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Up until yesterday. I thought my 93-year-old father was quite sharp for someone his age. He lives in the Independent Living area of a facility. He listens to the radio & watches TV, keeps up with major current events & has maintained a dry sense of humor. Also neither my brother or my husband have noticed any changes in him. Recently, some repairs/adjustments were made to his apartment which had been requested months ago. When his bathroom vent fan was taken out in preparation for a modification, he told me that "the guy came in, took it out & said nothing", meaning he was not told why the fan was taken out, what would happen next, etc. However, during a spontaneous conversation with the director, I was told that dad WAS given a detailed explanation.
I also handle his pillbox, which lights up when it's time to take a particular med. I was told that housekeeping has found pills in his linen when doing the laundry. Dad has always been particular about his med regimen. I briefly discussed these things with him & he insists that no one gave him any info about the fan. He also said he takes his meds when the pillbox lights up. These are just a couple of examples that I've been told that are very disturbing, if true. I even asked the director if he had him confused with someone else! I spoke to the head nurse who is concerned especially about the meds. I requested that she set up a cognitive eval for him.
My concern is: who is telling the truth? As a retired RN, I'd like to think I would see these kind of changes myself. How do I tell him about the cognitive eval without scaring him? How should I proceed otherwise? I'm not sure who to believe.

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I would ask myself why would these other people lie? What do they have to gain?

Sometimes we are too close to the situation and do not see what is right in front of us. It is always harder to accept decline when it is someone we love, when at work, people are at a arms length away...totally different.

I just took my step mother for evaluation, she didn't want to do it, I told her that we need to know because we want to keep her in AL and not have to move her husband into into MC. She said ok. Although I do know when he passes that is where she will have to go.

Good Luck hope that he will agree to go!
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My late fil would have told you he had taken his meds. Each morning, he counted out the pills he needed to take and put them in his chest pocket. If there were no more pills in it at the end of the day, he "took them all."

When I found random pills on the floor, we realized what he was doing and had to have his medication supervised.

My Dad generally appears to be all there cognitively. He sits at the table and organizes his pills. He takes them as scheduled throughout the day. However I find them on the floor, tucked under the edge of his place mat or under a napkin.

The cleaning staff have no reason to lie about finding your Dad's medication in his linens. Dad is telling his truth, then the medication dispenser lights up, he takes the pills out. But he may not take them right away. He may put them down, while he gets a glass of water, then get distracted.

My Dad appears to be 100% all there. He is also very defensive if questioned. It is very hard to see the changes in our own parents. Even for a retired RN like yourself. You want to believe Dad is 100%, when the evidence clearly shows differently.
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What benefit do you feel there is in their lying to you? I think you cannot know who is telling the truth, but I suspect that the AL is telling the truth, because I cannot imagine their fibbing about it. If you want to private message me I can tell you about a personal experience of mine I don't care to mention here, that taught me quite a lot. There is a reason that there is this "pill box that lights up" etc. There has been some recognition by someone that there is starting to be some failures, infrequent perhaps, in cognition needed to know when to take the pills. Perhaps things are getting a bit worse. As I said, I cannot imagine a reason to lie. Are you thinking they are wanting to bump your 93 year old Dad up in care level and there is a method to the madness? At 93, if Dad didn't have some forgetfulness going on I would be very, very surprised. I know I am 77 and I surely DO.
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nature73 Jan 2020
Not sure how to PM you. Will explore how to do this.
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About the fan. I expect the idea is something like "all people working in our facility should take care to explain any work they are doing to the residents involved," and I expect everyone is given some kind of basic training to that effect. And I also expect that quite a lot of the time it doesn't happen: the worker won't have enough time allocated to the job, the worker starts work before the resident is in the room and explaining would get complicated, or the worker begins to explain, the resident doesn't immediately catch the thread, and the worker gives up and goes about his (legitimate) business. So I expect that the director was telling you what ought to have happened, rather than necessarily what did happen or what your father was able to pick up from what was said to him (how's his hearing, by the way?). Nobody's lying, they're more... thinking wishfully, perhaps.

Pills in the linen - how fiddly are they, and how easy is it to get them out of the dispenser? One thing I have noticed (mainly male) people doing is shaking all of their tablets (and it's sometimes as many as eight or ten) into the palm of their hand, and then clapping the palm to their mouths, whammo, just like that, to get the pills down in one. It makes my hair stand on end. If any one of those little tablets goes astray down a shirt front or between the chair cushions I have to track it down, identify it, and record the mishap on a chart, and it is a gigantic pain; but we're not allowed to tell people how to take their tablets if they're doing it themselves. The other thing that commonly happens (more with blister packs) is that the pills are tiny and the tray is deep, and one or two get overlooked.

So if possible, can you be there when your father takes his medications and just observe him without comment? You might spot where the problem is and be able to make a minor adjustment, nothing at all to do with cognition (unless you count not being as punctilious as he might be about his meds).
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Barbeem Jan 2020
Yep that how my 97 dad takes his meds! Cup the hand and all in the mouth! Then I found many in the floor. So I showed him where they ended and encouraged to take one at a time! He would only take them "the right way" if I stood by him. Lol
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Thanks all for your prompt replies! I have no reason to think the facility staff are lying. This is a new facility & there are fewer than 30 people there at present, so they probably don't have him confused with someone else. But since he is in the Independent Living area, I don't know why they are so upset about the meds. I admit I still have a lot to learn about senior facilities. I will try to hang around when he takes a set of meds & see how he manages. Still could use some words to use when proposing a cognitive evaluation.
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Countrymouse Jan 2020
They're probably upset about the meds because every pill found has its own set of forms to be filled in! Is there anything about Medications Administration in his service contract with them?
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You can leave it to the facility to explain the evaluation to him. They have to anyway, because they can't carry it out without his agreement to it, and then when he tells you about it you discuss it as a matter of course, a standard baseline brain function assessment to ensure all is well, just part of monitoring his health overall. Which is all true.

Were any of the other examples less easily explained than those two?
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nature73 Jan 2020
The other day, 2 of the resident care assistants woke him up about 9:30 pm to WEIGH him! When dad told me this I contacted the ED to confirm since I wanted to know if this was fact or fiction. He said they were in the process of weighing all the residents for baseline info. & said he would speak to them about doing weights during the day. I guess this is why I'm insecure with this facility - why does the staff have to be told NOT to wake up folks in the middle of the night? Yes I know - some staff are lacking in common sense.
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I found that the facility and staff will lie when the truth serves better.

They will cover up for one another and misrepresent things to "pacify" the seniors advocate. Don't assume that they wouldn't lie or don't have anything to gain, how about a mew AL resident that has to pay thousands more monthly.

Do you own due diligence and confirmation of the facts, maybe test dad with some information, have blood work done to test for the levels of medication in his system.

Best of luck sorting fact from fiction.
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can you a up a temporary camera without your dad seeing it? Perhaps that my show you something.

Or the staff wants to take care of the meds so they can charge the family for that service. Yes, but it may be helpful...
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nature73 Jan 2020
My concern is exactly that - the facility can charge for med administration. I don't mind if it's necessary. That's one of my concerns.
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The cognitive eval could simply be presented as important to get a baseline now while everything is fine in case he should have a stroke or some other medical event or the doctors simply want to rule things out should his cognitive function start to decline. Maybe you could even get his doctor to help out by saying it's time to get a cognitive baseline because it can be so valuable in the future if needed. I wish we had gotten one before my mom's stroke, her aphasia makes some of the testing and results hard to read/accomplish now. So telling him it might be helpful in the future and he's fortunate to have a doctor who prepares this way isn't really lying it's just not sharing the part about current concern.

As far as whats happening with his meds in particular, we use an overhead camera for my mom mainly for just this, to make sure she takes and gets all of her pills. When we first set it up she was a bit more independent than now and still using the long weekly pill cases but it's even more important now. All her medicine is kept on the one table which sits next to her big main table and the camera is overhead. It is motion sensitive so every time there is motion under it, so she reaches for anything on the medicine table, it saves a clip and we can go back and watch when she took her pills for instance. If you can set something like this up in his room maybe and then be able to look back or peek in when he takes his pills to see hows he's doing it. This way you have some oversight and assurance without him feeling like he's loosing his independence. My mother by the way has known about the camera from the get go and it doesn't see the entire room we have it framed just over the tables and were careful about her privacy but she has become accustomed to it and comfortable about it all now, in fact she counts on it now so I am not suggesting to do this on the QT but you also don't need to bring it up after installing unless there is a problem. With your dad being in AL though I'm not sure if they will have something to say about it.
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Your father does sound pretty sharp as you say. But at 93, I would not be surprised that he is having memory problems. My FIL, also 93, finally agreed to move from home to facility in October 2018. He would only agree to go to independent living apartment in a facility with 3 levels of care. He had been providing care and supervision for MIL with moderate Alzheimer’s. I am also a retired nurse although I was still working at the time. Prior to their moving, I had been going to doctor appointments with them and noticing a lack of judgment on his part. He allowed her for example to go out on the driveway to pick up the newspaper. We are in Chicago area and when the driveway was a sheet of ice he thought it was fine because she remembered to put the rubber “ice picks” on her shoes. He seemed perfectly reasonable when he talked about all sorts of things. His type of dementia is primarily vascular dementia which manifests itself with loss of executive function like judgment and problem solving. So first I had her evaluated with neuropsych eval and then I had him do it. His kids thought he was fine but I told him and them that I was noticing things I was concerned about. He was not happy but he did go. The suggestions here to just say it is a baseline evaluation which is reasonable at his age are good. You don’t have to bring up the meds. But you do need to insist. Even then he may just come out as “cognitive dysfunction rather than frank dementia. It is just a piece of the puzzle. I have no doubt the fan replacement was explained to him. Maybe briefly but the guy probably did tell him. And he forgot. Or maybe he was not told. That is less of an issue than the pills. He is most likely not taking his pills completely properly. My FIL has always filled the med boxes for both of them once a week. I used to check and it seemed he got them right and he said MIL took her pills but she did not. When we ended up having to move them from IL I found pills all over the place. But he seemed very convincing that he had this under control. He had always been very proud that he was managing so well. But gradually he really wasn’t. And it was so subtle that I was not sure at first what I was observing. He always had a very plausible explanation when I asked about things.
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I would just be upfront about it. I'd let the part about the fan go; I can see how it's a little worrisome you're getting 2 stories, but there could be any number of pretty benign reasons for that. I'd go ahead and assume it was just miscommunication. But the part about the medication is more concerning for all involved.

So I'd just tell him that they've found pills in his sheets and under the bed and are worried he's having trouble with them, and that's why they are checking his cognition. Just let him know that you realize he may be dropping them inadvertently, and that you think he's very capable, but that you still need to help find a solution to the problem, and that besides, a cognition test is an important measure of how he's doing (can be used as baseline, as someone else suggested).

Reassure him that he's not "losing his grip" (as my dear, sharp, grandmother used to worry) and that no one is trying to take away his autonomy. You need him to feel he can trust you and the best way to do that is to assume the best of all parties involved and be as upfront and caring as you can. I'm sure if he's as sharp as you say he is, he will be able to reason through all this.
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As a nurse, you probably remember that older patients can confabulate to "cover" for problems. You also realize that staff will do the same to "cover" their problems. You'll have to check to see which version is true. Check dad's linens and also his garbage. I could imagine a pill or 2 accidentally getting in there if dad's vision is not the best but not every time. If you find more pills scattered about, it is probably time to ask the facility to administer his meds. He may have forgotten the conversation with the repairman. Some repairmen are good with instructions, some not. Did the repairman document the conversation? As for the cognitive eval, I wouldn't lie that he is getting one. Let him know that it is a good idea and maybe should become routine for all folks 75 years old and older... especially sine 75% of folks 75 years old and older have some dementia.
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As a family member who is close to him, you may not notice cognitive changes in him especially if they are subtle. I think a cognitive evaluation is a good idea. I wouldn't make a big deal of the evaluation just treat it it as routine. I don't think these events can be reduced to truth versus lies. Could be how dad remembers the situation compared to how the staff remembers. However, I don't think that the staff would enter the room unannounced nor do I think that they are misrepresenting the medication issue. In any event, what is best for your Dad should be the primary concern.
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Believe the staff. They have no reason to promote an untruth. The bathroom fan is a non-issue. The meds found in his linens is serious. My sister, with dementia, adored her 7# dog and treated him as her child. Staff told me she was being mean to him. IMPOSSIBLE!! So I watched her (unannounced) and Bingo, true!! I found a loving home for him within days.
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my2cents Jan 2020
I would never just 'believe' the staff. This family needs to put their own eyeballs in the room to see what is going on. And observation needs to happen for at least a week every day.
The fact that there were some pills in the bed means that he DID open the pill dispenser when the light went off. It's possible he just needs to be opening the box at a table where you could easily find one that you dropped.
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I was shocked at how bad my mom had gotten and had no idea until I stayed in a hotel room with her.  We drove out of town for a family funeral so my mom was out of her "every day element".  She was nuts!  I sent her into the bathroom three times to change her clothes and every time she came back out and had no idea what she went in for.  I found the clean clothes I had given her to put on, tied in a knot around the grab bar in the shower and I found the clean underwear in the toilet.  My mom truly believes what she is telling me when she talks, but I know what she is saying didn't happen.  When my mom says things that I know are not true, I don't consider her to be "lying" I consider her to be sick...she has dementia.

No one in my moms extended family wanted to believe she was sick.  I am not sure why they thought I would make it up, but they would say to her...you remember me giving you $100 for your birthday don't you?  And she would respond yes.  Or they would say don't you remember that kid Jimmy that lived next door to us when we were growing up and she would respond yes.  So they would say, see... she is fine.  Just recently though, my uncle asked my mom what his name was and she couldn't come up with it....he finally dug deeper than a yes or no answer.  He was shocked that she didn't know her own brothers name.

My point in telling you all of this is so you will dig a little deeper.  Take him to lunch and then ask him the next day what he had for lunch when you went out.  Ask him the name of the restaurant you went to.  Give him something to read and then ask his opinion on the matter.  

I can certainly see a worker knocking on your dads door and saying I am here to work on the fan that's broken...and not go into much more detail than that.  But I don't see why the workers would fabricate finding meds in your dads bedding.  What would be the point?

One of my moms neighbors in the Assisted Living Facility kept saying that the employees were stealing his things so his son installed a camera in his apartment.  So the next time he told his son that his bag of toiletries from walmart was missing, his son looked at the video, saw his dad hide the bag behind some things in a closet.  He looked in that spot and there were the items.  His dad had just forgotten that he hid the items. 

It is a horrible thing to accept that our parent is not the same and on the decline.  Your RN status does not change the fact that you you have been around this man your entire life and you expect him to act a certain way .... you are on auto pilot with him just as much as he is with you...  Just dig a little deeper...take him out of his routine and see what you see...

The cognitive eval is not a bad thing.  Just tell him the facility is going to have a visit with him to see how things are going.
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My LO was pocketing her meds, but would look you straight in the eye and tell you she took them.
The SNF now crushes her meds and adds apple sauce.
i didn’t request the crushing of her pills but I’m glad they do it because
it assures she’s getting her meds, and one less thing for me to worry about.
Her dementia has gotten worse in the last year, and even though she’s on dementia meds, along with mood stabilizers it makes me wonder how would she be without them.
Good luck with your dad. Sounds like he has kept himself together for Many Years. My LO is only 67 years old.
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Evaluation or not, I agree with JameJ that you will know what to expect if you dig a little deeper yourself. Cognitive decline shows. Now about scaring him : it's a real concern. I convinced my mother to undergo one 2 years ago (she feared it but did it for my sake) and I found it horrendous. The doctors insisted on asking her questions about her life in front of me, and asking me the same questions about the same events in front of her, just to make her realize how out of touch she is. We didn't even finish the tests. But then, other people I know have a better experience. Try to know where you go before you go. And also try to ask a reliable doctor if it really helps or not. Will his life be better ? Yours ? Is it necessary to have access to needed care or treatment ? Be practical : if the whole point is just to know what's going on... well, you will very soon know anyway.
I must add that after this aborted evaluation, her doctor said that at her age (91) she wouldn't be submitted to hard treatment anyway, so we let it at that. It's been 3 years, her decline is slow. I moved in with her and help with what needs to be done.
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AnnReid Jan 2020
My experience with cognitive assessment was very different from yours, and I regret that your LO suffered this indignity.

In our case, I sat behind my LO in a relaxed and somewhat familiar environment. I was able to signal the examiner if responses weren’t accurate.

The “text” was conversational and informal. I had not mentioned to my LO that she would be tested, and in my experience, and particularly with her particular difficulties, that was better for her. I wonder if your mother might have managed more comfortably if the same approach had been used with her.

Your point about collecting information for meaningful, practical reasons rather than demonstrating deficits is, in my opinion, VERY important. In our case, the examiner was able to determine that my LO was struggling in many social and life skill situations and needed much more support than we as her family, had suspected.

The exam results were interpreted to me immediately, and a follow up documented printable description of her test results and observed behaviors became a valuable tool in setting up what was needed for her new life in Assisted Living Memory Care.
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You or someone needs to spend more time w/dad - perhaps about a week of being there all day long to observe.
The repairman came in and took the fan, but director says dad given detailed info. Unless the director was the one sharing the info, she has no idea what the repairman said.
As for the pills, dropping them can happen. My mom is very alert about her meds and knows each one to get out of pill bottles each day. However, there are times I'll find one under or around her chair. It dropped, she didn't realize it as it went from hand to mouth and she missed a pill that day. If he has a kitchen table to sit at, put the med box there and let him know it would be easier to find it if it dropped. Just let him know that if he accidentally drops one, it can cause him problems.
I wouldn't do an eval on him right now. You just told him a repairman explained something in detail (that may not have happened) an talked to him about missing medicine (which he is really not forgetting to 'try' to take if they were found outside the med box). First observe.
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lealonnie1 Jan 2020
Not only is it a bit unrealistic for a family member to spend all day every day with a resident for an entire week, but that will not guarantee anything ANYWAY! Cognitive decline is a real issue; it comes and goes without rhyme or reason, too. They can be fine one day, and out of it the next. I never blindly believe anything my mother tells me in AL. Why? Because she's made up stories CONTINUALLY for years now! I have to fact check EVERYTHING she says otherwise she'd have me in a tizzy 24/7.
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Based on my experiences with my own Mother, who has Frontal Lobe Dementia and Delusional Disorder, I would 100% believe the staff. Much of what Mom tells me is not true. To hear her tell her, she is being tortured on a daily basis. The staff says she actually has made a couple of friends and is adjusted reasonably well. Definitely listen to the staff!
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My sweet LO fought her forgetfulness and confusion like a lioness, attempting for months to keep the secret that she herself knew her cognitive skills were failing.

Even I, who was probably the closest person available who knew her, was somewhat shocked when objective assessment was undertaken, and her degree of loss was revealed.

See what happens during the cognitive test.
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My mother is 93 at the end of the month; lived in AL for 5 years going downhill cognitively and physically the entire time. She told me stories that made my head spin! Had me in a tizzy many times, calling the AL, speaking to the ED, on and on. She was making up stories, is what it boiled down to. One time, she even had the SHERIFF come to her door over a 'stolen necklace' situation she INSISTED the staff had pocketed. When the sheriff showed up, she sent her away immediately, saying 'nothing was missing.' It was a show for her friends, as it turned out, and they ALL got worked up insisting THEIR stuff was 'stolen by the staff' also, thanks to my mother. When I arrived the next day, I opened up her jewelry box, and guess what I found? The 'stolen necklace' that was there all along. "Well where did THAT come from?" she wanted to know.

That little incident taught me something important: FACT CHECK EVERYTHING THE LOVED ONE TELLS YOU. Call the AL right away with ANY question you have, ANY claim that's made about anything that sounds in any way fishy. Get the real story from the staff and then you can let it go.

For those of you who insist there is 'no such thing as truth from the staff' at an ALF, that is false. There IS such a thing as the truth if you find the right ALF for your loved one. Not everyone is evil and out to hurt us. Not everything is a conspiracy. There ARE good and kind and loving CNAs, nurses and EDs who have devoted their lives to the care and nurturing of our elders. If you haven't found that, it doesn't mean you 'live in a small town' or that you're 'NUTSO' or that you're naive. It just means you need to continue the search for the RIGHT place for mom or dad.

As far as the cognitive eval goes, I have sat there and watched my mother go through no less than 8 of them. They're no big deal; they take about 15 minutes. They are not going to ask your father ridiculous questions like the square root of a number, or who was president in 1888. They ask a couple of memory questions; they will mention 3 words like cat, house, book, asking your dad to remember those words. Then, about 10 minutes later, they will ask him what those 3 words are? Then he'll be asked to draw a clock showing 4:00 or whatever. That is to test executive brain function, which is like the conductor of the orchestra. If the EB function is diminished, then the rest of the orchestra doesn't know WHAT to do, if you see the analogy. My mom drew some blob on the paper that had NOTHING to do with a clock at all. That's when I KNEW her EB function was gone and THAT was why she was having struggles with everyday life! The test is not designed to harm but to help. Laugh it off with your dad, sit there with him and smile. Don't turn it into a federal case and it won't BE one.

Wishing you the best of luck moving forward. This is not an easy disease to deal with. Allow common sense and above all, COMPOSURE to prevail. Hysterics and over-reactions are commonly advised here on this forum but rarely warranted.
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NeedHelpWithMom Jan 2020
Lealonnie,

Dementia and ALZ patients have this type of behavior. I know others who lie or put on a show without any dementia. They are attention seekers.

They know they are lying. They get caught in lies all the time. Personally, I think some people are bored, some love drama, some love the attention, etc.

Why do you think some people refuse to join in the available senior activities? Asking you because you see their actions on a regular basis so I feel you know more than most people.

Please tell us why some people stay in their rooms or stay at their homes and isolate themselves. Then they get bored and stir up crap to entertain themselves.
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All good answers here. Only one more suggestion. When maintenance does any work for an assisted living client, all instructions/communications should be written on paper for the resident to review. Many of them may have minor memory issues, but they also likely have hearing deficit too. Written and posted works better over all and ensures that the maintenance worker has informed the resident. A baseline cognitive test is always good is no need for worry. In fact, as long as one is worried about memory, one has little to worry about. It is when you are worried, that there are probably issues.
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Side note, my mom was (sometimes is) having issue dropping pills--especially the small one--despite using a pillbox. We switched to using a box that has a smaller removable box each day of the week. She can then open only the morning, midday, or night compartment and pour them into her mouth. Voila, less pills on floor, hidden in the chair, and under the bed. Maybe this idea will help someone else.
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NeedHelpWithMom Jan 2020
Dropping pills are common. Those boxes are too small, especially for people like my mom with Parkinson’s disease. Someone needs to design a larger more functional container.
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Believe the staff. I have gone through this so many times with my 93 year old dad.
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I would really like to believe that the Assisted Living was NOT telling untruths.
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Sometimes you don't see it. I don't think he is lying because I'm sure he believes he is taking the pills and remembering events accurately. Also, my grandmother passed a cognitive eval with flying colors at one point when we knew that she wasn't remembering things. Big things. We just learned to keep an eye out and speak to staff often. It did result in having her medication administered to her instead of having it in the room. (I have also found pills in the linens, under the bed). I believe they were just dropped while being taken.
As far as the eval scaring him, it might not. You can just present it (or the staff can) as a routine thing. No one told my grandmother that was what they were doing, but she told us later that she could tell they were testing her memory and she was super proud that she showed them! One of those moments I just had to laugh at.
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The first eval was scary for my FIL and he didn’t want to do it. He had just left inpatient rehab after an extended hospital stay and we explained it as a way to show the professionals that we have our ducks in a row, that we are able and doing what he needed. We just recently went back for an update. He wasn’t excited to go by any means, but we told him again it was to be sure we were doing our best for him. Idk if they are all like this, but we had a consultation and have a separate appointment for testing. That fight may be harder, time will tell.
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nature73 Jan 2020
Those are good responses to why a cognitive eval needs to be done. I'm also going to tell him we need a baseline so if issues come up we'll have something to compare.
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