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I have DPOA, and dad has dementia. I want to respect his wishes, but I take him to his cardiology and neurology appointments. (He thought he might be able to get his drivers license back from one of them) I noticed a 1.5 cm crusty skin cancer lesion, and his teeth (which he hasn’t brushed since August) are now starting to fall out. He often takes his pills incorrectly, even though he has a pill organizer. I’ve mentiined getting a new pill dispenser but he gets angry and argumentative. I’ve showed him how he took too many days worth of pills, and I’ve begged him to let me get someone to help me to help him. He thinks that caring for him only involves bringing him a “hero sandwich” every other day! I’ve mentioned that I’d like him to see a dentist and a dermatologist, and he gets furious and verbally abusive with me. Do I LET him fall apart? I’ve stopped nagging him to shower, so he stopped showering. I figure I need to pick my battles, but where do I draw the line? I am the only person taking care of him because he refuses help from anyone else. The neuropsychologist suggested adult day care and assisted living- but Dad just sits in his apartment smoking cigarettes and watching tv. He refuses to go anywhere! I am fully responsible for him, so I’m not sure if I can step back and do nothing for a week and “see what happens.” He could die if he doesn’t take his pills, or has no food to eat. He has 3 heart issues, and I’m afraid that when his teeth fall out he could get an infection that would affect his heart. I don’t know if the skin cancer can kill him, but he makes things so difficult that I’m losing my mind! I work full time, have my own family, and I have my own serious health issues to deal with. Any advice?

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It is challenging when they are stubborn and have dementia.

How do you pick your battles? Depends on how bad Dad’s dementia is.

If he is willing to see the cardiologist again perhaps have a chat with the doctor ahead of time and have the Doc tell Dad he needs to have his teeth seen to to prevent his heart worsening?

Skin cancer? My Dad is fastidious about having his skin checked after his first round of skin cancer 20 years ago. But he will not go to the dentist anymore. Like I said which battles to pick?

There will come a time when Dad can no longer live in his own. Perhaps start looking into options now, but do not tell him.

Dad will die at some point. Perhaps ask him if he would rather die of cancer, heart disease, stroke, malnutrition, COPD or some other malady? Then tell him you will not facilitate his death by neglect.

Remember you do not have to ask him about a new pill dispenser, just go buy it, load it up and take the old one away.

It is crazy making when they refuse help, then expect others to clean up the mess they create.

Sorry no real answers, just someone who understands the challenges.
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There's a difference between allowing a competent adult to make their own ruinous choices and allowing the same behaviour in someone with dementia - your father no longer has the mental capacity to understand long term consequences or to adequately care for himself. Sometimes a family member isn't the best choice as a caregiver because the elder resists or the caregiver finds it difficult to "disrespect" their parent, maybe it is time to enlist some outside help.
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He is not your dependent. Having DPOA is not the same as having guardianship. All you can do is try your best to keep him safe.

Because he has dementia and is a smoker, he is at high risk for setting his home on fire. Where does he live? What is the risk of a fire burning down other structures?

His health is poor. Perhaps it's time to discuss prognosis with his doctor and prepare for giving your father the best quality of life for whatever amount of time remains. If that means hero sandwiches every day or two, then enjoy that time.

Rather than mentioning things to him like getting a new pill dispenser, just do it. That is something that is within your control. Get him an automatic pill dispenser and reorganize his pills for him. They are expensive - $60-$75 - but they work for seniors with cognitive decline. Lock it and you keep the key in order to prevent him from taking extra medication.

What is his financial situation?
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Dadsakid Jan 2019
Oh, he lives in a senior apartment complex. I also fear that he will start a fire with his smoking, but at least he isn’t drinking any more. He drank heavily for over 65 years, and he smokes 1.5 packs a day of unfiltered cigarettes. When he detoxed from alcohol he was in the hospital, and they gave him s nicotine patch. The highest dose did nothing! They had to keep him drugged and sedated to prevent him from getting up and trying to leave in his gown out the front door to get cigarettes.
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You’re right! I will let the cardiologist talk to him about his teeth. Thanks for understanding.
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just a quick note, My dad died from skin cancer - however, he had a hole you could put a pencil thru in his jaw. stage 4 skin cancer. he refused to see dentists and doctors until it was too late
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Dadsakid Jan 2019
I’m so sorry you had to go through that! It must have been very difficult.
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If you are really his POA then you have to override what he is doing to himself and get him into a Assisted Living Facility asap. If his health has diminished past that point, then you should get him into a nursing home.
You may think that you are breaking a promise to him but the real promise is that you care for him and his health. Don't feel guilty about this transition because you will be taking care of his health and the staff at these facilities will care for him and deal with his stubbornness. You have a family and yoyr own prpblems to deal with. Take the strain off yourself. You need professional help at tjis point.
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His teeth are already causing infection inside his body not just his mouth. Periodontal disease...especially in a smoker is very hard to control. They have found the bacteria from PD in the brains of Alzheimer victims. He probably needs dentures.
Sadly he’s to a point in his dementia where he’s not processing things normally and he’s combative. I had to get an automatic pill dispenser for our dad before he went to AL. It worked great but was quite expensive. I could monitor it and control it wirelessly from my computer. I still have it and if you lived in OK, I’d sell it to you cheap. But anyway...your dad's physician should be enlisted to talk to him but you said he won’t go. What is his diagnosis of dementia...vascular? How old is he? If you could put something about your dad under your profile it is helpful to readers like me.
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Dadsakid Jan 2019
Thanks for the advice on PD. He’s going tomorrow to the cardiologist so I will talk to him about the dental issues.
dad is 80, and we just moved him 6 months ago from 3 states away after mom died. We took him straight from the hospital to an available apartment. Also he has NPH and was supposed to have a shunt put in but the surgeon canceled surgery the day before because dad smokes and won’t quit. Surgeon said he “won’t have a good outcome”...
Neuropsychologist said “you’ve got a complicated case here. You certainly have your hands full.” 🙄
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There is no choice here. You must step in, as you call it, and get him into assisted living or a nursing home. The decisions he is making, or not making, are detrimental to both of you. I know it will be very hard, but it's what is best. He has shows that he is incapable of making good decisions.
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dianedz Jan 2019
This is exactly right! My husband and I went through the same thing with my MIL. Do not think he is going to suddenly agree! You are trying to reason with someone who cannot reason! How will you feel when something really terrible happens?
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Yes.

My dad died about 18 months ago and I had been estranged from my family for about 10 years leading up to that point. When I came back home I realized my mom was not the person that I remembered. She wasn't taking care of herself in any way, she was living in filth, and despite having been an accountant she let her finances fall into a state of disrepair (including attempting to purchase a property with excessive earnest money) such that it took a year for me to clean up the mess and prevent her from going bankrupt.

In the beginning I had no idea that it was Frontotemporal Dementia. We thought maybe she was just depressed. We argued with her to let us intervene, but she was completely obstinate.

Eventually I took action, got DPOA, fixed everything, etc. But I realized that she needed even more than what I could provide with just DPOA. I hired legal counsel and petitioned the local probate court for guardianship and today am in the final stages of having her placed in assisted living.

The best advice I can give you is this. Start the process ASAP.

If you don't intervene now, the damage caused tomorrow could be much more costly than what's required to get things under control today. The sooner you get the guardianship process, the sooner your dad will have the care he *needs*, even if it isn't something he necessarily wants.
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lynina2 Jan 2019
How expensive was it to obtain guardianship and how long did it take?
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I'm learning that as contributors with responses, we can only help you with what has worked for us. There are always nuances to each situation that won't fit in this little box!

My sister and I are co-caregivers to our mother with fairly advanced Alz and now, a debilitating knee injury so she can't even walk. We decided it's time to get her into a place where they can at least keep her fed, showered (she hasn't had a shower in 2 years), and relatively safe. To help us navigate the ins and outs of an incredibly complex world of elder caregiving, we have contracted with an elder advocate who also works with a senior housing specialist.

The $1,325 we have paid so far for this out of Mom's accounts has already helped. They are also willing to be the "bad guys" when it comes to explaining to Mom that she can't live by herself anymore. The worst is yet to come - we've just started this journey - but to help you see things more clearly, prioritize which battles to fight, and remove some of the guilt that comes with the child/parent dynamic, consider an elder advocate in your area. Just google that phrase and see what comes up. Mine came highly recommended to me by a friend who went through something similar. We are lucky in that we have the most fabulous geriatric physician on the planet (we're in Fla.), too.

They can help with alternate sources of financing, veterans benefits if that's an option, and so much more. The short answer to your question is yes, it would be to everyone advantage to step in and override your father's poor decisions.

I wish you luck.
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Even if you get him in an AL or NH they cannot force him to do anything, even with Dementia. By the time I placed Mom, she was pretty out of it so excepted everything. An AL will not take Dad if he is going to be combatant. They aren't set up that way. POA does not mean you are physically responsible for him. It means you can handle his finances and take care of his wishes concerning medical. Guardianship is another thing but he has to be found incompetent.

Maybe you should get APS involved or Office of Aging. Let them evaluate the situation. They may tell you that there is nothing you can do. By doing this, it will show you didn't abandon him, it was his choice and APS said you can't do anything legally.
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help4momplease Jan 2019
Is there someone or a place we could call when the person gets combative and will not listen to us? My mom has dementia and she have tried 2 times to overdose on pills. is their a place that would take her temporarily when shes feeling overwhelmed. She has medicare and when she goes to the hospital they only keep her for a few days then release her. i was told in order for medicare to pay for the stay at a facility she has to go straight from the hospital to facility and they will keep her for up to 100 days. What other options do I have for a temporary facility to accept her and let medicare pay for it? i'm referring to only when shes feeling like overdosing.
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You sound like a good son. But As caregivers we can only do so much. Get the pill situation under control- buy the auto dispenser with his money. If you have health issues you should take care of yourself and your family first. Then you do what you can. Just going to appointments is a lot. Small Victories!
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Dadsakid Jan 2019
Yes! Small victories are good! I should focus more on what’s going right, and not stress about things that I feel are not the right choices!
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There is always a tension between the fact that your dad is legally an adult and you knowing that his decisions are not wise. Think about the fact that you make some decisions that are not in your best interest, I know I do. At some point you have to tell yourself that it is his life to do with as he pleases. You need to balance this with watching someone you love not take care of themselves. An evaluation by a gereatric care manager may be helpful. One of my loved ones would not take a shower. When I visited just for this purpose, she would not cooperate. The caregiver I hired for 2hrs twice a week got her to do it. I noticed that hired caregivers get more respect and expressions of affection than I do! This is true about multiple relatives. Please take care of yourself emotionally (and physically). An in-person support group could help. I just notice you mentioned smoking. If he has not and is not trying to quit, this says a great deal about his intention to take care of himself. He is not twelve and you are not his mom!
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Dadsakid Jan 2019
You are SO right! APS was involved, as his apartment manager found it strange that he kept coming to their office asking about how he could get his drivers license back. They closed the case after visiting once and determining that he was not at risk or being abused, neglected or exploited, and his needs were being met in his current living situation. (Of course, I do everything for him) but you’re right about the tension between when I should overstep his bad choices. I want him to feel in control of his choices for his personal well-being, but doing what I think makes better sense will definitely generate resistance and an argument. I told him tonight that I come to do his pills, drop off his groceries, and clean his bathroom...NOT to be verbally abused when I ask him politely to change his clothing. (He was wearing the same Depends for three days and left a stain on the towel I put on his chair) I would not have asked him to change if I wasn’t taking him to the cardiologist tomorrow...but out of respect for the doctors office furniture, I asked him to change “for tomorrow” and the belligerent arguing began😩
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Oh man, I have walked in your

Can you ask his doctor if hospice or palliative care should be set up?

From what you describe your dad has no quality of life so please don't try to increase his quantity. I know that is hard.

Hire caregivers, tell him whatever will get them through the door, oh yea, hire a smoker or it won't work out. Even just someone that can hang with him, make sure he takes his meds and has food.

You need to do what you have to, to ensure he is safe, you can't ask or explain, just implement. Which is hard but if he can stay in his home and get the care he needs, even if its just companionship, then let him, if he has the money you are in a better place then lots.

It will take time to find people he can mesh with but it will take a huge load off you and give him some quality for the time he has left.

I wouldn't get APS involved except as a last resort. If they do anything, big if, you loose all input, it will be up to them and he is nothing to them, just someone to house safely. Don't give up until you are truly defeated.

Best of luck! May God send people right away that will fill your dads needs.
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Dadsakid Jan 2019
Thanks for the advice! I’m sorry to hear you’ve been through this!
im not defeated yet, as every day brings new challenges, but I believe that everything works out eventually- if just for the fact that time goes forward.
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Exact same problems. Except that I have no authority what do ever..He would NEVER give me POA..We've never been close or even cared for one another but I'm his sole caregiver..since my mom died in 2010..I have a sister that lives in another state but all she does is call him every night.That's her contribution to helping him..She has been agreeing with him, ( on everything he wants or says)..and that includes cutting me down which I'm sure has to do with getting inheirantance..And "no" he has no will..He told me he wants us to "fight" over everything...He's either has no ability to know right from wrong or he is a really immoral person and father..What can I do before his dimize to see that things don't get out of hand..Please help!
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Dadsakid Jan 2019
So sorry you are going through this. Before I moved my dad closer to me, he had to fail on his own. He ended up in the county medical center for 2 weeks, and they realized how difficult he was. The social worker was great, and told him he’d be discharged to ME- at which point I moved him to a senior apartment 4 minutes from my house. It solved some problems but created others...

perhaps you could take him to an attorney to do a”living will” and let the attorney take it from there.
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Introduce caregiver, possibly male, as a ' friend or company' for him.  If he smoked all his life he won't give up now. Good luck deciding.  It is tough.  You are in our thoughts.  Hugs.
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Dadsakid Jan 2019
Thank you! You’re right about the smoking... I’ve joked at the tobacco shop that he is the “last human alive who smokes Lucky Strikes.” He doesn’t want to quit. It makes him happy.
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I'm sorry but what is the care that you are providing?
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Dadsakid Jan 2019
I found him an apartment, moved him 120 miles to be 4 minutes away from me, (because the hospital would not release him to go back to his house alone) sold both cars at his request, I’ve gotten him to 23 doctors appointments in 6 months, packed his house and sold it, filled every prescription, monitored his medication, bought and had all his furniture delivered, paid all his bills, do all of his grocery shopping, cooking, house cleaning, laundry, check on him every day sometimes more than once, I’ve visited AL facilities, consulted the area agency on aging, met with a geriatric care manager with him, And I work full time as a teacher, have a brain tumor, a thyroid disorder, kidney stones that will require lithotripsy, migraines, and I’m in rehab for a torn rotator. I. Addition I’m a mother and wife with my own house and family. I’d love to have someone to help me to help him.
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How will you feel after he dies if you do nothing? How will you feel if you give it your best and try to show him some nice places to stay and be honest about your feelings? Dad, you’re not able to take care of yourself and your place anymore; please let me help you I’d be so sad to lose you sooner than I’m ready! I’m worried about you so much and I love you; this is so stressful for me ! Please let me help you find a place that’s more comfortable!
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Dadsakid Jan 2019
its hard to say how I will feel if he dies, but I know I’m doing everything I can to make him safe and healthy, and happy- in that order.
Im just torn between “picking my battles” and going against what he wants in order to make sure he’s safe and healthy. I will never get him to stop smoking, but the teeth and the skin cancer???? I’m torn between listening to him saying he’s NOT interested in getting them checked, and deciding if the fact that his teeth are falling out and he has a very large skin cancer lesion are things that are worth the battle.
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Dad not brushing since August is not causing his teeth to fall out. This is caused by gum desease over a period time. Its from not having regular cleanings getting rid of tartar and plaque. The poison given off destroys the bone that holds teeth in place. So, they fall out when the bone is gone. Smoking doesn't help. The poisoning can cause health problems. Now they do surgery but years ago they just pulled all the teeth and wait for the poison to clear up.
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Dadsakid Jan 2019
Thank you for the info. I’m mentioning this to the cardiologist tomorrow. I fear that if his gums bleed, the blood thinner that he takes may also be of concern.
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Big hug. What hit me the hardest is when I said I had to take care of my dad because nobody else would. I was asked by my doctor what will happen if you die? It hit me hard. I had to go to a caregivers group. I went to therapy to work on things. I still helped my dad, but I had to learn to put boundaries. I agree talk to the doctor, get with area aging agency, See what programs you could use to help, in home help, some one to clean once a week. Check with meals on wheels, for dinner. Even if you start small it huge. It's rough I know it's not the same every situation, but what is the same is they will use you up. It's just how they are. Mine still smokes, won't move to assisted living, landlord evicting him, can't part with "antiques", won't live in an apartment, everything his way. If I would just do everything he wants it would be ok....for him. What I kept thinking was surly he would bend if he knew how tired and strained I was. Nope he turned it on me and said I thought you were tougher then this. Mind you he never took care of anyone with a spinal cord injury, worked a full time job, ect. I was so worried about him, I forgot about my family and myself. You love your dad, and it's time to start working on you. Time to see what programs he qualifies for. Of course he won't like it. But your family won't like living without you. When I watched the video on being the only caregiver it hit me. The wife died because she couldn't ask for help from her adult kids and as women you think you should do it all. when the father went to live with the adult kids family it tore them apart and started to ruin health for everyone. The father did better at the assisted living and they all were better. Happy ending I know. But it still shows that you must start somewhere. My dad's case worker said your dad is sound mind and can make his own choices no matter how stupid they are. It's hard to see the ones we love not take care of themselves I know your dad is not sound mind. Talk to a professional to at least get some options. I used to wish my dad was dead and then feel horrible guilt. Therapy helped me see I didn't want him dead I wanted the situation to stop. My dad doesn't like it when the wound nurse tells him things or won't put up with his crap. But the wound is healing. Best wishes i know it's tough.
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Dadsakid Jan 2019
Thank you for your heartfelt thoughts! It’s comforting to know that there are others who share the same thoughts and similar experiences.
Im so glad that you mentioned therapy. I’ve thought about it... just to iron out my anxiety in caring for my dad and my family, while dealing with a brain tumor myself. My fear is that my dad will outlive me, since I already have a “5 year survival rate” number attached to my life... and he has the best lab tests he’s had his entire life now that he’s eating, properly medicated, and detoxed from alcohol. The neuropsychologist (who suggested he consider outside help) asked him in front of me “what are you going to do if something happens to her? WHO will do all of this?” And he said he’d be fine “on his own.” 😳
bless you!
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I am in the same position.. my father had brain surgery 18 years ago and now he has completely fell apart!! He doesn’t shower or do anything hygiene wise and refused to sign poa idk what to do cuz he needs 24/7 care and he refuses and get verbally and physically hostile we are at our lay leg he is so mean and so sick I just want him in a home
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IsntEasy Jan 2019
If he has the money, move him. You have to do all the decision making and keep pushing. But it will happen if you decide it should.
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I know how you feel. My Dad has his neighbor come over and remind him to warm his meals up otherwise he would not eat. All he wants to do is sleep. To my frustration he has the Dr. all fooled into thinking he is just fine at home. They will not listen to me and look at me like I am just trying to get rid of him when I suggest an assisted living facility. He will not even consider a facility and gets angry when even suggested. What is it with showers  my Dad does not shower or change clothes often. He is 90 and tells all the Doctors he sees he is fine and they agree at this time we see no reason for a move to facility, yet without assistance I am sure he would just lay there and die. Frustrating but trying to stay positive.
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IsntEasy Jan 2019
Near as I can tell, my father has not bathed in close to 10 years and I have to bully him into changing his clothes every week or so. It's exactly as disgusting as it sounds.

Doctors really don't want to hear the messy truth. They can't do much about it except lamely giving their patient instructions (that your dad, if he's like mine, will interpret as he wishes). I started writing letters to his doctor. All written communication has to be made part of his medical record. It may come in handy. During visits, I can tell that his doctor has read the letters by the questions he asks dad. My dad's behavior and answers confirms for the doctor that what dad says and how he's doing are two different things.

If my dad had the financial resources, he'd be in an AL yesterday. Stop suggesting. Pick an AL that's near you and that you like, and start the process of moving him. He will be better off, no matter what he thinks.
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Could your route to school go via his apartment on a single-purpose meds run? I don't think you'd be overstepping your authority if you removed px meds from his home and doled them out daily. (My daughter is a teacher. I appreciate that you don't exactly have leisurely mornings at your disposal. On the other hand, a strict time limit would mean less opportunity for anger or argument).

Who is your back up? Because the 'what happens to him if anything happens to you' question needs answering asap, I'd say. What does happen?

Everything else is a question of mental capacity. If your father is still competent, then I'd say you are making a sterling job of it just getting him to key appointments. Once he isn't... it's a new world, of which you Will Be King. Mwahhhhaaahhhaaa...!!!

Try not to elaborate problems, though - mouth infections can be associated with cardiac infections, it's true; but compared to smoking the risk is negligible! - and besides you don't have to wait for his teeth to fall out for those bacteria to be having a rollocking good time in there. If you can get him to see a dentist, loud hurrahs. If he won't... he won't. Try again later. Try mouthwash. Try one of those fancy-pants electric toothbrushes with a timer and a pressure sensor to make them interesting to use. See if there's a visiting dentist who does outreach in your area.

Be comforted, you are fighting an incredibly difficult fight in a very carefully judged way.
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Dadsakid Jan 2019
Yes, I definitely could swing by in the morning on my way to work, and make that my “med check/visit”. (Although I will need some strong scented body spray afterwards- his apartment is filled with smoke from 3-4 smoldering cigarettes he has in his ashtray, despite two industrial sized air filters with Febreeze, and 4 air wick plug ins!) it’s gross...
And you’re right.... the smoking is FAR more dangerous for him. After 70 years of chain smoking, I’m honestly baffled that his lungs and heart are still functioning. I’ve given up on the dentist for him. He has always avoided the dentist, and i know that whatever dental work needs to be done will be ignored anyway.
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First, take care of yourself. The stress is clearly already affecting your life. Dementia doesn't get better. Keep in mind that it absolutely is an option to just let him have his way and see what happens. Check in and call 911 when the time inevitably comes. You could even speed the process by calling Adult Protective Services and asking for a check in for him (after a week of him mismanaging his life).

Does your dad have financial resources? If so, go pick out an assisted living community for him. Find one that you like and that will take him (smoking may be an issue, but there are ways to manage). DECIDE that he WILL move. That's the important thing. Be more stubborn than he is. Give up EVERY other battle but this one.

Good luck and, again, take care of yourself. Be upfront with your dad that you have to deal with your own life and will, if necessary, leave him to his own resources if he doesn't allow you to help him. Given his dementia, it will likely go in one ear and out the other, but it will help you to say it.
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Dadsakid Jan 2019
thanks for your help... I definitely need to be more forceful with insisting that he has help. I met with a company, and I requested a male caregiver who smokes. But of course, dad was fooling everyone into believing that he’s fine and doesn’t need or WANT help... and that was all they needed to hear, If he doesn’t want help they can’t force it.
If anyone knows of an AL facility that allows smoking in the rooms please let me know. I’ve researched high and low and they all have “smoking areas” or “smoking lounges” but don’t seem to allow it in the residential rooms. (And Dad is so belligerent, he lit up in the hospital!)
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Mouth infections from not brushing his teeth could cause a medical emergency. If an infection enters his blood stream, sepsis could occur. In addition, this is toxic for his heart issues.
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Dadsakid Jan 2019
I totally agree! This is definitely what scares me the most. He’s always been a nightmare to try to persuade to attend to his health issues, so I’m scared it might lead to sepsis. But his whole attitude is, “so what? Gotta die of something.” It’s just frustrating knowing that I will be the one stuck taking care of the mess he is surely creating. Once it becomes an emergency, it needs to be addressed immediately. Taking proper care ahead of time would make it easier to plan, but that’s the situation as it stands.
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Dadsakid, my heart breaks for you. My mother had full dentures put in - all her teeth removed - at the age I am now: 54. They never fit right and she never did a damn thing about it. Now she's 84 and her diet is basically mashed potatoes, green beans boiled beyond recognition and the like. Later this week, we are starting the transition to rehab for a debilitating knee injury and then into a memory care facility. She also smoked for 60+ years but without prompting, gave it up some years ago cold turkey. Her lab work is better than mine and my sisters. This generation is INVINCIBLE! on one hand, I admire their fortitude; on the other, I want them to ask for help when they need it! You pop clearly needs it and you're doing all you can to help.

There's a great Facebook group for Alz and Dementia caregivers. Good source of info as is this page. Consider seeking the services of an "elder advocate." A great friend recommended one to me and my sister here in Fla and she has been great. She connected us with a senior housing specialist who knows the ins and outs of the local market of housing facilities of all types - large and small, including private homes with maybe 5 or so residents. Your dad won't quit smoking (unless he can't get access to them anymore), so maybe a specialist who knows the market can find a facility that's more amenable to smoking. It's scary because they can cause harm to others, fires, etc., but let's be honest - you know he won't give it up.

My sister and I are paying the elder care advocate with Mom's funds and the housing specialist will be paid by the facility in which we ultimately place Mom. If you have the wherewithal to consider an arrangement like that, it will lift much burden from you. They know the questions to ask, and we have been very upfront with how difficult our mother is so she's not asked to leave where we place her.

I wish you so much luck in finding a suitable solution, so you can live your life again. And congratulations on hitting the 5 year survival rate. You can do this.
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Dadsakid Jan 2019
Thank you for your insight! Wow I’m glad your mom gave up smoking on her own.
i decided I’m going to take one day a week off, so dad will have to remember his pills and get his dry cereal himself.
i know that in the long run, everything will come to an end. I think that once dad has a medical emergency, the next change will happen.
Bless you! Hang in there!
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Dadsakid;
As your "screen" name says, dad is like a kid.
Being a parent yourself AND a teacher, you know how contrary and cantankerous kids can be!

If the pill dispensers are the usual little plastic weekly ones, get one of the locked ones - they hold more than a week worth and it is easy to check those missed (he won't be able to "double up" either.)

As for getting help - find a place where you can hire assistance, go WITH them and introduce them as a "friend" who is there to help YOU. I wouldn't exclude women from this attempt - I've read other comments where the person actually responded better to the female aide.

You might have to take some time off, or arrange visits/help when you are available. Start with shorter visits and they do tasks and get him familiar with them while you are there. At the least you can have this person check that meds are taken and do some cleaning, which will take a load off for you. If you have them bring your dad's "hero", he may learn to look forward to those visits. Gradually over time if he meshes with the aides, he may be more willing to comply with what they ask for. We tried bringing in aides to keep mom in her condo. She did not have a lot of medical issues, just wanted to get her used to having them, one hour per day, to check on her and that she took her meds (even with dispenser some were missed.) In her case she was too "independent" (she wasn't, only in her mind she was!) and after a couple of months, she refused to let them in. In your case, if you can get this working you can still "visit" when they are there and keep up the pretense that these are your friends helping you!

With dementia, you really have to learn that giving the person "decisions" to make doesn't work. Given a choice, they will choose NOT to do what needs to be done! For doctor and dentist visits, don't ask, just schedule it and if need be make some excuse for where you are going (time it for when he needs smokes or something, and say oh, we have to stop here first...) Trickery sometimes works! Our mother responds better if I put her appointments down in a pocket calendar.  Mom still can balk, but after a few "do I have to go?" or "why do I need this?" or "I'm fine, I don't need to go." I just put on the parent voice and say come on, we're late, we HAVE to go.

So, one at a time you can get all these appointments done, over a few months if needed. If it is basal cell, it can be treated (mom has had several, the last was small enough we just did a punch biopsy vs the MOHS treatment normally used.) It is also slow growing, so not as big a concern as other skin cancers. Not that I suggest you ignore it, just adding some perspective and prioritization!

As noted by others, DPOA allows you to make financial and medical decisions, but as for getting him to move? No. That's how I ended up on this forum. Mom wouldn't allow help in, but also refused to move (despite having planned for AL when the time came!) Elder attorney says we cannot force her out, but facility would not accept "committals", which was implied if we sought guardianship. We had to "trick" her - she got cellulitis, which is serious, and one brother drafted a phony letter from "Elder Services" at the hospital where she was seen in the ER. It told her she either goes where we choose or they would put her someplace. Madder than a wet hen, but she went to the MC unit. They did have to resort to a mild anti-anxiety for the initial transition, but otherwise despite wanting to go home (first condo, now previous address), she's "okay" there. Staff should know how to "manage" those who are contrary, if they are any good.

If you can find a MC unit that will accept him and TRY to work with him, you won't have to worry about the smoking. I seriously doubt you will find any place that would allow smoking indoors, and in a MC unit he cannot get out to get any smokes, so patch or cold turkey is it!
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Dadsakid Jan 2019
Thank you for sharing with me! Wow, I’m glad to hear that you were able to “coax” her into a MC unit.
The smoking issue is a huge thing for dad. I appreciate your advice about the caregivers. I’ve met with an agency and although they initially deemed that he was ok alone, im going to pursue a “friend” for him to come and visit. I told the agency that I thought it was better to have someone established now so that when his care needs go up, it’s already someone who is familiar with him.
God bless and thank you for your understanding!
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Dadsakid: You're welcome. Please know that you're not alone. Many elders have this wrong thinking. You may want to call in APS~pls forgive me if you've already written that you did that because I've just learned that my 74 y.o. wheelchair bound cousin died suddenly.
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Dadsakid Jan 2019
Oh no! I’m so sorry for your loss. Hugs to you and your family.
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