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My mother is widowed now and 74. For a while after my father died, she was stronger (he suffered with dementia for 2 years) and clearly was analytical and confident in her decisions as she got the house. Now, she is forgetting some things, mixing up names frequently, and is forgetting some conversations. She's very independent usually. But, I'm wondering if it's time to go with her on her next dr visit and make sure she has a power of attorney for health and financial issues. I don't want to put her on the defensive, but don't want her to wait too late to make some arrangements. We don't know if she's paying all her bills on time, if she's taking her medications like she needs. She has had some indicidents (that she told me about) lately where she forgot to take a med, or took double by mistake. What should we look at (my siblings and my mother) as strong indications that she is losing the edge of being able to manager everything on her own?

Her grandson is living with her and looks out for her - he's taken to her to the E/R a couple of times when she got hurt around the house, and has burned herself a couple of times in the kitchen recently. She still drives fine, and is involved in her church, and connects by phone to her sister and me every day.

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First of all, a POA for both finances and health care should be drawn up now. You can bring that up by telling her that you and your husband are getting your own documents prepared because anyone can have an accident or health incident and it's just prudent to have the proper documents in place. That way, she may even ask to go along and do hers at the same time. If she doesn't, you can gently bring up the fact that she maybe should do the same thing.
It does sound like she's slipping. With her grandson living there, she has someone to look out for her now, but it would be good if she'd let you go to the doctor with her. Since she's admitted to forgetting meds, she maybe won't be too resistant, but I'd frame it as a general checkup. There are many issues, including medication interactions and low grade infections such as a UTI that can cause the symptoms she is having. If she understands that she may cooperate.
Good luck,
Carol
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First, to the documents -- I absolutely agree with the need to get the POAs done sooner rather than later. The main issue is that you want these documents to be legally valid and not to be assailable down the line (for instance, by another family member who doesn't agree with the decisions you might need to make) ... so it's important that your parent make these decisions formally while he or she still has the "legal capacity" to do so. This was my concern when I started to notice my Dad's short-term memory getting worse ... I knew he still had (and has) the ability to consider the future, think about what he wants, and understand the possible ramifications of the choices he would be making ... but I didn't (and don't) know for how long that would be the case. I feel so, so much better to have these POAs. For a long time, I kept them in the drawer and never used them. This year, I have needed the general durable POA repeatedly as I took over dealing with most of my Dad's bills, accounts, pension, health insurance plan, and taxes. (Incidentally, check with your accountant or your parent's accountant ... we needed a separate POA to get the IRS to deal with me, and to send copies of all communications to me ... and I think the same was true of my Dad's state revenue department.) Every time I produce that POA and it "unlocks" a door so that a company or entity will deal with me directly, I feel so much gratitude to my Dad for having made it so much easier for me to watch out for him. And I am grateful to my in-laws, who were the first, several years ago, to urge me to get these documents in place (my father in law had run into major problems trying to take over his sister's affairs after she had a stroke, and knew how bad things could get for a caregiver or family member who doesn't have the necessary "authorizations" to act for their incapacitated loved one).

From what you describe, I think you are right to be a least moderately concerned, and that getting an assessment would be a prudent thing to do. I know this is hard, because Soozi is ALSO right ... when you're already worried, it's probably a little too easy not to give any slack for the fact that your Mom is simply human, and will make some mistakes even if nothing is really wrong. I noted this last year that Dad had missed paying some bills. Well, so had I (in my case, I tend to misplace the bill and then forget about it). But when I noticed my Dad doing it, it concerned me more -- partly because this was SO out of character for him, and partly because I didn't know whether it's just one of those mistakes anyone can make, or whether it's a symptom of a larger problem. I didn't want to "take away" his responsibilities or autonomy, but I also didn't want him to lose money to con artists, lose his long-term care insurance because he missed a payment, or incur big penalties for paying tax bills late. For a long time, we made things work by ensuring that every regular monthly bill that could be paid from his account automatically was set up to do so. I then made a list of the important "occasional" bills that don't come every month -- e.g., property tax, car insurance, and so on -- and I created accounts for him online with those entities wherever possible and made a note in my calendar of when bills for each should be due. For those bills, when I see on my calendar that one is coming up, I log into the account I created for Dad at that company and pay the bill myself.

Eventually, second-guessing myself all the way, I decided t that the short-term memory lapses and some other evidence of judgment impairment (many in the form of uncharacteristically large donations to questionable "charities" about which he could tell me nothing) were sufficient to warrant an assessment. It took a while to make that happen because of the shortage of Medicare docs in rural southern Oregon, but we did finally get a referral to a neuropsychologist, and, regrettably, a likely frontotemporal dementia diagnosis.

One more word on the POAs ... I don't know if other people have experienced this, but my Dad wasn't ready to sign these docs 4 years ago. I asked, and he politely (but firmly) demurred. Two years ago, he was ready. I think he was starting to find management of finances and such to be a little overwhelming, and wanted some help. But I don't think he would ever have brought it up to me, though, so just realize you may need to keep revisiting the question if she isn't ready yet.

Also, Suzmarie is very right. My Dad was "driving fine" until he wasn't. This is to say, he wasn't having accidents ... but I don't think he was driving with great reflexes. Four weeks ago, I went to Oregon to take him to the neuropsychologist for extensive cognitive testing. At that time, the doctor asked if he'd had any accidents driving, and we both told her (truthfully) that he hadn't. Last week, we went back to get the results of his tests. The doctor told us that the test results were indicative of frontotemporal dementia, and said he should stop driving immediately. It is worth noting that between the first visit and the second, Dad scraped the entire side of his van ($4800 worth) on the side of a building. I tell this story only to indicate that your Mom still getting where she's going when she drives doesn't necessarily mean she's driving WELL. The grandson who lives with her may have a better sense of her reflexes and driving skills if she chauffeurs him anywhere, of course ... you're lucky to have some "eyes on the ground."

Hope I didn't meander too much here ... bottom line, I think your concerns are reasonable and that an assessment wouldn't be out of line. If you don't have the POAs for finances and health care already in place, I urge you to get them done now. Even if you don't use them for years, you'll be very, very glad to have them when you need them.
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I agree with Carol's advice that it is prudent for ALL of us to have POA's for health and finance. I will take that a step further and strongly suggest it prudent for us all to have a health care directive drawn up. I would start with those things first with your mom, suggesting that it would be a good idea to get things in order now that she is on her own. It is a loving act for her children to get these things in order. After that, perhaps you want to be made joint account holder on her checking and savings account, tell her "just in case" she were to get ill and you needed to continue to pay her bills. I did this with my Mom when she was 90. It enables me to go online and check up on her....see if she is paying bills, if she is getting her Rx's refilled regularly. Or, you could get her set up with automatic bill pay for her utilities and other recurring bills. My mom loves not worrying about her bills being paid on time.

There are are some daily med dispensers that have alarms on them to remind us to take a dose, which might help your mom.

Might I suggest you find out if there is an Aging and Disability Resource Center in her county? The one in my mom's county has been a wonderful resource in getting mom some help. They set her up with Meals on Wheels, had lists for people who do snow shoveling and lawn mowing, home care help, rides for the elderly.....and the list goes on. They are extremely knowledgeable with all things concerning the elderly.

I also agree that an appointment for a thorough check up is a great idea. It is always a good idea to take a trusted friend or loved one along to a doctor appointment. Two can think up more questions for the doctor and remember things that are said better. Vitamin B12 deficiencies along with UTI's can cause forgetfulness or confusion. Good luck to you!
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I hate to be the grim reaper but if she has burned herself and is getting confused with meds its not only time for a neurologist visit but also time to stop driving. The key with the memory thing is a lapse can happen at any moment, just like the burning, just like the double medicine. She could easily have a moment and forget where the brake is.

Sorry but I would be too worried about her hurting herself or someone else or worse.
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When my mom started acting as if she wasn't fully capable of handling her affairs, I had a durable power of attorney drawn up. I presented it to her as a way for me to assist her with handling her business when she wasn't feeling well. She read it, we discussed it and she signed it. The key for her was that it stated that I would not use the POA to benefit myself. I immediately took the signed POA to the county courthouse and had it registered. I have had no problems using it. You should definitely go to the doctor with her and I would recommend that you write a letter to the doctor outlining your concerns and ask that the letter be placed in her chart. This way, the doctor can address the issues without you looking like the bad guy. Good luck!
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Both of my parents had durable power of attorney s drawn up years ago and I have one for myself as we'll. They are locked away and hopefully we won't need to use them. Just my way of saying this is a very good thing to do when there is no pressure. Like having a will, a good attorney will help you to have the right docs drawn up...and it doesn't mean you will need to use them. Also, I forget to pay bills sometimes.... Do you? I'm just saying, while we need to monitor our parents closely, we shouldn't be too fast to take all their responsibility from them. I agree with those who recommend assessment, and also I hope you can help your mom to remain engaged and independent as long as she likes and can do it, with only very minor mishaps that might happen to anyone.
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It took a 3rd party to come in and convince Mom to sign hers.
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As for not being insulting, we were told by our attorneys that these recommendations are standard good practice. Suze Ormand recommends the same... You can find general good advice on this almost anywhere. It is not personal and not specifically directed to anyone because of a shortcoming, but rather the good things people do to keep their matters in good order.

Find a good way to say that within your own family and maybe encourage more than one person to put these documents in place... As with my family, a few people could go to an attorney and prepare these documents.

You could tell your mother you are creating your own documents and also want to make sure she has all of hers in order too. Do it with siblings or cousins. Anyone who is close enough to discuss who will be appointed to be accountable. it is my opinion that the more open you are with family now, the easier it will be later.

She might appreciate that you are doing this healthy process together as a loving family.
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How do you talk to her is a GREAT QUESTION! Softly spoken, over coffee or lunch, calm not desperate, and definitely NOT a need to take over her life because she can't do it anymore attitude, if you try reaching her ~Mother instinct~ and relate to her on a " I " would be more relaxed if " I " knew in case you may need me to "I" can help you in the future I will be able to if that's OK with you MOM. It helps if she thinks you are doing it for "you" not her. Don't confuse her with all the details, in fact don't let her know about or hear you speak about things just set them up and say Your doing this because "I" need you to for "me". If she thinks she is going to give up her independence, her decisions, her anything, because someone tells her she can't do things herself anymore... This usually backfires and trusting is out the window, once she thinks family is taking over I would bet you she won't forget that. Once you are labeled in her mind as the bad guy it will stick like glue. We all know what your intentions are but she will most likely not understand if approached in a "we are taking over situation" . I am in no way accusing you of anything I just know the routine. You and your family may have Love and goodness in your heart but, her reality is fragile and unstable and not rational most likely. Good Luck
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My Mom knew she needed help and we could clearly see that she was getting more and more anxious, more and more forgetful, more and more in need of confirmation and direction. She can write and sign checks but you have to tell her what to write. When she drove she was never sure which way to go to places she'd been driving to for years. Years ago she and Dad, now deceased, set up a living trust and living will. My daughter, mother and I simply made an appointment to see their elder care lawyer, who knew exactly how to handle setting up the POA and health care proxy. We did this after seeing how confused she was after falling backwards off the love seat while trying to adjust the verticals behind it and breaking her left shoulder completely. I was traveling and had to be called to authorize surgery. A left total reverse whatever it was. We needed to add my daughter as the second in command in place of my brother (only sib) who rarely is in contact. I have had to track him down and currently do not know how to contact him. Each dementia is different yet with similarities. My fear is that my mother would get lost in the system were she to enter a program of any kind. She is very quiet, sits and reads for hours on end, and doesn't speak up. Adult Day Care has worked pretty well for her in the past.
I appreciate seeing other people's experiences with this complex problem.
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