My mom has been showing signs of Dementia and is refusing any help. She’s not bathing, barely eats, but she sees nothing wrong. Any advice?

Unfortunately, she’s not just showing signs of dementia, she’s got it. Having memories of things that never happened is called delusions and they are a big part of dementia. Refusal to eat and bathe is another. We need to take Brother out of the equation. He will be around when the will is read. Dad is enabling her probably because he feels overwhelmed and can’t deal with her. People with dementia can be difficult and sometimes combative.

Two choices, a facility or in-home care. I’m not sure of the ins and outs of who pays what for in home care, but you’d need to check with your local Medicare office, her Medigap carrier and file for Medicaid if you need to. Facilities are easier because their financial department does the work.

Be prepared for family members to come out of the woodwork when you make a decision. They will criticize any decision you make. Stand your ground. They’ll disappear into the woodwork again.

Well.

At 74 your mother is on the youngish side for developing dementia, and, besides, the self-neglect and erroneous beliefs (let's not label them without professional guidance) could be symptomatic of a whole range of other possibilities. Just off the top of my head, and speaking strictly as a lay person, for example depression, chronic disease of various sorts, or God forbid some new issue that is affecting her brain chemistry... Anyway, I really am guessing, I've no idea.

Mmm. When you say your mother used to make up some crazy stories and appear to believe them sincerely. You are sure about the crazy part, are you? Without knowing what they were of course I can't say; but if they were about her having been Secretary General of the UN, e.g., then fair enough; but if they were about quite possible events that you would rather not believe were true... Maybe keep your jury out on them for a while yet, no?

It does sound - self-neglect, loss of appetite - as though your mother is depressed. But whether that is because she has classic, chemical-imbalance-type clinical depression, or it's the result of some other kind of illness, or an exacerbation of an existing chronic mental health issue is, I suppose, what you need to know.

Try talking to her without contradicting or rejecting what she says. Accept what she is saying as her point of view. And, treading carefully, encourage her to talk to an "advisor" or "counsellor" about what troubles her. This might be one way of getting her in front of a professional who can give a meaningful assessment of her mental state and suggest ways forward.

Okay.

Well. If she won't accept help, won't even accept that it might be an idea to check if something might help, there's not a lot you can do - at least until something else changes.

So, the only remaining option, to make you feel less stressed and miserable about it, is to follow a different train of thought of your own.

So: what happens if you back off and do nothing? Looking ahead by stages - say, to the end of this year, next year, the next three to five years - how do you see your parents' situation developing if there is no new intervention?

Will you need to get Dad on side before you can 'do what needs to be done'? What are your issues with that?

I should start by warning your father that if he allows your mother to continue in her paranoid? delusional? state he is neglecting her wellbeing to the point of abuse. Advise him to take the first step by calling their family doctor and asking for help.

That said, how old are your parents? And what is your father's state of health? In this situation, he is the decision-maker and everything you do should be aimed at supporting him. I'm asking this for information, not as an accusation: what is he afraid of?

I will wish you luck with all the power of my being.

A 74 year old alcoholic who has not had any kind of medical review in four years... the possibilities are endless.

I hope she "clicks" with the counsellor and is able to have an open-ended conversation so that you all of you at least get some idea of how to move forward. Look on it as a first baby step, don't expect too much of it - the really important thing is that it goes well so that your mother feels more comfortable about talking in general.

Meanwhile, if you were to promise, cross your heart, that nothing to do with her mental state would be on the table for any kind of discussion, could you get her to agree to a basic medical purely on the grounds that it's about time?

If things go OK with the counsellor, perhaps you could ask for the counsellor to recommend someone 'who would understand better' to follow up. If you can then get a medico to home visit, it might be a step forward. I can understand that just stepping back and waiting for a crisis is a difficult thing to do, particularly in view of the possible problems for your father. Do a follow up with the counsellor, and make sure that the counsellor has whatever will satisfy them to let them discuss it with you - 'privacy' can make things impossible.
Best wishes.