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I am 79 years old and without family except a nephew who lives a 6-7 hr drive away. I use a walker outside my apartment because my balance is poor. If I fall I cannot get up alone due to knee replacements. I've had more than one cancer surgery in the past but am otherwise well and independent (but slow) in ADLs. However, I am so frustrated since I lose things daily (e.g. scattered phone numbers written in scraps of paper (I don't own a desk), my keys, my checkbook. I cannot do simple math nor follow my financial affairs on a computer, let alone compile everything for my tax accountant! I'm well-educated and sometimes I speak well, but often cannot recall familiar words or whom I've spoken to lately or regarding what.
It all seems alarmingly like Alzheimers to me. I'm a retired RN and have some professional knowledge in this area. I also failed the "clock test" a few years ago, but never followed up as I was advised by a visiting nurse whom I can't remember. Now I'm scared, feel like I'm barely hanging on. BUT nobody else I know seems concerned! Am I really hiding it that well? Or does no one else want to, or know how to, help me? My nephew is on my checking account and has a financial POA which he has never seemed to recognize a need for. I'm afraid of running out of money just to live anywhere.
Can you suggest any plan of action for me?

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I think you know what I am going to say, because I am a retired RN, as well. I am 77; so we are not too far apart. I think now that you are worried enough that DO KNOW you must see your primary MD and ask for the neuro referral for the testing. You must know for yourself where you are now. And then you must meet with your nephew and come up with a plan.
I must tell you that anxiety, to my mind, is the worst enemy a failing mind can have. Since my brother went into assisted living his mentation is about 100% better than it was before; since I manage his trust, his bills, etc. his mind is so much more alert that I wonder WHY I am struggling along to do it. Anxiety is what a lot of your stuff is sounding like except for the "cannot do math" and the "failed the clock".
So step one. Bite the bullet. Off to your own doc for the referral.
Step two, get the test. Tell them exactly what you just told us. Can't do the math and can't do the clock (because honestly NONE OF US can find our danged keys and checkbook!).
OK woman. There ain't nothing so tough as an old RN! Get out there and get it done and then get back to us. And to your nephew as well. Make sure he is up to it and if necessary give him over the control of the purse and POA (if you trust him) NOW while you and he are ready to go together to the banks, the Social Security, and etc. because this would take a whole LOAD off your plate.
And yes, the knees and the walker are worrisome. You already know that. Are you driving? I hope not. Time to come up with a list of the assets and income. Time to look around at what is available for some future time if needed. To talk with Nephew about possibly moving to Senior living more near to him? You are right where you should be--that is to say, thinking about all this.
Get back to us. Stay in touch. Update us. I am going to worry about you until I hear more!
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polarbear Oct 6, 2019
very good advice AlvaDeer
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My heart went out to you when I read this. I think it's time for you to have a good conversation with your nephew, and make sure he listens to you. Could you tell him you need him to set aside some time for an important conversation (so you're not hitting him cold on the phone at a time when he might be too busy to really listen)? And then, at the time you agree on, tell him what you told us here. I feel strongly about this, because I was in his position a few years ago -- I was (am still) the PoA for a widowed cousin who has no other family in a position to help her. She tried to tell me she was having memory problems, and I kept trying to reassure her that she was under a lot of stress (newly widowed, trying to sell her house, etc.) so it wasn't the best time to judge whether she had memory problems. Though that was true, she knew -- just knew -- something was going on, and had I taken this more seriously earlier, she could have given me better direction as to what she wanted. By the time I realized something was definitely going on, it was harder to have the conversations I now wish we’d had, because I want to do right by her, and I don’t always know what that is.

Here are some suggestions based on my cousin’s and my experience: 

1) If you're having trouble keeping up with your finances and need your nephew to take over, tell him; otherwise he won't know until it becomes so obvious that there will likely be some complicated messes for him to sort out. (In the case of my cousin, she just stopped paying bills and started hiding them, so some of them went into collection.)

2) Is your nephew’s name already on all of your bank accounts? I know you said it's on your checking account; if you also have a savings account, you may also want to add him to that, as he may have to transfer money on your behalf at some point.

3) Is your Social Security deposited automatically into your account? If not, set that up, because they do not accept PoAs, ever. Your nephew will have to apply to be a "representative payee" to make decisions about your Social Security.

4) Make sure that if you have investment accounts, they recognize your nephew’s power of attorney. We discovered they did not automatically accept PoAs -- there was an application process that required a couple of layers of paperwork. It got complicated at tax time, because I couldn't get hold of her year-end statements until the paperwork cleared.

5) If you’re ready for your nephew to take over your finances, get duplicates of your bills (or the bills themselves, if you don’t want a copy for yourself) forwarded to his address. It’s very little extra work for me every month to write checks for my cousin’s bills, because they come to me and I write the check from her account (which has my name on it, too). 

6) Make sure his name (and PoA and presumably healthcare proxy) are on file with your doctors. And if he is taking over your finances, make sure the medical bills go to him -- a couple of my cousin's doctors didn’t have this information, and by the time I found out there was money owed, they were threatening collection. 

7) Do you expect your nephew to use his own funds to travel to your location to check on you? Or do you want him to reimburse his travel-related expenses from your account? (If so, make sure that’s in writing -- it’ll help if Medicaid becomes necessary.) 

8) Are you wedded to your current location? If not, you might want to consider moving closer to your nephew. I live quite far from my cousin -- I’m in NY and she’s in Fla. -- and it’s too late for her to move, but she feels extremely lonely. If I could do it over, I would have my cousin look at continuing care facilities near me because I would be able to check on her in person more often, and she'd be closer to family, which she often says she wishes she were.
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Judysai422 Oct 8, 2019
Great suggestions with one possible exception. Your nephew should only be on any of your accounts as POA, not as a joint own. This is an important distinction because if he is a joint owner and, heaven forbid, someone sues you, his own assets could be at risk. The same is true if he gets sued...they could come after your assets. This was explained to us by our elder attorney, so it is wise advice.
One other suggestion. There are professionals who will handle bill paying, etc. For you. If your nephew cannot take on the POA responsibilities, then that is an option to consider.
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Dosmo13, I am in my 70's and I noticed my mind isn't as sharp as it once way.... just old fashioned age decline I keep telling myself.

The trick for keys and checkbooks is to place them in the same place each time. You can try saying out loud "I am putting my keys on __________". For some reason that helps with remembering.

As for failing the clock test, I bet the younger generation who have grown up with digital clocks cannot draw a clock by memory. For me, I rather have a clock face as I can judge quicker how much time I have left to go somewhere.

Oh, doing math in one's head, forgetaboutit. So many of use grew up with calculators that doing math in one's head is a lost skill. I'd be so lost without one.

When I was helping my parents, in their 90's, and needed to learn everything about Alzheimer's/Dementia just in case, I found myself over-sensitive should I forget someone's name, date, place, yada, yada, yada. I tend to freak out.

Then I had to keep reminding myself that being in the 70's means my brain is like file drawers, all those drawers are filled, some info misfiled, thus it takes us longer to find the info we need :P

For the tax accountant, get yourself a large legal size envelope and stuff everything that the accountant would need. And add to it during the rest of the year. If the item in the mail says "tax information", I don't even open it, just shove it into that envelop.
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Dosmos: In answer to your update, do make an appointment NOW with your primary doctor. There tell what you have told here. I didn't know you had dealt with a cancer dx in past, so not only are we alike being RNs retired and of an age, but we both survived the big C. I am 31 years out from it. That complication makes me think that this checkup is all the more crucial now. I want you to take what you have posted here with you. Because if you say "Losing things" he or she will laugh and say "Oh, don't we ALL?" You need to tell them about the math problems, the clock problems, the not knowing what assets you have or how to figure out your monthly statements. This is going to have your MD arranging a neuro consult. They are the ones to do it and I would say it is crucial and nothing to be said or done until THAT is done, and you know where things stand. Having the cancer in the past can mean that you are dealing with some recurance; I don't want to scare you any on that one, but they can do good fixes on some of that stuff and you HAVE to know.
IF your nephew doesn't want to manage things, it would still be nice to be closer, and a bank or a fiduciary can be appointed to manage finances. That would be better, if costlier, than his doing it, especially if it is not clear what things there are. I hope you know where old tax forms are. They can help enormously. You need someone to help you just go through and file things for you right now. That can be done by an organizer, even.
Dosmos, Private message me here any time if you just need to talk.
I am so sorry you are going through this, and are so alone? Are there FRIENDS in the mix? Even that would be an enormous help.
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From an RN to another RN - you. Seems you have some dementia beginning. Get to your doctor and get onto any meds that might help preserve your executive functions. Ask your nephew to come visit and set up automatic payments for any recurring bills. Let him know that he will need to start handling your finances now or talk to your accountant about handling your financials. Have one of these people set up a reloadable debit card and agree on the amount of money that should be loaded it each month for your incidentals. Start streamlining your home and assigning a "place" for each item. Label and write reminders for yourself to leave in areas you frequent - bathroom mirror, refrigerator, back of doors.

You did not mention the other legal documents: medical POA, DNR, living will, will... Now is the time to get to a lawyer and have those documents.

You may want to think about what is the best plan for you as your abilities diminish - round the clock caregivers in your apartment (my MIL does this option with her dementia and my BIL manages her care from afar), moving into a phased senior complex that moves residents from independent living to assisted living to total care. Move closer to your nephew. Ask your friends to help care for you.
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My husbands elderly aunt lived alone and never married or had children so her nephew, my husband, was all she had.  We knew she had some issues and we were paying a neighbor to check in on her, cut the grass and take her to the store, but it wasn't until another person in the town called us and said that she had called him looking for her parents.  Her parents had been gone for 45 years.  We simply could not manage her from far away, so we moved her into an assisted living facility by our home.  She was only there for three months or so before we had to move her again into a secured memory care unit.
Your nephew will need more than financial POA to manage your needs.  You need someone to make medical decisions for you as well and have in writing what your wishes are.  You need to call him and tell him he needs to come see you because you are getting worse and some serious decisions need to be made.  Involve your doctor as well.  It is in your best interest to move closer to him so that he can manage all of this.  It is not easy to manage someone's care and you want to make this doable for him.

We wish you well and I am sorry you don't have more family to rally around you during this difficult time.  Take care.
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Dosmo, I think one of the most important things to do as we age is to continue at some level or another the mental and physical activities of earlier years, and, most importantly, learn to use relaxation to refresh our brains. 

What hobbies do you have?  In what activities do you engage?   Do you read?  Do puzzles?   Work math problems? Craft?  Garden?

I've encountered similar experiences, thought about it a lot, and find that changing lifestyle behavior after the death of my last close family member and the stress it brought is helping me restore my brain function.

I firmly believe that, like physical exercise, our brains need mental exercise, whether it's working puzzles or doing complicated math problems. 

One pleasurable activity could be learning a new language, and meeting new people in the process.  You don't have to be highly conversant, just putting your mind in the learning mode will help.

Join a book club, even an online one if you're not able to physically get out easily.    Visit a Senior Center, meet new people, and take some classes, just for fun and to meet new people.   In fact, the art of getting acquainted is an excellent brain exercise in itself.

What hobbies did you used to do and still can do?   Which of them will stimulate your mind?  

Start with one new activity, something you enjoyed doing, and pursue it.   When your mind starts fogging up, take a break.

I remember when I was in college and was discussing this issue with a friend in law school (we were in our 20s).   She observed that sometimes she "meets herself coming and going."   This was after I shared that I felt as if my brain was being scrambled, in what I later learned was a superconductor.  

I still feel that way, especially when I think back on the challenges and anxiety of caregiving, and when I allow myself to become frustrated over the lack of accomplishment now.   So I take a break, read the English Garden magazines, and my mind starts soaring again with plans for new garden beds.  

Thinking is sometimes like running; you have to start at a moderate pace and work up to another level.

BTW, I'm in my mid-70s.  
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AlvaDeer Oct 6, 2019
Great advice and solid. But the clock and the match and the inability to understand bank statements has me concerned. I am a great believer in what you say. Without garden, sewing, reading, podcasts, dog rescue work I would be a goner from anxiety.
Still, Garden Artist, I know you can do that clock. So I am worried; I need her to check this out so she can, if nothing else RELIEVE her mind of it, and go on.
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In addition to what others have suggested, you need to get a handle on your current financial situation. Perhaps, just to do this, your nephew can help you again. Then I would strongly suggest that if you find you can possibly afford it, you hire a trustee to oversee your finances, as well as your final life plans, etc. It sounds like your nephew has enough to do and he's not close by! I am also a single older woman, and while my brother currently has durable financial POA (hasn't needed to be used so far) and is listed as the executor of my will, he lives fairly far away, is tied up with his own life, and is only a few years younger than I am--I might outlive him. I'm in the process of hiring a trustee for myself. My lawyer is making some suggestions, but I think my accountant could do so also, as yours may be able to do. Your bank may also have some suggestions. It's not an inexpensive thing to do, but it would provide you with a good deal of security and peace of mind. A trustee should also be able to guide you in decisions you may need to make about higher levels of care as time goes on. You want to be sure you do this soon in case later on issues of your decision-making competence come up.
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You could hire someone to come in once or twice a week to help write checks and manage paperwork. You would need to be sure of their background and references, but I used to do that myself. I was the "home office" help and could help as well with errands, appointments, etc.

Look for senior agencies in your area which have referral services for things you need help with at home. Consider part-time in home help for things that are too difficult to manage.

Continue the activities you enjoy. Don't beat yourself up about the games and activities that you find frustrating or confusing. Is there a book club in your area that you could get to? That is sometimes a nice supplement to your reading choices.

Good luck to you and to us. I am likewise on my own in my late 70's and trying to plan ahead for managing life as my own abilities decline.
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Bronish Oct 10, 2019
I find that these ideas and suggestions are helpful and excellent food for thought.
I'm starting to feel concerns as well....about how I'm going to cope and manage stuff like survival. I cannot rely upon my only child, my daughter who has sternly informed me that she doesn't want to be stuck helping me, that if she has to help me financially, then that will be akin to me taking food out of the mouths of her children....she does NOT want to have to help me, should that day ever arrive. Btw, at this writing, she's not married, no children.... she's just now finished her education, and has been busy at work as a resident doctor, but now she's a bonefide doctor.
I don't know where to turn, especially as I grow older and begin to experience a diminishing of my capabilities. I'm praying day and night to the Lord to take me home very soon. I don't want to burden my daughter anymore than she hates me to become a potential burden.... it's scary when family doesn't want to be there for you, in case you need to be assisted.
Right now, I'm in great health, but having big trouble already financially. Like I said, I'm praying that the Lord Jesus Christ has mercy on me, and will soon deliver me out of this Shadowlands...to borrow from C.S.Lewis. 😃
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Tell your doctor about balance issues. He/she can arrange for home health care to come out for therapy at your home. My sister and I did this for our mom and it helps so much. You do have to do your exercises every day to keep your balance in working order.
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