Getting into the VA Home

Everything seems so smooth now, that I forget how hard it once was.  I can’t believe this was 2 years ago now.  And thinking back on it, I can’t believe some of the craziness we went through.  Sometimes I think it’s probably best I waited 2 years to go back and revisit some of this stuff.  It’s such a relief that we are in a better place.  The disease is worse, and it’s hard to watch the decline.  But it’s a blessing he is where he is, and it’s nice to be reminded of that sometimes.

We had known throughout the diagnosis process that we would need to find a place for my dad to live.  We knew we couldn’t take care of him and keep an eye on him 24x7 , not to mention keep him away from the bad behaviors he so badly craved and obsessed over  every 15 seconds, like alcohol, roaming the streets looking for cigarettes, spending money...

But we had no idea how we would get him to agree to go, how he would afford it, and what place would be willing to put up with his behaviors.  He was still young, active (only 64), and looked relatively healthy compared to anyone else being placed on a wait list for nursing homes.  We weren’t sure where he would fit in.

Our uncle suggested the VA Home in Sandusky.  They had already visited it a few months back and had good things to say about it.  But it was so far.  And I felt weird about going with the first option without doing some more research.  I overanalyze everything, so I wanted this to be no different, to help ease my conscience.

I made lots of phone calls, learned more than I ever wanted to know at my age about Medicare (even though he was still a year away from eligibility), looked into how we could increase his social security/VA benefits, and very soon realized my uncle was right.  Besides the outrageous cost that my dad could not afford, there was not one single facility that would allow smoking.  To me, I liked the idea of a nice and updated assisted living facility that would be close by.  But I knew he would never be happy if he couldn’t smoke.  And they would never be able to keep him safe and on-site, because he’d be in constant search of a cigarette.  They’d kick him out in no time.

So our research went back to the VA Home.  The application process seemed simple enough.  Just some forms to fill out, some medical records needed, and voila, right?  WRONG!!!  Being stuck in the middle of the VA (US Department of Veterans Affairs) where he got his medical care and diagnosis from and is federally funded and the VA Home in Sandusky, which is state funded was one of the most ridiculous experiences I can ever remember going through.

After I submitted the application and the paperwork and followed all the instructions on the VA Home’s website, (as well as from numerous phone calls with the Administrative side of the facility itself) I was told it could be a month or so before we heard anything.  By the time I heard back, I was told they didn’t have any of the medical records they needed.  Well that’s weird, I thought.  But I figured ok, I’ll just call over to the VA myself and get them to send the records again. 

I don’t know if I’ve described before what it’s like trying to get someone on the phone from the VA before.  But it’s a crazy process.  Voice mail?  Who needs voicemail when you can call and listen to a ringer over and over and over again, only to have it click off and hang up on you?  And when you do finally get ahold of someone, you are starting over from square one trying to explain the situation and what is needed.  Wouldn’t it be nice if they had a computer system they could just look up a patient in and catch up quickly?  Well. They. Don’t.  It takes several hoops to jump through to just get ahold of someone from his family doctor’s office and to get them to agree to forward any records they have over.  But when you do that, you find out they really don’t have any records to send anyway, other than maybe a recent flu shot.  Records?  Who needs records?  I still don’t understand why the real diagnosis from the initial neuropsych testing and the MRI showing the holes in his brain were not enough, but they weren’t. 

And ready for the kicker?  After all this time waiting for the application to be reviewed and told we needed more, and then tracking down what we could from the VA again, we were told that the information was now OUT OF DATE.  It was beyond 30 days and it was now TOO OLD…  Are you kidding me?  Are you saying he needs to go through this testing again?? Do you understand what we went through in the first place to GET him to these tests?  Do you realize you can’t even get an appointment with the VA without an 8 week wait?  I remember asking the social worker from the VA Home what happens if we can’t get everything they need, and she simply said well then he doesn’t get in.  She explained they need to be able to determine his correct level of care. That they are audited by the county board of health, and they check the dates.  It felt like I was trapped in some twilight zone.  There was no way to win this.  And even if we miraculously got them what they needed, after they reviewed everything, would they agree to let him in?  Would they find out about the alcoholism and say they can’t take him?  I can’t even remember it all now because I think I blocked it out.  But somehow, someway we scrapped together what they needed.  We got his doctors to sign what they needed to sign, fill in some physical BS stuff, and the VA Home FINALLY agreed they had what they needed.  We just needed to wait for their answer.

I don’t know that we ever got a YES, but we got an invitation to come check the place out.  So we scheduled a visit with my dad.   He said he was interested in checking it out.  As if it was a nice day trip we were taking him on.  We carefully tried to hint that he might want to live there, that he would have his meals cooked for him daily, he’d never run out of food, he’d have cigarettes, and his finances would be managed.  He’d have things to do.  He agreed he would like to see it, but didn’t know that he would want to stay there. 

We knew the VA Home has a few different levels of care.  We were hoping he would qualify for the assisted living where he would still have his freedom.  We did our best to coach him in advance.  We went over questions they might ask him, reminded him what he can still do on his own.  Gave him a cheat sheet of what medications he needs to take and when.  He seemed to get it, and we just crossed our fingers he would pass their tests and be willing to sign paperwork to enroll.  We had our POA papers, but I didn’t want to have to force him if he didn’t want to.  But I also knew he couldn’t stay where he was, and I didn’t know where else he could go.

I remember the day we picked him up.  He was dressed up in an outfit he used to wear for Christmas.  He had on his dress shoes and nice overcoat.  I was so relieved he wasn’t in his usual ripped up dirty sweats.  It made me so sad to see though, because he looked so normal and I felt like we were trying to trick him into leaving his home.

The drive down went ok.  We were so fortunate to have our uncle come with us, because the thought of getting him out of the house and kept calm the entire drive to Sandusky brought me a lot of anxiety.  He commented a lot about the scenery and told us about all the things he would like to do and try.  Things he never used to discuss, and I’m not completely sure these were really things he wanted to do, or if his brain was in such a positive phase from the disease (which was a nice change from the last 10 years) that anything and everything sounded good to him.

When we got into the assisted living meeting room, you could sense him shutting down.  He was very quiet and withdrawn.  He seemed like he didn’t want to be there, and I was praying he wouldn’t say he wanted to leave before we even started.  A nurse from that section talked with him a little to see if she felt he could handle living independently with them.  I think we were all a little naïve at how bad off he was.  We figured he’d gotten by on his own this long, and all he needed was a little extra care.  But the nurse came to speak with us after and said she did not think he could handle the assisted living.  They really are on their own.  It was more independent than I even realized.  They come and go as they please, rooms are inspected monthly…he’d probably leave site with the other guys and go to bars non-stop.  He’d spend money he didn’t have, and he’d probably burn his room down with a lit cigarette before it was inspected in a month’s time.  We were all a little disheartened that this nurse could pick up on his condition this quickly and knew he couldn’t handle it.  It was eye opening that he was worse than we were willing to accept.

So we went over to the nursing home side of the facility feeling dejected.  Because after seeing the assisted living, this just looked and smelled like a nursing home.  The residents were easily 20 years older than him, most in wheel chairs and not able to get around.  When we sat down to meet with the nurse from this side, we discovered they were interviewing us for the locked care section.  That was not what we were expecting.  Lock down at age 64?  How can we do this to him?  We convinced them to let us consider the regular nursing care instead during one of my dad’s many agitated smoke breaks.  He asked if we thought he’d take off and be confused and get lost.  We said no, he’s not like that and his sense of direction is perfectly fine.  So he agreed to walk us through that interview.  I hated to admit it, but it did seem like a better fit than assisted living, it was just hard to accept all in one day.  At least the residents still had their freedom, but it was a little harder for them to come and go.  And they still had all sorts of activities and group events he could participate in. 

We took a tour of the facility and I kept watching my dad, thinking he must feel like we’re walking around a hospital.  We saw the rooms that housed 2 to 4 people.  You could get on a wait list for a single room, but it took awhile (meaning people had to die to get to your turn, which was an unpleasant thought). It was difficult to swallow.  But he kept saying everything looked nice.  I don’t know if he meant nice as in I could live here, or nice as in this is a nice day trip tour.  I don’t know if he really got it.

We then met with their financial administrators and went over paperwork and applications and this was the scary part.  They had all the paperwork and applications and consent forms completed.  We just needed to sign them.  I didn’t know if he would or if he wanted to.  I knew I could talk him into it, because he could be talked into anything, but I hated to do that.  But whether he understood or not, he signed himself in.  He was all set.  So this was really it.  He passed.  We passed!   We just had to wait for a bed.   It was a weight lifted. We were done with our day trip and heading home.  But I couldn’t help but worry when the bed was available, how were we going to get him here to stay?

Bittersweet...

After a year on the market, dad's house finally sold!  Seeing it in the state it was once in, and all the issues it had, I never thought we'd be able to sell it for what it could be worth.  But we actually did better than I expected, so it was worth the wait.  Today is closing day. 

In hindsight, it probably was for the best that it took this long to sell.  It took me awhile to come to terms with this.  Selling his home and him having no idea.  It feels so wrong.  But I know he can never live on his own again, and it needed to be done.

As I am going through my dad's files today to pull out his original durable power of attorney papers that we will need for the title company tonight, I am reminded of what a painful day that was getting them signed.  One I will never forget.  There were so many times I felt like we were tricking him in to getting things done that we needed.  I know he didn't fully understand our requests, but we started to realize that he would do whatever we asked him to.  It was sad because we realized (too late) that this is what was going on with outsiders looking to take advantage of him.  And they had for years.  I know we had his best interest at stake, we were helping him, and it was for his own good.   But I still felt like I was being sneaky or doing something wrong.

After much research and soul-searching, meetings with lawyers I didn't fully trust and who could never seem to answer all my questions, we decided not to follow through with filing for guardianship.  I struggled with my dad being served papers notifying him that I would be his guardian, going through the courts for it - maybe even seeing my dad in court...not to mention it was costly, time-consuming, and would require us to go back through the court for every decision made.  I lost sleep over it and I couldn't do it, there had to be another way.  The lawyer I worked with kept pushing that was the only way.  So I kept searching for another answer.

I made an appointment with another elder-care attorney's office.  They were amazing.  Night and day between the two offices.  The receptionist who took my call was very knowledgeable and kind.  The lawyer returned my calls right away, got us in for a meeting right away.  And best of all, disagreed with what the other lawyer had advised.  Guardianship was the last thing we wanted to do, if we could avoid it.  If he was at all willing to come in and sign durable power of attorney papers, a living will, etc. for us, it would be so much simpler, much less costly, and much much quicker!  I was so relieved they were willing to go this route with me.

They got us in within the week, had the papers drawn up within days, and had us come back with our dad to sign everything.  This is the day that will always be ingrained in my brain.  It turned out to be a snow day for my kids.  So we all took a trip up to the lawyers office.  My sister had the task of surprising my dad in the morning and getting him out for one of his last appointments.  He of course obliged and was happy to get out and see us.  He showed up in his not so clean sweatpants, looking ragged, confused, but happy to see us and the kids. 

The lawyer did their best to explain why he was there and kept asking if he understood.  He would say yes.  But when asked if he could explain back why he was there, he couldn't.  Long uncomfortable pause, and then "no, I can't."  So once again, she would try to explain differently, in simpler shorter terms.  And when asked if he was ok with everything he'd say yes.  But when asked to repeat, silence again.  He just couldn't. It was heartbreaking and so uncomfortable.  You could feel the tension in the air, the lawyer trying so hard to get him to understand, the witness quietly waiting, my sister and I silently willing him to be able to put this into words, terrified they would not allow him to sign and force me to file for guardianship.  All I could think about was how brilliant he once was.  How successful he was in his business, you couldn't get anything past him.  His brain calculated numbers and figures with ease.  These are the things WE would go to HIM for.  And now he was stumped.  At a loss for words.  He truly just did not understand.  I think he was embarrassed and uncomfortable, but he still sat with pen in hand waiting to sign.  And then they let him, and so he did.

Now it allows us to take care of him and do things like sell his house without him being involved or even knowing about it.  And I feel so so guilty.  But I have to keep thinking my role is to take care of him and have his best interest at heart.  And I do, and I know we're doing the right thing.  It just feels so wrong and unfair that we have to.

I feel like with some of the stuff that happened in the end that just fell into place, that there had to have been a higher power watching over us. This lawyer was truly our savior.  They had so much compassion for the situation.  I feel like they put themselves at risk for this.

Turns out this visit was just in time.  The following week my dad was arrested while trying to get into parked cars looking to bum a cigarette, and from there he went straight to the VA Home.

Confirming the Diagnosis through MRI 11/5/13

So the next step to confirm the diagnosis we already knew was to get him in for a MRI and PET Scan.  The MRI would show possible atrophy or shrinkage of the brain.  The PET Scan would capture images as the brain is actually functioning, not just structural images as shown in the MRI.

The hard part would be getting him to cooperate.  The MRI sounded relatively easy and was only supposed to take 20 minutes.  But getting him to stay still, not want to fidget, pace or smoke, would be the challenge.  The PET Scan was the hard one.  It was supposed to take 1 1/2 hours and he wasn't supposed to eat or drink anything for four hours before the test.  That seemed impossible, as he would never give up his morning coffee.  Smoking was also not recommended, and another impossibility for him.  Not to mention we had not yet told him about the diagnosis or why he was having these appointments in the first place. 

I was hoping to get both tests scheduled for the same day, since I was afraid if he went to one, he would refuse going back for the other.  Scheduling back to back appointments in different departments at the VA, seemed to be even more of a challenge than getting my dad to the tests.  I'd get through to one department to make one appointment, and by the time I'd get to the second one (which required several voicemails or phone calls in which it would ring endlessly and no one would answer) the other time slot would be taken and I'd have to start over.  I also had to work between our work and kids' school schedules.  I ended up getting the appointments scheduled for 10/30.  But I had no idea how we were going to get this to work.  I remember many nervous, sleepless nights.  Looking back I see I created so much extra stress.  I don't know why I was so stuck on scheduling them on the same day.  And as usual, things had their way of working out.  Just not as I planned.

Turns out 10/30 I ended up with strep throat and I had to reschedule his appointments (again).  I got him in for the MRI 11/5, and scheduled the PET for a later date.  My Uncle took him to the MRI, and he cooperated pretty well.  We got the call a couple days later that there was no need for the PET Scan.  The MRI told them everything they needed to know.  There were visible black areas or "holes" in the right frontal lobe.  At the age of 64, my dad's brain was shrinking.  Diagnosis complete.

My dad's FTD case is pretty text book and the MRI explains why:

The cell damage caused by frontotemporal dementia leads to tissue shrinkage and reduced function in the brain's frontal and temporal lobes, which control planning and judgment; emotions, speaking and understanding speech; and certain types of movement.

patients with frontal lobe injury fail to adhere to social norms.  In behavioral terms, patients with damage to the OFC, particularly in the right hemisphere, show a pattern of behavioral dyscontrol that may involve

1. either emotional blunting and emotional liability, including an insensitivity to others emotions,
2. deficient decision-making, including poor social and non-social judgment, lack of self-monitoring, and/or inflexibility, and
3. deficient goal-directed behavior, including apathy, disinhibition, task impersistence, and general disorganization.

Unlike other types of Dementia or Alzheimer's Disease, his memory was fine.  You could hold a normal conversation with him and have no idea anything was wrong.  He seemed a little "off" with his behaviors, but still as sharp as ever.  He could recall trivia, politics, sports, regular topics of conversation like normal.  His memory seemed fine.  The more I read about other families' stories, and I see how many misdiagnoses they've gone through, I think we were fortunate to find the 2 amazing doctors we did at the VA who were able to help us.  (And from everything else I saw and experienced with the facility, they may have been the only 2 amazing doctors there!)

Managing the Finances of an FTD Patient

So after taking over my dad's finances, it became apparent how difficult they were going to be to manage.  There was no way to stop him or any of his new "friends" from accessing the money.  His social security check would go in, and in a matter of days it would be spent.  We decided to open up a new account and have his checks go to the new account.  Since it was an account he wasn't familiar with, I hoped that by transferring over money to his old account a little at a time, we could buy time to get his bills paid before all the money was gone each month.  He'd make daily trips to the bank to withdraw money.  And of course, he never went alone.  I'd get updates from a couple of the bank tellers that knew the situation to tell me XX came in with him again to take out money from his account.  I felt like it was only a matter of time before they discovered he had a new account, and there was nothing that could be done to keep them from accessing it. But he seemed to understand he was being given an "allowance" now and he was ok with me taking over his bills.  At least this way he was guaranteed to have utilities and groceries.  And he seemed to understand that.  It actually worked out pretty well for a little while.  Until this popped up one day...

I figured I'd paste in my email to my family, since it captures the frustration better than I can now 2 years later.

                            

RE: An Overdraft Notice is Available Online (WTF)

Sent: Friday, November 15, 2013 10:30 AM
what?!?

 

11/13/2013

Auto Deduct

PROG DIRECT INS INS PREM

190.66

I don't even know what this is for! There's nothing to click on for more detail. I've never seen this before.  Is this that insurance X was talking about - she had a policy set up with her and him?  So of course he's paying it.  Am I supposed to call her and tell her to cancel?  Is it really $200 a month?  This is just a never ending battle and I want to throw my hands up and say forget it.  Now he's in the hole $200.  Is he going to keep getting NSF fees until 11/20 when his SS comes in?  Well hey, I called the lawyer on Fri and again on Monday.  at least he's called me back....NOT. It's only been a week.

 

Sent: Friday, November 15, 2013 11:26 AM
I called the bank to see how many more fees he's going to incur.  She said he'll get another $28 on Monday, and then his SS should be in before the next one.

 

I asked about any accounts I can put myself on with him where he can't access the money and she said there are no options without guardianship or power of attorney.

 

Maybe I'll have to use one of his checks next time and write myself a large check, put it in my account and pay his bills that way.  What a pain.

 

I also called Progressive to see if I could find out more about the policy and how to cancel.  Of course they wouldn't give me much info. since I'm not on the account.  I explained the situation with dad and how he's being taken advantage of.  They said "hypothetically" I can't do anything, and neither can dad.  X set herself up as the primary policy holder and dad as the secondary.  So even if he wanted to cancel, he couldn't without her approval.  Basically all we can do is set up a stop payment with the bank and eventually it will get canceled that way.  Silver lining is he assured me this would impact her credit and not his.

 

A couple months later I was able to close these accounts down completely and open up a new joint account between my dad and his children at a new bank.  He didn't know how to access it, but didn't need to.  We took him out for his errands, brought him his food, and not too long after he was placed in the VA Home.  Now his finances are a breeze, and we are so fortunate he is able to be where he is.

 

He unfortunately received a call from X about six months later while he was at the VA Home. She wanted him to pay the outstanding insurance that we put a stop payment on and apparently was impacting her credit now.  How she thought he would be able to access funds while he was sick and living in a nursing home is beyond me.  What goes around comes around lady.

 

 

 

Cognitive Assessment 10/1/13

It's been awhile since I've been on to update and fill in some of the holes leading to my dad's diagnosis with FTD.  After the appointment with the neuropsychologist, it was recommended we set up a cognitive/mental assessment at the VA.  This appointment took place on 10/1/13.  As always, it was nerve-racking getting him there.  Would he be home when we came to pick him up?  Would XX find out and talk him out of it?  Would he be unwilling to go?  Luckily when I showed up, he was agreeable as always, but just wanted to eat breakfast and have his coffee.  I hurried him out as quickly as I could, but we got stuck in the construction going downtown and got there a little late.  Also, as usual, he didn't ask questions about why he was there.  

 

I remember being nervous the whole time about whether he would agree to continue with the appointment.  Would he get frustrated and want to leave, or would they get frustrated with him for not cooperating?  My sister came to take over the 2nd shift and he kept coming out for smoke breaks and to talk to us.  He'd go out for a smoke, come back and tell us about it, and then say he was going to go back out for a smoke again.  It was so hard to get him back in that room.  I thought he'd never finish.  The test was supposed to take a couple hours.  It ended up taking 5.  I can't believe everyone cooperated that long and got it done.  It was a huge relief and we hoped it would get us one step closer to the answers we were searching for.

 

We weren't allowed in the room with him while he was testing, so we don't know too much about what went on.  Although it was evident that each person he had met with saw the odd behavior we were trying to describe.  We were told to call back later in the week for an update on how he did and what it might mean.

I got a call later that week to fill in some holes.  He asked a lot of questions about alcohol and his drinking habits, depression, etc.  I had a sinking feeling that all of this would lead to nothing.  We would never get an answer.  It wasn't alcohol, it wasn't depression, this wasn't out dad. 

 

 

Update - Quarterly Assessment Visit

It's been awhile since I've updated.  Luckily there is not a whole lot that has changed.  I met with the nursing home staff today for our quarterly assessment and he is still upbeat, easy going and active.  There is some new staff, so I'm adjusting to that, trying to sense how well they know him and understand his issues. 

The new head nurse read from the report the last nurse took before they left.  It was more detailed and thorough than I was used to hearing.  Maybe it was just her approach.  And she didn't have a lot to offer since it wasn't her report and she doesn't know him well yet.  But she mentioned that he is "still" on a bathroom schedule since he has had some incontinence and bowel incontinence issues.  That certainly got my attention.  Reading about FTD, the 2 biggest signs of an impending decline, and maybe a sign of the later stages of the disease, are incontinence and refusal to eat.  Luckily his appetite is still great.  But I was a little surprised and upset to hear this.  She spoke as if getting him on this schedule to remind him more frequently to go might help him improve.  I wanted to say that I knew what this was a sign of with the disease, and he wasn't going to "improve".  But I kept my mouth shut.

The activities coordinator is also new.  A male this time around, which actually may be better for him.  He seems like he may have been a vet himself, and that he does things that seem more "normal" to me.  He said my dad participates in activities daily.  I pictured the toddler-style music classes we witnessed in the past.  But when I asked what they do, he said he participates in the trivia and conversations.  He takes him outside every day - sometimes for walks, sometimes in the court yard just to sit.  He even said he considered taking him out to shoot pool and wondered if he'd like that.  I said he would love it!  When I was out with my dad later I even saw him outside pushing one of the other vets around for a walk.  So that was a good sign.  Maybe he can relate better to the vets and be more on their level.

They also said they had him on a watch period for a week in May to see if there were any issues: showering, behaviors, diet, incontinence, staying completely dressed, etc, etc.  And they said there were no issues and he passed everything.  He still gets annoyed with some of the other residents' behaviors, but he handles it well.  When I asked if he still spends a lot of time on his puzzle books, they all agreed that he spends a lot more time out of his room doing other things and socializing than he used to.  So he doesn't appear to work on them as much.  Looks like he has found a new routine for now.

After the meeting I took him out to shoot pool and ordered some sandwiches for lunch.  As usual, he kicked my butt.  He does repeat his routine a lot more than he used to.  I don't know if it's a forgetful/short-term memory thing or an OCD/comfort thing.  And he told me he was going to use the restroom about 30 times before he actually went.  That's going to make me nervous now that I know about the incontinence thing.  I hope we have more time before that gets worse.  He also seemed to keep forgetting that my husband was at work and my sister wasn't able to come.  He kept wondering when they were going to get there and I had to keep reminding them that they couldn't make it today.  It's sad, but the visits are still uplifting because he enjoys them and is generally just happy to be out.  So, as always after a visit, I'm exhausted but so happy I went.

One year in and a little hindsight

It's been a year since moving Dad into the VA Home. Sometimes I find it hard to believe it's been a year and when I think about how he was a year ago and how he is today, there's been some noticeable decline. But for now, as long as he still beams when he sees us come for a visit, and we can get him to laugh, and he's not terribly confused, we take that as a good day. 

There's something I've been meaning to post for a while now that still haunts me a little when I think about the signs that were right in front of me but had no idea what to make of it. We all knew dad was not right for a while but here's what was sort of brewing, approximately one year before we got his diagnosis for FTD.

From: Debra Thornsberry
Sent: Tuesday, September 18, 2012 3:19 PM
To: 'Denise Tomecko'; mom
Subject: dad

 

Today was indescribably uncomfortable, but I will try my best.
 

I thought he was going to be super shut down when I first got there. A nurse was in his room so I waited behind the curtain, he saw me and waved. I heard the nurse ask him a few things a few times and either he didn’t answer right away or I just couldn’t hear him well. I thought is he being uncooperative and avoiding? After she drew a bunch of blood and checked other signs, she left. So I took one look at his leg and it looks terrible. Can’t see any bones in his foot, or his ankle and the calf is a good half-size bigger than the other. Then I noticed that his other foot looked swollen to me. I asked him if he thought so too and he agreed. I asked if his right foot started off looking that way too and he said probably. I asked him all about medications and what he might have been doing around the time that this all started and he really didn’t know. It’s almost like he tunes me and the situation out. 

 

Shortly after I got there he needed to use the bathroom so I showed him where it was. While I was waiting in his room I couldn’t help but notice how dingy dirty his jeans were. Like that hadn’t been washed in over a month. Then on the table I saw his wallet with post it notes sticking out, his smokes, lighter, keys and some sort of free beer token. That’s always good to have on hand when going to the hospital! While he was out, his phone rang which I’m guessing was Colleen. She called a few times while we were there. All I’d hear him tell her were updates as he learned them.

 

Then they took him down to get his ultrasound so I waited around in his room. Once he came back, it was like he ripped his robe off and started jumping into his clothes. He said they didn’t see any clots so I guess we can get out of here. I’m like uh, I don’t think it works that way. the doctor will still have to review everything and release you. We can’t just leave! Pacing around, pacing, pacing, pacing. Fidgeting with everything. What do you suppose this does? What do you think this is for? like some kid. Clicking, pressing, turning the lights on and off, playing with the tv, playing with the sink and its motion sensor. Playing with everything! He just couldn’t sit! 

 

I tried to talk to him about stuff, Brett’s work, hospital stuff, tried asking him more stuff to get a clue as to what’s wrong with his foot/leg. Talked about Colleen. Asked if she’s still working downtown only to find out she hasn’t worked down here in years! She doesn’t work at all, so all that stuff she told his family was just a lie. She lives with her son and her “spaced out” daughter, which is how dad described her. Government pays Colleen what she needs to survive, I guess. Said she was in the navy and gets money from that too. So my radar is definitely up now. we have to make sure he’s got some sort of living will going before something serious happens. 

 

Dozens of times, he goes back to checking his phone, his watch, his IV bandages, poking, prodding, checking, asking when they’ll take it out and I thought he was ready to pull it out himself. I even joked with one of the doctor’s aides that all the standing and pacing he’s doing probably isn’t helping him elevate his leg like they want him to! When they finally came around with instructions and to release him, I’m not so sure he fully listened. He just seemed so rushed. For what? There’s no place he really needed to be that I was aware of. All the questions I would answer and all the stuff I witnessed him do and how he acted. 

 

Dad is like 62 going on 82. Almost a dementia/mental-82. It was really uncomfortable.

 

 

The contents of dad's pockets that day.

 

***

 

Look at all the signs! His strange and distracted behavior, his filthy clothes and mixed up priorities, and the woman who ultimately took him for all he was worth, all right there playing out in front of me that day.  I just didn't make the connection. None of us did. Not until almost a year later when his behavior became even worse and my sister found him living without utilities, in a filthy hoarding house, with an avalanche of unpaid bills on his table while he played crossword puzzles all day and roamed the neighborhood for cigarettes, that we finally realized we were in store for something pretty bad. 

 

All I can say, and I think I can speak for all of us, is we are so grateful that Dad is a Veteran and has found a new "home" this past year.

Getting Caught Up...

It’s been a long time since I’ve posted.  I’ve had thoughts over the past few months of what I wanted to write about so we wouldn’t forget later on.  But things just got too busy, and it got harder and harder to get back here.  I realized with my visit this past week that things have kind of come full circle since I last posted.  So that helped me come on here to get back on track.

Back in the Fall I started visiting my dad on my own for a short weekday visit while everyone else was at work and my kids were at school.  I was nervous about it at first.  I figured it would be awkward and I wouldn’t know what to talk about.  Plus I was afraid if he was having a bad day and hard to re-direct, that maybe I wouldn’t be able to get him back by myself.  He’s still my dad and I’m still the kid, so I find it hard being the one in charge.  If he tells me he wants to stay and shoot another game even when it’s time to leave, or that he wants me to get him his 1000^th cup of coffee, it’s hard for me to say no!  But it turns out I really enjoyed these visits.  He was so happy to see me and appreciative to get out and play pool.  Even though I’m really really bad.  He always helped tell me what I should shoot and was conversational about family and things.  He seemed genuinely interested.  Complete turnaround from before the disease.  I found myself looking forward to these one on one visits.  I’m grateful that we were able to figure this disease out when we did, or we’d never have this time to come to terms with everything.

These visits came to an abrupt halt when there was a flu epidemic running through his unit before Christmas.  He ended up getting it, but from my phone calls to the staff it sounded like he was fine and handled it well.  We still waited 3-4 weeks to get back there because it was spreading through the facility.  They even had to postpone the holiday party for families.  When we went back, he was a different person.  We had read that an illness can cause a setback.  That it takes so much energy to heal and get well, that everything else suffers – they are more confused and appear worse-off with the dementia.  It’s unclear if these setbacks are temporary or permanent. 

He definitely had a setback.  He was very tired, didn’t really light up when seeing us, was more confused and very hard to get moving.  He’d get “stuck” when he was supposed to do something like take his turn.  He’d say ok, but then continue to just sit.  His cough was horrible and his appetite seemed weak.  The snacks he usually goes through in less than a week were still there from our previous visits.  It was sad and scary that maybe the visits we looked forward to, were now going to change.  When it was time to leave, he was very hard to get back.  He was just “stuck”. 

After Christmas we visited and brought him a tablet.  We put a few games on it, hoping it would give him something else to do.  We also set up an email account, but figured that might be something more advanced he might not be able to handle.  It turns out it just wasn’t something he was able to connect with.  I really think if we had given it to him before he got the flu, he may have been able to handle it.  But not after the recent setback.  These last couple visits were more sad and depressing.  But it was encouraging that he did seem a little improved each time.

I called to speak to the social worker to see if they’d noticed the decline and if they could tell us anything more.  They had basically seen what we had, but kept saying it was normal.  She also said that sometimes he gets confused and will come out not completely dressed, and that morning at breakfast he showed up without his pants on.  She said it was no big deal, that it’s very normal with the disease.  They just re-directed him back to his room and helped him get dressed.  I get that it is “normal”, but it’s not normal for him.  To me it’s another regression.  And he’s 65, not 85.  So it’s really hard to hear.

 

Now it’s been about 2 months since he was sick.  And I think it’s safe to say he has turned the corner and bounced back.  Yes he is still a little more confused, and I think in general the disease is still slowly progressing.  But I went for a solo visit again this week and he was great.  So happy and upbeat, he kept thanking me for coming and he didn’t act tired or “scary”.  It was such a huge relief.  Because seeing him the way he was before was just hard.  I know he’s going to get worse, but we hope we can have more time with him before that happens.

There have been some changes in the past few weeks.  The activities coordinator from his unit retired, so they hired someone new.  I’ve heard that she is really good and has been getting the guys involved in different things.  When I got there this week, all the guys were in the dining hall finishing up the personal pizzas she had helped them make.  It looked so fun and seemed like a really good idea.  I’m interested to hear more about what she does with them.  Especially as the weather gets nicer and they can go outside again.

My dad also had the opportunity to move into a single room.  I wasn’t sure if he would want to because he’s so set on his routine.  But he ended up making the switch, and we are all so happy with it.  Now we can bring some more personal things for him to hang up.  He has a nice view of the courtyard and was already commenting on certain people he sees out there regularly.  So it seems he already has a new routine and is doing well with the move.

 

So a couple things to note from my visit this week…after I pulled him out of the lunch room, we got his pool stick and started to head out.  He got sidetracked by the big screen tv because Dr. Oz was on and he really likes that show now.  I remember him saying that in the Fall, so I guess it’s part of his daily routine to watch Dr. Oz now.  I like to hear these little tidbits about his day.  It helps to know he’s doing something and has things to look forward to.

It was hard to get him on task when it was time to leave.  I can’t even explain why it’s so hard.  It just is.  It takes a lot of re-directing and being firm.  Then, once you think he gets it and is ready to comply, he’ll ask again “so do you want to shoot one more game?” And then you have to explain again how he’s going to be late for lunch.  And he’ll say ok, and then sit down and crack open a can of pop and light up a cigarette…I finally got him to agree to come by talking him into getting a coffee on the walk back.  

Once we finally got going he stopped by the tv again to watch a St. Jude commercial.  They were showing kids with cancer and it was hard for me to watch.  I didn’t expect it to phase him.  After all, the emotional feeling is supposed to be long gone with FTD.  But he stopped to watch and commented how hard it is to see those kids like that.  I was surprised, and almost wanted to change the subject before he ruined the moment and said something inappropriate to follow it up.  But it seemed genuine so I’ll take it. 

 

Then that was ruined on the walk back as we passed a large woman riding a floor cleaner.  She stopped to let us pass, smiled and said hi.  As we passed dad was like “Wow.  That woman is almost as big as that floor machine!” I pray she did not hear.  From an outsider it would be almost comical, because he’s not looking too slim himself these days.  Not to mention, he was wearing a sweatshirt that didn’t quite cover his belly.  But that’s the disease.  We stopped for his coffee and as we continued to walk, I stopped to check the time and bumped into him, spilling his coffee over his hand and arm.  I felt so bad.  But he didn’t even flinch and didn’t mind at all.  The coffee was fresh from the pot 2 minutes ago.  I guess it’s really true that he just does not feel temperature the same anymore. 

When we finally got back to his room I told him I wanted to clean it up a bit while he went to lunch.  It’s always hard to get him to just leave as I’m still there.  I started stacking up magazines that he’d been hoarding so I could take them home and get rid of them.  The one I pulled out on top had Elle MacPherson on the cover.  He saw it and was like “WOAH!  Who is that????”  all googly-eyed like a 13 year old boy.  So that’s always fun to hear from your dad.  Again, distraction, it’s all you can do. 

 

Then I discovered a note pad on his desk with some things written on it.  I saw he had some tv shows with times and channels written on it.  Dr. Oz, The Big Bang Theory…and then my heart sunk.  At the bottom of the pad was the phone number of that “woman”.  The one who took advantage of him and got ahold of all his money…the one who had tried calling the facility a couple times to speak to him.  I have no idea where this number came from.  I tried to sneak through his phone real quick to check the call log, but didn’t have a lot of time at this point.  I didn’t want to keep him from lunch.  I didn’t want to come out and ask him and remind him of her.  So I tore the number off and took it with me.  I’m completely baffled because he doesn’t know his cell number, so she couldn’t have called him on it.  If she called at the front desk, we’re supposed to be notified.  And I don’t see him remembering her number long enough to go back to his room and write it down.  So we’ve got some investigating to do…

 

9/3/13 First appointment towards finding the diagnosis

I've been doing a bad job at going back in time and putting some of the back story on here.  There is so much to this.  Not just the present situation, but how we came to the diagnosis, and some of the horrible incidents that happened long before we knew he was sick.  It tore the family apart and took many years to figure out why.  I always used to pray that we would some day find out that he felt bad for all that he did, and how he treated the family.  I just wanted to know that he recognized it and felt remorse, even if he couldn't ever admit it to us.  Never did I expect it to be a disease like this.  I should be relieved that it wasn't his fault.  But it just makes me more sad that this disease had to come in and ruin half his life.  And he has no idea.  With it being Veteran's Day, it made me think a lot about him.  Growing up, I never used to give much thought about his service in Vietnam.  It was something he never talked about.  But the older I get and I am able to understand and appreciate what these veterans have done for us, I am truly proud of him.  I also can't help but wonder if this disease stemmed from him being in Vietnam.  How unfair for a person to be drafted, go to war, and then end up with this horrible life-altering disease because of it?  We will never know.  Unless of course another family member gets it and we discover it is genetic.  Either way, it's unbearable.

So getting back to his very first appointment leading to his diagnosis.  It was with a social worker from the VA on September 3, 2013.  My Uncle took him to the appointment with my one page summary of his symptoms - recent and past  - in hand.  Here is an email I sent my family about it after I had spoken to the social worker after his appointment:

Dad signed a consent form so that she could speak with family members for his health issues, so she was able to call me and talk.  I think this stands for all his future medical care.  She said he wasn't very forthcoming, which isn't surprising.  And not new to her either, dealing with all personality types there.  She picked up on his hygiene/appearance.  He told her he showers daily, and she tried to put it tactfully that she didn't think he showered today.  He told her he drinks 2-3 beers/day.  I told her that isn't true, and she knows she can't go off what a patient says, she said they lie all the time.  She said she gave him a memory test.  It doesn't hold a lot of weight in diagnostic testing, but he did poorly on it.  She said it's obvious (X - insert name of woman who took advantage of him) is involved big time and she feels she is exploiting him.  She said she called twice while he was in the appointment, and it was clear she didn't want him there.  (Strange how he answers mid-session).  I think his issue is he shuts down when he's asked questions like this, but since he wasn't able to go out and smoke or dive into a crossword puzzle, this was tough for him.  I think he shut down by not having a lot to say.  She said she's going to write it all up to his doctor and see if she can get him in sooner, and get him in for blood work also - that should be done through some sort of geriatric testing, but he needs the papers from his doctor.  I asked if she could have the dr. call me if we can schedule him sooner, because calling dad won't do any good.  Especially if X has anything to say about it.  The social worker wants to give Adult Protective Services a call.  She thinks its warranted in his case - even if I said no, she would probably be obligated to call based on what she found today.  It may speed things along, and at the least help us get guardianship over his finances sooner.  My other thought, is would he just sign that over to us right now?  Not really sure what he needs to sign, or how that is done.  I guess that would be another call to the attorney's office.

And here was my uncle's perspective after the appointment:

I took your dad to his VA appointment today - he was a little puzzled about the reason for the interview but co-operated when I explained we were going to initiate the process toward additional VA benefits. He indicated that X had already told him that she felt there were opportunities for further benefits.

We met with the social worker and I explained to her in detail the circumstances of your dad's financial and behavioral problems. I described his relationship with X and the apparent level of control she has over him.  I tried to make clear the extent to which we feel she has taken control of his life.   Your dad was surprisingly unresponsive during my presentation and offered very little comment. Ironically, during the interview, X called your dad's cell and her tone and demeanor toward him during the call (the phone volume was high enough for all to hear) spoke volumes to support our description of X and her influence over your dad. Incredibly, she even called back minutes later with a "furthermore".  The social worker was taking notes throughout -- the episode was not lost on her.

She got your dad to agree to respond to a lengthy series of oral questions - a psychological and cognitive assessment I imagine. -- he was a little irritated by some of the questions but completed the test anyway.

She feels it is necessary to accelerate the time until his next doctor visit. She said she will arrange this with the doctor and call us to advise the new date for the examination. Your dad was agreeable to this and said he would co-operate.

She also got him to sign a consent form which allows the VA to share his medical records and evaluations with you, your sister and myself.

So, that is how today went.

Let me know if any questions.

 

Looking back at this, I still can't believe how "easy" it was.  He cooperated for every appointment along the way, but we worried the whole time he would not.  He hated doctors and never went.  I think it was a fear thing.  It was so strange to us that he kept going.  We started out being kind of sneaky about it trying to almost trick him into going.  But we soon realized that wasn't necessary and he almost looked forward to getting out of the house and going.  It was such a blessing in the end.  The next appointment on the agenda was with the neuropsych on 9/16...

8/20/14 Visit - Veterans' picnic

Last week we visited dad on a Wednesday since the VA home was hosting one of their monthly picnics for the veterans.  Since dad doesn't usually expect us on a weekday, we didn't see him sitting in the lobby waiting for us.  Instead, we found him sitting at his desk, in his room, working on his puzzle books.  He had his back turned to us, intently working, that we had to greet him more than once before we could get his attention.  He was very happy to see us and quickly wanted to go shoot pool. 

Before we left his room, my sister and I noticed there was a nurse sitting at the bedside of his roommate. We didn't think too much of it at first, but then wondered if something might have been wrong.  When dad was moved to the dementia unit this past winter, while it was sad to learn that dad would be the youngest in the unit, it was a little amusing to find out that he was being paired up with the oldest resident.  I don't think they've ever spoken a word to one another. 

Once we left the unit, we decided to start by taking him to the picnic so that he could eat right away and we can spend the rest of our short visit shooting pool.  It's sometimes hard to flip the script on dad and introduce a new routine and if we start by shooting pool, he will lose sight of the other things planned for the day, and we definitely didn't want him missing a meal.  Unfortunately, due to the weather forecast, the picnic was moved indoors, but the food was still good and they had some entertainment. Dad seems to light up when he sees other veterans or staff that he recognizes from his unit, especially when they are all outside of "lockdown." It's like their world just got a little bit bigger, at least temporarily. 

Dad usually has a hard time sitting still, especially when we try to do something new.  He was anxious about getting food and then getting over to the member's lounge to shoot some pool.  But I went outside with him so he could have a cigarette while we waited for them to finish setting up for lunch and that seemed to help.  After that, he was really quite calm and didn't seem so antsy. He ate his lunch and commented about a lot of the songs the band was playing, even tapping his hand on the table to the beat. 

After lunch we made our way over to the member's lounge where our brother showed up to shoot pool with dad. Dad still likes to read the signs along the way and I always like to see if we can still make him laugh.  When he pointed out the sign in one of the kitchen areas that said, "Please do not store bait in the refrigerator." I asked him, "Where am I supposed to put all the worms that I brought with me?"  He laughed and said, "you didn't bring any worms, did you?" I wonder if he thought that just maybe, I had. But he's still pretty sharp with the banter and jokes, so that's good. 

After several games of pool with Ricky, dad actually remembered that we needed to leave by 2pm so that Denise could get home in time for the school bus drop off. At about 1:40 he suggested that we start heading back. It seemed like enough time, but we always forget that it takes longer than we think. He's got a routine for everything, and returning to the unit is no different. There's more signs, bathroom stops, one last smoke break and sometimes we look at the birds in the lobby before finally ringing the buzzer to let us back in. 

Then once we are in the unit, he takes his "shortcut" back to his room, which is not much shorter than the other way, but we always meet back at his room after signing him back in and returning his smokes.  When we returned to the room, it was quite obvious that his roommate was not well. We realized that he was probably moving on soon, as there was a different nurse at his bedside, making him comfortable and taking notes. I think they were watching him around the clock in what was probably his last hours.  We got it. Dad probably did not.  He went right to his desk to work on more puzzles and was blissfully oblivious that he might be getting a new roommate soon. 

Tomorrow we go back for dad's quarterly assessment report from the staff, so we shall see...

Father's Day visit

It was our first Father's Day visiting Dad in the VA home, and in some ways, it was probably the easiest planning we've had in the last several years.  It used to be difficult deciding if we should host him or take him out somewhere when he'd seem to be antsy and uncomfortable doing either.  But that was before we knew his diagnosis. 

We all went out to see him, with the plan of having a picnic lunch brought in so we could try and eat outside.  He's very much into a routine when we visit, so it would be interesting to see if he'd let us change things up on him.  As it was getting pretty close to noon and we didn't want the staff to have Dad already seated for lunch, I decided to give them a quick call to let them know we were close by and should be there in just a few minutes.  We're not sure if he really knew if it was Father's Day or not, but the nurse said that he will be so thrilled and that he'd been checking the calendar and the pacing the lobby waiting for us. When we got to his unit to be buzzed in, there was another lady waiting outside as well.  She was there to visit her dad and we got to talking with her.  Sure enough, there was Dad on the other side of the glass, and since he can't let us in without the aid of a staff member, he cupped his hands to his mouth to shout through the window that he'll go get someone to let us in. It's so bittersweet.

The lady waiting with us asked if that guy worked there.  We said, "no, that's our dad." She was shocked and couldn't believe how young he was.  He gets that a lot.  People often think he's a staff member and not a resident, especially in the lock-down wing where he's easily 20 years younger than most. 

We signed Dad out to go shoot pool with him, which is a big part of his routine with us.  He always gives a little smile and a laugh when he sees us, and that's something we cherish while we still can. You just never know how long that will last with FTD.  Once we leave the wing, it's the usual routine of pointing out artwork and photos on the walls as we walk.  He'll tell us step-by-step how we will get to the member's lounge to shoot pool, even though we can all probably get there with our eyes closed now. We let him talk and do his thing.  He always thanks us for bringing him things to eat and drink and really enjoys getting to shoot pool. 

While the guys played pool, I enjoyed the outdoors with my sister and niece and nephew and we called for lunch to be delivered.  We were afraid that Dad would be stuck in his routine and want to get lunch at the dining hall, but it only took a little bit of coaxing to have him sit outside on a beautiful day with us. After we ate, he seemed anxious to check out the museum - another usual stop on his itinerary when we visit. But we wanted to give him our gifts first. 

We pulled together a nice gift to compliment his crossword puzzle hobby - a magnifying light, a desk light to work from, some more puzzle books, and his favorite cereal bars that he likes to snack on.  We also decided to make him a new Army scrapbook.  He had a book that my mom made years ago with all the photos and memorabilia that he'd send home from Vietnam. Over the years, the book started falling apart and many of the photos came loose, so we thought this would be a fitting gift, especially now that he's in the VA home, where there really is a sense of pride and respect for those who served for our country. 

I think it came out pretty nice. 

 

 

 

 



We never know what he's thinking or if we'll trigger certain thoughts that might be difficult for him.  When we gave him his gifts, he went through them all pretty quickly but he did seem to like the book and took the time to go through it.  It's amazing how his short-term memory can be so off while his long-term is completely intact.  He pointed to some of the guys, remembering their names like it was just yesterday.  Overall, we didn't get a huge reaction out of him, but we weren't expecting that, either, because with FTD, emotions are usually pretty flat. I hope he continues to look through this book and shows other family when they visit. 

 

Update on our concerns after 5/21 visit...

After our last visit and discussion with the nurse on dad’s changing behaviors, I wanted to address our concerns with the social worker.  I sent her an email explaining what we had heard and how we were upset that maybe this was a sign that things were changing.  He had been so friendly and agreeable since we discovered him in this state last summer, and we wanted to hang on to this phase as long as possible.  I had also heard earlier that week that they upped his Vitamin D after he tested low, so I wondered if that could have any impact on his behavior.

She explained that after talking to the staff, they had noticed some increased agitation gradually over the past several weeks.  And that it was worse over that weekend into Monday.  There were a couple incidents with other patients where he thinks he is “helping”, like wanting to push them somewhere in their wheelchair and the other patient doesn’t like it.  But he doesn’t stop.  And he hasn’t been as easy to redirect as he was in the past.  It sounds like things escalated a little and there were raised voices involved on both sides.   There was another incident over a puzzle.  He wanted to help another resident work on a 25 piece puzzle of the United States.  Sometimes this is ok, and other times the resident just wants to work alone.  This was one of those times, but my dad wasn’t getting the message.  It sounded like it turned into an argument.  I can’t help but think how this sounds like an incident that would occur in a preschool classroom. 

She put our concern about the Vitamin D on the doctor’s board.  But it sounds like these were gradual changes that occurred before they started him on it.  She said the staff talked about it and now they understand that they would need to take more time to redirect him.  Whereas before it was a quick “Hey, let’s do this instead” was all it took, now they might have to try a different approach to keep things from escalating.  It also sounds like it may be on the lines of what we saw at the end of our last visit.  He was on a mission, and nothing was redirecting him or sinking in.  He wasn't unpleasant about it, he wasn't trying to be difficult, but the connection just wasn't being made.

She thinks it may be a sign of a decline.  It’s just so wrong.  I try not to let the severity of this impact me too much on a day to day basis.  I am happy he is in a safe place that he seems to like, he is being fed real meals every day, his health is being monitored, and they generally seem to care about him.  But other times it really hits home that my 64 year old father is in a nursing home.  He’s completely mobile, but he’s in a nursing home.  In a locked unit.  For his own good.  He would have hated this if he was in his right mind.  Brilliant mind that he once was...

VA2K - Surprise Weekday Visit

We saw in the VA newsletter that they were having a 1 mile-ish (actually, a 2K) walk on 5/21.  We thought this might be a nice way to get dad outside and enjoy some of the nice grounds of the facility, so we decided to go for a visit.  When we got there we realized it might be tough to get dad to change his routine and spend part of the day outside, rather than shooting pool during our visit.  He really seemed to have no interest in getting outside and leaving the pool table.  We decided we just needed to be firm and tell him this is what we were doing.  He agreed, so we walked over. 

The facility is so large, it was practically a mile to walk over to the pavilion outside where they had sub sandwiches and some food and music playing for the walkers.   He was dressed in sweats, which was way too warm for the weather.  I was sweating just watching him, but the temperature never seems to bother him.  Once we got to the pavilion we decided to just sit and eat rather than doing the walk.  He had already walked far enough, and we didn’t want to push him too much.  So we got our food and sat at a table and enjoyed the music and sunshine.  It felt like a normal spring day at the park with normal conversation.  He often commented on the different songs, whether he liked them or not, how old they were and who sang them.  It sometimes surprises me how his memory has held up for certain things.

After we ate, we started on the long walk outside again to shoot one more game of pool before we left.  He started saying he needed to use the bathroom.  Which he always does because he drinks 9 cups of coffee and 3 cans of pop and bottles of water and whatever else he can find because he seems to have no sense of fullness when it comes to food and drinks.  He started making grunting noises as he was walking which was a little unsettling.  My sister and I looked at each other like, are we pushing him too much?  Is he too hot?  Is he going to the bathroom right now?  We picked up the pace to get him to a bathroom faster, but he kept saying he would be ok.  He didn't seem anxious about it at all.  But we sure were.  We made it back and all was fine. 

Since this was a weekday, I needed to be back early to get the kids off the bus after school.  I was paying careful attention to the time, and when a game wrapped up around the time we needed to leave, I told dad we needed to get going to get the kids.  He said ok.  But then proceeded to break the balls and start a new game.  I tried again, “dad, we really need to leave because the kids are going to get home and no one is there to get them off the bus. We don’t have time to play a new game.”  He said “oh, ok” but continued to play.  He was pleasant and it didn’t seem like he was trying to be difficult.  I think he was just confused and it just wasn’t getting through to him.  I worried maybe we had pushed him too far off his routine, especially with the heat and the long walk.  So I let it go, let him finish the game and prayed it would be a fast one.  Then we rushed him back to his room.  He seemed more confused than usual and kept forgetting we had just eaten, asking when we were going to lunch and saying we could stop at the cafeteria on the way.  He’s done this before, but this was worse and took a lot more reminding and redirecting than usual.

As we were leaving, one of the nurses made a couple comments to us about some unusual behavior he had been having the past few days.  She mentioned he had seemed more agitated and had been acting out a little with a couple of the other residents, which was very unlike him.  It was unsettling and I had a ton of questions, but we didn’t have time to discuss it much or ask what she meant.  It was kind of a downer after a visit that started out so nice.  There were times being outside on the nice grounds of the facility, where it was easy to forget he is sick.  We left that day realizing it would be unlikely that we would be able to take him offsite for some little day trips this summer like we were hoping to do.