So far he is managing but there are signs of the beginning of decline: needs help with bills, rotting food in fridge, more forgetfulness. I know we need to find out what health/medicaid plans he has so we know what services will be covered.I guess I am asking for advice on what else we could be doing now - for anyone that has gone through this was there something you realized or found out later you wish you had done sooner?
Needs help with bills - no way a normal person would let bills slide if he's been handling them well during his adult life.
Rotting food in fridge - way beyond beginning. A normal person would be getting rotting food out as soon as there's a need to remove it. Executive function kicks in and says "Oh, that fruit has been in there for xx weeks, time to take a look and make sure none of it is rotting." Cognitively declining person losing executive function says, "What fruit? There's no fruit."
Forgetfulness - if he doesn't live with you, you aren't aware of everything he's forgetting.
He shouldn't be living alone, but don't move him into your house! He needs 24/7 supervision, not just a sitter for 4 hours a day. You've very wise to want to get ahead of this, and the time is now. Take a look at continuing care facilities. He can start at one level and continue through the levels as his condition declines. also, he can make friends and won't be lonely. Also, if he'shard of hearing, get him hearing aids. Loss of hearing contributes to cognitive decline in a big way.
Good luck with what you need to do.
Is your dad a Veteran? If so get whatever info you can and contact your local Veteran's Assistance Commission. Their service is free and they will help find out if he qualifies for any benefits. It does not matter if he served during war time he is still a Veteran. The type of benefits will vary depending on where and when he served. It could be a little or a LOT. Well worth checking out. And don't let him tell you there are "others that need it more" his benefits are HIS and by taking his benefits he is NOT causing someone else to lose theirs. (big concern for many Vet's)
Next check with your local Senior Service Center or Area Agency on Aging. There may be programs that can help him.
Is there an Adult Day Program near? If so that can help a lot. Typically they pick you the participant in the morning, provide a breakfast, lunch and a snack. A variety of activities and then bring them home late in the afternoon.
See an Elder Care Attorney. He may still be cognizant enough that he can appoint a POA for Health and Finances. if not someone may have to become his Guardian. So if he has a "good" time of day make the appointment for then.
If there is any possibility that he may have to apply for Medicaid find out how that can be done legally. (there is a "5 year look back" so no gifting or "hiding" money)
Ask him what his wishes are for Health care. A document that is more detailed than a DNR is a POLST (called by other names in some States) it goes into detail about what measures he would want taken.
Pre paying, preplanning his funeral is one way to spend down assets and take a huge burden off the families shoulders when he does die.
figure out the Where will he go.
Will he move in with a family member?
will a family member move in with him?
Will he go to a facility that can care for him safely?
Will he stay in his home with a caregiver?
The attorney can help him establish all the paperwork to make sure his health wishes are respected (like does he want a DNR, does he want to have certain life saving measures attempted or not. —like ventilators, etc.), he can elect a POA in case he is ever deemed incapable, etc. It doesn’t mean death or dementia is imminent, it is just so all ducks are in a row and everyone knows his wishes. It’s good for everyone. He can also do a will or trust, etc to take care of his finances.
Everything that has to be done is a lot to digest and can be emotional and feel to him like loss of independence and privacy. But it is really to protect him and make sure his wishes are known and respected. At this point (my dad had a cancer diagnosis so it made broaching the subject easier), my dad took me to all his doctors appointments (I had already been driving him to them, just not attending them), and signed HIPPA forms allowing the doctors to talk to me, make appointments for him, etc. If you are going to be that person in his life, then be prepared. Depending on his current and future health issues, this alone can be a lot of time, effort, and emotion coordinating between specialists and researching appropriate questions, etc., scheduling labs and following up on them (doctors don’t look at them until you broach the subject or have an appointment, so if there is something that needs quick attention you have to instigate it), etc. My dad just turned that all over to me. Because of his poor hearing he had barriers to communication (especially since it was still covid times and everyone was masked). Your dad may not want that level of involvement from you so you will have to navigate with respect all of that.
The attorney can also discuss with him daily finances and having backup help there .
It sounds like he could use some help with daily life. I was seeing what you are seeing, after my mom died and my dad was trying it out on his own at his house. I also observed a lot of dropped meds on the floor and poor hygiene (dad also has vision issues). It was “easy” for me to broach him having help, because of his cancer diagnosis. It may be less well received by your dad. Mine moved in with us (NOT something I would recommend, but my relationship dynamic and situation may be different from yours, and it was still very much Covid when we were addressing all this). There are various ways to arrange and pay for care help in the home, or he could consider Assisted Living apartments. You will get a lot of good advice here. I would recommend always treating him with respect and consideration and LISTEN to him. I would very carefully consider how involved you become in daily care and what you are and are not willing to do—reading on this site some of the issues and situations that can come up that you would not be able to anticipate yourself, and carefully weighing options.
Adding to my already very long response: Geaton777 very wisely suggested taking him to his PCP to check out possible reasons why you are seeing what you are seeing in his home. Elderly do not present with the usual UTI symptoms, always, and I have found some docs are less familiar with that fact and that the bigger symptoms can be cognitive, fatigue, etc. Some vitamin deficiencies definitely can effect daily functioning, etc!
As suggested by Rosered6, make sure he has all his legal ducks in a row so that he has all protections in place and documents that will make managing his affairs legal and efficient.
Next, take him in for a full medical exam to make sure that what you're seeing is actually some form of dementia and not a treatable problem, like a UTI, dehydration, vitamin deficiency, uncontrolled diabetes, high blood pressure, strokes/TIAs, tumor, etc. Only a few dementias can be diagnosed through imaging. Start with his PCP. Make sure you or a male family member accompanies him to this appointment and is in the exam room with him ("to take notes because the doctors tell you lots of stuff and talk fast"). Make sure he assigns someone as his Medical Representative on the HIPAA form that all medical offices have. This does not permit medical decisions for him, but legally allows his medical team to discuss and receive his private medical information without further permision or need to be present.
Once you know what's going on, you will need to figure out if he's safe staying by himself in his home or if he needs in-home aids or a move to an AL. At the end of day you can't force a resistant adult to do/accept things they fight against, but this is where having durable PoA becomes critical.