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Need advice on a difficult situation with my father
twills83
Posted: Wednesday, October 9, 2019 10:48 PM
Joined: 10/9/2019
Posts: 23


Here is the background:

He was first diagnosed with an unknown degenerative brain condition (probably Alzheimers) in mid 2015 at the age of 72.  He also had evidence of multiple small to moderate strokes beginning prior to 2015 and he has had at least one since then.  My opinion is that he suffers from both Alzheimers and vascular dementia. 

He is now at the point where he has very little short term memory but can still remember events from the past or distant past fairly well but it depends on the day and the time of day.  Sometimes he is more lucid than other times.

He cannot walk very well due to a stroke in May 2019.  

He struggles with simple tasks like using the telephone, sometimes he will call and ask if he called me or I called him.

Aggression and anger is starting to show up occasional.  Most recently he was angry that he does not have access to credit cards and could not book a plane ticket.  It would be completely impossible for him to travel anywhere without a nurse.  He struggles to walk more than 10 or 20 feet and even if his mobility were OK he often forgets what day it is, what time of day it is, where he is, where he is going, etc.

He settled in Thailand just prior to his diagnosis in 2015 and has remained there even since.  In 2017 he met a much younger Thai woman who he now calls his "wife" although they are not legally married.  As anyone that knows anything about Thailand will immediately know, the Thai woman was obviously taking financial advantage of him and basically relieved him of every penny he had to his name. 

In August 2019 he moved of his own free will to an assisted care facility and said that his "wife" was "annoying" and a "pain in the a**" and he wanted to end the relationship with her.  Apparently now his opinion has changed on that.  He lives at the facility and she comes to visit from time to time.  I think, but don't know for sure, she constantly attempts to convince him to move back to their home (well "his" home which is now "her" home that she and a crooked lawyer conned him out of, but that's a different story) likely because she wants to regain access to his social security payments. 

The problem now is that he frequently talks of wanting to leave to leave Thailand and move to a different country (perhaps US), he also talks about wanting to go back to his home with his "wife" (it just depends on the day, it's all random).  He is never able to articulate exactly where he wants to go or when, just somewhere else because he's "bored" or because "nothing works here".  I have visited the facility and found it to be quite alright.  I cannot imagine that I can afford to get him a higher level of care anywhere else. Because of the low cost of labor Thailand, there is a very high staff to resident ratio which I think would be difficult to meet or beat anywhere and in my mind this is one of the most important factors. 

If I were to move him anywhere I think he would immediately not like that place as well and complain of being bored and things not working but I think the care level would likely be lower. 

Also, I do not know of anywhere in the world where he really has any friends or family that would visit him regularly.  The few friends he still maintains contact with are spread all over the world.  He really only has one or two friends he maintains regular contact with, one is in Thailand and the other is in the US.  The friend in the US is mentally sharp but suffers from mobility problems from also from stroke and is well into his 80s.  If I were to move him near that friend it's unlikely he would have a better "social life".  It seems as though most of his remaining friends don't have a great deal of interest in talking to him because of his dementia. Sometimes he seems fairly lucid except for short term memory loss but other times he seems essentially "insane".  He routinely talks about visiting New York as if it's just a short drive down the road to a neighbors house and he wants me to call friends in the US to make "dinner plans for tomorrow night". 

I do not know how to handle him.

Sometimes he aggressively rants and raves about not having access to his money and to working credit cards and angrily demands that I need to provide them so he can book plane tickets (or whatever else) because he is an adult and it's his money.

Does anyone have any advice?

Also, does anyone have any predictions about how this terrible condition is going to progress and on what timeline?  

His decline, in hindsight, could have been spotted as early as 2010 or perhaps even earlier.  Short term memory issues started to pop up as much as 15-20 years ago.  As of 2016 it became obvious that he was not able to make rational decisions around money, finances and financial planning.  By late 2017 early 2018 he was proposing completely irrational things although he could still live on his own and was generally mobile and knew where he was, what day it was, etc. By mid 2019 it became nearly impossible for him to live on his own both due to memory issues and mobility issues. 


terei
Posted: Thursday, October 10, 2019 9:10 AM
Joined: 5/16/2017
Posts: 412


You are handling this long distance problem very well IMO.  I assume his social security is going to pay the AL.  As long as you are confident that he is being treated properly, he does not need to go elsewhere, regardless of his demands.

Whatever he asks for, continue to deflect ‘I can look into that for you’ etc.   His disease is progressive + he will continue to decline.

I assume you do not want him at the ‘wife’s’ home + if that is true, I would tell the facility that he is not allowed to leave there with her unless she can produce legal documents that they are indeed married.

I think you are doing what you can reasonably do, considering the distance.  If he is disruptive with many phone calls, contact him when YOU wish to speak to him, again, as long as you are confident the facility will contact you in an emergency.  Good luck to you.


Victoria2020
Posted: Thursday, October 10, 2019 1:44 PM
Joined: 9/21/2017
Posts: 924


There seems to be four issues.

CARE His care and where he gets it-- you say he gets good care at a great price where he is. As long as he can't check himself out and be at risk (wandering the streets) that sounds good. You call it "assisted living"- will it provide memory care (locked) and geri psy as he worsens? But his verbal skills and  its veracity are declining, how will you get honest updates about his condition in the future from across the world  ?

MONEY You say the gf cleaned him out except for his social security payments. Unclear if you have any financial authority over his money- can you have the SS deposits made to an acct you control and pay his care home out of it?He would be hands off it.

THE GF AND THE LAWYER If there is no money to try to get - they will move on. Do you know for sure she didn't marry him along the way to try to be a surviving widow? From an article:"In most circumstances, you must be married to the deceased person for at least nine months to qualify for widow's benefits based on your spouse's Social Security benefits.'

HIS BEHAVIOR There are many threads on this site that give links to books and videos that can help.

He will decline, the issue is whether you want to have him in who knows what condition unmonitored across the world. And yes, the friends don't matter anymore in deciding where he lives.

 


twills83
Posted: Thursday, October 10, 2019 10:15 PM
Joined: 10/9/2019
Posts: 23


Thanks for the replies.  Answers below:

"I assume you do not want him at the ‘wife’s’ home + if that is true, I would tell the facility that he is not allowed to leave there with her unless she can produce legal documents that they are indeed married."

Yes I don't want him there because she is not only a bad parasitic person but she is quite simply too stupid and also too physically weak to offer the care he needs.  Unfortunately there is nothing I can do to prevent him from leaving and neither can the care facility.  Things are more complicated because we're dealing with Thailand here.  I don't believe she'll even desire to remove him soon as she begins to realize that 1) there's no more money coming her way, and 2) it's going to be a LOT of work.

"But his verbal skills and  its veracity are declining, how will you get honest updates about his condition in the future from across the world  ?"

I met the owner and the nurses and they seem good.  I am daily contact with them via a chat app and I get daily updates often including pictures.  He has six different nurses that care for him on rotation. It was common for 2 - 3 nurses to be attending to him at the same time. The owner is a foreigner which also adds to my piece of mind.

"Do you know for sure she didn't marry him along the way to try to be a surviving widow? "

No I don't and there is little way I can know definitively but I don't think so. Thailand is a very backward, corrupt, third world or nearly third world country.  She could probably present as legally married even with fake documents. 

"From an article:"In most circumstances, you must be married to the deceased person for at least nine months to qualify for widow's benefits based on your spouse's Social Security benefits.'"

I also believe you have to 60 years or older and she is not.  Furthermore, whether she can get his social security after he's dead is of little consequence to me, I wouldn't be entitled of it in lieu of her.  I would prefer she gets nothing but it's not a big deal. Also, she is likely too stupid and incompetent to organize that.  I would be sure to notify the government in case of his death and tell them is not married.  I'm sure they would stop the payments.  Let her argue with the government bureaucracy, she'll never figure it out and she's barely literate in English (read: an elementary school level understanding of the language, especially in writing).

"HIS BEHAVIOR There are many threads on this site that give links to books and videos that can help."

Any specific recommendations?

"You call it "assisted living"- will it provide memory care (locked) and geri psy as he worsens? "

Yes they specialize in Dementia / Alzheimers.

He could most certainly not be moved without a nurse traveling with him and that seems difficult and costly to organize.  Thais need visas which are not terribly easy to get to go to Western Europe or the US.  

I travel a great deal and where I do spend most of the time there are not good assisted care options.

As for his current condition, he shows some signs at least sometimes of stage 3, 4, 5 and 6 (https://www.alzheimers.net/stages-of-alzheimers-disease/):

Stage 3: Mild Decline

People in stage 3 will have difficulty in many areas including:

  • Finding the right word during conversations - rarely 
  • Organizing and planning - always 
  • Remembering names of new acquaintances - often

People with stage three Alzheimer’s may also frequently lose personal possessions, including valuables - yes.

Stage 4: Moderate Decline

 

  • Have difficulty with simple arithmetic - always
  • Have poor short-term memory (may not recall what they ate for breakfast, for example) - always
  • Inability to manage finance and pay bills - always
  • May forget details about their life histories - sometimes

Stage 5: Moderately Severe Decline

During the fifth stage of Alzheimer’s, people begin to need help with many day-to-day activities. People in stage five of the disease may experience:

  • Difficulty dressing appropriately - unknown
  • Inability to recall simple details about themselves such as their own phone number - some
  • Significant confusion - sometimes

On the other hand, people in stage five maintain functionality. They typically can still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.

Stage 6: Severe Decline

 

  • Confusion or unawareness of environment and surroundings - sometimes
  • Inability to recognize faces except for the closest friends and relatives - no
  • Inability to remember most details of personal history - no
  • Loss of bladder and bowel control - no
  • Major personality changes and potential behavior problems - some
  • The need for assistance with activities of daily living such as toileting and bathing - bathing (may be able to blame this on his mobility problems from his stroke, but also not sure he would remember to bath regularly either)
  • Wandering - Sometimes he tries to leave his room in the middle of the night for no particular rational reason or because he's "hungry".



 Does anyone have any wild guesses re: projecting the trajectory of his decline?  


MN Chickadee
Posted: Friday, October 11, 2019 9:36 AM
Joined: 9/7/2014
Posts: 840


Everyone is different, but this is a description of the stages and average length of each stage. Remember, it's just averages. If he does have vascular dementia in addition to Alz (it's not uncommon to have multiple forms at once) then he might progress differently. A person could have a mini-stroke in the brain and take a sudden decline. 

https://www.alzinfo.org/understand-alzheimers/clinical-stages-of-alzheimers/


twills83
Posted: Saturday, October 12, 2019 7:06 AM
Joined: 10/9/2019
Posts: 23


MN Chickadee wrote:

Everyone is different, but this is a description of the stages and average length of each stage. Remember, it's just averages. If he does have vascular dementia in addition to Alz (it's not uncommon to have multiple forms at once) then he might progress differently. A person could have a mini-stroke in the brain and take a sudden decline. 

https://www.alzinfo.org/understand-alzheimers/clinical-stages-of-alzheimers/

Thanks for the link. According to that link it sounds like a long painful path still ahead.


 
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