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LO will not stop work - Dr. said its urgent
I am posting this here for suggestions. My spouse has been diagnosed with AD and is early mid-stages. Dr's orders are to retire from private practice. Now. That was 3 months ago, and LO gets irritated if I mention Alz at all. I can imagine the frustration and fear, but we can't pretend this isn't happening and there's no way to avoid or validate around closing a business, advising and transitioning clients, packing up/moving out of the office, shutting down, essentially. I've called it career-shifting or semi-retiring, but the response is, "AD? Then I'll just have to work harder." Any further discussion prompts full blown anger, secrecy about activities, etc.
Any advice or experience from other professionals (or spouses) who have had dementia interrupt their careers? How were you able to stop/shift/disclose or not disclose but quit practicing?
Anyone have approaches to anosognosia or just not accepting the diagnosis, when it is urgent? I would love to just support LO with daily living needs and take each day as it comes for the rest of this journey, never again mentioning Alzheimer's if that's best. But we've got this huge hurdle first, and it seems I'm losing the battle and the war. Family isn't a help. They don't want to get on his bad side and seem comfortable with me taking the fall for everything.
I am helping (without income) as much as possible at the office but its not sustainable as things progress of course. Every day, there is more and more for me to "pick up" and it is not my field. LO has no pension, and let the insurance slip last summer unbeknownst to me, plus the savings has disappeared (thank you AD) so we also can't afford to have me not work for much longer. (I'm getting a bit depressed just typing this.) So, I can understand why LO must feel frantic and that working harder is the key to any retirement options, but that's delusional under the circumstances.
Any suggestions to transition out of the old career cooperatively, would be greatly appreciated. There are still things LO can do; just not this.
Could you also post this (copy and paste) the on Spouse Caregivers Board? There is a very wise man (lawyer) who posts on that board and I think he might have some suggestions for you.
It is not wrong to post on this particular board but "Crushed" only posts on the other one, as far as I know.
This is certainly a difficult situation and your concern is understandable. You are trying your best to do all you can, and I can imagine how stressful this has become for you.
Question: You mention your husband being in "private practice." Is this a medical, dental or legal profession? Reason for asking is that your husband's physician was adamant in his declaration that your husband leave his profession "NOW" which sounds serious and your term, "private practice." There can be increased risk to others if this is one of the fields he is in. It also gives you different options to use to get him "retired."
If he is in a profession that could cause harm secondary to his decreased abilities and judgment, then not only are his clients/patients at risk; he is also at risk of being sued should there be a negative outcome to a client/patient. Can you get the cooperation of the doctor to put his strong recommendation to retire "NOW: in a letter to your husband including the reason why? Perhaps that could that be more helpful if he sees it in writing.
If he is in one of the professions mentioned above, another option would be for you to contact his licensing board and either make a report OR remain confidential not giving a name but asking questions about how this would be handled if you make a formal report.
Also, if he has friends in his profession, perhaps they could be helpful; or even clergy can sometimes make a difference if you belong to a house of worship.
Most important is that neither his clients/patients or you and him come to harm secondary to his diminished judgment and reasoning. If he will not comply with the doctor's order, and if he continues on; then you will have been pushed to the only option left to you, and that is reporting him to his licensing board if he is in a profession that has one.
It is also helpful to speak to a Care Consultant at the Alzheimer's Assn. Helpline at (800) 272-3900. There are no fees for this service and Consultants are highly educated Social Workers who specialize in dementia and family dynamics. They are very supportive, have much information and can also assist us with working through our problem solving.
I am sorry this is happening; please do let us know how you are and how things are going; we truly do care.
Who’s in charge? Are there partners? Is he the boss?
My DH was senior/founding partner at a small professional firm, (not docs) and signs of his Alzheimer’s were obvious long before diagnosis.
It got ugly at his office, and extremely hurtful. I did not and still don’t know a lot of details. I was not part of his business.
The others just started shutting him out. He was left out of meetings, not told things, they’d proceed without him—just acted like he was not there, without being outright hostile. They were polite, but he was totally excluded from business. (they were largely justified, it’s just that nobody ever said anything about it to him)) I still have very little idea what he did there in the last couple months...I wondered then why he did not quit or retire, now I feel sure it was all his Alzheimer’s.
There were no policies nor departments for recourse, all they had were partners, few workers/staff, and support staff. At the business beginning, he just trusted all would do the right thing. They did not, IMHO.
They didn’t have anything in writing about forced retirements or separations, etc. they could fire staff, but partners? It’s a long sad story, and could/should be an object lesson for other younger/newer people in such a business.
Long story short, he finally had a medical crisis (not the Alzheimer’s) and was out for a couple months and they told him how glad they were he was retiring (he had never talked about retiring, although he was of age). “Enjoy retirement, here’s the personal stuff from your office” They sent contents of his office home. Clients were told he retired.
Decades of friendships gone, pretty sure money owed is too. Things were promised, which was enough for DH then, but now DH doesn’t remember much of anything except hurt feelings. He’s essentially gone (shell remains) and nothing found in writing...
Find out NOW all you can about pensions, retirements, anything. Don’t worry about being a pushy wife. You may think someone else will help and do right, but that’s not always the case if nothing is in writing.
A PWD (person with dementia) with anosognosia will resist being constantly reminded that he has dementia. It can help if you make the problem something else besides dementia. Blame the need to close the business on a slow economy or another health problem. Or say you want to travel now. It doesn't matter what excuse you use. You are in a precarious financial position. Making complex financial decisions is probably past him now. The less he has to deal with the better.
Does he still have professional liability coverage? Would it still be valid with his doctor's cease NOW order? He shouldn't do one more thing truly. If word gets out, people may come forward with invented unhappiness and say they deserve refunds, damages etc. Or he may give terrible advise and not be able to assist in a lawsuit.
You need to talk to a lawyer about this right away. Every dollar you'll have in the future depends on it.
I know how heartbreaking it is hear him say he'll try to help. But he can't anymore. You'll have to get the closing done, get him settled and then look for employment.
Use these boards to ask questions, vent , etc.
As others have mentioned, liability is a huge concern. Whether it is healthcare, financial advice, accounting, investments, etc. if he causes damage to anyone through poor services you could loose everything. Practicing anything with a known diagnosis seals that fate.
If there is a professional assistance group to reach out to, do so immediately. Otherwise...
Reporting to the appropriate licensing board may seem drastic but is probably the only way to (hopefully) shut things down, unless there are other people in the practice to do so.
There are going to be other things that come to light that can destroy you financially if he spent the savings and let insurance lapse without your knowledge. Immediately:
Check both of your credit reports with Experian, Transunion and Equifax. FREEZE your credit for both of you. Then he cannot try and take out more loans, credit cards, etc. Also protects you as his judgement continues to lapse and he gives out personal information. Not a temporary credit alert - a total FREEZE. Easy to do, they give you codes to unlock them if you need to. Do it YOURSELF, don't tell him.
Get online access to all personal and business acounts, bank accounts, deny him access.
Most importantly - find a Certified Elder Law Attorney (www.nelf.org) and update the POA's, medical POA's now. Before the disease progresses and competency to execute comes into play.
As Iris stated is the way I would go in addition to a committee set up. Your spouse has done nothing intentionally wrong as you know I'm sure. You must intervene but maintain some dignity. Perhaps you can contact the clients to notify them of your husbands retirement without letting your husband know per se.
Perhaps the building must be earthquake compliantwhich requires you to vacate 1 As someone else suggested get a handle on the finances- who does he owe or who owes him?
Thanks for both responses Ruth. Working on all recommendations here as quickly as possible. I was offered a letter recently but the Dr. wanted me to provide the language for it, which I was unsure of. I've requested that they use their best judgement since this is what they do...(?) And since its the med team's assessment that work must stop immediately.
Hopefully the letter will be forthcoming soon. Maybe with the language someone else suggested here, explaining to LO why it is necessary to retire at this time, because ultimatums seem to just cause more "digging in."
Dear Jo C and all,
You all are the best. Yes, J, you hit the nail on the head on all points. I have been following up on the excellent suggestions here, and appreciate the wisdom and compassion as well. I appreciate this community so much already, though we have a long, long way yet to go.
I will keep you all posted, as I can see that sharing experiences, ups and downs is helpful to me, my LO and others, ultimately. Thanks much.
My spouse is the boss - solo practitioner - and many people and organizations will question my authority (e.g. even with DPOA at the bank recently they refused to close a couple of the problem accounts that both our names are on). Also other professional relationships, clients, landlord, vendors, and others mean there are some complicated interdependent links to separate from with as little damage as possible to LO as well as others. The negative "ugly" approach and outcomes you experienced are exactly what I'm hoping/trying to avoid. That just feels totally wrong to me, even if DH will forget in the long run. Others won't forget and he deserves better despite (and because of!) this hateful disease.
I understand I will have to do what must be done soon, possibly with no close support and that he will likely hate me for it. But I so appreciate all the forum recos to help me move forward as compassionately, discreetly, and professionally as possible. It would be ideal to do the "retirement" convos with DH's participation as much as possible, but that can't happen if he continues to refuse.
Hi Iris -
Your sound advice is much appreciated. This is exactly what I am seeing in my husband's responses and behavior. I'm working to learn how to maneuver in this new reality asap and not trigger him unnecessarily. He can't face facts, I see, or actually his facts are different now, and it is we who have to face THAT. I have learned so much reading the discussions throughout this forum for a few months and it is a true asset in this thankless role. Your comments among others, are so helpful. Thanks!
Victoria, I think you are right, the malpractice insurance may become invalidated with a diagnosis (I've been afraid to ask them outright) -- or technically may depend on whether LO "is aware" of his issues which it truly seems he is not. Regardless, this is not a sustainable situation even with the backup support we have from colleagues who I've been strategically updating and enlisting for client support so there is no jeopardy to others in that regard. But basically, you are on point that it is a very precarious and vulnerable position and we do know AD only goes downhill from here so its time to stop, truly. Plus it is Dr's orders, not mine.
For now, DH is not buying my invented (and even some real) opportunities/ needs/alternate plans despite his having talked about retirement plans and dreams for years. Its like all that never was real for him, and/or maybe he's forgotten it. All that matters now is his work, just as its become clear that he can't do it well anymore at all. I'm taking all advice to heart and applying all ideas offered. Thank you!
Thanks so much. You are right on target. There is, and we did meet with that professional assistance group a few weeks ago actually. They gave good advice and referral resources including a very clear "how to close a practice" checklist. After our meeting, DH laid that aside (at least he didn't shred it) - and has either forgotten or is ignoring it. Its the kind of thing that sets him off if I bring it up again. So, I've copied and reviewed it in detail for next steps and am working through them as quickly as possible but some require his participation or agreement, hence my post.
I am truly hopeful this does not have to be accomplished through forcing a crisis with the licensing body, which would create its own potential liability via opportunists and other potential messiness. What a terrible way to end a career. I'll avoid that at all cost, if possible, while helping him out the door asap. I really appreciated your input.
King Boo -
Thank you for your thoughtful post. I have been busy trying to stay 1 step ahead of the disease since posting. Will try to get the credit freeze done asap tonight. I know you are right about that, as financial mismanagement has been a major problem area and point of serious anger, anxiety, etc. for my LO. The financial havoc was one of the first signs and because I was not in his business until recently, I truly did not know. What a way to back into learning about a dementia diagnosis. We are in such deep waters and the recos from this forum, CELA and the hotline have been saving my sanity these last several weeks. There is just so much to do, but the guidance is priceless in such a terrible situation that we all have been touched by in some way. Much appreciated.