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Slip the nurse a note to give to the doctor that your Mom probably won’t remember his instructions or suggestions and then all you can do is hope they will talk to you.
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My husband and I were married for 35 years. He would not let me go to the DR with him. Because of Hepa the DR would not talk to me, would not even READ a letter I sent explaining everything going on in our house. I felt very frustrated and almost in a panic. My husband was in his late 50's early 60's when he first had a heart attack than a massive stroke. He was still driving(had a terrible accident - 1 vehicle thank g-d) he could not speak or help himself at that point. I finally had the DR's attention. My only choice prior to that was go to court and have him declared incompetent. That might be the way to go rather than live with the guilt of an accident. Good luck, its not easy
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disgustedtoo Feb 2020
That doctor was not only a jerk, but irresponsible for refusing to read a letter from you. I would take a dying scorpion to see him! Hope you have ditched him and moved to someone with more of a brain and/or capability to use the one her/she has!
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Tell her that afterwards y'all will go for ice cream 🍦 at McDonald's. Works with Mother every time.
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Do to have medical POA? If no, maybe time to get one.
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"The POA just has to be filed through the lawyer now. She signed it already." This is a good first step. Do understand that POA doesn't give you all encompassing power over her (that would be full guardianship.) For instance, it doesn't grant you the power to take away her car or driving privileges.

"I also have access to her accounts so I can see her spending and put a watch on her credit since she thinks she gave out her SSN to one of those IRS scams."

At this stage she shouldn't need any credit checks, so I would highly recommend freezing her credit reports and alerts on her accounts. Freezing has to be requested with each of the three bureaus and you will get a pin number that you need to keep handy along with any other info needed if there's any need to unfreeze (YOU keep it in a safe place!) This is now FREE to all of us, freezing and unfreezing. She can continue to use whatever credit she has, it just prevents anyone opening new credit, among other things, in her name with her SS#.

Of all places, the EC atty office sent mine out via email. The staff person reviewed the trust document and needed to confirm my SS# to request tax id for the trust. Instead of calling me or asking me via email to contact them to do this, she included it in the email (NOT secure!) and asked if this was correct. I immediately called and expressed my serious concerns. She doesn't get it. Her response was their systems are secure. Sure toots, but once you hit SEND, it isn't on your system anymore, is it???

I spent the $30 needed at that time to freeze all my credit. One time later I had to pay an additional $10 to temp unfreeze one. I also put alerts on every account and credit card I have! Problem is, once the snake is out of the box, you don't know when or where it will strike!

While this is especially important for your mom, given the uncertainty of what she may have given out, IMO EVERYONE should do this, given all the various security breaches. Yes, it can be a pain, but much less of a pain than undoing what can be done to your identity if it is stolen and compromised! All those promises of protecting your information that you have to pay for, is (also IMO) a waste of money. I've had those given for free for a year due to a breach, but they never reported ANY suspicious activity and what good is a year? If they have your info, the criminals wait 366 days (or more) and have at it!!!
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To Annessister: you make a great point about doctors who may make wrong assumptions based only on age or may be dismissive of an individual's capabilities. I love your stories of older drivers who tested and drove just fine. We need doctors who are worthy of our confidence. Thank you for your reminder of another part of the picture!
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Those memory tests totally embarrassed my mom. She asked why are they doing this to her. It was quite obvious at her appointments that she was repeating herself. I saw no reason to add to her confusion...she would feel terrible and then forget anyway. But why make her feel bad for even a second?
One other thing...My mom had a wonderful doctor that would talk TO HER. He knew I was taking notes. I had talked to him in private early on. When he retired, the new young doctor would talk around her and say things like...she needs to do this, she shouldn't do that...blah blah! They should never do that with mom in the room. He may not ever understand until he goes through this with his parents. Needless to say, I did not go there any more,..because he didn't get it.
I told Mom I would take her to her doctor and give her private time with him and then I'll go join them to see if there's anything I can do to make things easier for her. It worked great. Good luck to you. It's a tough road. My Mom passed away a year ago. I will miss her forever, but never realized how much I was actually doing and how stressful it was, till she was gone.
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One other thing....her doctor should ask her if she's still driving. My mom said she felt uncomfortable doing so. So he said he would feel better if she does not drive. I found that if I left moms car key on her key ring, it put her at ease. We left her car in the parking lot at the AL so she could see it, but we disabled it in case she tried to drive. Eventually it got easier because she forgot about it and knew she couldn't drive due to being in a wheel chair because of severe arthritis. It's so hard...but white lies to put them at ease are well worth it. Again, good luck to you.
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With HEPPA you either have to get Power of Attorney or she gets the right to keep her medical records and appointments private even from you. That's her right. I don't think doctors are as apt to recommend that the person have that right taken away unless they are truly, truly not capable of making their own choices.
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She needs a good physical but also a good cognitive test. As noted, there are conditions which can affect memory. Repetition was the first clear sign I had for our mother. Later, adding in other odd behavior, which was dismissed at the time, there were some little bells ringing. I knew nothing about dementia until I noted the repetition and started research.

When you say you live out of town, how far out? Your profile shows St Thomas, so is mom on the island or back in the states? If the latter, this could be difficult. If you don't already have any POAs or HIPPAs signed by mom, that could be a problem. Doctor could and should take input from family members, but it doesn't always play out well, esp if you can't be there to back it up.

Bringing up hot topics like driving will definitely get the dander up. It and other topics can bring on anger, belligerence, denials, shutting you out, so it has to be done carefully. It would be best if the doctor can be the initial bad guy. If s/he does broach this subject and from testing determines it isn't safe, s/he should be able to start the revoking process, but beware - many who are told not to drive and/or have a license revoked often ignore it and continue to drive! IF you get doctor to revoke and get notice from DMV that it is suspended or revoked, you will need to step in quickly to move the car. You won't necessarily be able to sell it, even with a POA (the document, if you have one, will specify what you can do and when), but to get it where she can't access it will be key.

There could be anger, threats, tears, any number of reactions, but you have to stand strong. If she is still capable, she could try to fight it or get around it (ask ExhaustedPiper about that!) She sounds like she might be in the early stages of dementia, and quite often people at this stage can surprise you with what they can pull off! It will also probably be the most difficult stage, when dealing with the car and other "privileges."

Wishing you lots of luck and strong backbone! It wasn't too hard with our mother, but it also wasn't pleasant! Thankfully we're beyond all that (car, making the move, etc.)
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Her physician should be calling her in for her routine ANNUAL Medicare wellness exam. No one likes to lose their independence, but at this stage, she probably shouldn't be operating a motor vehicle.
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anonymous1017765 Feb 2020
My sister let’s my mom drive her around to see how my mom drives and says she drives very slowly and carefully and is limiting her driving on her own because she senses she might not be able to go much further now. My sister also feels like she will be completely lost without her independence.
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You live out of town; are you RNs or Docs? I would be angry as well if the doc says I'm good but my daughters kept insisting that I wasn't. Is she a danger to herself or others and how? Has she been in car accidents recently or dented the car? I bet I could find some memory issues with you. I always play devil's advocate. If you're serious go to court to have her declared incompetent. File for guardianship first then get a doctor to declare her legally incompetent. After he has decided she is legally incompetent you go to court to make it official. Simply having a doctor say she's incompetent isn't good enough...she has rights. This taking her for ice-cream and going to the home is barbaric. What comes around goes around. I know of no home/facility/etc that would accept a new patient like that...the psych ward would take her as an involuntary admit but she would have to garner the attention with bad behavior.
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Talk to the Doctor or aNurse on the phone. Explain your situation. She probably has some demmtia. The doctor wil let he rknow when she needs help and perhaps tey can converse with you as to how each appointment went. You are aconcerned family member, After all.
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This thread is a wonderful example of why the guardianship process is and needs to be so difficult to obtain. Based on _one_ person's statement that an 73 year old adult's memory is impaired (because she uses limited subjects and repeats stories over a phone call) so the senior therefore needs a care giver, and a companion to her doctor's appointments and to stop driving, even when considering the person making the statement is REMOTE and the senior's doctor does not agree she is significantly impaired... look how many people are willing to jump on the band wagon and deny this legally competent person rights to self determination, privacy and her own property. Is this "one person says" the standard you want applied to yourself today or in a few years?

People pass cognitive tests because they retain enough function to be orientated to their environment and execute basic tasks; they may not be as "sharp" as they were previously but that is not the standard. Competency does not require you do not age or have declines; the standard is whether the cumulative declines have reach a point where you cannot function safely. I recently went through a series of cognitive tests for my own baseline since both parents have cognitive issues and found out my IQ has dropped 3 points since I took the same standard test 40 years ago. I can still correctly solve mathematical problems but lost some points for requiring a few more seconds now than when I was 16. People pass driving tests because they retain at least the basic skill level required before DLs are issued. Reaction time is not a critical driving skill; if it was teenagers would be the safest drivers instead of the most unsafe on the road! My mother, years into her short term memory problems and after a complete neurological examination and initial MCI diagnosis was a very safe driver, using good judgement to pick her routes carefully and using red lights for left turns. My father was an unsafe driver before his vascular dementia diagnosis: speeding, changing lanes without signaling and with very small clearance margins and turning out in front of other vehicles - much like the behavior or driving style of many a teenager. Dad could pass a driving test as easily as a teen too. Even though I considered him unsafe because of his judgement difficulties and not his driving skills, I did not take the car (and had no right to do so) until he was deemed incompetent and I became his guardian. I was able to get him to restrict his driving to daylight hours around his home, but he would not agree to stop completely.

Maybe senior parents would not be so "resistant" to offers of "help" if the children were actually "offering" cooperative help and not just wanting to substitute their own judgement for their parents' at the first sign of an aging decline. In most cases the testing performed in a doctor's office is a better measure of competence than the lay person's educated guess or opinion. Writing a letter and providing a doctor with more information allows the doctor to better determine which tests to perform.

If I had been tested multiple times and cleared repeatedly by my doctor, I think I would a bit "angry" with a child who continues to insist she knows better than the doctor and wants to start making _my_ decisions for me.
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Isthisrealyreal Feb 2020
Thank you for your post. I was cheering as I read it.

You are an inspiration in good sense.

I had to laugh about your dad's driving, we have called my mom Andretti for my entire life, she is h3ll on wheels and it is becoming more pronounced as she ages. I am thankful that I live in a different state. Your dad and her would have been great car mates.

Keep helping us stay in our own lane when dealing with an aging individual.
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I do agree that guardianship, any oversight, revoking of license, etc. shouldn't be a snap to get, but sometimes the "guidelines" and flaming hoops one must go through are too stringent and the person who truly needs help doesn't get it. Sometimes it can be too late.

The original post is fairly short, and doesn't provide a lot of detail. OP gave a little more insight in a response post today. I have three things to say about this: 1) doctors often only see a person once, maybe twice a year and that visit is so minimal there is NO way for them to determine if there is an issue and 2) we as family see a person more often and can see the progression more clearly and 3) the simple test, if even done, can be misleading. If we have no POA/HIPPA, the doctors should at the very least take input from family and DO some additional testing!

Too often someone who has early stage dementia can pass off being fine. Sure, don't jump the gun, but DO more exploring of the issues observed, even if only by family. Even family members can be duped, if they don't see the person very often and only for short visits. It could also be some other medical condition causing the symptoms. Thorough testing/input from family is NEEDED.

Comment about repeating stories - sure, many of us do this, myself included. That alone isn't enough, but when OP says "...repeats herself constantly.", flags go up. THIS is what clued me in for my mother. When someone repeats the same statements, questions, requests over and over in a matter of minutes, SOMETHING is wrong and should be checked. There are other signs, some of which I missed because it was prior to the light going on for me (accusing others of stealing items was one - WHO would steal tweezers????) Without the later observations, this made no sense to me (lack of knowledge about the signs, esp the subtle ones.) Did we immediately jump to remove her? No. We tried various ways to keep her in her condo, but it wasn't going to work. We DID take her car away (it was NECESSARY, before she killed herself or someone else!)

Forgive me if I missed it, but I didn't see anything about the doctor not agreeing with impairment, however even if it is posted in this thread, doctors don't always get it. Some have posted elsewhere that doctors ignore input, one said the doctor stated the person couldn't have dementia as nice people don't get this!! Without my input, the doctor mom had at the time would NOT have a clue. Even then, he promised the letter I needed to take over her federal pension, but never delivered (9 months of pestering the office was useless!)

That said, if WE (mostly ME) hadn't been aware and proactive, mom could have been dead by now. We finally got Dx from a nurse from the aide company who tested her. We implemented a timed/locked medication dispenser and started 1 hour aide visits. Less than 2 months she refused to let them in. We started looking for a place, but she refused to consider ANYTHING (AL, brothers offers.) JUST prior to the move, she injured her leg and developed cellulitis. We are all "remote" enough that we couldn't do daily checks on her other than by phone. She didn't have enough sense to have it looked at or even tell us. Her neighbor told me. Lucky for her it was just before the move and OB was arriving the next day. THAT could have killed her quickly.

"People pass cognitive tests because they retain enough function to be orientated to their environment and execute basic tasks"
SOME can pass those simple tests when in early stages, because it isn't that hard. Mom's current doc attempted this test on her despite being 2+ years in MC, and being hard of hearing (hearing aid went through laundry, hadn't had time to get replacement.) She couldn't even finish it. The same test was given to me several months later at my checkup. Thankfully I passed!

Driving and summary TBD posted to this comment.
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disgustedtoo Feb 2020
"People pass driving tests because they retain at least the basic skill level required before DLs are issued."
I will agree that some can "pass" these tests AND that various sensible driving skills are not present in MANY people's repertoire, but... There are indications that driving should be curtailed or stopped. If someone gets lost, has unexplained damages to their car, etc. there is reason for concern. Although many say it isn't legal to take a car away, I would rather deal with the legality of that than the consequences of allowing the unsafe driving to continue.

FWIW - when I was taking my initial driving test, they failed me twice! One said not enough signal, which I don't believe, and because I couldn't do a 3-point turn on a tiny side road with a big station wagon that had no power steering. The second person was a phenomenal jerk, stomping on my foot (was on the brake already) and yelling at me that I almost hit a car and ran over 2 people! The final test the person was perplexed (the previous tests are on the paperwork) and said he didn't understand why they failed me, as he hadn't seen such a good driver in a long time! So, you can't even trust any of them to know what's what. Driving tests don't look for someone to get lost or perform other actions that might result in dings or accidents. Driving skills ARE part of one'd long term memory, so it might be easy enough to pass a simple test, esp in the early stages of dementia.

The various sites I have explored about dementia clearly state that simple aging decline of cognitive function is NORMAL, but other signs of cognitive decline are NOT a simple part of aging. One needs to be aware of the difference AND be observant enough to know the difference.

"In most cases the testing performed in a doctor's office is a better measure of competence than the lay person's educated guess or opinion."
Not from what I have seen! Some don't even use the typical simple test, they just talk with the person and they can skate through this minimal yearly exam.

We (mostly) all understand the concerns you present, but WE can't blanket state that what you are pointing out is the case. We don't know the details. We don't know these people. We don't know what is behind the concern. I would rather see someone be concerned than just fluff it off. As noted in another post, it isn't clear what "out of town" means. I was almost a hour from mom's place when this was very early stage and stayed in touch by phone mostly (was still working then.) I moved further away, so it was about 1.5 hours. Interfacing often enough and knowing what mom's "baseline" was, it became clear that she had something going on. I started my research into dementia then. Sure, I'm no expert on dementia, but I DO know my mother much better than ANY doctor. When she repeats herself constantly during a phone call (not repeating old stories, but asking/saying the same things over an over), forgets she asked me to take her to appts so she calls every other day or so to ask again, is making mistakes with finances (check for $2.39 to pay $239.00!!), clearly there is reason for concern.

I would also say that our mother was totally in denial about having ANY issue. She would say she is old and entitled to forget (true statement, but forgetting what she forgets was the issue!) She would insist that she was fine, independent and could cook. None of that was true. After taking the car, I had to facilitate grocery shopping. Sure, she would buy the "right" things, but she was NOT cooking. Freezer was full of old stuff and veggies would shrivel up in the fridge. She was relying on frozen dinners and boxed crap as she couldn't cook anymore. We couldn't monitor everything, but she clearly wasn't caring for herself properly.

OP and sister know more about mom's "baseline" than any doctor seeing her for 20 minutes/year (2 visits). If no POA/HIPPA, doc should welcome input. Hopefully they can get one of these set
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Family may know a lot more about LO's "baseline"; however, family often overreacts when they realize there is a cognitive problem, even a minor one! _Any_ decline does not mean our LO is incompetent and needs a constant oversight and loss of privacy or even needs to immediately stop driving.

Our system (which I generally agree with) is that until there is significant decline in executive function or orientation a person is still competent.

I have stated in other posts I wish our legal system had a in-between state for MCI where people remain competent but must designate some other competent adult to "co-sign" major decisions (like rewriting a will, re-deeding or selling a house, giving away large sums of money and yes, renewing a driver's license) confirming these decisions/changes are in the principal's best interest. I do not think the co-signer should be a child or any other family with a potential conflict of interest.

I wish the many commentators who post about HIPPA problems could have experienced my estranged brother verbally and emotionally badgering my mother about her short term memory problems were really ALZ and how she needed to "mind" him because her brain was garbage and her thoughts and opinions about her life and running her house didn't matter. This was 8 years before she scored a 27 of 30 on the mini eval! Or course estranged brother also told our mother when she had no cognitive problems of any type (and wouldn't for another 16 years) she had dementia; our father had dementia and she was about the same age so she was bound to have it too! If you think every child should be able to invade their parents' privacy, please consider how you would feel having your worst enemy go through your medical records. Yes, HIPPA can be a pain for the good kids who want to help a parent, but please consider how destructive some of the information can be in the hands of someone with problems who doesn't really care about the parent - maybe the child with a drug problem or the child with mental issues of their own?
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Remote: Your sister feels as though mom will be lost without her indepedence? But if she ceases to operate a motor vehicle, she'll still be alive. And what about the Medicare cognitive test? Has she had one?
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Has your mother had a cognitive evaluation by a geriatric psychiatrist or a neuropsychologist? Have you spoken to or received any input from her primary care physician? If there have been issues related to driving, I would suggest speaking with her physician so that he can submit a driver's license revocation form to the state. I would also suggest that she gets her affairs in order: last will and testament, advance directives, funeral plans, etc. If she needs everything that you state, your best bet is involving someone that she respects and will listen to.
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I am curious, besides driving, what things does your mother do that makes her independent? Can she use a phone? Can she call someone? Can she talk on the phone? Get herself dressed? Get something to eat? What does she like and not like? Does she pick out her clothes?In what ways is she independent now. Possibly your mother is terrified of being placed in AL or a skilled nursing. Possibly hiring a friend to play cards or take her to a movie. A friend that may gain her confidence for future needs. Prayers for the journey.
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Do you have Power of Attorney for Medical on your Mother? If not you really can't intervene.
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