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My father had a very small skin cancer removed many years ago by his nose. In his late 80s, we asked about a small spot on his temple and were referred to a dermatologist, who found 4 spots to remove in her office. Then a year later, a couple more. After that healed, they told us they didn't get it all and he needed a Mohrs (deeper surgery) for the area beside his nose, which had been removed years ago. He was tired of having his face cut in the more superficial removals; the healing process was slow and he kept picking the bandages off his face, etc. Got blood all over his sheets. I asked how important it was to get this Mohrs surgery asap. They told me at his age/dementia, we could wait a year. We chose to wait. A year later, he went in for it - knowing why he was there but still surprised at the pain. I was present in the room for it and a little horrified at how much they took off. Not even to the extent of what you describe for your father. I was amazed at the traffic in the waiting room as people filed in/out to have pieces of their face removed and I decided it must be lucrative.

When I took him in for cataract surgery - also in his 80s and with moderate dementia - the doctor and I went over and over the process ahead of time and I managed the drops since Dad couldn't. The doctor talked to him just before surgery and still, after the procedure, he was surprised by it all, thinking he was just getting his eyes examined.
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First of all-- tricking him is not being mean-- it is helping him--- he SHOULD NOT be living at home but be in an assisted living facility and he needs to be tricked to get in there as well--- so Invent a reason or two-- tell him you all are going to a big hotel and give him something to drink-- and knock him out.... then when he comes to, tell him his home burned down because he left the stove on. My father-in-law did that-- they were stupid and took out the stove--- they should have taken him out--- he died from falling a week later. STOP playing fairly--- be that POA-- or let someone else to it who is going to be more about helping him instead placating his insanity. After 2 weeks in the facility he will forget about his home and be all about making every meal on time and watching TV in his room. Do not feel guilty about being the Tough Lover. It is your job.
OH-- btw--- he will need to be in a place where they can bathe him and change the bandage on his face--- and he may have to be restrained the first few nights to keep him from scratching it.
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Darlin Oct 2019
Perhaps you need to read more carefully before you respond. Guilt is not an issue here.
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Regarding my uncle, due to his dementia I did not consent to treatment as I knew being in hospital would just cause him more stress and he could get quite belligerent at times if confused. Yes it was signing his death - but he went on another 15 months longer than the doctors predicted. For the majority of that he was happy and non stressed with pain relief and doing the things he enjoyed.
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If you know he would not want the surgery, then I would not do it.
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Suetillman Oct 2019
He isn’t in his right mind and can’t make any decisions on his own.
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IMHO, he should be told about the surgery and should have it. Someone is going to have to handle his hygiene, though.
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Do what the doctor said. He really needs to be in a nursing home. Nobody in his shape should be living alone and nobody should go 8 months without a shower. I can’t even imagine the stink or the stuff crusted on him. It doesn’t matter what he thinks at this time in his life. He isn’t in his right mind.
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When the surgeons suggested the sedative to get your father to cooperate with the surgery, did they have a game plan for explaining the bandages and alteration of his face? When the physician said that he will have a hole in his face eventually, could he provide a time frame? It seems to me that there are more pressing issues to address such as his hygiene. I think he needs to be placed in a facility. A physician preferably a geriatric psychiatrist needs to be consulted to manage his behaviors with medications. I'm worried that someone may call protective services and charge you with neglect.
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Catnk9 Oct 2019
Ahhh....... 20 years of geriatric nursing and boy, do I remember some residents and their fighting spirit on shower days! 2 a week unless excused by the nurse on duty. Majority were ok with it but a few were not and I mean NOT! Protective services don't deal with poor hygiene and you are never legally responsible for any relative unless you are a legal. court appointed care provider.

Duggan B. can not be legally charged with neglect any more than they could charge me with neglect for his father. Just sayin.
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Update! The surgeon called again yesterday , after consulting with an expert and was advised to not undertake this surgery. Aside from my dad being against it--and he was clear about that-- she said it would likely disfigure him to the point of him not being able to eat, and that infection was too likely, as well as the trauma of putting him through it all.

She was very gracious in the reversal of what had been her original reaction, prognosis and plan (or lack there-of). I'm so thankful she consulted an expert. I am grateful that she and her staff and his regular MD, his caregivers and case worker, and the court investigator are all kind to him, caring and not grossed out by his hygiene issues. He does the best he can. I do the best I can.

We all need to understand that memory care facilities and assisted living are for people that have money- not very poor people. My dad will eventually be in a nursing home or mental hospital ( via Medi Cal)--but not until he is failing in other areas. There are a lot of people checking in on him. Being a conservator is not something one takes on lightly. There are a lot of hoops to jump through and checks and balances.

I thank everyone for their response and input. We're all in this together.
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DareDiffer Oct 2019
Amen! I’m glad they got another opinion, it sounds like it really is the best option in his case.. As to hygiene issues they are used to a vast range of abilities or not - it’s a part of the job.

Good to hear all those involved helping your dad are kind and kind and caring as they should be.
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Have y'all ever just applied Vitamin E oil and other skin repair agents -- organically and all? There has to be a eastern (oriental) method that is less invasive. Surgery should always be the last resort. Tea tree ointment and/or tea tree oil can maybe slow the growth . Good luck, and Godspeed.
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Darlin Oct 2019
Thanks DugganB!
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Happy to hear that the doctors have figured out that this surgery is probably not the best solution and/or isn't likely to happen! Hopefully there might be some kind of topical treatment that might help in some way - slow it down or treat it a bit.

Also concur on the idea that not everyone can go the AL/MC route. Too many immediately suggest placing people without considering that many can't afford the cost (even worse are those who say NH because people have to meet certain needs to be eligible for that - needing specialized nursing care, dementia isn't enough - and it is even more expensive than AL or MC! On top of that are those who say Medicaid will pay - not always the case there either!)

Although we didn't have to go the guardian/conservator route, I do understand that management of their care takes effort and sometimes a lot of work! Our mother is in MC (thankfully she can afford it) and although I have 2 brothers, all the financials, medical care, paperwork, contact, etc, goes through me. Some months are better than others, but it is still a lot of work!

Blessings to those who have to tackle all these things AND provide the hands-on care! For many reasons (esp any physical care) I can't care for her myself, even if we could hire help, but ensuring she is safe and cared for is something I can provide.

Hoping things go well for you, as best they can given all the issues.
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Darlin Oct 2019
Thanks so much for responding. Blessings on you!
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