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Let me give some examples. I had a new roof put on a week ago. When I got home, I asked him, "Did the roofers talk to you?" "No." "They didn't come to the door?" "No." I then spoke to the roofer who said he had spoken to my father. When I told him, he said he talked to them about driving on the lawn and not the roof even though I hadn't specified. Plus, the roofer did talk to him about the bad piece on the roof. A few days later though, I asked him why there were so many nails under the tiling in the foyer in the basement. He told me that they put in two layers of plywood (he actually built most of the house). I asked if they did that everywhere, and he said yes. He also was able to immediately find the pool extension tube that we haven't used in over a year when I needed it to try to rescue a hawk. He spends all day in his recliner, mostly asleep. He doesn't care about anything. He even leaves on lights. He used to be anal about turning them all off. He ignores most questions and answers others as simply as possible. Sometimes, I wonder how he can be alive but then he can answer specific questions about activities from 50 years ago. Yet, when I got an invitation over a year ago and didn't know who it was, he didn't either. There was an e-mail on the card, and person was his first cousin. When I told him about her, he still didn't know who she was. My father had dementia testing two years ago, and they said mild to moderate impairment at that time but would not diagnose since he had just gotten through a period of hyper-mania and psychosis (he's bipolar). Since he refuses to see a doctor or have any tests because "Nothin's wrong with me," can I feel pretty confident that yep, he has dementia?

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You could be right that it is dementia. Bipolar disorder, particularly when it is not treated with something like lithium, is one of the risk factors for Alzheimer's.

Selective memory is no unusual. My mother remembers certain things and even obsesses on some of them. She remembers the good things from her childhood and marriage. She forgets the bad. I've often wish she would forget the bad things that her teenage children did. I hear about them a lot like they were yesterday.

I imagine that different events get stored in different areas of the brain. Those that are stored in undamaged sections can be remembered. Sometimes they get a little doctored over time, like a fish tale, but they are still in there.
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It's difficult to say, but the behavior and memory sounds consistent with dementia to me. If it is, it will become more and more apparent as it progresses.

How is his mental illness being treated if he refuses to see the doctor? That would concern me.
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He hasn't seen a real doctor in two years but he sees a psychiatric nurse about every 3 months, and she prescribes risperidone, lithium, and trazodone. The first two he took for over a decade so I know they're not causing him to be a zombie because he was very active then. The trazodone was prescribed because he never slept when manic. Now, all he does is sleep. He only gets the trazodone at bed time, and yet he's just as asleep at 9 pm before his meds as 9 am so I doubt it's the reason. I've been giving him his medication since his last commitment two years ago because he was non-complaint which is why he went off the rails to begin with. The nurse gave him a slip at his last visit for blood work but that was about 3 weeks ago, and it's still sitting on his desk. At least I cleared off the desk earlier this year as it was piled high with two years of mail! I found an uncashed check among other things so I do all the mail now and pay all the bills. He actually still walks 2000 feet daily to the mail box and gets the mail though. He hasn't walked outside of that range in over a year though. He didn't even walk around the house to inspect the roofing job. At least I got the roof! It was leaking in one spot (no other bad plywood). Maybe the clueless nurse will finally realize she needs to talk to me (the last time I tried to talk to them, they said they needed his permission) when he doesn't have the blood work done although he might still do it before the next visit but I'm doubting it. In case you're wondering, in the past, I have MANY times told him that I would drive/take him to the doctor, to bloodwork, for a hair cut, etc., and when he does reply, he says he doesn't need it. To be honest, it pissed me off when the excellent geriatric doctor that I put him on a waiting list for (my late mother's doctor) finally called after 9 months when I was at work, he told them that he didn't need to see a doctor. When his brain is working better, he can be very insistent and good at convincing people that he's just fine, as his 9 months of hair growth that hasn't been washed with actual shampoo in two years flops on his head. Only now are other people starting to get it but since almost nobody sees him but my brother and I, nobody (nurse, relatives, neighbors) seems to believe it. Everything thinks of him as the old Bob he used to be.
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Your father needs to see a psychiatrist and a neurologist. A nurse practitioner is the only nurse that can write prescriptions and only while working under a doctor's supervision. Your father should be seen by a doctor in much less than 3 yrs' time. You've described multiple incidences where he isn't functioning normally. A neurologist can diagnose dementia. You need this diagnosis and the authority to speak for your father in terms of medical decisions so he won't do any more things like dismissing the excellent geriatric doctor you found for him. He needs normal hygiene for his hair, teeth and body. Sleeping most of the day isn't normal and needs to be checked out, too. Best of luck to you.
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I know he does. But how do I MAKE him against his will?
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Zombie, it is one of the biggest problems of caregiving. All the good advice in the world cannot be used if the care receiver refuses. Unless we have guardianship or the receiver has been ruled legally incompetent, we can't make them do things. The only things we can do are encourage and wait for a time that they are receptive to the advice. Until that time, we try to keep them as safe and cared for as we can. We also have to deal with our own feelings and frustration. I find it's better if I step back emotionally and try to handle it like I am a professional. That keeps me a little more sane.
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I agree with JessieBelle's answer. Should your father have a more serious problem crop up, you may find the new problem allows an opening where you can get some control over your father's health legitimately & legally and then be able to pursue better overall health treatment for him.
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Exactly. I'm stuck in this waiting pattern, waiting for the other shoe to drop, for him to fall down, need a hospital, etc. At least he seems content, calm, not in pain, and sane. When he was hyper manic and insane, we had to wait weeks for him to get worse until the powers that be decided he was a risk to himself and others before they would commit him. Then, they wouldn't give him meds for weeks until he agreed. They would just shoot him out with Haldol when he'd beat on the doors of other patients and stuff. All he needed was lithium and risperidone, nothing else worked but they did other drugs again and made it go on and on and really damaged his brain this last time.
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Zombie, how awful for you to see this happen and feel helpless! It makes no sense for the "powers that be" to decide he can't make his own decisions, commit him against his will, then decide to wait for him to give permission to take medications. The "powers that be" were flip flopping back and forth as to whether the power rests with themselves or your father. There is something seriously wrong with that. Read: they don't know what they're doing (IMHO). This is dangerous for your father as you no doubt already know. I have to wonder how long your father will be paying daily for a stay in this facility with no medicine...3 months?....6 months?...do they even know?? Do they have any plan of action or treatment or is it up to your father?

Can you avoid these people and this facility and search for a more consistent one? It's a tough thing to do, I know. I think if it were my Dad I would make app'ts. with one psychiatrist at a time to search for the right one who could answer my questions satisfactorily. Who would treat my Dad with a logical plan of action regarding both possibilities of Dad's cooperation and non-cooperation. I'd also ask around for referrals from other people and other Drs. and search the net for patient reviews. Best wishes to you and your father.
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This is my exact situation. I wish I had an answer for you. Hugs.
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Coloresue, my father was in the psych ward for less than a month three times - 2004. 2005, and 2013. The last time, they released him while he was still manic and insane, and he went around throwing stuff out for about another month before the meds (that I gave him) kicked in. He only takes the medication to avoid the hospital as he denies he is bipolar or sick in any way. He has been at home since. My mother died Nov. 2013, and she always made the decisions. Since then, he does almost nothing. The last time in the hospital, my mother and I wanted him to go to the specialty psychatric hospital that did a good job in 2005 but he said he wanted to stay in the crappy county hospital because he was insane and couldn't make proper decisions. He also freaked out when we visited saying the hospital was giving us MRSA on purpose. He got this because I did get MRSA there in 2009, and my mother had leukemia so she was immuno-compromised. But, he made it in to a conspiracy to kill us all. He said the news came there and covered the story. He told my brother that his 8-year-old daughter had to visit (he called over and over), or he would cut them out of the will. She didn't come, and the will is the same. So, in perspective, Zombie dad is better than psycho dad!
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Yikes, Zombie!! No kidding, Zombie Dad IS better than psycho Dad! Do you or anyone have POA for your Dad? Especially for his health care decisions? If not, do you think reminding him of his own words: "he was insane and couldn't make proper decisions." would help to get him to assign someone as POA when he isn't able to make good decisions for himself? I know this is easier said than done. It could get complicated but seems very necessary. And your Dad sees it too.....sometimes. The specialty psychiatric hospital that did a good job in 2005 sounds like a good option. Hopefully you will have some say the next time your Dad needs hospitalization.

You need to speak with a lawyer who specializes in this area of medicine with the diagnoses your Dad has. He is bipolar, seems to have dementia, and maybe some other mental illness? This type of lawyer can help you navigate the difficulties of a Dad who is sometimes normal (right?) and sometimes not.
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My father never said "he was insane and couldn't make proper decisions." I just said that in the last post. My late mother and I are listed on both a durable power of attorney and an advance health care directive. I'm presuming in order for me to act upon either, I would have to have him declared incompetent or whatever. I really don't want to drag my father to court. He's cognitive enough to hate me for that.
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Excuse me, I thought you were saying your Dad said "he was insane and couldn't make proper decisions." My error. That makes a big difference. Of course you don't want to drag him to court and have him declared incompetent.

I wonder how other family members who have POA over medical care issues handle decisions for bipolar relatives during periods where the bipolar person hasn't taken their meds as directed and their behavior is a serious problem. This has to have happened many times before now. Maybe you could put this question to the whole community? Or you could ask it of your father's attorney or a different attorney?
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Zombie, yes, of course, your dad has dementia, on top of his reasonably well-treated bipolar disorder. The short term memory is more severely affected than the long term. It seems unintuitive, but long ingrained habits can be remembered and things from years ago are still there, but new memories are not being laid down. He is not going through the mail on his desk because he can't mentally process it.

If he lets you do what is most critically needed with just a POA in hand, despite denials that anything is wrong, that's great, maybe you will never need a guardianship. But if you have to get it, you can and should be able to. He might not have to appear in court - he does get a notice of the proceedings and if he can interpret that he may contest it, but he may not even understand it. Maybe on one of his more lucid days he can sign a HIPAA release (or better still, that plus a medical POA) at least that would hopefully make his nurse realize she can talk to you.

It is hard to take over, to become more of a parent than a daughter, but our parents who are losing their memory, reasoning and cognitive skills need us to.
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In case it helps any, the way to circumvent the HIPAA thing is that if you are there at a visit with him, and it is obvious the health care provider is talking to both of you and he does not object to that, it can be a two-way conversation. Some will feel a need to ask if it is OK to discuss ___ with you there and you could end up invited out, so of course getting a HIPAA form, healthcare POA or proxy form or some sort signed would be ideal.
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It is normal for someone with dementia to have selective memory. Not that they deliberately select the memories they will retain, just that the nature of the damage to the brain is selective.

It sounds like Dad is very lucky to have you looking after him!

I would say that this man is no longer able to deal with discussions with service people, no longer able to make his own medical appointments, no longer able to conduct business over the phone. Actually, he is probably beyond the point where he can safely be left alone at home for long periods.

This is sad, and a huge challenge for his caregivers! I send you good wishes and lots of hugs.
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