What kind of professional is best able to manage and advise the total scope of someone's Alzheimer's care?
What kind of professional is best able to manage/advise the total scope of someone's Alzheimer's care? My father is at home after multiple sedative overdose at a nursing home (and three weeks in the hospital to recover). We have two paid staff caring for him most of the time except for afternoons when there is one. He lives with my mother who is 80 and very dependent on outside advice for all decisions regarding my father's care. His doctor is an internist who is also my mother's doctor, and I believe there is a conflict of interest. He is more concerned about my mother's health due to her stress, though she is not doing any direct care of my father anymore and is now able to sleep at night. She is not happy having people in the home but my sisters and I begged her not to let my dad die in the nursing home, and she has gone along with that. Most of the time my father is kept in bed. Before the nursing home episode he was ambulatory, could go to the bathroom by himself and eat normally. He could go out and get the mail and check to see whether the cars were in the garage, etc. Because of the drugs in the nursing home (Haldol, Ambien, Atavan and Benadryl), he almost died - kidney failure and lungs were filling with fluid. The drugs paralyzed him so he could not eat. After three weeks of recovery in the hospital he was walking with help and could eat ice cream, but they sent him home with a tube in his belly anyway. Medicare paid for some physical and speech therapy but they only paid for three hours of therapy, six half hours each and his case was supposedly closed (I cannot get the agency to return calls). He has regressed from where he was in the hospital. The staff leaves him in bed a lot, even when awake. I would like some answers but the care agencies seem most concerned with liability so when he sneezes they say go to the emergency room. Help!!! I am thinking about getting a geriatric doctor for him. My mom is OK with this. But it seems to me a doctor will just examine him and point us to more of this "care" that is more concerned with filling out the proper forms for Medicare and limiting their liability. Social workers seem to be experts at how to obtain benefits (and where to find a nursing home), but most of these Medicare "benefits" that my dad received appear to have been a waste of time and taxpayer money.
Expert Answer
I'm appalled at your father's treatment, but sadly, I'm not surprised. You're correct that your father needs to be seen by a gerontologist, an MD with a geriatric specialty, or a geriatric psychiatrist. Also, contact a social worker to help you through all the mazes.
I would expect the new doctor to make substantial changes in your father's care. As long as he's able to swallow, he should not be on a his feeding tube.
Talk to the new doctor about a comprehensive plan, including physical and occupational therapy. Ask the doctor to write a detailed directive to the agency. (You can write it and have it ready for the doctor to approve and sign.) If the agency staff won't comply, it's time to switch agencies. If you need to, file a complaint with your state's licensing agency.
For his mental and physical wellbeing, your father should be up and walking and encouraged to participate in daily life as much as possible, including his old pleasures of getting the mail and checking on the cars or something equivalent. Direct his caregivers to keep him up during the day, except for a one-hour nap in the afternoon. Ask the physical and occupational therapists to give the staff a care-plan to help him rebuild his muscle mass. (A few days in bed will quickly cause atrophy in our muscles.)
I'm sorry that you've had such negative experiences with the "system." Unfortunately you've discovered the hard way that families need to be proactive when helping a parent with dementia. I hope that you're acting proxy for the healthcare of both your parents. As healthcare proxy you have the right to specify if and when your father's to be taken to the emergency room.* The truth is that ER visits can be so traumatic that a person can suffer an immediate and sharp decline in their dementia. If the healthcare agency is not willing to follow the directives, dismiss them and hire another company.
We all need to be well-informed and proactive when caring for our aged parents. When you meet with your "team" (caregiver, geriatrician, social worker, PT and OT) put together a comprehensive care plan and stay involved as much as possible.
Your father is the consumer. Don't let the system bully him and you! Your dad deserves to live the best of days, eating ice-cream or whatever makes him happy. Good luck.
*A personal note: I had a directive for my dad when he lived in a care facility. It said in no uncertain terms: DO NOT SEND DAD TO THE EMERGENCY ROOM EXCEPT FOR A BROKEN BONE OR UNCONTROLLABLE BLEEDING. He lived to 96 1/2, happily dancing and singing until the last day.