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We believe my mother in law has dementia and we have a fairly ironclad Power of Attorney but we can't figure out how to use it to help her. We live in one state and she lives in another.


She refuses to see a doctor for a legal dementia diagnosis. The closest we got was she was told she failed the mini-COG given by a home based RN evaluation. She claims she never took such a test and has gaslighted all attempts to prove otherwise even though we were in the room at the time she took the test.


She refuses help of any kind including taking over her finances even though she can't even add 2+2 anymore. Her bills are paid automatically so there is no way of her being evicted, etc.


She refuses to stay home during the stay at home mandate and leaves on a whim because "I have been stuck home for a week and you can't keep me home".


We moved in her grandchild last year after she broke her hip to be her caregiver. Now that she has recovered from her hip replacement, she ran that grandchild out of her house. She wants zero other people living in her home but invites her entire church group over to visit at least once a week.


We've asked her primary care doctor for help and he is unable to help unless we can get her to see him. She claims he is a quack and again and again and again refuses to keep any appointments.


She is incontinent. Sometimes she uses a cane or the walker we purchased and other times throws them aside. She is almost completely deaf -- refuses hearing aids -- but is in otherwise really good physical health.


Her friends feed her paranoia. They tell her she is right and since there is nothing wrong with her she doesn't have to do anything she doesn't want -- "since it is your home, Mary". It isn't legally hers. They are all older and in worse health (both mentally and physically) than she is so agree to anything she says.


She was just allowed her drivers license renewal. The state she lives in does not screen extra based on age. The license is valid until she dies or is over 100.


She is income limited to only social security and Medicare. She doesn't qualify for Medicaid. We wanted to try and get guardianship through the courts and was advised by an attorney that without the dementia diagnosis from a medical doctor, with her friends declaring she is in fine health on her behalf, and solid proof she can't take care of her daily living, there isn't a path forward for guardianship.


We don't have the resources to pay for her to be in assisted living. I'm disabled and my husband is my caretaker. There are no other relatives to turn to for help.


Question:


How do we help her and protect those around her from COVID-19 if she won't stay home?


Any ideas on dealing with a stubborn woman with dementia during the pandemic is greatly appreciated!

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Update: She is on her own. My husband moved the grandchild into their own place and the grandchild is now better off. If we can save one of the two, it is definitely going to be this way. Traveling to help with the move forced him into a mandatory two week self-quarantine.

In case this helps someone else, I'm posting it here. I did some investigating and I believe I found the reason for 100% physical autonomy in her state: her state allows physician assisted suicide (PAS). For PAS to work the person has to have 100% physical control to be able to administer the drugs when they desire to use the prescribed medications. PAS does not allow the physician to administer the medications directly to a patient. The negative impact on family helping the mentally ill is an unintended side effect. So, it is what it is and for now, mother in law is on her own.
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Reply to AinSeattle
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AinSeattle, you're quite welcome.   I wish I could offer solutions, but sometimes these situations just become intractable until something disastrous happens and recognition by the elder suddenly comes into play that they need help. 

Sometimes I think it's like a last hurrah, a quest to hold onto independence as long as possible as opposed to segueing into an alternate lifestyle.

My thoughts will be with you; I hope you are able to find peace and a solution.
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Reply to GardenArtist
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You are trying to help someone who doesn't want help.

Yes, contact DMV. Pay her bills with her money.

As for the rest, back off and save your sanity. Wait until she breaks a hip or comes down with a serious illness and needs to be hospitalized. At that point, you can work with discharge planning on getting her into a facility, or, if she is still deemed competent, sending her home.

You can't care more than the person needing care does. Her lack of planning doesn't make her care YOUR emergency.

I've been down this road with a cooperative mom and a stubborn, uncooperative MIL. Guess who got better care?

This sort of behavior has its roots deep in the psyche, in issues of trust and control. Fighting a person like this only inflames and energizes their need to fight back.

Let go and let G-d and fate steer the ship.
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Reply to BarbBrooklyn
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Right now there's little you can do. Let her friends and church community take care of her. Let her friends' families worry about her friends. Stay away from her because she may well have contracted the virus on account of her disobeying the social distancing and stay home decrees. You cannot lock her in and so I would stay out.
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Reply to NYDaughterInLaw
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AinSeattle, yes this is a challenging situation. In many states you can submit an anonymous complaint online with your MIL's DMV. You will need to make the case as to why she is a danger on the road. They will most likely send letter for her to have an eye and/or road test. If someone drives her to this test, she may or may not pass. BUT with the lockdown I'm not sure anything will happen as the states all have skeleton crews and here in MN I don't think they're doing any driving tests at all right now. You could contact the police in her town to let them know the situation. Not sure what they can do but it may help. Maybe a neighbor is willing to sneak in and remove the battery from her car. No perfect answers right now.

I'm also an elder in my small church. Regarding meetings at her home: I would contact the senior pastor and the elder board to tell them in so uncertain terms that they are  exacerbating an already trying situation and that they must stop immediately. They need to know about failing the cognitive test, etc. Then let them know what WOULD be helpful to the family in this current situation, like sneaking away her car keys and bringing her cooked meals so she isn't out and about. I'm so sorry you have this added stress at this point in history. I wish you success in managing some of her behaviors and peace in your heart that you can only do what is do-able.
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Reply to Geaton777
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You "hit the nail on the head" when you observed that her friends support her disillusion that she doesn't need help.    She wants them around because they make her feel stronger and more self sufficient than she really is.

I think this is one of the hardest situations a caregiver can address - that others feed a fantasy and close out the family.

I don't have any really good suggestions; it's a hard and challenging situation, but at least you recognize that she wants these people around her b/c they provide what she wants to hear.

You could try backing off and pretending to agree with her, in an effort to get her to be more receptive.   

There's also the possibility that she does recognize decline but is mentally refusing to accept it - she's in denial. 

Does the POA require declaration of dementia to allow you to act?
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Reply to GardenArtist
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AinSeattle Apr 5, 2020
Feed a fantasy, denial and what she wants to hear are perfect descriptions!

As for the POA, yes and no. In the state she resides, under our strong POA or even a court appointed guardianship she still has/would have 100% physical autonomy. We can and have used the POA for financial, medical, insurance, government, utilities, etc., etc. with great success. As long as she remains physically capable, we have no recourse in what she will or won't do. Mental capacities and physical rights are separate entities in her state. The two are so divided that the nursing home she rehabilitated in after her hip surgery, and after getting a copy of the POA, notified us
1) if she could figure out how to use the electronic keypad at the door or
2) could climb out her window or
3) had a friend pick her up or
4) went for a walk and wandered off
they wouldn't stop her from leaving. It was explained it wouldn't be the first time the local police had found a senior walking home after climbing out their window. The police were required to deliver the patient to the patient requested location. The nursing home then automatically discharged them under patient requested discharge codes. At that point, they would notify a guardian or a family member they were discharged and no longer physically at the facility.

You've given me some insight to think about and discuss. Thank you.
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