Help and advice - how to convince a relative to get tested.

[ZoeKate]

Hi,
We have serious concerns for my father in law with regards to his memory. He is currently in a rehabilitation center following a fall which broke his hip, since he has been taken out of his normal environment his memory problems have become increasingly obvious - so much so the home which he is in have also picked up on this and have suggested a memory assessment. They have discussed this with him however he point blank refuses to be assessed as he feels they are trying to trick him into failing and that he'll only get tested if he knows the questions in advance! Whenever the subject is broached with him he becomes extremely aggressive and abusive and then just shuts down and turns the TV up or orders us to leave.
We've tried to convince him to have the test to ensure that his medication is correct but he still refuses.
His father had Alzheimers and we're convinced he knows that something is going on with him which is similar which is why he will not have the test.
The home want to send him home as they have done all the works they can with him for rehab purposes and following a home visit last week they are having his capacity to understand risks assessed this week by a social worker however if they deem him fit to understand risks we don't know what else to do. He'll be living alone with carers helping him for the first 6 weeks but following that he refuses to pay for additional care so he'll be on his own.
We've written to his GP expressing our concerns and asking for his help but nothing has come of that.
Is there any way to force him into a memory assessment so we can get him the help and support he needs before he does himself some serious damage once he's home?
Any advice would be appreciated.

 

[Shedrech]

hello @ZoeKate
a warm welcome to TP
what a worry for your family
it's tricky when someone is deemed to have capacity, so their own wishes take priority despite others being able to see that support is needed
I wonder whether the clinic would agree to a bit of a fudge - you say your FIL will only agree if he knows the questions in advance - so might it be suggested to him by you that the assessor has come to talk him through what the assessment would be so that he's prepared, and maybe even say that you expect he'll show them all is well, so it'll be worth him having a go to shut everyone up (bit of revers psychology) - this will keep family in his good books, which really helps

 

[karaokePete]

Hello @ZoeKate, I don't want to be a scaremonger or advise taking away a persons liberty to make their own choices. However, would you consider a bit of pretend scaremongering help such as saying that if a hospital or home think it's in the interests of protecting him they may take out a DoLS order and that would mean the Authorities taking control so it would be in his best interests to volunteer now as he may be able to stop that happening? After all, he would like that less than a test, wouldn't he? Just a suggestion that you may think unreasonable and take with a pinch of salt.

 

[ZoeKate]

Hi Guys,
Thanks for both your replies. Unfortunately we've tried the reverse psychology on him and it didn't work, we've also tried telling him that if he has another crisis social services will take charge and he'll have no say in where he goes or what happens but again he just gets abusive.
The home have tried talking to him, they have managed to do an informal assessment with the mental health nurse who says there's definitely something going on but unless he agrees to the full assessment then their hands are tied.
It's so wrong, we all know something is wrong but unless he agrees we can't move forward even though he may not actually understand what's happening to him enough to agree to an assessment. He forgets conversations you've had with him the day or even hour before, he asks the same things over and over again and as I've mentioned his temper is becoming a real issue.
We just don't know what to do that's why i was wondering if there's a way of the assessment happening without his agreement.
Thanks again

 

[karaokePete]

Hi @ZoeKate, the only extra thing I can think of is if your FiL's GP Surgery offers a 'Wellman' service. Maybe the GP would agree to calling him in and then doing a test as part of an overall check-up. It would be a shame if you just have to wait for a crisis as that may deprive him of available help in the meantime.

 

[ZoeKate]

That's a good idea, i'll look into that although the problem we have is he isn't mobile now and can barely walk so we'd have to see if the dr could come to him. Thanks though i'll definitely look into that.

 

[karaokePete]

Hi Guys,
Thanks for both your replies. Unfortunately we've tried the reverse psychology on him and it didn't work, we've also tried telling him that if he has another crisis social services will take charge and he'll have no say in where he goes or what happens but again he just gets abusive.
The home have tried talking to him, they have managed to do an informal assessment with the mental health nurse who says there's definitely something going on but unless he agrees to the full assessment then their hands are tied.
It's so wrong, we all know something is wrong but unless he agrees we can't move forward even though he may not actually understand what's happening to him enough to agree to an assessment. He forgets conversations you've had with him the day or even hour before, he asks the same things over and over again and as I've mentioned his temper is becoming a real issue.
We just don't know what to do that's why i was wondering if there's a way of the assessment happening without his agreement.
Thanks again

I've just read this post again and paid more attention to the anger issue. In people with dementia what is seen as anger may just be an expression of frustration as the person has lost a lot, or all, of the abilities to understand what is happening to them and express their wants/needs. Arguing won't help.
During my career I ran courses on the subject of negotiating skills. It is a well tried technique when trying to diffuse anger or get a deal to keep agreeing with the other side as people find it hard to argue with someone who agrees with them. What you do it think of all the issues that your FiL has brought up and try to agree with his point of view as much as possible on one point after another until you have him calm and on your side before you introduce what you want. Make friends before you introduce the punch line. You may think this worth a go if you haven't tried it already.

 

[ZoeKate]

We've tried that approach and it gets us nowhere as as soon as we have him happy and talking with us the moment we say something which he doesn't want to hear he blows up. We are actively trying not to fight him now however when he is fixated on coming home and putting himself in a potentially fatal situation (if he tries to walk upstairs unaided it could well be fatal) then we have to try other options with him but i agree arguing gets us nowhere. The home have tried talking to him gently as well but he digs his heels in. The biggest problem we have is trying to get him assessed, if we can do that we can then we can hopefully get him the support he needs and at least we then know what we are facing for definite.

 

[Bunpoots]

I wonder if it would be possible to present the test as a fun set of puzzles to have a go at? I can't remember the name of the one most commonly used but you could probably print something from the internet and then present the sheet to his GP. Just to give him some idea of what's going on?

 

[ZoeKate]

Unfortunately he's not one for puzzles so I don't think that would work. He's also not one for fun nowadays. Sorry to keep dismissing ideas.

 

[Rosettastone57]

My mother-in-law was always extremely resistant to any sort of interference or change in her life she's had mental health problems and personality difficulties for over 30 years. So when we realised it was more going on for example the dementia we had to use our strategies that we put in place for many years to try and convince her to get help. We use the same strategies for both obtaining power of attorney and also for getting the memory tests

. Because of her increasing paranoia what we did for the memory test was asked for the memory clinic to come to her home as she was very immobile. However before the actual appointment which I agreed to go to with the memory clinic nurse we used a trusted neighbour who agreed to help us out with trying to persuade mother-in-law to do the test. For several weeks before the actual appointment the neighbour agreed to come into mother-in-law's home with me simply for a social visit. We had already primed the neighbour before hand with what we wanted to do and she agreed with us that this would be the best method . The neighbour used to talk in a casual manner to my mother-in-law about how everyone had these tests at a certain age how she had had the test which in fact wasn't true. It was done in such a way almost as if it was an everyday occurrence to have these tests and she would drop the idea of a test gently into conversation now and again every time she used to visit my mother-in-law. It was all about getting my mother-in-law's trust and decreasing her paranoia so that she would see it was just a normal event. Eventually when the appointment came I was present with the memory clinic nurse and although mother-in-law seem a little bit anxious about the whole thing she willingly did the test quite easily with me being present.
It was all about my mother-in-law not being seen as different to anyone else

 

[karaokePete]

We've tried that approach and it gets us nowhere as as soon as we have him happy and talking with us the moment we say something which he doesn't want to hear he blows up. We are actively trying not to fight him now however when he is fixated on coming home and putting himself in a potentially fatal situation (if he tries to walk upstairs unaided it could well be fatal) then we have to try other options with him but i agree arguing gets us nowhere. The home have tried talking to him gently as well but he digs his heels in. The biggest problem we have is trying to get him assessed, if we can do that we can then we can hopefully get him the support he needs and at least we then know what we are facing for definite.

Was your FiL always the type of person in full control of their lives and a straight talking "I call a spade a spade" type? If so it may be that he reacts badly for two reasons in that he sees his control of his own destiny being taken away and he sees duplicity in the way people try to smooth talk him. Would straight talking about what the loss of assistance and medication may mean followed by a blunt statement that it's entirely up to him and then an end to the discussion work by letting him think about it and maybe come to the right decision himself?
Failing any of these suggested solutions offered by everyone it may unfortunately be a case of waiting for the crisis, which would be unfortunate. I can't think of anything else and wish you luck.