Mom has dementia and refuses to move to a skilled nursing facility or allow me to hire an aide to help her. Where do we go from here?

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OK, so my 97-year-old mother, who currently lives alone in senior housing one hour away from me with no services, was finally diagnosed with dementia (“Major Neurocognitive Disorder”). She is still in the hospital, but desperately wants to go back to her apartment. She refuses to allow me to hire an aide to come in to help, and she refuses to move to a skilled nursing facility... basically because she refuses to believe that she has dementia. She just “forgets names.” (She has no memory of going outside in the dark to frantically search for me because she hears me screaming or crying outside, or because she sees me laying in the street.) I cannot trust her to go home alone because she cannot be trusted to take her heart pills, never mind take her new risperdal which seems to be quieting the hallucinations. Before her hospitalization, I was driving down there every other day and it was taking a toll on my health. I cannot move down there with her and I cannot drive down there every day. Mom has always been a very controlling, bull-headed woman and it’s her way or the highway, and even though I have POA that does not give me the right to move her to a home or hire help against her wishes. I welcome thoughts and ideas from any of you who have dealt with this situation with a parent like mine. (Anyone who had a compliant, sweet parent ... that is not my mother. Anyone who has ‘tricked’ their mother by bringing a ‘friend’ to visit who ends up being the caretaker, my mother is too smart for that.) Thanks in advance.

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I'm not sure that returning to her apartment is a good idea even with aides to help her if she "has no memory of going outside in the dark to frantically search for me because she hears me screaming or crying outside, or because she sees me laying in the street", IMO she needs the 24/7 supervision of memory care or a nursing home.
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Reply to cwillie
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Your mom has dementia, she's 97 years old, and she's in the hospital. To put it bluntly, she doesn't get to call the shots anymore. Because she's controlling and bullheaded you have to treat her as such and speak frankly to her.

Because of the dementia her reasoning is non-existent so trying to reason with her, trying to get her to understand that changes have to be made will likely not make an impression on her.

You tell her this: if she still wants to live in her apartment she's going to have to accept some help. That's the bottom line. Tell her you want her to continue to live independently but the only way she can is with some assistance. Explain to her that it's either that or a nursing home, her choice.

A few years ago I became very ill. I also had a bad reaction to a medication which caused transient dementia. I was completely incapable of caring for myself and had to be hospitalized until the drug was out of my system and other health issues had resolved. But because I was unable to care for myself my support system of friends, neighbors, and family took care of me. Because they were the ones doing all the caregiving I had to go along with what they said. They loved me, they were trying to get me the help I needed, and it was my job to let them. This is my current perspective and as I've been told was NOT my attitude at the time. They had to care for me despite myself and it was very difficult on them. But I was the sick one, they were in charge, and it was their way or the highway which is the attitude that got me the help I needed and I recovered.

When our parents need our help, our caregiving, we try to honor their wishes and respect their decisions but when they begin to make decisions that are not only caused by dementia but are harmful to them we have to step in and be the one in charge. This can cause a lot of friction but when someone can't care for themselves they're not in a position to dictate terms.

If you can't get your mom to accept a caregiver you'll have to get her to at least tolerate a caregiver. Start off small. A few hours a day (if that) and have the caregiver do things that you know your mom would appreciate. For instance, if I had to have a caregiver but didn't want one, if the caregiver vacuumed the rug while she was here I might start appreciating the help. If the caregiver fixed me a nice breakfast I may not continue to object. Start the caregiver off with simple things that aren't too personal and/or intrusive to your mom (showering, help in the bathroom, etc). Explain to the caregiver that your mom is using the service under protest and advise her not to hover over your mom too much. Ease her into your mom's routine nice and slowly.

And you're right, you can't force your mom to move to a nursing home....yet. But if she continues to refuse help her choices will be taken away from her once she has a nasty fall or becomes ill, two things I'm sure your mom will refuse to believe can happen. But they do. All the time. And once that hip breaks her choices will be gone. At least for now she has some choices.
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Reply to Eyerishlass
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A friend of mine is in a similar situation with her father, who is difficult and has destroyed the family with his behavior. Out of desperation she hired a geriatric care manager who works as a consultant for her, not her father. So far she is very happy, because the care manager is helping her wade through the legal issues and helping her get him into a safer place with the support he needs. She found her doing a google search and made sure she belonged to the national association that is working to provide standards and ethics, as this is a relatively new profession. Although my parent is easy going and compliant, I may hire one to put together a care plan to avoid other problems with family in the future.
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Reply to AtoZ0806
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