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Hi everyone. I just joined the forum and apologize in advance if I'm doing things wrong with the posting. I'm not really a caregiver at this point, but my husband and I are trying to figure out what to do for his mother. She lives in the house she's been in for 60+ years and is adamantly opposed to living anywhere else. She has been getting by with some help from my husband and his brother, but we are concerned about her safety there. Also we live two hours away, and my husband has been six hours away much of the time lately because of having to go out of town for work. One of our concerns is that she has left pans of food on the stove and then gone to sleep. My husband is considering disconnecting or removing the stove, leaving her with the microwave for heating food. She has always been a rather stubborn and cantankerous individual and seems to be becoming more so with age. This is making it difficult for her sons to help her. Her latest crisis seems to have begun with dental problems. Her remaining teeth are in very bad shape and causing her pain. She has been refusing to see a dentist because "they put their hands in my mouth." None of us know how a dentist can work on her teeth without doing that, but that is her argument. Because of the dental problems she hasn't been eating much and because she doesn't eat she hasn't been taking her medicines. (Some of them need to be taken with food.) She has diabetes and heart problems. A few weeks ago she called my husband saying she needed him to take her to the doctor right away, but wouldn't say what was wrong. By the time he made the two hour drive, she had driven herself to her heart doctor wanting him to do something about her toothache. The heart doctor refused to treat her and told her to see a dentist. A week or so later she called my husband to say she had called an ambulance to take her to the emergency room, again refusing to tell him what was wrong. As he was in route, she called to tell him the hospital would not admit her, and that he needed to come get her because they were going to throw her out. He said he was on his way and would be there as soon as possible, but that wasn't good enough for her. He asked her to let him speak to someone at the hospital to explain that he was on the way, but she refused. By the time he got there she had left. He didn't know where she had gone or with whom, and the hospital couldn't tell him, either because they didn't know or because of privacy concerns, I'm not sure which. She was mad at him for not coming soon enough and was refusing to answer her cell phone. He called various relatives and finally learned that his cousin had picked her up and taken her to his aunt's house after she called the aunt telling her that she was at the hospital about to be thrown out and her son wouldn't come. The problem again was the toothache, and the er doctor told her to see a dentist. Not long after that, my husband got her admitted to the hospital after she called to say she was very weak and couldn't even get up. She had not been eating right or taking her medicine and her blood sugar was very high. She has improved somewhat and has gone from the hospital to rehab, where she is uncooperative, unhappy, and wants to go home. When my husband refused to do as she wished, she got mad and stopped taking his calls. She called her other DIL wanting to be taken from rehab to the ER to get her toothache treated. Rehab has a van to take patients to non-emergency medical appointments, and they have arranged to get her to an appointment with an oral surgeon. It remains to be seen whether she will cooperate. If she doesn't, I don't think she can be forced. In the meantime she is on antibiotics for the infections caused by the bad teeth, and on pain-killers. This will be the third attempt to get her to a dental appointment for this problem. Previously after a few days of antibiotics and pain-killers she has decided she is better and cancelled appointments. This was before trying to get the heart doctor and the ER to treat the problem. Ok, this is horribly long. I'm sorry and thank you to anyone with the patience to read it. I'm wondering if anyone has any advice. From what I've read, she can't be forced to do anything she won't agree to, and she won't listen to her sons, her doctors, or anyone else. It looks like we have to wait until things are bad enough that she can be declared mentally incompetent and have a guardian appointed or adult protective services steps in to save her from her own bad decisions. At this point, I really don't think she's mentally incompetent, just incredibly stubborn and ornery. I am, of course, very glad to be living in a time and place where the individual's right to self-determination is protected, but it looks like we can't help my MIL until things get a whole lot worse. Looks to me like we have to wait for her to crash and burn, and hope she survives long enough to get help. Any suggestions? Thanks.

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I'd say you have it about right. It's sad that the relative picked her up from the ER, because the hospital might have called APS if no one had showed up to assist her.

So, she's in rehab now? When they start talking about discharging her, her sons need to talk to the SW or other discharge planners about the fact that their mom is no longer safe (emphasize that word SAFE) living alone. And that she is non-compliant, uncooperative with helpers and that moving in with one of you is NOT an option (she will be non-compliant in your home as well).

She is no longer competent to make good choices about her health; it very much sounds like vascular dementia may have set it (the inability to plan, see consequences, make good choices).

You have an opportunity now that she is "in a bed". The facility can help with applying for Medicaid if that's needed.
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Agree with Barb. This women needs to be in assisted living. Moved from rehab directly into care. Sounds like dementia with maybe UTI and other stuff.

Different locales have different procedures for dealing with mental incompetency. APS, ombudsman, social worker etc.

I would try the MOM YOURE GOING TO THE ASSISTED LIVING PLACE UNTIL YOU GET BETTER method. Staff at these places deal with this all the time and are pretty darn good at it.

This worked with my parents just recently. I didn’t have to use any legal maneuvers other than my POA. Mom doesn’t like it, she’s mad, thinks she’s just fine and should be home. Reality? She can’t even stand without assistance.

Time to get some tough love going here. If she goes home it’s just gonna be a bigger mess down the road.
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To start, maybe a family meeting is needed just to make sure everyone is on the same page so that a well meaning cousin doesn't "rescue" her. If everyone presents a united front that she needs to be somewhere safe - spin it as "just until all her health problems are taken care of" if that helps - then she really won't have any other option but to go along.
I hope someone has POA?
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Echoing what the others have said. cwillie's suggestion of a family meeting is excellent. Everyone needs to be on the same page and realise how sick your mil is, and that she needs help permanently now. I don't think she would be evaluated as incompetent, but it appears to me that she has a degree of cognitive decline. She is making some very bad choices for herself.

Since she is in rehab the family needs to talk to the discharge worker and fill them in about her circumstances, non compliance etc. and work towards placement in a facility. Good luck and let us know how it pans out. There are many here with similar situations. You are not alone.
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Thank you both so much for your responses. Yes, she is in rehab at the moment but threatening to call a cab and go home. My husband has talked to social workers, and he and I have looked at some nursing homes in our area. Neither of us thinks we could live with her, and my brother-in-law and his wife feel the same way. Also, three of us are employed and the fourth is disabled, so there would be nobody to care for her during the day and keep her from burning down the house. I am hoping if we could get her into a nearby nursing home where we could visit regularly she could learn to live with it, but I just don't know. My husband thinks the last downward spiral was caused by the dental problems and that if she will finally cooperate to deal with those she might regain her strength and be able to go back home. I'm afraid that might be overly optimistic. Until recently she had some home health people coming in twice a week to check on her, but she told them not to come back. She won't have people coming into her house and telling her what to do.

My husband will be talking to the social worker again soon, and I will give him your advice. It's really hard to tell whether she has dementia or is just being her cantankerous self. UTI is also a strong possibility. She is incontinent and subject to those. I didn't realize until a few days ago reading on this forum that UTI could have such a strong effect on mental state.

Thank you again for responding.
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I agree with the others. When she is in the ER you need to tell the doctors that she lives alone and her home situation is unsafe and no one can take her in. They need to be the ones to place her in AL.
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Got more responses while typing. Thank you ALL for your responses. My husband has talked to his aunt to prevent further "rescues." My concern is that if she isn't evaluated as incompetent (and I don't think she would be), it may not be possible to get her into a nursing home against her will. From what I have read, that can be very difficult to do. Maybe, as some of you have said, we will be able to push it as a temporary thing until she regains her strength.

I've been reading posts on this forum for several days now, and I realize many people are going through similar and worse problems with aging relatives. It's good to be able to get advice from others who are in the same boat and have more experience with it. Thank you again.
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I have an aunt like that. Puts in her two cents even though she does not know the full situation. I know she is trying to help but it just makes things worse.
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Dogperson, cantankerous would be not going to the dentist. Going to the cardiologist and expecting to have your teeth taken care of is something else entirely.

Another thought for down the road. Geriatric psychiatrists can be very helpful with agitated elders. Sometimes meds make for a world of difference. Good luck!
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Anyone else hearing a strong echo of Dorker's situation?

I would tell the rehab place that she leaves pots on the stove unattended. That is a very graphic example of an unsafe living situation!
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Dogperson, as I was reading your original post I was feeling your angst. How many times have I been in similar situations! I, too, read postings on this site for months before I posted my first question. I agree with Barb, that a geriatric psychiatrist could help your mother. I have read on this site that a psychiatrist told the caregiver that most elders will keep the personality they have had all their life, it will just become more intense. So the cantankerous mother will just become more cantankerous! My personal thoughts are that a lot of difficult people have lived their life with an undiagnosed mental illness and maybe at the end of their life, when someone else becomes responsible for their medication, they could finally get some help.
My father, on the other hand, was a raging alcholic most of the time with periods of funny sweetness. We never knew what we were going to get! After losing the ability to get his own alcohol and going through a detox period, he now takes a mild antidepressant and is as gentle as a lamb.
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His mother sounds like a hoot. It appears she is still competent to know what she wants. She may raise hell even in an AL or SNF.
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Zam, this is an elderly lady with dental pain who won't go to a dentist, but DOES go to a cardiologist to have her teeth seen to. This does NOT strike me as someone who " knows what they want" and it sure doesn't strike me as funny, not for the lady in pain and not for her family.
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If you are successful with getting her to a NH, try choosing one that is closer to where one of the children live. Get a physician statement. Plan your own family meeting to determine which child will assist in times of need. It does sound as if her mind is broken so make it easier on yourselves. My husband is one of 4 siblings with a 3 hour separation. Each person took one part of the plan. The most distant became the bill handlers and the closest became the ones to fetch things like pills and personal items. Each sin would visit once a month on scheduled weeks.  You may need an attorney to determine medical and financial POA, but use her money as you liquidate her belongings.   Absolutely do not pay yourselves unless you enter a care contract with her signiture.  Use all funds on her, (attorney is included and may be expensive but well worth it) and save all recipts for when she needs Medicade.
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I like this bit: "When my husband refused to do as she wished, she got mad and stopped taking his calls."

Sounds good to me! Peaceful, like. But sadly only temporary, it seems.

Dogperson seems pretty sure that MIL would not be assessed as incompetent. And it is certainly true that there is a huge difference between being demented and being idiotic and foul-tempered and making unreasonable demands (especially when in pain. As you might well be when you've let your teeth rot in your head, for example).

Has anyone tried a different dentist before now? I'd wait and see what happens with the next appointment. Could be the change in surroundings and personnel will help.

Poor family, I do feel for them. And I think DP herself is right, that all she can really do is rub her husband's shoulder blades and wait for MIL to crash.
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I guess maybe there really is some dark humor in the whole situation, but I'm having trouble appreciating it. I know her going to the cardiologist for her teeth sounds like age-related dementia to people who don't know her. I can certainly see why people would think that, and they may be right, but I'm not sure.

As an example of what I'm saying, my husband should have had his teeth straightened when he was a child. He wound up having it done several decades ago as a young adult after he developed TMJ. I had just assumed his family couldn't afford orthodontia when he was a kid, but it turned out that wasn't it. MIL told me the story of trying to get the problem taken care of. She had decided that one of his canine teeth, which stuck out at an odd angle, needed to be pulled so the other teeth would fit better, and that is what she wanted the dentist to do. He wouldn't do that, and tried to explain the approach he (and professional dentistry in general) considered appropriate. The dentist wouldn't do it the "right" way (i.e., her way), so she didn't get her son's teeth straightened. MIL was in her 30's at that time and in her 50's when she told me about it. Her decision strikes me as crazy, but it wasn't age-related dementia.

This is part of what we're up against now. How much of her craziness might be dementia, and how much is just her craziness. It's obvious to everyone but her that she is making bad decisions, but mentally competent adults have a right to make their own decisions, even if they make bad ones that are not in their own best interest. So it looks to me like the question will come down to whether or not she is mentally competent.

My husband will be in a teleconference on Friday with the rehab people to discuss how his mother is doing. He and I have been making a list of our concerns about her living situation, including things like leaving pans on the stove and not taking her medicines. We'll see how that goes.

I am also concerned that she will "raise hell" even if we get her into an AL or SNF. I've been googling to find out more about how to deal with this situation (that's how I found this site) and have read horror stories about facilities refusing to take or keep patients because of their bad behavior. I have also read that mentally competent patients can leave if they so choose. There is certainly a lot to worry about. Thanks for the advice about the geriatric psychiatrist. Sounds like we'll need one at some point.

Someone posted that MIL's situation reminded them of Dorker's situation, so I found that thread and have been reading (or at least skimming) that long and painful saga. I don't believe I'm even halfway through yet, but I hope I have learned enough from it to avoid the trap Dorker has had to fight so hard to extricate herself from. I'm glad I found this forum, and heaven help us all and our relatives.
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The one thing you really need to be sure of....do not let the rehab discharge her to her home or to the home of one of you.

Everyone is right. And this is going to keep getting worse.

If any sibling allows her to be discharged into their home...then you need to make it quite clear that they and they alone are signing up for this ride. It won't end well. The worse thing that happens is the family meeting has a well meaning family member that says they will take dear Mom into their home...then all the rest chime in with how they will be there to help. The result is anger, frustration, guilt, and often the dissolution of the family over it all. Don't go there
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More people were posting at the same time I was typing. She has been to three dentists, two of whom have told her not to come back. I don't blame them a bit. I just got a text from my husband that MIL is in oral surgery now, thank heaven. She will get the bad teeth removed and will get studs to snap her lower dentures onto. (This was supposed to happen yesterday, but it turned out the van service rehab uses didn't run because of the Martin Luther King holiday.) MIL has dentures but has been refusing to wear them because they aren't comfortable. Part of this is the bad teeth, but part is her refusal to go back to the dentist for adjustments because if she does that the dentist will put his hands in her mouth. We will see how this works out.
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This seems to be a no win situation for this family so i would call in some "big guns' if you can find any like Adult Protective Services and explain that she is definitely a danger to herself and others.
Does anyone have POA? If not i doubt she will sign it now so you may have to go the psychiatric assessment route. She will talk herself into Memory Care if she is unable nad I stress unable to co-operate rationally. Very important that no one pick her up from rehab or anywhere else. if she discharges herself and calls a cab which of course she can call APS immediately.
By the way dementia can start well before a person becomes elderly and of course there is also mental illness.
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Katiekate, you are right that it will continue to get worse, It is, in fact, doing so even as we speak. I just got another text from my husband. MIL has a broken jaw. It did not show up on the x-rays. The oral surgeon found it while preparing to put in the denture attachment studs. Oral surgeon says it is probably the result of tooth root infection. He is now working on a bone graft. He will use artificial bone to try to glue everything back together. The heal time will be 6 to 8 weeks. If it doesn't heal, she will need further surgery for a plate and screws.
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Thank you, Veronica91. Nobody has POA and I can't imagine her signing it now or ever.
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Oh DP it never rains but it pours!!
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Dogperson—I doubted my mom would be found incompetent but we had her assessed in a Geri Psych unit (in a psychiatric hospital). She thought it was 1984. Case closed.

My mom got a new medication and a diagnosis while she was there. She has depression and moderate dementia! She is a good actress, playing straight on the phone.

You and your hubby are about to fall down the rabbit hole. That’s how it’s been for me! God bless all of you!
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Hi Dog Person and welcome,
I was living in Puerto Vallarta, Mexico and was talking to my mom in San Francisco every day (thank God for Vonage phone service!).
We chit chated and she seemed fine. I ordered her groceries on line and had them delivered to her apt. She'd tell me what she wanted. I saw over the course of time, she was ordering less.
I visited at Christmas and realized she had dementia. OMG! How did I not know that? She couldn't write a check, she was completely confused in the grocery store, etc.

I took her to a neurologist and it was apparent. Either I was in denial about some questionable behavior or I just was ignorant of how the disease manifested itself.
They told me she should not be living alone. Her primary doc and the neurologist wrote letters stating that she was incompetent to handle finances and needed to be placed in a memory care facility.
She went there a few months later.

What I want to stress here is that I chalked up some unusual behavior to old age, being a grumpy old lady, etc. when, in reality, she had Alzheimer's. They can "fake it" pretty well, even into the more advanced stages. Family members don't ask their loved ones what year it is or who's president. So how would we know?

Can you have a geriatric neurologist visit her at the rehab? She won't even have to know that it's a psychiatric evaluation. Then you can go from there.
Good luck to your whole family.
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I am so glad that she is getting her dental issues dealt with. From what you write she has had mental illness for a long time. if she would agree to an assessment that would be ideal and I am sure it would show deficits. A geri psych eval would be a good way to go while she is in rehab. Pots left on stoves are dangerous. Surely things are bad enough now to contact APS. Mother has life long mental illness which, to some degree, masked the onset of dementia. She was also very bright, so her MMSE score was high, but we all agreed she had deficits and was making decisions that were not in her best interests. Treatment with meds may make mil able to adjust to life in a facility. It calmed my mother down considerably and her behaviour was not that much of a problem once she was on it. Keep us updated.
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Praying for you and your family, Dogperson. This is definitely a crisis situation but one that may endure for some time until she gets the help she needs. Take one day at a time (or even one hour or minute!). Try to practice good self-care during this time, and Breathe! I have seen this advice many times on this site. We forget to breathe deeply and end up causing ourselves more stress with short shallow breaths. Your MIL must have been in awful pain with her broken jaw. I think she has been suffering from mental illness or dementia for a while.
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Hi dogperson (I'm a dog person too. ) I can certainly relate to your stressful predicament. I went through that with my parents. I would go home to help and get things sort of straightened out and as soon as I left they would go back to their old ways.
One thing came to mind is: If she is in rehab the Dr. can order a nurse or home health care as well as physical therapy to make some house calls when she goes home. It is paid for by medicare if written by a Dr. Just ask the Dr for it. We did that with mom after a hospital stay and because the Dr ordered it she went along with it. Also, it got her used to having people come over to the house and she actually started to enjoy the visits. Later on we hired caregivers and they were angels! You know its scary losing your freedom. I myself plan to go out kickin and screaming. I want to die in my house, in my bed with all my dogs and my cat piled on top,lol. We tried assisted living for my parents and it was terrible. It was a very expensive place and after being there 4 months mom had big sores all over her rear because they didn't change her or clean her often enough. It was very cliquey and my Dad was very loney and not part of the clique. We moved them back home and hired a service which was about the same cost as the assisted living. Let me know how it goes, Martinaa
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Dogperson,
Welcome!
You are a caregiver.
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Just because you haven’t had to physically care for someone in their home does not mean you aren’t a caregiver. Your concern for her and just by seeking out answers means it weighs on your Heart and mind and makes you a caregiver!
Unfortunately My mom had a quick decline and I’d come back to visit and take her to doctors. Even though I got her the medical alert, called every night, registered her with the police department, paid her bills online for her (after I learned she couldn’t handle the finances) and got her in home nurse and PT, it wasn’t until the home PT found her on the floor and she went to the hospital that i was able to step in and do something. She also wouldn’t give me POA, she is stubbor! But one day i kept asking and talking and she gave me POA!! So don’t underestimate, keep trying! I let some of my moms forgetfulness and stubbornness go before I realized it was dementia or brain injury from the fall (brain bleed). Try try try to get POA while in the rehab where they usually have a notary available! It makes things a lot easier. Make sure doctor and social worker know her living situation! If all else fails and she declines...Last and probably hardest decision will be to get CPS involved. My prayers are with you as the worry becomes unimaginable at times.
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Thanks everyone for the responses, the good wishes, and the welcomes. I appreciate it.

MIL is back at rehab from the oral surgeon with new antibiotics, new pain-killers, and new diet rules (liquid diet for awhile). I hope this will at least resolve her mouth issues eventually and relieve her pain. Husband is on the way home and hoping to make it before the weather gets worse. Snow is predicted for today which is why my place of employment is closed and I am home.

Hi Martinaa. Nice to meet another dog person. I also would like to die in my home surrounded by my dogs. It depresses me to realize that probably isn't realistic, but I can't focus on that now. Just have to hope some version of the Rainbow Bridge is true and we'll all be together again someday.

I do think this is the crisis that will force a change in living situation. We will add this to our list of reasons MIL can't live alone or with either of her sons.
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