How do I go about having my Mom screened for dementia or some other mental illness?

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Sometimes I think she is playing me for a fool. She did have a traumatic time more than four years ago. She lost her brother, mother, and husband around the same time. She was placed on anti-depressants and shortly thereafter, adopted two of her grandchildren. When I moved back to my home state, I realized that she had begun buying uncontrollably. The closets and one entire room are no longer accessible. The other rooms are piled up with stuff and she has begun using a spare bathroom for her "bargains". Her stuff spills out of the house and into the driveway. I had to help her remove her 12+ cats because she refused to stop feeding them. (Thankfully she did not allow them to live inside.) She seems completely lucid to me, but I began getting concerned about her taking care of administrative things. I discovered a huge basket of unopened mail related to her property taxes. She had not paid any of them along with other county taxes for almost four years. She had lied to me and told me that everything was taken care of. She even seemed offended that I asked. She was close to $10,000 in debt. So, I have pushed her to make these payments a priority. I found out that instead of mailing the payments like she agreed to, she went and blew almost all of her monthly income on jewelry! I confronted her about this and her attitude is that it is not a big deal. She feels that she has been responsible all her life and it is now time for her to do what she wants. They have threatened to take her home to recover the costs of the unpaid taxes. I have now offered to mail the payments, but if her spending isn't under control - the checks will bounce. I don't have the money to pay for them - as we are already paying for her transportation. She takes good care of the kids and she seems to be in her right mind except for these unhealthy and dangerous habits. She seems to try and deflect responsibility to me more and more. She is 63 and I am 31. It gets to the point where she doesn't want to take care of basic responsibilities and tells me, "Could you do it for me? I don't know how." She does this so she can go back to doing what she wants to do. I live five hours away, so it becomes frustrating when she shrugs her shoulders and plays this card with me. I feel overwhelmed and angry. I find myself yelling at her a lot because she doesn't seem to care about the consequences that this will have on the children, herself, and ultimately me. Her other four kids don't care and never lend a hand. My husband is patient, but getting frustrated too. Is this typical of dementia or some other illness? Or, is this just someone who prefers to be taken care of by someone else? She has impeccable memory, but she often tunes me out. I love my mother, but this is like watching someone deliberately try and wreck a train... Any ideas? Suggestions?

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First, Salt06, let's be very clear: None of this is your fault!

Three people very close to your mother died four years ago. This apparently had a detrimental effect on her mental health. Not Your Fault.

Her grandchildren had to be removed from her daughter's home. Not Your Fault.

She decided to adopt those children, without consulting or even telling you. Not Your Fault.

She has become obsessed with buying things. She is a hoarder. She is showing very poor judgment regarding her financial security (and therefore the security of the adopted children). Not Your Fault

Frankly, if it weren't for the two small children, I'd agree with the neighbors. It is her money. If she is irresponsible with it and won't accept help, she can face the consequences. It will be fun to buy five sets of silverware at a crack ... until she is homeless. She can deal with that then. Not Your Fault. Not Your Problem.

BUT, since she is responsible for two young children, it is highly commendable of you to try to intervene. Please understand as we make suggestions we are not blaming you. We know this situation is not your fault and we'd like to see you make some progress in helping matters.

I think the question you raise in your title is exactly the appropriate one. How do you go about trying to get some medical intervention? I think that can be approached on two levels:

1) Get authorized to get involved in Mom's affairs. All you need to talk to her doctors is her permission. Most clinics will have a HIPAA wairver form where she can list the persons who can receive information. Get Medical Proxy (aka Medical POA). This is usually assigned in a Health Care Directive. Get POA. There is a standard form for this, but in this case where there may be hard feelings among family members it would be worthwhile having all these documents drawn up by an attorney who specializes in Elder Law.

I make this sound easy, and it can be. But convincing Mom to do these things might not be so easy. The only way you can get these authorities is for Mom to give them to you.

2) Once you have the authority, talk to her doctors. Start with the one who is treating her depression. If that connection is no longer active, consider suggesting to mother that she see a geriatrician as her new primary care provider. Ordinarily she might not be considered old enough for that kind of doctor, but under the circumstances of being concerned (you, not her) about potential dementia, it might be best. And/or take her to see a geriatric psychiatrist.

Again, the hardest part of this step might be convincing Mom to cooperate.

3) If you are not able to get Mom's cooperation in the first two steps, don't beat yourself up. It is very hard to help someone bent on self-destructive behaviors. If you have to back off, at least keep close watch on the welfare of the children. They are the ones who really deserve an objective advocate here.

And I think it would be a very poor idea to have Mom and the children move in with you, at least until/unless she is in treatment for whatever her mental illness is.

I join others on this thread is wishing you the very best outcome for all concerned.
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Power of attorney is definitely required to get involved and handle mom's financial & personal business affairs on her behalf. You're going to want to file a copy of it with the bank, the insurance companies, and just about everybody else she does business with so they can talk to you. Never give away the original!

DO NOT put your name on the bank accounts as a joint account holder. I did that for my mom, and it ended up dinging MY credit rating.

My mom went into collections on a $150 due on a fridge. She could have paid cash for that, but had decided she had paid enough and was done giving them money - exactly like you said - because it was time for her to do as she wished-$150 short of paying it off. She just folded the collection letters up and let them sit on her table until I got there to deal with it all. I'm 1800 miles away, so there was A LOT of these kinds of messes to untangle.

My mom was also a compulsive buyer. She had a house full of nice clothes. Shoes, purses, gifts intended to be Christmas presents. Stuff was everywhere. It was falling out of closets. She hoarded canned & dry food as well. Magazines. Anything that came in the mail got kept. Boxes and boxes and boxes of every flyer, promo, and envelope that had come to her in 15 years, all folded up in the original envelopes.

Hoarding is a sign of OCD and depression, which are mental illnesses . There is medication, but it's not a cure. These problems need a doctor's help. You may not get what you need from a GP or family practice doctor. You may very well need to have her seen by a geriatrician and neurologist.

Dementia is not 100% about forgetting names and faces. Especially early dementia.

Dementias can be more about loss of reasoning and problem solving. I know it was for my mom. She couldn't problem solve her way out of a paper bag, but she could remember what grade my kids are in and all kinds of obscure trivia that would surprise you. Mom has moderately severe to severe Alzheimers, bi-polar, and a host of other medical ailments. Memory gaps is not always a good trigger for a neurological problem. Going from being a bill paying, up to date person to not paying bills is a sign of something else, maybe dementia, maybe not, but it is a big red flag.

Constantly reorganizing stuff (aka "cleaning") is not necessarily a sign of being OK. My mom would take apart piles of clothes and resort them, repile them, move the piles, hang things, unhang things. It's part of the OCD ritual behaviors. It's comforting for them to do this. When mom would get stressed out about her bill problems, she would take things out of the closet and not be able to get it all back in again because the process overwhelmed her.

To any family, friends, or visiting social workers her story was that she was reorganizing her closet for the change of seasons, or because she changed sizes, or was going to donate this or that. It was all lies. Very believable lies that went over just fine with everyone who did not know what was really going on.

Mom would be up at all hours sorting, piling, unpiling, moving things around, hanging, etc. and be completely worn out in the morning. The fact she was driven by this was a red flag. The fact that it never got better was a red flag. The fact she never made any progress on this work was a red flag.

When we cleaned out her house, we found a perfectly new, never used recliner under a giant pile of clothes.

Mom had the OCD and mental illness problems long before Alzheimers dementia, but by the time I figured out what was going on and intervened, it didn't matter anymore. She needed to be removed from the house and put into care where she could be safe.

It was very, very difficult to look at it with a clear eye and see the problems for what they really were. Her sisters are still in denial about it.
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Salt, the obsessive-compulsive buying signals depression. Ignoring the tax bills signals dementia. Your sister is obviously the stress-point trigger, the one sucking the life out of her. At the very least mom needs a Conservator, and I doubt if the siblings could agree which one of you should be appointed. The Judge would end up appointing an impartial third party. Nobody is going to like that result. It's too bad you can't get a restraining order against family leeches. My sympathies to you, you are doing the right things.
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pamstegman, I do appreciate your responses, but pointing the finger at my situation is not fair. I live five hours away. I cannot walk away from our employment and relocate. She does not want to move in with us because that would mean losing contact (in her opinion) with three other grandchildren that live in the area. It would also mean that we would not live in a house stacked with boxes of her things. She has made a demand of me that we would need a very large house with at least five bedrooms for her to consider the offer even remotely. I do not have custody because I was living out of state when the children were taken by CPS. I was not told that they were placed up for adoption until after my mother had her lawyer prepare for the adoption process. I was only able to move back to my home state a year and a half ago and one thing I have found is that she and my sister like to keep secrets. I was not given an opportunity to adopt these children - or else my husband and I would have done so immediately. We were made aware of the details behind the CPS and adoption situation when we finally moved back into my home state. I had to prod and prod to get answers because no one involved wanted to speak about it. We have rooms prepared for my mother and her grandchildren in our house. We have offered to do everything in our power, but relocating again is not something that we can afford. My husband's job offer made this move possible and we do the best that we can with what we have. I think it is unfair to pin her refusals on me when I have offered everything I can to support her. We are far from rich and I have never asked my parents for a handout. I have been financially responsible for myself since I was 18 years old. But there is only so much I can do to convince someone to accept help. That is why I am at my wits end. Nothing I offer her seems to spur a desire to make a change.

Her memory is sharp for long term and short term events. She remembers events, sequences, places... anything that I can converse with her on a regular basis has not given me a red flag. What she does is refuse responsibility. I have caught her in several lies about her spending habits. When it comes to buying 5 sets of silverware, she claims she is buying five sets in case her kids want them. She also tries to say that when she passes away she wants no one to feel left out, so she buys multiple items.

I do get resented by my siblings because I have made her stop paying for their bills. I am seen as someone wanting her inheritance because I have made them take responsibility for their own mistakes and lifestyles. The youngest is 26. She was covering their phone bills, car insurance, fines, and tickets. They also had access to her accounts and had stolen multiple times from her. I put a stop to it once I found out - and that in turn has caused tension. My siblings resent me and my mother resents that I stood up to them. What I have done is for the sake of the kids and my mother. I do not want them to lose their home. I want them to be financially sound. But aside from my husband, no one seems to think the situation is bad. They think I exaggerate, but threats of liens and unpaid taxes speak for themselves.

Thank you for the information on the POA. Now I have a point to start with when speaking to her about it without making her feel threatened. I know she likes her independence and I want her to be independent as long as she can do so functionally and safely - and without creating situations like this. I have asked her to give me her tax statement information so that I can monitor what is owed and ensure the payments made are credited to those accounts. She has also agreed to sign future-dated checks so that I can send them in with her payments. So far, we have satisfied the lien threats but there is a long way to go.
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One other thing - the "impeccable memory" - is it for only long-term things, i.e. things that happened 5, 10, 20 years ago, while she is having trouble remembering that she already has four sets of silverware before she buys yet another? Do not let her make you feel you are out of line, especially when you can lovingly and straightforwardly state real world consequences. You can bet your bottom dollar that the neighbors have no idea of the 10K in debt and the threat of losing the home over unpaid taxes; she's probably glibly reassured them too that everything is just fine, and for all you know they think you are just wanting her to not spend money so there is more left for you.
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She's about to become homeless, and where does that leave the kids? Can she grasp that she can't keep her grandchildren if she can't provide for them? You would think a social worker - either CPS or maybe area agency on aging related - could be the bad guy and explain this.

The possibility that she has mild cognitive impairment and is just starting to really decompensate in terms of her hoarding behaviors is very real. LUCID is a loaded term - I suspect it means that she recognizes familiar people and carries on conversation, but look at her judgement and her real ability to get critical things taken care of, and ask yourself how safe the children are. Would she know how to deal with a house fire? With a child's illness? Can you realistcally provide enough supervision to keep her from losing the home or having utilities turned off? If some of those answers are "no" it is time for her to have a formal evaluation of her mental status with a good geriatrician or geriatric psychiatrist, and another call to be made to CPS. No, they would not remove children from a cluttered home that was not seriously unsafe or filthy, but at the very least, stuff obstructing exit paths is a fire hazard and this is probably a deteriorating rather than improving situation without intervention.
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The fact that she won't live with you tells me your situation is less desirable than where she is now. The fact that she has custody of these children and you don't is another red flag.
She is not in her right mind. She is drowning emotionally. She is shipwrecked financially. Her children have sucked her dry.
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No, the doctor does not have to diagnose some mental illness for you to pursue POA for your mother. Your mother needs to give you both medical and durable POA for she will need for you to have them in the future. I'm sorry that her neighbors and friends don't agree with you, but how much detail do they really know or need to know? If her doctor evaluates her as incompetent to handle her affairs in a business like manner, then it will be too late to get POA and you will be left with the expensive process of getting guardianship for your mother which involves going to court and having doctors testify that she is incompetent.
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When I say 'keep it all', I am not talking about trash - I'm talking about clothes, decorations, etc that no one uses anymore. She still has baby clothes that no longer fit the kids. She has boxes and boxes of new and used clothes, sheets, towels, decorations, unused dish sets, etc. She has five unused sets of stainless steel cookware, for example. Boxes of toilet paper, canned goods, life vests, shoes.
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I was present for two of the CPS visits and they saw the stacks of boxes in the house. She kept the kitchen, living room, children's rooms, and one bathroom normal - and started cluttering the others. The lien threats started in June of this year - about six months after they closed the case. I don't have a POA on her. I thought that the doctor would need to diagnose some type of mental illness for me to be able to pursue it. I am afraid she will shut me out if I try and I make at least 2-3 visits a month to check on her handling of the house and make sure she opens her mail. She has some neighbors and friends that visit, but they disagree with me. They don't think she has an issue and they encourage her to spend as she wants to. They do not support me in trying to get her to focus on the right priorities and getting help. So, she listens to them and ignores me. My mom always liked to spend money, but she was more controlled about it (paying bills and saving first) and she would cycle things out of the house rather than keep it all.
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