<p>I agree with your husband. Arrange a meeting with the facility and your mother. Ask your mother what living arrangements she has made? (She is not capable of making arrangements as you have noted). State your belief that you believe she is safe and well cared for in AL and you will not jepordize her health or safety by making other arrangements. You make a clear and concise statement and it drops it back in your mom and the AL lap. The AL cannot release her to the streets. Is there a MD who could back you up with your mom if you took her for a visit? The most that I would do is look at another AL that might suit her social needs and hire a company to pack and move her. I only wish that I had taken the “tough love” stand years ago. This “in-between” time is the most difficult for everyone. Now is also a good time to get a base line neuro evaluation and talk to an elder attorney about POA, health directive, etc. My thoughts and best wishes are with you.</p>
<p>CCSO- so sorry that she has made this decision. That said, does it mean that you and your brother have to buy in and bail out? It could be a very long haul of being held hostage by increasingly unreasonable demands that she doesn’t even believe are occurring. My ability to help my parents through the aging process is directly related to the degree to which they trust me, work with reality and respond to outside input when the task at hand becomes beyond them. If your help is somehow presumed (but I doubt acknowledged in this case), the plan has to work for your family also. A lot is beyond our control, and one has to let go. It may be a question of when/how she is allowed to fall on her face (somewhat), so that unrealistic alternatives do go away. </p>
<p>Good luck to all. This is so hard. Some elders are not destined for smooth, pro-active transitions, but rather reactive responses to crisis. I have heard a lot of wisdom on this board regarding those situations.</p>
<p>CCSO - So sorry for what you’re going through with your mother. I was very fortunate that all my mother did was complain about being in AL, but she never threatened to leave. She also thought she was much more capable of handling her affairs than she was.</p>
<p>How tough CCSO! Can you and your brother show up together and put on a united front? That’s what my brother and I did to convince my father that he needed to put the house on the market NOW but it seems my parents are easy compared to most on this board. I agree with the tough love, though I know it’s hard. My brother has been telling his wife to do that with her mother and she just can’t. Therefore she lives on the other side of the country with her mother who refuses to move out of her house.</p>
<p>I think my mom lied to my brother and had already turned in her 30 day notice but said she hadn’t. She does not yet need AL since she can feed, dress, and bathe herself. OTOH, she doesn’t cook, clean, or drive and like some college boys, thinks sheets unchanged for four or more months are perfectly okay. She told me that one of the handymen she has had for a number of years will be helping her move and that one of his friends used to be a mover. She plans to move back to her house which is so filled with stuff that you can’t even tell that she vacated the place. Of course the handyman has a vested interest in having her stay in her house; it’s an easy gig because she can’t process very fast to tell him what to do. Her <em>To Do</em> lists regularly take me an hour at most, and at age 60 I’m neither particularly young nor fast, and she ALWAYS tell me how fast I am – which tells me more about his/their speed.</p>
<p>The good news is that my brother, my only sibling, and I are on the same page. Thankfully, he is not in denial about her capabilities even though he is on the other side of the country. And maybe he sees it more because he doesn’t see her very often?</p>
<p>My MIL has also in her 80s has grown frail and no longer does much of anything. The big question is what will happen when her younger sister who lives in her house leaves for an extended trip, departure date and length so far undetermined. Sigh.</p>
<p>You can get a social worker involved,( through her doctor, I believe,) to run a mini assessment. We had this done with my MIL, at one point. It clarified how she stood, from their perspective, without out own concerns or frustrations coming into play. My MIL was fooling people, because her social skills were (always) strong. Even for us, we hadn’t realized how many management functions she had lost.</p>
<p>I have the same issue with to-do lists, for my own mother. Then, she won’t let us near, to deliver the items. My younger girl often runs these- and recently had her birthday ignored because her sister didn’t send a thank you note for something or other. It’s hard. Our aged relatives think their way works. I get a lot of “you don’t know how it feels to be old, to lose friends.” Of course I do.</p>
<p>ccob, I am really sorry your mom has the bit in her teeth and is doing the wrong thing. She sounds like my mom last year. It is really HARD to stand there and watch mistakes being made. And even harder to answer why did you let it happen later on. But I didn’t LET it happen, I couldn’t stop it and that is something to keep in mind. Getting social services on board, is great advice. Ours was listed under Adult and special needs agency instead of Senior anything so it took me longer to find help than I would have expected.
It is good advice not to second guess yourself when you know you are doing the best you can, but it is impossible to take that advice…</p>
<p>montgut. … I am SO sorry for your mom and the DNR. ick. I over rode my mom’s Physicans Orders for Sustaining Life because he had put in yes feeding tube. Mom didn’t want that and I knew it. And I filed it with the state so that the providers cannot get around it to keep the meter running. </p>
<p>I haven’t been commenting much but do follow along in these leaky boats we are bailing. My mom took another step down. Partly I am afraid, because we let her know that her “dear old buddy” the handyman had been stealing and he was fired. She wanted to be the one to fire him. He left his free rental finally, taking the washer, dryer, stove, and fridge with him. I am frustrated because it has been more than a month since we reported the other theft losses and the county sheriff hasn’t done anything, including returning my calls.
And I am mad at the AL place. I had told them months ago not to just drop Mom off the bus for Dr. appointments because she doesn’t remember what the Dr. says. So 2 weeks ago she went to the cardiologist, who ordered some blood tests, which I knew she hadn’t had. So I pinged the nurse with it (she thought the Dr. was supposed to fax her anything like that). So today they took her to the lab, dropped her off and when she was done, she couldn’t remember where she lived to have them call the bus to pick her up. It scared her. Poor little thing. So I am mad at pretty much everyone.
No, though, she can’t come live with me. I would need the crazy farm after about a day of it.</p>
<p>New to this thread. It is certainly comforting to know that others share my problems.
Today my mom’s internist suggested a geriatric psychiatrist. Has anyone had experience with this type of doctor? If so, what do they do? Mom has both dementia and now depression. We already see MANY specialists and so many seem to do nothing except say “please return for a follow up in 6 months.”</p>
<p>Welcome, ksm. My aunt’s neurologist takes care of her medications. She received the “official diagnosis” of vascular dementia and depression a year ago when she had her stroke. A geriatric psychiatrist ordered her medications when she went to rehab. I am a retired ER nurse and know all of her MD’s. The neurologist was comfortable continuing the medications so that we did not have to add psychiatrist to her long list of MD’s. My aunt is home now and I can relate to the “6 month follow up” visits. I went back to CT from FL in March,(took a break from vacation) and took my aunt and mother to a total of 10 MD visits and 2 dental visits in 18 days. I finally told each MD that we would return in 1yr or sooner if necessary. It is nearly impossible to get my mother out of the house and in and out of the car for a 2 minute visit. The dentist had to come out of the office to the parking lot and convince her to come and get her teeth cleaned. I finally said, “enough”. Sorry, felt a need to vent, now, back to your question. Is your mom receiving medication for the depression? Many primary care MD’s do not want to order psych meds for the elderly due to possible serious side effects. If she is having symptoms that interfere with her care, it might be wise to start with the psychiatrist and look for a local MD that specializes in geriatrics and would be comfortable ordering the meds. Best of luck.</p>
<p>ksm - My mother was evaluated and treated by a geriatric psychiatrist several years ago when she was diagnosed with dementia, depression, and paranoia. The psychiatrist finetuned the meds she had been prescibed in the hospital. After she moved to AL, she was followed up by a psychiatrist that came to the facility occasionally. I felt more confident that she was being treated appropriately after she had seen the geriatric psychiatrist. The psychiatrists in the hospital were medicating her with some heavy duty meds that I was glad to see the geriatric psychiatrist discontinue.</p>
<p>I’m nervous–taking mom in to see the internist for a physical. She has a cough and plegm that just won’t go away. She also has been taking shorter and shorter strides and has a very difficult time hearing. We’re concerned that she’s becoming socially isolated and want her to get physical therapy so she will walk faster, as she did only a year ago. </p>
<p>She was upset with me when I told her I scheduled her to see the doctor tomorrow and will drive her before I fly out to Chicago that evening. She reluctantly says she’ll go and take the tests today and see the doc tomorrow. I am also asking that she get a hearing test, as her hearing is getting worse and worse progressively and am concerned that she will only listen to the doctor, as she doesn’t listen to us about giving a hearing aid a good try. Hope we don’t overwhelm her but the cough that triggered my call has persisted for over a month now, even though she took a course of antibiotics. Hopefully, if she gets a new course of antibiotics, gets physical therapy and gets a hearing aid she’ll regain her life (otherwise I feel she’s getting increasingly isolated, especially being unable to participate meaningfully in conversations).</p>
<p>I know that compared to the rest of you, these issues are pretty minor and we’re lucky to live less than two miles from her house, but it’s still tough when SRs don’t want to do things that will make their lives and those of loved ones better. Stubbornness isn’t always the virtue it’s touted as–her friends are concerned as well.</p>
<p>HIMom, glad you put your foot down for your Mom. I find it is really hard to parent a parent. I think whirlwind appointments work out for the best myself. You get a momentum going.
I think being close physically is a mixed blessing. Yes you know what is what and can keep an eye on things. On the other hand, do you ever get a break? My H thinks I devote too much time to Mom even from 400 miles away (he is partly right, partly wrong… he never went through it in his family. I saw my mom live with my Alzheimer Grandma and keep her alive an extra 5years.)</p>
<p>ksm, I can’t help with the geriatric Dr. there is only one in Mom’s town. I think getting a geriatric PA would be very helpful . Just someone who focuses on the little things for older people might uncover problems in time to fix them for a while.</p>
<p>ECmom … yikes about getting your mom out! That is a good dentist that would get it done. My mom is the opposite, she is trying to get to the Dr.s all the time; possibly as a cry for attention. She forced the AL place to take her to the Dr. late Thursday (they called and I told them I really didn’t think she needed it, but yes, her leg was swollen). Since they have taken her off coumidin, they are really worried about clots, so they sent her off to an ultrasound which was negative. I was both sad and glad I was right .</p>
<p>CCSite, I hope your aunt does get a break. That is hard to arrange sometimes. I would be very careful with handymen/friends helping. So often they just help themselves. Mom’s handyman has cost / stolen more than $30000 just this year and I have been fighting him off every way I can. Sheriff isn’t very interested in stolen tires, appliances and rent when they have drug busts and murders to tend. Just stay on top of it and let the “friends” know you are watching everything. … if you can!</p>
<p>Ksm- If a geriatric psychiatrist is available (so hard to find), a consult would be useful as it is clear your internist doesn’t want to deal with such things. Hopefully your internist would follow a treatment plan set up with the psychiatrist to not involve multiple visits. But I also wonder, does your mom really need to see so many specialists? Really, the internist could really manage the treatment plans set up by the specialist. As a family nurse practitioner, that is certainly what I do in order to save the patient and family multiple visits to multiple care providers. I would have a discussion with the internist as to whether he can take over management of some of her conditions which are sending her to specialists. I know I don’t tend to take over such care for stable conditions unless requested by the patient as I assume they want to continue specialist care. </p>
<p>I also think it is reasonable to start shedding specialist care after a certain age and physical condition when quality life and independent living for as long as possible is your goal as opposed to longevity. For example, cholesterol meds are famous for causing muscle pain. But they are good for preventing/stabilizing coronary artery disease 20-30 years in the future. Do we really need to be prescribing them for 80 year olds? Shouldn’t our goal be to decrease meds that are possibly causing muscle and joint pain in order to preserve physical function? Consult with the geriatric psychiatrist to improve quality of life seems to me more useful than maybe a Cardiologist.</p>
<p>Oh, GTalum, your thoughts are based on common sense and patient advocacy, not on profit margins! I can usually get the MD’s to follow my requests, only because I knew most of them when they were lowly residents, (at the time, there was a group of us RN’s that was determined to “train” the new MD’s, we also kept them well fed). The local hospital has bought out the majority of private practices in our area as well as several smaller community hospitals. There is no competition and the offices have “quotas” to fill. What a sad state of medical care. Thank you for advocating for patients.</p>
<p>Thanks EC. We also sold our private practice I owned with a physician partner to a hospital network last year. I am the busiest provider in the county and have more patients than I can manage and am not accepting new patients. But actively managing a patient’s care is what my job as a primary care provider is.</p>
<p>Grrrr … in my quest to get the Long Term Care insurance to pay, I got sabotaged by Mom’s Dr. He is a good guy, but WAY too busy. He just checked off the boxes and basically said she is still independent. I had called his nurse with some of the things she does, but I guess it was too late or I didn’t stress it enough. I am writing a detailed letter. She is “independent” in that yes, she eats and dresses herself. But she can’t remember taking meds, she is forgetting people. she doesn’t know where she is living. She can’t understand bills and things she reads (that is how I got her snowed on the guardianship.) And of course the LTC takes his word over the 24 pages of incident reports from the facility. Rats!
And best of all, I found out on the SAME DAY that the LTC premium bill arrived. Insult to injury!</p>
<p>eso, when we were filing my parents’ LTC claims, I was told that if the person has dementia, then the ADLs are irrelevant – dementia alone is enough to trigger the benefit. Of course, every policy is different, and I don’t know how they define dementia (although I think it was based on their own assessment, not on a doctor’s dx). But that’s something to ask about.</p>
<p>You said the insurance company is relying on reports from the facility. Aren’t they coming out to do their own on-site assessment? Genworth was insistent about that, and the nurse they sent spent like 3 hours with my parents (looking for ways to deny the claim of course). But anyone who spends any time with my dad cannot credibly deny that he has dementia, and that’s what got his claim approved.</p>
<p>LasMa , I should push for them to get their own assessment, but they seem to have an arbitrary 9/30 on the mini mental which is basically a vegetable. They didn’t take the pages of documentation from the OT last year (when Mom was in an actual nursing home for both physical (knee replacement) and mental issues). They had test after test that Mom failed.</p>
<p>The policy says “sever cognitive impairment” and not the number, so I am going to appeal it if they deny it again. </p>
<p>And I am writing the doc.</p>
<p>Just a suggestion. It would be useful for you to fill the form out yourself and then ask her doctor to review and sign.</p>
<p>So now we start a new part of the journey.</p>
<p>Following a fall, MIL spent 3 days in the hospital, then a week in rehab. She then went back to the hospital to have some fluid drained from her abdomen. After talking with the oncologist, the decision was made to transition her to hospice care, as it appears the cancer treatment is just not working. I have no idea how long she has - maybe after she quits getting chemo she’ll have a brief period of feeling better until the cancer takes over completely.</p>
<p>The issue now is where to go for hospice care. She would rather be home. She’s quite lucid, and really much more cognitively capable than FIL, so being in a nursing home is tough for her, because the other residents are frequently, well, not lucid. The problem with being at home is that their home is packed with “stuff” and has no accommodations for her mobility issues, so there may be some limits based on what the hospice team can do for her there. </p>
<p>This is really hard for FIL. He’s been thinking all along that she would be cured, and is having a hard time coming to grips with this new reality. And he wants her home, but for some reason can’t face modifying the house to make it possible. I’m hoping that SIL can talk some sense into him, but we’ll see. Once again they’ve been talking to the staff at the hospital about what their options are, but I’m not sure they’ve considered that they could just pay for some things that are not covered by insurance to get some better options.</p>