New Bachelor Pad Chosen

I chose a new, “permanent” memory care facility for my dad today.

Yesterday I toured the nice new facility I looked at last year. I will call it ALF A. After putting him in a lower-tier local place for a week, it looked like Buckingham Palace. The ceilings are high. The windows are big. The common area is nicer than what you would expect to find at an expensive hotel. The residents have a lot of room to move about. They had a sort of bar where the residents could sit and eat brownies and snacks. They have activities. I did run into some smells here and there, but there weren’t many, and judging by the general atmosphere, overall, the place is very clean.

Today I looked at a place closer to home, which I will call ALF B. I had low expectations from looking at it from the outside, but inside, it was very impressive. It’s older than ALF A, but it’s substantially nicer in some ways. They have a serious medical area with x-ray equipment and an exam room. They also had a bar, and a lady was behind it serving normal-looking food made from scratch. I barely smelled anything during my entire visit. The rooms were much smaller than the rooms in ALF A, but they looked a little less institutional.

ALF B is a little nicer, yes, but it’s mainly nicer in ways my dad doesn’t need. He does not need to be x-rayed on the premises. It won’t bother him if there are times when an area smells while an accident is cleaned up; he has no sense of smell. ALF A has a better building and a nicer courtyard, and those things do matter.

I had a long talk with the sales lady at ALF B. She was extremely helpful. She put me in touch with an attorney who handles ALF stuff for veterans. I found out my dad might be eligible for help even though he has assets. While I was researching these things myself, I found out my dad did not really serve during the Korean War, as he had claimed. He actually served after it ended. The attorney’s office told us the eligibility dates actually extended past the date of the war’s end, so we may be in business. Also, the attorney is able to deal with the VA, which is something I’ve never been able to do. They give you the runaround and fail to respond to letters.

We talked a long time, and she said something she probably should not have said. When I mentioned the cost of ALF A, which I thought was high, she said it must have been an introductory rate. She thought it was low. She said they would probably raise it the next year. Then I found out what ALF B charged. They want over $6000 per month! ALF A would save us around $1500 per month.

When she told me I was probably getting an introductory rate, it made ALF A look better, not worse. An introductory rate is a good thing. If I can get excellent care and save $18000 per year, I’m not going to sneeze at it. To save that much money, I am perfectly willing to drive him to the doctor a few times.

My dad may not live a year. If not, the introductory rate is the final rate, and there is no down side.

I called ALF A and left a message, telling them to get the ball rolling. If I had infinite resources, I would choose ALF B, but we are going through a period of very big expenditures for other reasons, and I feel uncomfortable about overspending right now.

What if ALF A doesn’t work out? No big deal. I move him to ALF B. We lose nothing except for a move-in fee. Both ALF’s allow residents to break leases with 30 days’ notice, with no penalties. I would not want to lose the move-in fee, but if he’s there for two months, it will be more than paid for by the difference in price.

The sales lady said ALF B believed in letting people “age in place” until they died. Sounds great. I don’t know how important that is to a demented person, however. I believe my dad will soon reach a stage where he doesn’t remember things well enough to consider a place home. During the last two years of her life, my aunt had no idea who her husband was.

In other news, we went to a neurologist. I thought it was a waste of time and possibly a move intended to generate fees. His primary care doctor recommended it. When we got to the exam room, the neurologist asked us what we wanted from him, and I told him the visit wasn’t my idea, so I was open to suggestions. Clearly, the PCP didn’t have anything definite in mind, which makes me wonder why we got a referral. Doctors like to send their buddies business, especially when Medicare is paying.

He looked my dad over and said some surprising things. He said he thought my dad might have Parkinson’s or hydrocephalus. My dad has balance problems, and I have been given to understand that they were caused by vascular dementia. His old PCP believed my dad had vascular dementia, so I accepted it and assumed that was his only problem. I didn’t look for new answers. The neurologist he saw in Miami didn’t mention Parkinson’s or hydrocephalus.

We are getting an MRI soon. The neurologist seemed to think we didn’t really need it, because treatment was no longer a practical option, but he decided to order it anyway.

Hydrocephalus in adults is a strange disorder. Russ Emerson of Tacjammer was diagnosed with it a few years back. Terrible thing. One of the most-liked people in the Blogosphere. Before the VA figured out what he had, he sustained paralysis in his legs and God knows what else. I think he also had some CNS damage.

If they catch hydrocephalus early, it can be reversed to some extent. That’s my understanding from Googling, anyway. I was disturbed to read that, because it made me wonder if I let bad doctors give my dad the wrong treatment. What if a shunt could have restored a lot of his mental ability, and I just didn’t know it? The new neurologist says treatment will not help my dad now, however, so I suppose the question is academic.

Truthfully, all responsibility ultimately lies with my dad. He ate and drank what he wanted all his life, and if I had not interfered, he would never have done anything about his mental state. He would probably have died 5 years ago.

If the first neurologist had told my dad he had hydrocephalus, and treatment had been a viable option, obviously, we would have tried it. She scanned his head and saw no evidence of hydrocephalus. When I talked to her on the phone, she didn’t mention it.

I can’t save the world. Things will always slip through my hands. I hope I didn’t let my dad down.

I don’t think there is any doubt that my dad has vascular dementia, because he slips in sharply defined, instantaneous, permanent steps. The new neurologist said that was characteristic of vascular dementia, and my dad has a history of high blood pressure, high cholesterol, and atrial fibrillation, which cause vascular dementia. Also, his sister had vascular dementia and then died from a stroke.

There is no reason why he couldn’t have vascular dementia AND Parkinson’s or hydrocephalus. The gait problems didn’t develop until well into the dementia process, so for all I know, he started out with vascular dementia and then developed an additional problem which no one saw fit to treat because it was assumed that vascular dementia was the cause.

His remaining sister has Parkinson’s. Maybe he got a double whammy.

He did so many things wrong, who can guess what he did to himself? He used to drink 5 shots or more per night. Maybe that, by itself, could have caused dementia.

I was afraid the neurologist would want to put him on dementia drugs, but they don’t reverse the disease, and the side effects are awful. Another problem for everyone who cares for him. I looked into them, and people whose loved ones were on them did not seem to like them at all. Also, his old PCP recommended against them.

Dementia drugs can cause new mental abnormalities. I suppose that wouldn’t be my problem if he were at an ALF, but I don’t think he would enjoy being psychotic or having insomnia.

The urge to overtreat is a big danger. Years ago, I sent him to get himself a CPAP because I was concerned he might get brain damage from sleep apnea, and I ratted him out to his PCP when he drank too much, but today things are different. I just want him to enjoy life. He doesn’t have to have every conceivable treatment; only those which make him feel better. He’s going to die. We can’t bring him back, so there is no point in filling him with new drugs and carting him from doctor to doctor. If he didn’t insist on continuing to take his circulatory drugs, I would be happier to see him give them up and let nature take its course. The future will only get worse, so there is no point in dragging this out. I just want him to receive salvation and move on to the afterlife without a lot of unnecessary struggling and suffering.

I am getting an inkling of what post-Dad life will be like. Today I worked on a faucet in his bathroom. It reminded me how abnormal my life has become. He broke the faucet over a year ago, but I didn’t get it fixed because I didn’t want to send a plumber in there. Even after mopping with bleach, it was just too nasty. I didn’t want to touch the faucet myself, either. Now that he’s gone, the bathroom is nearly clean. I have been cleaning and re-cleaning. I was able to lie on my back under the sink without wanting to soak my body in Clorox afterward.

I have been concealing my food and flatware from him. Now that he’s gone, I can’t get used to putting the bread on the counter or in a pantry. I keep looking for the flatware in the wrong place. When your food is constantly threatened by filth, it’s traumatizing, believe it or not. It changes you. I have to get used to the fact that I can use the cupboards and drawers again. I can move my food from my special locked fridge to the one in the kitchen.

It’s very strange to go into the kitchen and not see smeared fingerprints and handprints on all the counters. He used to put his hands in places you don’t want to know about and then rub the counters for no reason. He used to put spit on his fingers and try to rub the pattern out of the granite because he thought the pattern was dirt. I used to use alcohol, window cleaner, and bleach all day long. I know I don’t have to clean things obsessively now, but I still feel the urge.

Today is the first day in a week that I haven’t seen my dad. I ran around looking after him all day, and while I was on the road, he got on the phone and called me. I didn’t see that coming. He argued with me for maybe 15 minutes. I had heard it all before. He wanted me to take him home THAT MINUTE. He hated the ALF. He could take care of himself! After a taxing, depressing session of trying to get him to relax and knock it off, I did not have the strength to go see him. I wish I had, but it was just too much to ask.

I know his suffering is real, albeit likely exaggerated. That doesn’t mean I can reasonably be expected to leap into action and fix it. He is signed up for another week in the ALF he hates, because it will take that long to get him moved over to the new one, and it’s the best I can do. Poor decisions have consequences, and sometimes your loyal children can’t protect you from them completely. That’s life. Sad.

If he were in prison, he would be suffering. If he had cancer, he would be suffering. I’m sure he suffered when he was drafted. Sometimes we’re supposed to suffer. Suffering doesn’t necessarily mean another person has let you down or owes you something; he has never understood that. If there were three of me, he would be here tonight, and two of us would be taking care of him, but I am one person, and that person can’t do it right now.

I’m very happy about ALF A. I’m not thrilled about the expense, but the facility is great. If he complains about ALF A, he is simply being unreasonable. But for the occasional poo smells, I would be happy to live there myself. It actually seems tempting, after handling all these responsibilities. Comfortable little room someone else cleans. Laundry bag someone else empties. Food someone else cooks. No lawn to mow. No woods to maintain. I should call and see if they have any more rooms.

I hope they didn’t give away their last room before I called. If so, I may move into a culvert.