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Mom has dementia. She currently has a public health nurse fill her med tray every 2 weeks. She has a homemaker 2x/wk. She lets her leave early and doesn't let her do all she can do for her. Adult protective services wants her to have more care in the home. I have rheumatoid arthritis and live 100 miles away. My sick brother who was living with her recently died. I'm working w her new PCP to help medically document her symptoms. What can I do?

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Persons with dementia cannot safely live alone after the very earliest stage. So you are probably right that Mom isn't safe at home. APS may be right at the moment that additional in-home help would allow Mom to live on her own longer, but that would be a temporary solution.

What can you do? As others have said, you are limited in what you can do if Mom is still considered competent to make her own decisions. You could call APS, of course, but they are already involved. I think that is good. If they can arrange for more in-home care that would be good at least for a while.

You are working with her PCP. That is good.

But this may be a case of "waiting for a crisis," as JessieB describes it. I know that is not at all satisfactory, but it may be the only thing you can do.

Maybe a lot of people do take a one-year leave of absence from work to arrange things well for their parent. Maybe. But no one in my family could possibly afford to do that. When my sister retired she took our mom in. That lasted about a year until the care needs increased, and then mom went into a nursing home. Fortunately we were able to convince Mom that these were good things to do. If she had resisted, I'm not sure what we would have done. Waited for a crisis, I guess.

Early in his dementia I told our children that their dad could not possibly live on his own, even with a lot of help. If something happened to me they should NOT let him convince them that he could manage with just a little help. Fortunately nothing happened to me, but I do know first-hand that it is not feasible for a person with dementia to live alone safely. (Sometimes it is not even safe for them to be left alone for a few hours while the caregiver shops!) BTW, at no time in the 10 years with dementia was my husband "incompetent."
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Safety is the first thing a state or an adviser looks at. I think since you live that far away, even if she was in a nursing home, you would not know if she is still safe. Many people take a leave of absence for a year or more and temporarily move to that location due to this type of scenario. This is done to try and improve the situation to a point where it can be better managed, because you never know, if she is 80 or less, she may live another 15 years. Even documenting symptoms with the PCP remotely is hard. It's hard enough to even do that type of thing and get the proper referral to a specialist when a person lives in the same town as an aging parent.

Comfortable surroundings, things that they are used mean something to them more than most other family members understand. It's part of getting old. Comfort brings safety also, but yes, if she is a fall risk, due to medical reasons, better find out. If its just about home safety vs. assisted living/nursing home safety, that is even harder road to travel financially.
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Here's another option, but, it may not be feasible. You can consult with an Elder Law attorney and get information and advice on what is required in her jurisdiction to get Guardianship. It involves funds, which you may or may not get reimbursed, You can ask that yourself or someone else, like the County be appointed her Guardian. Different jurisdictions have different standards for what is considered incompetent. In some places, if you can't manage your own household, you might be found to be incompetent.

This is a huge responsibility. If I lived far away and had my own health issues, I might encourage the county to pursue this procedure and let them take responsibility for her care and treatment, since, it's really a full time job.
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Nelson, ultimately, I think that Jessie and I are saying the same thing.

You COULD fly across the country, give up your job and your life and move in with mom. She would then treat you like a moocher who is living with her "for free" because she doesn't recognize the need for care-giving.

Or you could wait for some higher authority to take over and move mom against her will. Or you could wait for a fall or something and move her closer to you.

All the choices suck, I know.
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I was in this situation with my mother and father a few years back. Both had dementia, but neither was considered legally incompetent. I was living halfway across country and neither of my brothers were available. I tried to arrange for a care manager, but they fired her. They hired a maid, then fired her. There was really nothing I could do since they were not legally incompetent to make their own choices. Sometimes we have to wait for a crisis to convince them that change is needed. What we hope is that the crisis is not too bad.
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You can't convince someone with dementia of anything.

Let APS handle this. They can arrange for the state to take guardianship if they feel she needs to be in a facility.
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