. Is there anything you might suggest to help with this? They keep changing his medication but nothing seems to help. 


    Panda
    A:

    Parkinson’s disease dementia (PDD) patients can develop agitation and sleep issues. It is common to give medication trials to see if he responds. Ramelteon (Rozerem) 8 mg nightly often helps the circadian sleep wake cycle dysfunction common in those with PDD. Over the counter melatonin is another choice. Trazodone nightly can safely be used for sleep issues. Seroquel at night might help both with sleep and agitation due to false beliefs. If you wish further information regarding the best behavioral treatments for these conditions, you may wish to purchase my book, "Long-Term Management of Dementia" (Informa Press) through Amazon or click on the icon next to my picture.  

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    Q:

    My father-in-law has dementia. He’s 89 years old and is bedridden— he can only get out of bed with help. He has caregivers during the day and evening. When they leave at night, they lock up the house. My worry is what could happen in case of a fire since he can't get up and get out. I think he needs to be put in a home where he can get 24-hour care. He could have that at home, but refuses for anyone to be in the house at night. We can’t make him understand that he needs someone there all the time for his safety. He has money, but he says he can't afford it. When we show him that he can afford it, he agrees, then changes his mind. What can we do? Can we be held responsible for his safety? 


    Karen from IN
    A:

    He has physical problems, but it is unclear to me how severe his cognitive issues are. If his dementia is to the point that he is no longer able to make appropriate decisions, then if he has a Durable Power of Attorney (DPOA) for health care and finances set up, it should be put into effect and that individual(s) can decide for him and have someone stay the night or have him move to a facility. If he does not have a DPOA and is significantly demented, a guardian appointed by the court is the next step. Another way to approach his reluctance is to bargain with him and suggest that just temporarily, as a trial, for a week or two, you are having someone stay overnight. Tell him it is mostly for your own peace of mind and that it is affecting your health (if it is) because of worrying about him so much. After the trial period, you can reassess and maybe extend it temporarily if things are working out. 

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    Q:

    My mom is 88 and on hospice, diagnosed with dementia. She has had muscle spasms for about a month that affect her entire body nonstop. Her spasms keep her mouth opened and cannot swallow very well. Hospice doctors have her on Ativan (lorazepam) and just started Neurontin (gabapentin). But it is not working. It mainly just puts her to sleep, but she wakes up in a spasms. Is there anything else we can try to help her? 


    Tina from FL
    A:

    I am not sure what type of spasm you are describing. Myoclonic jerks are quick, can be one side or whole body and may affect the jaw of mouth. They can occur frequently. These are best treated with divalproex sodium (Depakote). Muscle cramps, like a Charley horse can be related to electrolyte imbalances. Try tonic water or pedialyte like drink. Rarely, tetanus can occur from a wound infection and lead to facial and body spasms. 

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    Q:

    My mom is 80 and underwent a breast cancer operation. She also has Parkinson’s disease. My brothers are not taking care of her. She is always sulking when thinking of them. How can I bring happiness in her life and a smile on her face? 


    A:

    Depression is a common disorder in those with Parkinson’s disease. It is caused from environmental situations, but is contributed by her brain dysfunction from the areas damaged in those with Parkinson’s disease. Increase pleasurable activities for her and talk to her physician to see if an antidepressant is suggested. 

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    Q:

    Mom has a blockage in the back of her head and has been doing things that aren’t like her. She tried to adopt a 67-year-old woman and her son. And mom thinks I'm after her money and things. I don't want her stuff. I'm tired of people taking advantage of her. Could this be dementia? 


    Joy from NC
    A:

     She has issues with judgment and probably insight. If she is also having problems with memory, language, sense of direction, problem solving or performing activities of daily living, she is developing dementia. She needs to be evaluated by her physician to find the potential reasons and to get appropriate treatment to prevent further cognitive loss. The sooner, the better. Have her physician give her the SAGE test, a self-administered cognitive assessment tool. This is an excellent screening examination that can be downloaded free from the web at http://www.sagetest.osu.edu

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    Q:

    My father is 87 years old and has dementia. He is totally incontinent and is on coumadin for an irregular heartbeat. He lives in a very nice memory care facility. Lately his heart rate has been fluctuating. He wore a 24-hour monitor and his rate varied from 40 to 187. His cardiologist is recommending a pacemaker. We're leaning toward that because if he were to fall due to the low heart rate and become lightheaded, he might bleed out due to the coumadin. So Of course there's always the chance he could just fall just because of getting older. He still walks on his own. Wondered what your thoughts are on this. Pacemaker or not—I am torn and not sure what's the best thing to do. 


    Carol from TX
    A:

    I would follow the advice of the cardiologist who knows your father’s medical condition the best. 

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    Q:

    My grandmother just turned 100 and was very active until around 8 months ago. Since then she has experienced multiple behavior changes. She is now in an assisted living facility. She has lost a great deal of weight, refuses to eat or take medication so they are not giving her anything. Just recently they started Ativan because they did not bathe her or change her clothes for two weeks because she would not let them or even me. What stage does she appear to be in and what does the assisted living have to do when a patient refuses meds, water, food, to change clothes or any real care? 


    A:

    The solutions to these questions would depend on the reason she is refusing care and nutrition. Sometimes when individuals get that old, they have decided they have lived long enough and wish to die. They may not tell loved ones their true intent for reasons of their own. Others that old may develop dementia and not understand the need for nutrition or care. In some cases, their organs are just shutting down after 100 years. In others, there may be some underlying depression or a mix of a lot of things. The goal at that stage is to provide quality of life and not force individuals to have to follow all the “rules.” 

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    Q:

    My mother is 94, suffering many health issues and getting direct care solely from me, her son, with the exception of 2 hours per day personal care from a private-pay agency. I have no participating siblings or support. My mother's pension income is approximately $5500 a month. She lives in my home. All bank accounts are jointly held by her and me. The original deposits were from the sale proceeds of a home seven years ago that we also held jointly. Should she go into a nursing home in our area, she would run a deficiency of about $3500/mo if using just her income. Can the joint accounts be attached? Should I close those accounts and place them in my name only? What other ramifications are there in doing that? Would she


    Chris from MA
    A: Answered by Howard S. Krooks, JD, CELA, CAP

    The joint accounts may not be attached; however, the existence of the accounts will render your mother ineligible for Medicaid as she will be over-resourced. There are many avenues available to you with proper planning to achieve Medicaid eligibility for your mother, even with her high income, and still preserve the assets, including separating the assets from the sale proceeds, deducting care expenses, using a Personal Services Contract and other planning techniques. You should not close the accounts without first meeting with an elder law attorney as the closure of the accounts may be considered a gift, which would render your mother ineligible for Medicaid.

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    Q:

    My parents are living together, but are not married. They are currently renting a home in Port Saint Lucie, FL. My question is, if one parent passes away, is the other party held liable for the reminder of the lease?


    Wendy from FL
    A: Answered by Howard S. Krooks, JD, CELA, CAP

    If both parents have signed personally on the lease then they are each individually liable for the obligations under the contract.

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    Q:

    My wife has been diagnosed with Lewy Body dementia by two different doctors. Her condition has been deteriorating rapidly over that past few years. She is currently bedridden for most of the day and night. I am now at a point where I can no longer give her all the help she needs. We get some help, about 6-7 hours a week from a local agency, but have had to hire additional help, 12 hours a week, at a cost to us of $144 per week. I am a disabled veteran, but get very little help from the VA. Are the new expenses, about $7,500 per year, deductable?


    Leslie from IN
    A: Answered by Howard S. Krooks, JD, CELA, CAP

    This is a question for your CPA or accountant as the answer depends on your complete tax picture. However as certified elder law attorneys we may be able to obtain a monthly check from the VA to help defray the costs of the private aides and we may also be able to insure that your wife obtains Medicaid in a skilled nursing facility when and if placement is necessary.

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    Q:

    My brother and I were informed that my 62 year old stepmother put my 82 year old dad in a nursing home. We were shocked that she did not discuss this with us, and I would like my dad to live with me. We called the nursing home and she has full power of attorney, so we aren’t able to get any information about his health or his condition. We asked to have a meeting with his doctors and caseworker, but were told my stepmother would have to set that up. She says she will, but keeps giving us the runaround. Now she is claiming he was abusive to her and he has Alzheimer’s. What can I do? They live in New Mexico.


    Sam from NM
    A: Answered by Ellen Morris, Esq.

    To address care issues, you may wish to retain an elder law attorney in New Mexico to request a care plan meeting with the facility and your stepmother in order to address your father’s care plan needs and secure your involvement. If the care plan meeting is unsuccessful or impossible, then it may be necessary to file for guardianship in New Mexico.

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    Q:

    My father was taken to the hospital Friday January 18th and is doing extremely poorly after a massive stroke and bleed on the brain. The next day my stepsister (theonly child for my father’s second marriage) emptied his house without informing me or anyone else. I am the sole executive if anything happens to him. Is she allowed to do this?


    Graham from DE
    A: Answered by Ellen Morris, Esq.

    During lifetime, an individual who holds power of attorney, depending on the terms of the document, may be able to take possession of the property. If your stepsister has power of attorney for your father, including power to manage his personal property, then she may have the authority. However, she is supposed to act in the shoes of your father and in his best interest, and if she is not doing so, there may be an action against her to compel her to return the property. An individual who is nominated as an executor (known as a Personal Representative in Florida) does not have any authority to act until the court grants such authority after the death of the individual in a probate proceeding and such authority only extends to estate assets.

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    Q:

    My mother-in-law is in a nursing home (she will not be getting out). We have been paying her mortgage for the last four years because we have been told when she passes, we can sell the house and split the money among her four kids. Her $600 social security check goes straight to the nursing home. When she dies, will the nursing home take the house? Or we will in fact be able to sell it? We live in South Carolina. I don't want to be throwing money away if we can't sell it afterwards.


    Rachel from SC
    A: Answered by Ellen Morris, Esq.

    Assuming the house was the primary residence of your mother prior to going into the nursing home, you have been given correct information and her children will inherit the house upon her death free and clear of claims from the nursing home, Medicaid and other creditors. However, in order to inherit the home, if titled solely in your mother’s name, a probate proceeding will be needed. Probate is costly and time consuming. We recommend your mother or her Power of Attorney execute a “ladybird” deed pursuant to which which the property will pass by operation of law to the children without the need for probate. Our office can prepare and assist with the execution of the deed.

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    Q:

    My mother in law fell on the 15th of November. The house we live in is safe—the bathroom, living room, her bedroom and the kitchen-dining room are all on one level with easy access. She has a walker and a personal toilet in her room for her convenience. When she fell she got a bruise right on the side of her right eye, she lost mobility and couldn't get around by herself so we took her to the hospital. The next day we went to go get her and she did not feel ready to come home—they took it that she was scared to come home and told us they wanted to put her in a home. It would be devastating to her to take her away from the family, and we want her around as long as possible to see her grandchildren grow up. There is always someone her with her and willing to get her food and help her. Two days later, she was ready to come home and they let her have a physical therapist come over and a nurse who looked at the house and thought it was great and safe. Today we took her to her doctor who asked her some questions and she said she has dementia without giving her a proper test. The doctor was very rude and said she wants mom in a home and is not capable of making her own medical decisions. She wants to take my mom away from us when we have done everything to make sure she was safe and happy. What do we do? 


    Leslie & Cody from CO
    A:

    Even if your mother in law has a dementia condition, from your description, she is safe and well taken care of at your house. You have family that care of her and know her and so your home would be a great place for her to be. Anyone can fall, even if you are standing right next to them and try to prevent a fall. There is no reason you would need to place her into a nursing home unless Adult Protective Services (APS) for some reason felt she was not safe or well cared for at your home. You could ask APS to come to your home so they could verify that the home setting is appropriate. If your mother-in-law has the capacity to make decisions, she can designate a person as her Durable Power of Attorney (DPOA) for health care who would then be her surrogate to make decisions for her if she were no longer able to make decisions on her own. You can consider contacting the local chapter of the Alzheimer's Association to help you understand more about a DPOA. Other agencies or a lawyer skilled in elder law could be considered as well. Her dementia condition could be further evaluated with cognitive screening tests like the Self-Administered Gerocognitive Examination (SAGE), that is best taken at her doctor's office but that is also available on line at http://www.sagetest.osu.edu. 

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    Q:

    My mother, 89, and father, 90, still live in their home, which is paid off. They live in NY state. About 20 years ago, my parents put their home and all stocks in an irrevocable trust in my and my two sisters’ names. If they were to go into a nursing home, what assets would the facility take to pay for their care? Would the facility be able to access the money from the trust? 


    Lisa from NJ
    A: Answered by Shana Siegel, Esq., CELA

    That really depends on the terms of the trust, but if drafted correctly the answer should be no. The trust may require the income to be used but not the principal. 

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    Q:

    My brother and I are concerned about our grandmother who lives with our parents. She fell for a second time and broke her left hip this time, and is now in a rehab/nursing home. She fell before and broke a bone in her face and arm. When she goes to the hospital they ask: is anyone at home miss treating you? She always says no. She has dementia and in her head she thinks everyone is nice. I had to ask the doctor to check her blood, check her bladder, see if she is dehydrated because no one else did—she needed 2 pints of blood, she had a UTI, she was dehydrated, and she got a bed sore. This woman was good to my brother and me, and my parents treat her like crap and do not care. They sold her home for nothing and do not want her anymore. After her hip gets better, how can we get her if our father has POA (she gets SSI and disability)? 


    Upset from WV
    A: Answered by Shana Siegel, Esq., CELA

    You might want to consider calling adult protective services who would then conduct an investigation. 

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    Q:

    My father had a serious motorcycle accident in 1991 with head trauma and brain injury. My mother took care of him from then until she passed away in 2011. My dad is on disability and unable to make important decisions on his own because of his head injury. Since my mom passed, I have moved in with him to care for him. He is easily persuaded by anyone and can be convinced of anything. I have tried to talk with his doctor about his mental health, as he has become increasingly violent since my moms’ passing. His doctor refuses to speak with me because my dad told him not to. He is about to lose his house and vehicles because he refuses to let me help him with his bills anymore. He has met a woman who has talked him into giving her all his pain and anxiety medication each month. Therefore he is not taking part of his medication to help keep his mind balanced. Is there a way I could legally get POA over him to get his mind and life back in balance? 


    Leslie from TN
    A: Answered by Shana Siegel, Esq., CELA

    Your only option is filing for legal guardianship. This can be quite difficult in this type of situation as you will need to get him evaluated by physicians. I would suggest you speak with a certified elder law attorney in your state. 

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    Q:

    I have been living in my elderly mother's home for the past 2 years to care for her. She has chronic illnesses that would make it unsafe for her to be alone. My sisters have informed me that when my mother dies, all of my belongings will become part of my mother's estate, since they are in my mother's house. Is this legal? What can I do to protect my belongings from being taken by my sisters after she dies? 


    Jane from MI
    A: Answered by Shana Siegel, Esq., CELA

    I would send them a letter that outlines what property you purchased and belongs to you. They cannot claim the property simply because it is physically located in your mother's home.  

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    Q:

    My mother, age 66, has Alzheimer’s and lives with my 86 year old father. I went through Florida’s access application and applied for Medicaid for them. They live off social security and make roughly under $1700 a month combined. They pay a mortgage and are receiving some food stamps. However, they were denied for Medicaid. There was nowhere on the application to state that she has Alzheimer’s. How do I proceed? I can't even get a counselor from children and family on the phone. 


    Barbara from FL
    A: Answered by Shana Siegel, Esq., CELA

    First you need to return the denial notice with a request for an appeal immediately. This may allow you to preserve her eligibility date. I would suggest you seek out a social worker at a senior center, Jewish Family Services or some other community support that may be able to assist you.  

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    Q:

    My Mother's assets are extremely low at this point so she is trying to apply for Medicaid. She has a term life policy that has a cash surrender value of about $3500, which is standing in the way of her Medicaid eligibility. She has signed the beneficiary over to the funeral home, thinking this would satisfy Medicaid's requirements. Given that she is applying for Medicaid we understand that as her children, we cannot touch this asset and put it in our names even though we are her POA. It appears to us that this is best choice at this point. Are there other options that make more sense? 


    Jeff from IN
    A: Answered by Shana Siegel, Esq., CELA

    She should just ensure she is complying with the Medicaid regulations regarding pre-need funeral arrangements.  

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    Q:

    My 75-year-old mom is still in very good physical and mental health. She's had type 2 diabetes for 20 years, but it's under control. However, she had a medical scare last year, a side effect from a medication. At that time, she added me to her bank account, though I have no direct access. She says she has a living will, but I'm not sure where it is. And, as far as I know, she hasn't given anyone a power of attorney. Is that the next step? 


    Sami from CA
    A: Answered by Shana Siegel, Esq., CELA

    Yes, absolutely. She should make sure she has a POA as well as a health proxy or living will, which appoints an agent to make decisions for her.  

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    Q:

    My Grandfather (84) passed on 12/21/2012. My Grandmother (80) was told she must apply for Survivors Benefits (SSI) to match what his monthly SSI was. Why is she unable to collect both SSI accounts? In effect, she is losing $900 a month, which was just enough to keep the house running. 


    Michael from MO
    A: Answered by Shana Siegel, Esq., CELA

    Each of them was entitled to their own Social Security benefits. As his surviving spouse, she is entitled to the greater of her benefits or his, but not both, because she is only one person. She may have to look at other options like a reverse mortgage. 

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    Q:

    My husband and I are living with his mother in Florida due to her decline in health and dementia. She is 89 years old. She only has Medicare insurance. It is coming to the point where she will have to be placed in a nursing home. She has $20,000 in stocks and she owns her home. My husband’s name has been on the house since it was bought 20 years ago and he has POA. Can the nursing home/Medicaid force us to sell the house? Thanks for your help. 


    Susan from FL
    A: Answered by Shana Siegel, Esq., CELA

    They cannot force the sale of a property that is jointly owned. However, if her name is also still on it, then the state could place a lien on the property after her death. 

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    Q:

    My Mother has been diagnosed with Lewy Bodies Dementia and told me she is "losing it" and asked me to take over. She has been living with us for 5 years now and I do have POA and I am the only named person in her will. But she has a very large sum of money in investments, two houses and a vehicle. How do I go about getting all of this in my name? 


    Amy from FL
    A: Answered by Shana Siegel, Esq., CELA

    There are pros and cons of doing this during her lifetime. You may not want to do so if there is any chance your mother may need Medicaid as they penalize transfers made within five years of application. I would suggest meeting with an elder lawyer who can advise you about all of the tax and asset preservations issues.  

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    Q:

    My father is living with my sister. He’s 83 and had a stroke on a Friday. She didn't call an ambulance or take him to the hospital. She let him lie in bed for 4.5 days while she was going all through his paperwork, did not call me until Tuesday evening 7 pm to tell me he was admitted to hospital and put on morphine. Is this considered a crime of negligence? 


    Tammy from ME
    A: Answered by Shana Siegel, Esq., CELA

    It sounds like it would qualify as elder abuse if your state has elder abuse criminal statutes. It certainly would warrant a call to adult protective services if he is released back into her custody. 

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    Q:

    My grandmother has dementia/Alzheimer’s and has been dating a man for about 4 to 5 years. This man came along right when her signs and symptoms began to appear. Also, he lives in California; we live in Delaware where her house is. He takes her to California for months and months and only comes back to Delaware for a few weeks. We now know that she is not capable of making her own decisions and she relies on him to make them all for her. However, he is not making these choices based on what is best for her. In a sense, she is brainwashed. In fact, she is not "allowed" to see any of the family unless he is around, a rule he made. We know he does not take good care of her—she has been in the hospital a few times because she has not taken her medicine or forgot she had already taken it and overdosed. She needs a supervisor. Is there a way to legally make him go away and in a sense take custody of my grandmother? Anyway to prove she is incapable of making her own choices? We know she does not like having to choose between the family and this man, but what kind of person would take someone away from their family when they are losing their mind? 


    Ashley from DE
    A: Answered by Shana Siegel, Esq., CELA

    This is a difficult but not uncommon situation. Your family needs to consult an elder law attorney with experience in contested guardianships. This will involve court action and could get messy, but should be addressed before your grandmother ends up being seriously harmed by this man. 

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    Q:

    My Dad is 74 and was diagnosed with frontal temporal dementia in August 2012. Since the diagnosis and various visits to psychiatrists and social workers, it is suspected that he may also have undiagnosed bipolar disorder. We are trying to request further evaluation to confirm this and properly administer medications. Mom is his main caregiver and they live with my sister and her family in WA and visit with my family and me in BC. It has become painfully evident that Dad is requiring too much care for Mom to provide 24/7. They are on limited income and have a small amount of proceeds from the recent sale of their home. I need to ensure that Mom has money to live on once Dad is in care. Do I instruct Mom and Dad to buy a house? How do I calculate WA state Medicaid? I cannot get a straightforward answer anywhere...I look forward to your help!  


    Carmen from WA
    A: Answered by Shana Siegel, Esq., CELA

    You need an elder law attorney. There are a number of certified elder lawyers in your state. There are spousal protections for your mother—generally she can retain half of their resources up to a maximum of $115,000 plus a primary residence. 

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    Q:

    My father-in-law is in a memory care unit for dementia at a skilled nursing/assisted living facility in Seattle. He became difficult and "unresponsive," and they sent him off in an ambulance to the hospital. The ER said there was nothing wrong with him physically, he was just angry. The ER doc evaluated him and there was no reason to keep him. We then heard that the facility where he is a resident refused to take him back! This was at 10pm on a Friday night—no warning. What can we do? Is there any recourse? Don't they have to give written advance notice? The hospital said this is called “patient dumping." We are stunned by this revelation. Any advice you can lend would be appreciated before we contact the facility. 


    Marci from PA
    A: Answered by Shana Siegel, Esq., CELA

    Unfortunately, while there are protections against discharge without notice, there is no requirement to re-admit after hospitalization. This is an all too common ploy to get rid of difficult patients. That being said, I would contact your state ltc ombudsman as well as the state agency that inspects and regulates nursing homes. 

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    Q:

    Five years ago my grandma, now 97, asked me to take care of her and never put her in a home, and I moved her into my home. We started getting hospice care in a year ago as we thought she was going to pass. She is in better health now and we want to take her off hospice, but they keep finding a reason to keep her as a patient. We live in a beautiful home and she is well cared for by my wife and me. Hospice now wants us to move her out because they think she needs more care. We have an hour gap when grandma is alone (she is bed ridden) and we hired a nurse to come for two hours a day to cover that time frame. Hospice still wants her out and is threatening to call adult family services if we don’t. We think they have a hidden agenda. Can they do that or can we deny their services instead without consequences? Thank you. 


    Shane from OH
    A:

    Hello Shane,

    I understand you want only the best for your grandma. As such, you may consider being proactive by contacting Adult Family Services yourself to seek their advice and recommendations. In response to your question, in most states, hospice agencies are mandated to report any concerns or suspensions of abuse.

    For ongoing recommendations on ensuring your grandma receives the best care, you could also reach out to your Local Area Agency on Aging:

    • Local Area Agency on Aging: Call for the phone number of Adult Protective Services.
    • National Adult Protective Services Association: Visit http://www.apsnetwork.org/Abuse.index.html for a list of agencies and phone numbers by state.

     

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    Q:

    My dad has been moved to a rest home so that he can get physical therapy on his ankle. He is 78, has lots of medical conditions and cannot take care of himself, let alone walk. He is insisting that he goes home even though he can clearly not take care of himself. My mother is beside herself with worry. He could fall and hurt himself and her. She is not able to fully take care of him in his present situation. He is too heavy for her to lift or even help him up. But he will not listen and the facility says they cannot hold him if he wants to leave. I don't know what to do and I’m worried sick for both my parents. 


    Taming from CA
    A:

    Hi Taming,
    Determining the right care option for your father is a major life decision that warrants sufficient consideration. Start by asking yourself the following questions:
    • How often is care needed? Depending on the severity of your father’s medical conditions, it appears he may need assistance around the clock.
    • What type of care is needed? From what I can gather, your father needs assistance with personal care (i.e., bathing, dressing, transferring), and potentially medical assistance as well (i.e., monitoring of chronic conditions).
    • What payment resources are available? Speak with both your parents about this, and explore all options (i.e., Social Security, Medicare, Medicaid, long-term health insurance, reverse mortgage, Veteran’s Aid and Attendance Benefit, etc.)
    • What is the ultimate objective? In this case, the ultimate goal is to provide a safe, loving environment for your father in the comfort and familiarity of home.
    Many people think their only option is assisted living or skilled nursing; however, these days, many home healthcare agencies, including Home Helpers, can provide 24/7 medical care in the comfort of home.
    If you determine that assisted living or skilled nursing is the best option, consider replicating the look and feel of your father’s home by bringing familiar furnishings and décor from the house into his new residence. Senior relocation specialists, such as Caring Transitions, have floor planning software that allows you to virtually arrange items to ensure a proper fit before the move.

     

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    Q:

    How do I go about finding a home healthcare agency that is Medicare funded? 


    Ilene from FL
    A:

    Hi Ilene,
    I would suggest starting your search online at Medicare.gov, the official U.S. Government website for Medicare: http://www.medicare.gov/HomeHealthCompare/search.aspx.
    This website allows you to search for and compare home healthcare agencies in your local area that accept Medicare.
     

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    Q:

    Over the past year or so my mother’s health has been gradually decreasing and she is still pretty young at 69 years old. She gave up her independent living apartment that was based off of her income to move in with one of her sons, who soon realized she was too much work and kicked her out. We rented her an apartment near our condo 1 mile away so that we could help her if need be. The issue now is that she is in and out of the hospital every couple months for high blood pressure and UTI infections, and cannot walk on her own anymore. Her health continues to decrease and she is no longer taking proper care of herself. I do not believe she is able to live on her own anymore—she cannot get up to use the bathroom, cannot shower herself, falls asleep while she is cooking something and makes irrational decisions. Her only source of income is her Social Security, which is not much, so we end up paying everything for her. I know of assisted living facilities that are willing to take her based on her income requirements, but she is unwilling to go. This last time she was in the hospital she started to show signs of early onset dementia. She was having very vivid dreams of things that never happened, for example she thought her son and daughter in law had a newborn child and she called the entire family telling everyone about this kid that never existed. We asked the hospital to do a neuro psych consult while she was in there, and the neuro-psych questioned her and suggested she get a full psych report. She will not seek any medical advice that might allow her son to get power of attorney to put her in assisted living where she needs to be. Is there anything we can do to get power of attorney from her? The situation keeps getting worse as time goes on, and she is so unwilling to let us help her.  


    Nikole from IL
    A:

    Hi Nikole,
    In this case, I would suggest you speak with a hospital social worker or discharge planner about your concerns regarding your mother’s health and safety.
    Because each state has its own laws and regulations, these additional resources can direct you to local professionals who are experts in senior-related matters:
    • ElderCare Locator: Call 800-677-1116 or visit http://www.eldercare.gov.
    • Local Area Agency on Aging: Call for the phone number of Adult Protective Services.
    • National Adult Protective Services Association: Visit http://www.apsnetwork.org/Abuse.index.html for a list of agencies and phone numbers by state.
     

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    Q:

    Our 87 year old father suffers from dementia and a significant eye disease and is noticeably declining. He lives in the family home with my younger sibling who works during the day. Currently, dad continues to drive short distances to the store and back, and is quick to let you know that his driver's license is legal for 3 more years. In anticipation that his driving days are numbered, we have hired an aide, three times a week for six hours each time, to do activities with him as well as drive him to the store. During Dad's recent visit with his PCP, I spoke to her privately. She absolutely noticed his deteriorating awareness and agreed it was time to stop driving. I requested she contact the eye specialist to ask him to tell Dad he needs to stop driving due to his eye condition and must have his license revoked. We felt it would be easier for him to accept that his sight is no longer safe for driving rather than that his faculties have reached a point unacceptable to retain his driver's license. We hope to keep his dignity intact as much as possible. Next week is Dad's appointment with this doctor. I anticipate he will not accept this well at all! How should I prepare for a possible inappropriate outburst of anger? What can I do to console him during the 45-minute ride home? What can we do to minimize the depression he will experience moving forward?  


    Kathlyn from NH
    A:

    Driving issues are difficult for many. It is to your advantage that the eye doctor is willing to "be the bad guy" and tell him that it is now unsafe for him to drive. In this way you can say that it is not you but the doctors that are telling him not to drive. He will likely counter that he can see well enough to drive. In those cases, it may be wise for the doctor to refer him to a professional driver evaluation test or to his local motor vehicle department for paper and behind-the-wheel testing. If his cognitive issues are getting worse, it is likely he will fail those tests. Another technique may be to tell him that temporarily he needs to stop driving while x, y or z is being evaluated or because he is starting on a new therapy, if true. It is always easier to be accepting of something that is "temporary" rather than something permanent and stopping driving forever. Periodically, he could be re-evaluated and the doctor can declare that he still needs to temporarily hold off on the driving.  

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    Q:

    I am so confused. My mother was diagnosed 13 years ago with Parkinson’s. The past five years have demanded constant one-on-one care, but recently my mother has been acting very strange. She started complaining about headaches in the back of her head about a month ago. She was taken to the emergency room and had extremely high blood pressure, thought to be based on food she ate that day. She has started talking like a baby and saying things like "Me see you, you see me?" over and over. She has complete knowledge that she is doing this and makes a point of making sure we notice this—she says that it is due to a stroke and that she has read that your speech is affected after a stroke. She has been acting very childish, actually pulling a tantrum if we don’t pay attention to her and getting upset when I go college, even going as far as to call me and insist that I not go to college anymore. My first day of college was when she actually claimed she had a stroke and told me I needed to miss school and take her to the emergency room—doctors didn’t find any evidence of a stroke. Is she acting out or perhaps experiencing dementia? How can I approach this without causing resentment? 


    TJ from TN
    A:

    High blood pressure can be a cause of headaches. High blood pressure can also cause strokes. However, if she had an MRI scan of her brain, strokes are very easily found, even if they are very small. If she had an MRI scan of her brain and no stroke was found, then she did not have a stroke. A CT of her head may not reveal small strokes. When strokes cause language deficits, they are usually very obvious to everyone and would not fluctuate with good and bad days. The person may not be able to comprehend well or may not be able to get words out well. Strokes affecting speech would cause slurred or strained speech patterns, which also would not fluctuate. Acting childish and having tantrums are not typically stroke behaviors. Perhaps she is afraid of you not being around. You can offer her ways to contact the emergency squad to take her to the hospital if you are not around (button around her neck to push, phone to call 911, etc). You can arrange for companions to come in to be with her while you are away. Senior centers or day care centers can be used to care for her during the day. Depression and anxiety symptoms, if present, can be treated with antidepressant medications. You need to sit down and tell her that you will be gong to college but that you can help arrange for her to be safe and protected while you are away.  

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    Q:

    My mother, 85, is taking medication for Parkinson's and has a level 6 Alzheimer's. She as been doing very well on the medication, but the other day she fell and hit her head and was knocked unconscious for a few minutes. She has been admitted to the hospital as a small spot of blood was found in her brain after a CT scan was done. The doctors are monitoring her and watching to see if the blood spot changes. I have a concern with her behavior now as she can answer your questions but then goes off in her own little world and talks about “golfing and it’s your turn.” She also gets up and goes to the table in her room and starts folding the bedding and towels, piles them neatly and then goes on to say it’s your turn play a card. She has never been this confused. Has the fall made this happen? Is there anything I can do to stop this? 


    Paul from NY
    A:

    Head trauma with bleeding in the brain might cause confusion, depending on the degree and placement of the trauma and bleeding. Changes in environment such as being in a hospital can, in and by itself, cause confusion. Parkinson's medications can cause confusion and false beliefs. Any new medication could be a cause. Infections, like a urinary tract infection, are frequent causes of confusion. Her physicians can run some tests to determine if there are alternate causes for her confusion. During her confusional state, make sure she is very well supervised to prevent more falls or injuries.  

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