susie379 Asked September 2012

My 93-year-old mother has mild dementia. She needs to move to assisted living, but refuses. Ideas?

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A doctor, minister and other family members have tried to reason with her, to no avail. Paying for assisted living is not a concern, she has plenty to cover it, and knows it. Mom comes up with every excuse and reason under the sun for not moving. My siblings and I live across the country from Mom, and she has refused all offers over the years to move near one of us. We can't just move her to assisted living without her consent. If we activate her health power of attorney, the assisted living center we have chosen has told me that she would not be considered as a good candidate and she would have to live in their memory care or nursing home facility. Any tips on how to convince Mom to move? She is declining bit by bit and we are worried sick about her living alone.

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susie379 Sep 2012
Thanks Jeannegibbs. I have been learning how to stand firm and about tough love. That is how I got 2x week in home help and meals-on-wheels set up. Didn't give her a choice. I am going to get her meds dispensed at her pharmacy on my next visit. It is a service they offer for $10/wk. It will be another struggle with her, but I am not giving her a choice. I have been working with her county "Aging and Disability Resource Center" for a couple of years and they have been a wonderful resource. They have never mentioned a geriatric care manager. How would I start my search for one? She lives in a suburb of Milwaukee, WI. To use an old expression, Mom is one tough nut to crack. Don't know how to get through her stubbornness. Oh, you are not the first one to suggest that it is going to take a crisis with Mom to get her moved. I am slowly beginning to believe this is the way it will be. Sure hate to see it go that way but......
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jeannegibbs Sep 2012
Susie, I am so sorry for you! This might be one of those situations where it will take some crisis, maybe a fall, to get the ball rolling.

It is especially hard to be doing this long distance, isn't it? Since there are funds available, have you considered hiring a local care manager?

There are probably ways to make Mom a little safer in her home for a little longer. Having a nurse set up and monitor her pills box weekly, having her meals brought in (so she doesn't have to use the stove), having a bath aid in once a week, having her laundry done, having her wear a health alert button ... etc. But you have tried many of these things and she refuses. Sigh. Now what?

I understand that you want to avoid invoking the POA. But could you use it in a get-tough approach with Mother? "As the person you appointed POA, I'm responsible for your safety and well-being. You have choices to make. You can go to that lovely assisted living place, where they will provide necessary services to you. Or we can arrange to have the services brought to you. If your choice is to stay at home, then you MUST cooperate with the services. Someone will do your laundry. Someone will help you with a bath or shower. Someone will get your breakfast every day. (etc.) I love you, Mom. I have the authority to do what is best for you and I will do that. First, you MUST go and tour the assisted living where xxx lives, and have lunch there. Then we will talk about whether to get more services at home, or to move into the AL." Whew. Tough love. Could you pull that off? You and I know that it might not be all that easy to enforce your decisions, but if you act confident, maybe Mother won't know that.

I think your best bet, though, is to hire a geriatric care manager who will handle the local details and keep you in the loop.
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susie379 Sep 2012
Thank you JessieBell. I have suggested to Mom that we take a tour and have lunch at an ALF, but I get a flat "No" from her. Tried to tell her that it isn't a nursing home, and describe them....no dice. She had a friend living in one that would call her now and again and tell her how much she loved living there, but Mom retells it as the woman hated it there. Sigh. I'm out of ideas.
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JessieBelle Sep 2012
Yes, it sounds like she is not capable of living alone. It sounds like she needs some help every day. Older people have a very hard time giving up control over their lives, and they often don't recognize their own limitations. There are several options to force her into an ALF, but none are so pleasant. The ideal way would be to schedule appointments at different ALFs and ask her which one she likes best. That might open the door for some negotiations about moving to one of them. Many ALFs are quite nice. Personally I would not mind moving into a few of them I have seen. Maybe if she felt she had some control over the choice of ALFs she would be more willing to move. There may be one that has people she knows from her church. That is always a good way to break the ice by saying this woman or that man stays here, too. Some ALFs will not rent to people with dementia, so it is best to check, so she won't have to be moving again too quickly.
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susie379 Sep 2012
As of this last July, we do have in home help twice a week to buy groceries, clean, do laundry, wash her hair and encourage her to bathe. Mom fought us on this, but we insisted it was necessary if she wanted to continue to live in her home. So far the help has not been able to get her to shower while she is there. This has been an ongoing problem which Mom denies. "I shower every day" she says, but she smells. I booby trapped the bath tub and I know for a fact at one point she went 18 days without bathing. The only laundry Mom has allowed to be done by the help is towels and sheets. Her clothes are stained, but she insists they are clean. Well, she rinses them in the sink with Downey, so they smell clean to her. The in home help cannot do a thing as far as putting her meds in a dispenser or calling for refills, against policy. Over the past year she has been inconsistent doing the meds herself. At one point she stopped taking one of them for 2 months. Just forgot about it. I have been keeping a closer watch by calling her when I figure it's time to order refills and then call the pharmacy myself to check up on her (authorization on file at pharmacy). Mom also has macular degeneration and chronic UTI's. Each time she gets a UTI, and it clears, it seems that it has worsened her dementia just a little bit more. She really does need to be cared for at an AL.
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JessieBelle Sep 2012
I know this is a hard situation for you. If your mother has mild dementia, chances are that she will do fairly well on her own for a while. See if she would consent to having some in-home help to take her to the store and clean around the house. It will be hard to screen candidates from a distance. Perhaps her church will help. With people coming in to help, you may be more comfortable with your mother staying home a while longer. If she has mild dementia, you would most likely not be able to activate a POA against her will. Having someone come in to her home to help will be like AL, but she will be able to stay home.
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