Elderly Parent Advice Needed

[East Coast Sue]

My dad is 82 and he’s been having balance issues- he falls. I’m a bit more than an hour away and his only relative who visits. I need some advice on what to ask/discuss with his gp doctor at his upcoming appointment. My dad has agreed that I can go to his appointment but he can be very difficult (stubborn, unreasonable) and likely is experiencing cognitive decline. He forgets a lot. 
Should I ask my dad to sign a medical power of attorney so I can speak with his doctor? Should he be looking at a caregiver or at what point does he need assisted living? He’s in a ranch within a 55+ community and he drives (but I’m not sure he should).

[SHP]

I am in the US and my answer reflect living here.

You don't need a medical POA to speak to his doctor, just a release of information. The doctor's office should have them for you to sign at the appointment.

If he is falling look into a life alert or similar service.

Re: caregiver and assisted living 

Are you planning to pay out of pocket for either? If yes then you can hire a caregiver at any time. If you plan for his insurance to help cover it then you have to talk to his doctor about medical need then play the insurance game. A lot of what you ask you have to talk to his doctor about.

[cintinative]

You don't need a MPOA to speak to the doctor--there is a form that you sign when you go into a doctor regarding HIPPA and if he lists you as a person with which they can share medical information, then you can ask the doctor questions, provide input, etc.

MPOA is more for if you need to direct his care, as I understand it. You might still want that. 

[Laura Corin]

Even without this issue, a POA for medical and financial is crucial for his wellbeing and independence.  You also need to record his wishes for end of life care, and check that his will is up to date.  All of these things need to be done while he is still legally competent.

Balance is made up of lots of things - people often disregard strength.  If muscles have wasted naturally with age, he will not be able to catch himself in normal situations of slight unbalance.

[cintinative]

You might want to ask for an OT and PT evaluation.  The doctor should be able to order that--you need to assess the reason for the falls and if any preventative measures can be taken (bars, rails, etc.) as well as if weakness is an issue.

[Katy]

I agree that he needs a neurological exam (simple, can be done in office with you), an OP & PT evaluation can be very helpful. It’s possible with a bit more exercise he can regain lost balance. 

[East Coast Sue]

26 minutes ago, SHP said:

I am in the US and my answer reflect living here.

You don't need a medical POA to speak to his doctor, just a release of information. The doctor's office should have them for you to sign at the appointment.

If he is falling look into a life alert or similar service.

Re: caregiver and assisted living 

Are you planning to pay out of pocket for either? If yes then you can hire a caregiver at any time. If you plan for his insurance to help cover it then you have to talk to his doctor about medical need then play the insurance game. A lot of what you ask you have to talk to his doctor about.

He has life alert and that has been important for summoning help. I’ll talk with his doctor and keep in mind the great advice everyone has shared. Thank you!

[heartlikealion]

If he's stubborn and unwilling, I'm not sure there's much you can do, but perhaps you can get "doctor's orders" as an excuse to make him work on exercises that help with balance. 

And maybe he needs a cane or walker now, rather than later. My mom had a bad fall once and broke a hip. It was awful. That was after a Parkinson's diagnosis, but before she'd been using anything to help with her gait and she was walking on her toes (neurological thing). Look at his feet next time you see him in person to see how he's walking. My dad does Tai Chi for balance, but I think that sounds hard for someone that is already struggling. 

[East Coast Sue]

54 minutes ago, heartlikealion said:

If he's stubborn and unwilling, I'm not sure there's much you can do, but perhaps you can get "doctor's orders" as an excuse to make him work on exercises that help with balance. 

And maybe he needs a cane or walker now, rather than later. My mom had a bad fall once and broke a hip. It was awful. That was after a Parkinson's diagnosis, but before she'd been using anything to help with her gait and she was walking on her toes (neurological thing). Look at his feet next time you see him in person to see how he's walking. My dad does Tai Chi for balance, but I think that sounds hard for someone that is already struggling. 

He has a cane but he’s either reluctant to use it or he just doesn’t understand/remember. I think he forgets to use the cane and doesn’t quite understand that it’s really important. 

[Laura Corin]

3 minutes ago, East Coast Sue said:

He has a cane but he’s either reluctant to use it or he just doesn’t understand/remember. I think he forgets to use the cane and doesn’t quite understand that it’s really important. 

My mother only started using her stick when a nurse sternly told her that she had to choose the stick or probable disability due to a broken hip.

I would talk to the doctor in advance about your concerns - even if they can't disclose anything,  they can listen. 

[athena1277]

1 hour ago, East Coast Sue said:

He has a cane but he’s either reluctant to use it or he just doesn’t understand/remember. I think he forgets to use the cane and doesn’t quite understand that it’s really important. 

That sounds like my dad.  He had Parkinson’s and some dementia.  It was like he would forget his physical limitations then fall because he wasn’t using his walker.  It eventually got to a point where someone was always with him because he was always trying to get up when he didn’t need to.

[Harriet Vane]

Ask the staff ahead of time for the doctor to order a full neuropsych workup. If he's got beginning dementia issues, you will need to get a baseline. 

The dementia tests they do in a regular doctor's office are almost useless, imo. Many can get through it on a "good" day even when they are having real struggles. I think we need to be more proactive about assessing cognitive decline. 

[Beth S]

It seems like EVERY Elderly Parent is resistant.
Agreeing with getting the testing & diagnosis, which may show something that's treatable.
Another option is moving him to a handicapped accessible apartment that is closer to your house.
Or Elder Care during the day, or a neighbor who can be paid to check in on him periodically.

All 4 of our parents are now in retirement apartments or locked memory care.
There's a point where they can't be left alone.
It's difficult for them to agree to move, much less deal with all the changes.

And strongly agreeing that you get POA for both finances and healthcare, while he's still able to sign off on them.
It's beyond "extremely difficult" to make decisions on their behalf without them.
Getting a estate attorney to quickly create those documents is only about $100 or so, & makes your future job 1000% easier.
 

[City Mouse]

Will he allow you to put a tracker on his phone/car if you are worried about him getting lost while driving? 

If you think he is dangerous to others when driving, then you may want to find out what the regulations are in your state. Sometimes an elderly person can be persuaded to stop driving, but other times it is a huge battle. I had to flat out tell my mother that if I ever found out she was attempting to drive their car (she had threatened to start driving again) that I would report her to the state. In Texas, if that happens, one of her doctors must certify that she is safe to drive. I know that none of her doctors would ever take on that liability, but if one did then it was out of my hands.

while jumping in and requesting all the recommended evaluations may be the way to go, some people may require a softer touch. I have relatives that would have tolerated a more aggressive approach to assistance, but other would not allow it. At first, just getting consent to allow medical information to be shared and just tagging along to appointments was necessary. As more trust was built up or as the parent declined further, then the adult child could intervene to a larger degree.

You may also want to find out what extra services may be available in his community for an extra fee. Could he have a meal delivered? Is transportation offered for shopping or appointments?

He may be at the point where a little more help could be beneficial but not be ready for a daily caregiver.

[City Mouse]

Regarding Assisted Living:

Without giving you all the details of my own family drama, services provided in AL can have quite a range. Where my parents now live, the basic rent includes weekly housekeeping, weekly laundry even personal laundry, three meals a day in the dining room, snacks/drinks on request, schedule transportation, daily activities, field trips (before Covid), even some grocery shopping. Before Covid, there were scheduled days  that residents were taken to certain stores, but now the staff will shop for the resident. Assistance above that is available, and there is a whole menu of types of assistance and the cost for each separate thing. Other AL places work on a point system. Each type of assistance is worth so many points, and  at a certain level of points the price increases. If a resident does not show up for meals, then someone will check on them. 

My father is good with just the basic level of services, but he does have the AL place manage is medications (not required if the resident can manage on their own). My mother needs assistance in most of he daily activities including bathing, dressing, pushing her in her wheelchair etc. She has fought any help for a long time, but has a private pay personal caregiver come on a daily basis to help her instead of paying the AL place for that assistance. Now she is able to get from her wheelchair to her recliner and back with a walker. She is able to get from the wheelchair to the toilet and back again with the walker. If she loses more mobility to the point that she is 100% dependent on caregivers to move, she will be required to go to nursing care based on the regulations in Texas.