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What to do When the Patient Refuses to Go to the Doctor

• Schedule the visit for them and accompany them.  Be firm in the way you present the appointment and present it as fact, not choice.  (We are going to the doctor this morning.")
  
  
• Tie something the person enjoys doing to the visit to the doctor.  ("After we see the doctor, we can go to lunch.")
  
  
• Depending on the individual, you may want to inform them of the appointment the week before, the day before, the hour before, or just after you get into the car.
  
  
• Use another reason, other than memory loss, for the check-up, e.g., check your blood pressure, flu shot, get prescription refilled, etc.
  
  
• Enlist the aid of other family members or trusted friends and advisors who may be able to convince the person that a check-up is needed.
  
  
• Validate their fears and agree with their arguments.  ("I know you are healthy and don't feel you need to see a doctor, but I would feel so much better knowing you have a clean bill of health.")
  
  
• If the person is afraid of an Alzheimer's diagnosis, reassure them that there are many other treatable things that cause memory loss.
  
  
• Try not to argue about or have lengthy discussions that will only increase the person's resistance to going.
  
  
• Tell your loved one that you need to go to the doctor and ask them to come along.  (The caregiver can get blood pressure checked or something simple at the actual visit to make the person feel more at ease.)
  
  
• Tell them that the insurance company is requiring a check-up for insurance renewal.
  
  
• Ask the physician to call them to schedule an appointment.
  
  
• Call ahead or write down your concerns (specific signs and symptoms you have noticed) and give them to the doctor ahead of time if you don't want to discuss them in front of your loved one.
  
  
• Try to get the person's appointment for the first appointment of the day (to reduce waiting time) or at the time of the day when the person is least agitated.

 

 

What to do When Handling the Finances is No Longer Possible

• Remember, money represents independence.  It is very difficult to give this responsibility up willingly!
  
  
• If person has typically paid the bills, set a special time to go over bills together or arrange a time to "check" them before they are mailed.
  
  
• Get important legal documents, like POA, as soon after the diagnosis as possible so the person has control in planning.  Arrange your POA at the same time so the person does not feel "singled out".
  
  
• It may help to leave a written reminder for the person, such as, "My son, John, takes care of my check book."
  
  
• Tell the person that you have arranged for a financial planner to handle all check books in the family to remove that burden from everyone.
  
  
• Arrange for a PO box and have mail sent there to avoid confrontation when bills arrive or to screen for solicitation mail that might become a problem (e.g., contests, donations).
  
  
• Arrange for "automatic payments" via bank to all vendors to allow moneys to be automatically withdrawn from the person's checking account each month.
• Avoid arguments at all costs!
  
  
• Assure that the person always has a small amount of spending money.
  
  
• If the person insists on having checks, get checks stamped as "voided" from the bank.
  
  
• Establish "tabs" with trusted, regular merchants so that the person can still shop.
  
  
• Be prepared for accusations that you're "stealing" from them.

 

What to do When the Patient can No Longer Drive Safely

• Try a frank discussion with the person about a driving problem you noticed.  Be tactful and gentle in your approach, not confrontational.
  
  
• Arrange for someone else to drive.
  
  
• Get support and agreement from others (family, physician,, clergy, attorney, friends, etc.)
  
  
• Let the physician (or advisor the persons trusts) take the lead in telling the person they can no longer drive; have them write a letter to this effect, or prescription.
  
  
• Have insurance agent provide written documentation that the person will no longer have insurance coverage.
  
  
• Blame not being able to drive on the long wait for test results or the insurance company, not on the person's inability to drive.
  
  
• Do not leave the person in the car alone while it is running or the keys are in the ignition.
  
  
• Co-piloting is not recommended.  There is not enough time to cue someone in a hazardous situation.
  
  
• Reduce the need to drive (e.g., arrange for prescriptions/groceries to be delivered, for friends to come over regularly, to drive the person to regular stops or to take the person out regularly, etc.)
  
  
• Don't assume that taking away a driver's license will discourage driving.  Be prepared.
  
  
• Don't put off the issue if the person is a danger to themselves and others.  The caregiver could be held legally liable if they knowingly allow a demented person to drive and they get in an accident.
  
  
• Get the BMV to revoke the person's license.  Call our helpline (888-303-0180) for the guidelines to follow. Click here to review the guidelines.
  
  
• Experiment with ways to distract the person from driving (e.g., someone else should drive because taking new route, bad driving conditions, medications make the person too drowsy, you want the person to enjoy the scenery, etc.)
  
  
• Control access to the keys.
  
  
• File down key so that it no longer works or put a wrong key on the person's key ring.
  
  
• Disable the car (remove the distributor cap or starter wire, or instal battery with "on/off" switch)
  
  
• Move the car so it is out of the person's vision (park down the street, etc.)
• Consider selling the car.
  
  
• Be firm and positive about not driving.  Don't waiver in the decision, but avoid arguing about it or giving long explanations for why the person cannot drive.  (Say something like, "Until the doctor is finished running tests, you cannot drive" OR "because you are on medication", etc.)  Spend your time and energy helping to preserve the person's dignity by focusing on the things they can still do an enjoy.
  
  
• Get a non-driver State ID card for the person for check cashing and other identification needs.

For additional thoughts, see Lisa Snyder's essay here.

 

What To Do When Your Loved One Is Unwilling To Move

• Try to determine the overriding reason behind their resistance to moving, e.g., denial, fear, pride, a "stubborn personality", not being ready, etc.  Understanding "why" may help you choose the most appropriate strategy for overcoming their resistance.
  
  
• Involve the person, as much as they're comfortable with, in planning for the move and give them as much opportunity as possible to make choices, if there are choices.  ("Let's go look at some of the apartments and you can choose whatever place you like the best.  Or you can move in with us.  I'll go along with whatever you decide.")  Keep in mind that there is a difference between making the decision, which the caregiver might have to do, and participating in the planning, which the impaired person can be encouraged to do.  If a person is too impaired to understand what is happening, it may be better to make the move without the added stress of involving them in decisions about the move.
  
  
• If it's early in the disease, try explaining the need to move in a reassuring way, but avoid getting into lengthy discussions or explanations, which often increase their resistance.  ("Dad, you left the stove on yesterday, and I want you to be safe.")
  
  
• Use another reason, other than Alzheimer's, for the move.  ("Mom, it's just not safe for you to live alone in this neighborhood anymore.")
  
  
• Understand and acknowledge the person's feelings from their perspective; they're giving up their independence and it's extremely hard for them.  Enlist their support in the process.  ("I know it's hard to leave your house and it will be an adjustment for both of us.  Thank you for helping me make this move as easy as possible.")
  
  
• Play up the advantages of the move.  ("Since you don't have a car, we'll be able to take you anywhere you want to go if you move in with us."  Or, "At the senior apartments, you won't have to worry about shoveling snow." or any household chore you know they particularly dislike.)
  
  
• Enlist the support of the person's physician, perhaps even asking them to write a letter.  (E.g., "As you know, you have experienced short-term memory loss for some time now as well as - any other medical condition.  For your health and safety, I'm prescribing a comfortable apartment for you at _______ where you will be able to get some additional support but keep your independence.")  This will provide the person the opportunity to read and re-read the explanation and removes the burden from the family.
  
  
• It is often helpful for a person with dementia to move before their illness becomes too severe so that they can better adjust to their new environment.
  
  
• Be prepared for a period of adjustment.  Help them by putting cues, favorite items, and orienting material in the new location.
  
  
• If appropriate, consider including this decision in the early stage planning process.  Open, early, and continual communication can help the person with dementia and their family to agree on a course of action before a crisis occurs.
  
  
• Slowly introduce the person to the new location several times before the move occurs.

If you need help determining whether your loved one is able to live alone, print and answer this questionaire.

 

 

 

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