What do I do with my extremely stubborn declining father?

You may need now to consider that in future your father will need to be placed where he can get continual 24/7 care, and you can go on making a life for yourself, while visiting him, and supporting him in being his POA for financial and for medical care. We all have limitations. You have a right to your life. This will be worthy of mourning, and will be sad and difficult, but you as the child have a right to your own life.
If you need help making this decision for your life going forward it is time to grasp that it IS your decision, and it is coming. You will have to make it and live with it, whichever you decide. You may want to consider the counseling of a Licensed Social Worker who specializes in life change passages, and in dealing with them. Remember, the decision whether to have the life you were born to have, or to sacrifice your own life to your father is difficult to make, but is solely your own decision. I am wishing you good luck.

You need to get him evaluated and have a doctor write a letter saying he is not competent to make his own decisions. This will help to put the POA in effect too.
Then you call APS asking about resources for a man who has been deemed incompetent with Dementia so can no longer make informed choices. And you need help caring for him.

The other options are an Assisted living if he can afford it. If not, LTC with Medicaid paying for the majority of his care, his SS paying the rest.

Another choice would be Medicaid in home care. At 30 you need to get on with ur life. The next 35 years will be the ones counted towards SS. These are your earning years. As you get older its going to be harder to get a job with no experience.

Mariavictoria, you have already done heroic helping of your parents. Please try to reject your feelings of guilt - you have nothing to feel guilty about! It was your parents' responsibility to plan for this eventuality and they should never "assumed" you into the role of their sole caregiver. The caregiving arrangement needs t work for both parties (receiver and giver). It is not working in your case, and honestly never will because the reality is you will burn out and then your father will still need help from elsewhere.

I'm assuming you are also your father's medical PoA. If you believe your father has any cognitive decline, create a "therapeutic fib" to schedule an exam for him with his doctor (tell him Medicare or SS now requires an annual physical). When there present a pre-written note to discretely hand to the doc or staff asking to perform a cognitive exam because you have some concerns. They will gladly do this, they did it for me w/my MIL. IF your father does have decline it will now be in his medical records and you can go about his business with the PoA. This means you can call back Family Services without your father present and request an assessment for in-home help. He may still resist outside help, but you must insist on it. This may buy you some time.

You can hire in-home help from an agency, or outsource some tasks (like housekeeping, cooking, laundry, etc) but HE must pay for this, never you. This may also buy you some time. FYI hiring people privately makes him/you an employer and and you must comply with your states tax withholding laws. My own opinion is to stay away from private hiring -- it is a crap-shoot and can cause more headaches than it's worth, even if it is less expensive.

Ultimately, he will need care in a facility community. You will need to research your options. Make sure they accept Medicaid and have provide a continuum of care (like AL to MC/LTC to hospice) so he can stay in the same place. He may require Medicaid to get into a facility now. You will need to ask social services if your state provides aid for AL (I think it's called an elder waiver). Many states only provide 100% aid for LTC/MC and hospice. If he has assets more than SS, a car and a home you may want to invest in a consult with an estate planning elder law attorney who is knowledgeable in Medicaid. If he has been gifting you money or you are joint on any of his bank accounts, this can cause problems in Medicaid qualification. State lookback periods can be from 2.5 to 5 years.

Your life now comes first, don't put it on hold any longer. It is not wrong to do so. I wish you much success, and a solution that brings you peace in your heart.

I hate that you have had to deal with so much at such a young age. You sound very mature to have dealt so well, so far. Now that being said, I am sure neither of your parents would ever want you to put your life on hold, to take care of them. I know your mother has passed and I'm sorry for your loss. Sounds like you haven't really had time to properly grieve for her, when you chose to take on the responsibility of your father.

It sounds like it's time to find the nicest Assisted Living place your father can afford and place him there. That way he can get the help he needs and you can get on with your life, and continue to be his daughter and not his caregiver. You deserve a life too you know? You are way too young to have to take on all these responsibilities. So get your father situated in a facility and you get to planning your wedding. Wishing you the best.

Does one need to be assigned med POA before getting the parent a cognitive exam?

Also, is an advance directive a form of med POA

I could pretty much write your story except ours is with our mother. She sounds pretty much the same and will not give consent for any help. We actually tried hiring someone to come in and help we told her they were coming etc and she refused to leave them in. We finally had a Drs appt last week and getting a trying to get a cognitive test scheduled for her. We know she needs assistance and we are both returning to work shortly and cannot be left alone for long periods of time but we also cannot force her to get the help she needs. It does sound like you have done so much already. Good luck

Mariavictoria ,
God bless you girl for taking such good care of your Dad.
I am curious as to whether or not your Dad has been properly diagnosed by a Geriatrician? If not, seek a Geriatrician!
Sounds like Dad has at the very least, Dementia if not Alzheimer's.
If that's the case, you as POA have the responsibility to make sure he is in an appropriate place for his current diagnosis. As POA, you need a diagnosis that substantiates your legal right to intervene.
There is no shame in placing him in Assisted living or Memory care!
He may give push back in the beginning, but will soon assimilate!
This is exactly what these facilities are designed for.
Truth is that not all of us are able to care for our elderly LOs in our homes.
Sending you prayers and (((hugs)))!

Hospitals in your area should have a Memory Center, or Center for Geriatrics or something like that; you might have to travel to a major medical center. Make an appt there for an initial evaluation and request neuropsych testing. You will need to tell him he either goes to this evaluation so they can check him out and see if there are meds to help him (there are not but he might not know that) or he will have to find another place to live. If he is still competent to make decisions after this evaluation, then he can decide how to live but he cannot live as he wants if he lives with you. And you cannot place him against his will if he is competent. I know he gets angry and stubborn. After he saw what happened to your mother, he is probably scared.

I will say that you might approach this differently by asking him how he sees what is going on and how he thinks things will go in the future. My FIL kept saying they could not move from their house, but when I asked him a version of the 5 questions posed by Atul Gawande in the book Being Mortal, he had no way to answer but it made him think and got him to accept reality. Prior to that, I had been telling him what to do but this approach helped and started a dialogue.

The geriatric psychiatrist was a major 'find' for us. She has continued supporting dad over the last several years and we do an appointment every other month. (right now, video calls). She has been an excellent source in getting his medications regulated and anytime I have a question or concern, I can send her a message and ask for guidance.

You state in your profile that your father has Alzheimer's. That suggests to me that a doctor has used the appropriate Alzheimer's CPT codes for billing Medicare. CPT code 99483 enables clinicians to be reimbursed for providing care planning services to individuals with cognitive impairment, including Alzheimer’s disease. 

If you have not already done so, on the Medicare website you can establish an online account for your father so that you can track his Medicare charges. I'm not sure but I think you should be able to find that CPT code if you look back to when he was diagnosed.

You already have POA, so that is good. You can begin to use it to make decisions that work for both you and your dad. If you want to get married, you are going to have to make changes. Your father's needs are not more important than your own. Caregiving must work for everyone involved.

Your dad lives in your home. You need in-home help. As POA, you have the authority to help him with his Instrumental Activities of Daily Living (ADLs). You also have the authority to bring in help such as housekeeping, meal prep, laundry. Your father may feel more comfortable with a male home health attendant. Pay for these services using his funds. Look at it as in lieu of him paying you rent to live there.

You must stop asking your father if he needs help. You see that he needs help with his medication and activities of daily living (ADLs) such as brushing his teeth. Learn to say something like "Dad, I need help and have scheduled an appointment with an agency to get us help so that you can continue to live here. I need your cooperation. If you refuse, I can't continue."

Either way, you need to prepare for when his needs exceed your ability to keep him safe in your home. Look at his budget and start looking at memory places where he can live within his budget. It's best to start looking at placement now before a major crisis happens.

You're only 30 years old. Do you work?

I also have a Dad just as stubborn as yours. But I am a little further down the road. Maybe the techniques I used will help. My Dad lived alone and he’s 93.

He stopped taking showers because he was afraid he would fall (Parkinson’s). After a week or so, he was given two choices of people who were going to help him shower: me or his friend - he went with his best friend. No arguing, no saying no, just a choice. We used it every time we knew he would balk about something, which was a lot!

The last time was the biggest - the choice was 24 hr in home care (and the cost that came with it) or long term care. He agreed to long term care because he knew that he could only afford a few months of in home care. But he insists he’s only going until he gets strong enough to come home again and live alone.

I have the same very autonomous dad with short term memory to boot and very agile at almost 94. I did t say anything and got a helper disguised as a cleaning person and handyman to initially do my labor intensive house cleaning and cooking . I also said the gov pays for it under his benefits to go to the local gym with the person of his choice and the local gym gave me a months membership as a trial run. Eventually my dad befriended the familiar housekeeper and a strategic schedule can slowly be created. Problem is you need to tell everyone you know and your neighbors that you are looking for such a person . I had to take my dad to the local beach twice last month to get him to shower . But I give him wipes and sitz baths and say OK no shower but sit into this ..

Many answers are encouraging you to put your father in an assisted living facility, but the bigger question is "Is this affordable?" and "can you make it happen?". Your father lives with you - in YOUR home or in HIS? Hopefully it is in HIS home, because you can leave anytime you want; it's much more difficult extracting him from YOUR home. You are WAY TOO YOUNG to sacrifice your life to an old grouchy man, regardless of your close relationship - the result will be this: You will give up your privacy, your relationship with your husband-to-be, your ability to travel, you will find it intolerable to socialize in your own home b/c your father will be sitting there...always. Your last memories of your father will be that of resentment and negativity - and those last memories are the ones that stay with you forever because they take over the fond memories of the past.
Make your own life now while you have the chance. I speak from experience.

Imho, since your father has Alzheimer's, he no doubt requires the help of an Assisted Living Facility - for now and maybe a Memory Care later. Btw, perhaps the social worker needed to make a personal visit to see your father for herself/himself as your father may always say that he does not require assistance. He may always take a pass over the phone, but in person the socail worker can see your father's decline for themselves. Prayers sent, Mariavictoria30.

Hi MariaVictoria
Its so nice to see how your helping your Dad. It’s difficult for anyone, especially a young person as yourself sacrificing everything to care for a family member.

Please contact the county board of social services, the social worker can guide you to
agencies to help you ,possibly caregivers who are trained to deal with your dad’s behavior. Everyone needs some help .

My dads dementia and health issues started 2 years ago. He lost his independence so the only place for him was a nursing facility. He had no money for assisted living. I had to work and I’m the only child . I couldn’t possibly change diapers and bath him. The dementia made him prone to falling and that was another big issue.


I fought hard for him to go back to his apartment and his friends but it just couldn’t be.

You can connect with programs that can at least give you a break
until you see how he either progresses or decline. Sometimes and outside person can have a different affect on him.
Best to you

Can you provide more information? 
Do you work outside of the home?
Are you living in his home or is he living in your home?
Only child?

You are very young and deserve to have a life and the opportunity to marry.  Unfortunately, if you are living in his home, you are more than likely going to have to sell it so that he has money to go to an assisted living facility.  If and when he needs a nursing home, they will take his assets to pay for his care.  So even if you move out and marry, there is still much to do to get him evaluated and moved.

Do you have any family you can ask for assistance?

If he already has a Dx for dementia (Alz falls under that), I would call that place back and state that he is not competent to answer questions, including the one asking if he felt he needed help. Honestly that is ridiculous - sure, some people may call and say whatever about someone, but the person IS competent, but over the phone they don't know that! Someone should ASSESS his needs! My mother would have said no as well, but despite telling everyone she was fine, independent and could cook, she wasn't and couldn't! If you have no doctor paperwork for his condition, you could get outside assessment. When we were going to hire aides, they sent a nurse who did a FULL test on mom in her own place. Medicare covered the cost and subsequent visits by the nurse, even after we started the aides.

His doctor office may be a resource for getting the help you need to sort this out. They may know places that will take him and/or write the orders needed to have him placed. Worst case is getting guardianship, which takes time and is costly!

While your rights and his are determine by state law, with POA you should have some say in getting help.

The only experience I had was the EC atty told me we couldn't force our mother to move if she refused, even though we have POAs. POAs allow you to stand in for your LO, signing documents, managing finances, medical, etc. SHE wanted nothing to do with moving, including/especially AL, even though that was in her plans before dementia kicked in. She was not even at the level your father is, but clearly was not capable of staying alone. We tried bringing aides to her place, only 1 hr/day, initially as a sanity/med check as none of us live close enough to check daily. This would be increased as needed, but didn't last 2 months and she refused to let them in. EC atty told me we would have to get guardianship to force the move, however the facility we chose would not accept committals.

We moved ahead, making plans, etc. I had already taken over her finances and was taking her to appts, store, providing supplies, etc (we had taken her car away before this.) Just prior to the planned move, she injured her leg and developed a serious infection. This delayed the move a few days, but YB used it to draft a letter from 'Elder Services' at the hospital she was treated at, telling her she either moves where we choose, or they will move her. It was enough of a fib that she went with my brothers (MAD, but she went!) I wasn't pleased with how he did it, but it worked. Facility said just get her there, they would take it from there. We had NO doctor orders, no doctor Dx in hand. It was a private pay facility (IL/AL/MC), not a NH. NH may require doctor referral.

So, you may be able to find an acceptable place and move him there, even if he doesn't agree with the move. Sign all documents as DPOA. The only other option is to bring help in - he may or may not work with them, and depending on how many hours/day or week needed, it can be more expensive than a facility.

If he doesn't have enough funds to pay, you would have to try Medicaid. If his income and assets are low enough, he could qualify. You may want to consult with EC atty to process that. Medicaid can also cover some in-home services.