Caring for an aging alcoholic.

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My mother is almost 89 and has about doubled her alcohol intake in the past several years to where she is drinking about 12 oz (hard liquor) per day and she is only 116 pounds. She is still living independently but in an apartment situation that comes close to assisted living. She is going through her money at a fairly good clip due to not only insisting on the high alcohol consumption but also an obsession with eating out (at O'Charley's) in a nearby town at least three days a week despite having her meals paid for at her living situation. Her immediate and recent memory functions are pretty much nonexistent, and her attention/concentration is poor, but otherwise she presents as fairly high functioning. Her liver enzymes are still normal, amazingly (is it the Irish in her?). Her kidney function is slowly failing but she was still only borderline Stage IV renal failure last year when she was checked (due to see specialist in October again). She has high blood pressure controlled. No other health problems currently.

My husband and son are helping me. My husband drives 34 miles to get her then round trip 25 miles to take her to lunch then 34 miles home on Monday and my son makes the trip on Fridays. On Wednesdays she pays for transportation from the living facility to go to lunch. I take her medication/pill organizer to her on Saturdays but don't stay long as I can only take so much of being around her. Her medication is locked up and staff get it out and watch her take it. She actually takes very little medication, just 2 for blood pressure/heart, and the rest is nutritional supplements because she is so depleted (folic acid, vitamin d, b vitamins etc,). We have tried Aricept since March but as I see no improvement in memory, and more decline, I am thinking of stopping it. This is likely alcoholic dementia and the usual cognitive drugs will not help. I am wondering if I should not bother with all the vitamins either, since I read she is likely absorbing very little of them.

We have been trying to figure out how to get her to stop shopping when we are not with her due to fall risk and the fact she can't remember what she needs, she buys things she already has, and she doesn't even follow her list when she does shop. But mostly the fall risk. Plus in Wal Mart she gets a scooter and is dangerous driving it. Also we are trying to buy her liquor and keep her supplied so she won't go out and shop for it on her own, but she keeps drinking more than we expect.

She has had repeated falls but rarely any serious injuries. She did fall down her basement stairs at her home in 2010 but amazingly only broke her arm.

Her apathy is increasing. She refuses to socialize at the place where she lives because "they listen to Christian music and are people that don't do anything" (as if she does anything besides drink and watch Fox News). She is more and more obsessed with getting out of her apartment and complains constantly about loneliness.

As she declines further, I am unclear what lies ahead. I can see her needing a higher level of care, but how will they deal with the alcohol consumption? In 2010 she was given a prescription for a limited amount of alcohol while she was in LTC briefly but she wasn't drinking as heavily then and handled the reduction. At what point and how do we decide that she is spending too much money on the alcohol/eating out (right now it is about $800 a month with the gas, lunches out, and all the booze). She still has money left but if she needs a more expensive living option, she is not going to have money for long. She is spending about 2,100 a month now for the apartment situation.

We did take away the car in January. She was still driving and has been driving drunk for years. The wake-up call for us was a notice from State Farm that there was a minor personal injury lawsuit over a minor fender bender that occurred in 2012. It was worked out with insurance but we figured it was a warning that her luck might be running out. She put up a fuss for awhile but doesn't talk about it any more and says she knows she can't drive now but thought we took the car away "too soon."

So my main questions are dealing with the alcohol consumption and ethical issues in managing her money for her--do we put her on a stricter budget for example? We do not have guardianship or anything but she is letting my sister manage all the bank accounts and bills (she doesn't have the attention or memory skills to handle anything to do with money anymore).

Thanks for any and all input in advance!

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Leslie one thing you may not know and I do not have chapter and verse but you can check. If you place your loved one in the facility of your choice as a private pay patient for a specified length of time and I believe it is six months then Medicare is not allowed to move them when they change over. So as long as you can set aside 6 months money for N/H you will have a choice of facility. Nursing homes prefer private pay too so you are likely to get a bed sooner. Sad but true
Jinx I am English and could make a smart remark but will refrain!
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I was commenting to Veronica about her reference to a certain "ethnic group" and she apologized.

No everyone finds the same things offensive.....
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As for specialists, physicians, etc. we really don't have a lot of options where we are. Things like geriatricians and such as for metropolitan areas. We did get her to change her primary doc to a better one and he is okay but not a specialist for the elderly by any means. He is good with heart issues. The NP in his office I haven't been as pleased with. She was losing weight and eating less and I moved her appointment up so the doctor could impress on her the need to eat. the NP saw her first and was like "you know your mother is her own person" and "well if she eats fried appetizers for lunch and crackers/cheese for dinner that's at least something." He came in and was nice and direct and said "You need to eat. You don't need to be losing any weight at your age. You must have more protein." And she has eaten better since then.
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And yes I agree about the crisis. My sister and I have been saying the same thing for years and my sister has been expecting "the crisis" for about 10 years now LOL. You would have thought falling all the way down the basement stairs alone in her house at 12:00 midnight in 2010 would have done it. She had fallen asleep "with a scotch in my hand" as she told the ER people and forgot to let her dog out. So she got up and let the dog out the back door like usual, but then sat on the landing step instead of leaving like she usually would during the day. Then when she got up she grabbed the open door, which of course was not stable, lost her balance, and toppled to the left down the landing and on down the basement stairs. She crawled over to the phone, and accidentally unplugged it and had to plug it back in! And managed to dial 911. She had gashes over her eyes and facial bruising, and a spiral fracture of her humerus. No concussion. Upon discharge from the nursing home where she went for rehab, she continued to refuse a life alert. She lived alone in this house and was going up and down those basement steps to do laundry until she finally realized she couldn't manage last year and moved to the independent living situation last November. She is one tough cookie.
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Also, we actually did an intervention in 2003 due to my dad's issues. He stopped wanting to put up with her abuse after he had a heart attack. We even hired a highly regarded specialist to help because we knew she would be a hard sell. And of course she didn't bite and after that he agreed to go to the Al-Anon meetings with me. So we gave it our best shot back when she was more lucid. there was a moment in the intervention when you could see she was considering it and asking questions about how various logistics would work out. But mostly she was just pissed off about it.
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Maybe you missed my comment, I have been to Al Anon with my dad for several years. They don't really give you any advice, it is more just support and I already know all the philosophy of the approach from going those several years e.g. take care of yourself, set boundaries, you can't change the alcoholic you can only change yourself etc. I really don't like going to the meetings. I just went with my dad because it really meant a lot to him. The night before he died the next morning he was talking in his sleep and spelling A-L-A-N-O-N.

We totally could start diluting the alcohol but wouldn't she just drink more to maintain her desired state of numbness from reality?

I am wondering about her vitamins, if it is just a waste since she is likely absorbing very little of them.
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I'm Irish, and not at all offended! But that said.. I agree that you should start to dilute her alcohol. It can't hurt and if she is not willing to slow down...
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The group you want is Al Anon, for friends and relatives of alcoholics.

Your mother is not the first elder to have this problem. I would look for expert advice, as well as Al Anon. Is her primary care up to the task? Is a geriatrician available? Get a referral to someone who specializes in alcohol abuse and detox to get an idea of what the future might look like.

Veronica91 is correct that this situation will probably come to a head with a crisis. You can't force her to stop drinking, and you can't reason with her. An intervention, with expert guidance, also has low odds, but it sort of worked with my father.

I am Irish, Scottish, and English. The Irish and Scottish had to become insanely stubborn to stand up to their bossy neighbors! They are to be credited for their endurance. The English, former masters of the universe, would probably not object to my statement.
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btw the Irish are not a racial group. They are a nation with a specific culture which does include valuing independence and strong will. So it is not "racially offensive" to make the type of comment that was made, it is simply acknowledging a cultural trait that is commonly found in that culture.
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thanks for responding.
I don't recall saying anything about wanting to stop her drinking. That is not an appropriate goal for her.

We do already have POA for healthcare and financial as well as living will. This has been in place for some time. We have also consulted with our mother's attorney regarding handling her financial affairs.

I took my dad to Al Anon meetings for several years before he died when he started having problems about her treatment of him. So I know pretty much all they have to say.

Medicare does not cover Long Term Care. Medicaid kicks in when all the assets are gone, but then you don't get much choice of facilities. We would like to be able to have her afford a place that specializes in dementia, as that is where we are headed it looks like, and those are not cheap around here at least the better ones aren't. So this is not about inheritance. And yes, she is spending her savings. She does have some monthly income that would cover the room and board or close to it. But not all this extra spending.

My father was very concerned in his later years about how she was spending down their money even then. He had a major stroke at age 42 and was never able to work at his potential, and they had to very carefully manage their finances. He was able to build a small nest egg but if she keeps on at this rate I do fear it will not see her through. She seems to be unusually lucky with falls etc.and may live quite a few more years the way it seems.

My father would be turning over in his grave. And yes they were having a lot of conflict about this at the time he died in 2006. He spent 5 weeks in the hospital and was then discharged and I helped convince him to choose assisted living over a rehab placement in a nursing home. He was dying of lung cancer (caused by asbestos exposure in the 1950's at his job) and no way was he wanting to do physical therapy etc like she was pushing. So she was upset and complaining about "spending all that money" and she "might not have enough" and 'our money isn't going to last forever". And he lived only three days after hospital discharge. But now it is a different story and she is spending more than he was at that time.

Her attorney tells us that it is too bad "she has burned a lot of bridges with a lot of people in this town." Also, she had restricted herself to one friend, a woman from her church who was evidently using her for transportation and a place to drink. This woman got mad when my mom decided to move to the apartment and kept trying to talk her out of it, and when my mom moved, this "friend" refused to come see her any more. And once the car was gone, she has cut off all contact with my mother. So this woman basically was a friend for my mom's car and house, and once those were not in the picture she has disappeared. And she was all the time trying to plant ideas in my mom's head about me (as she hasn't spoken to her own daughter in 25 years) which didn't help my relationship with my mom. My mom does seem aware of the betrayal as she told my son the other day she didn't want the woman having anything to do with her funeral (the woman is organist at the church).

My mother would refuse to live with either my sister or myself, she wants to stay in her small town. Neither of us has a home that would be safe for her anyway. My sister is further away (3 hrs) and has plenty of room but it is multilevel. She took my mom there for a visit 2 years ago and the first night my mom fell in the night when she got up to go to the bathroom.
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