MIL (90) lives alone and is 200 miles away, has dementia and is verbally abusive and accusatory. What do I do?

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Accusatory to myself, my husband, granddaughter, all. She keeps all curtains drawn in her house, so that no one can peek in at her and so the sunshine does not fade her furniture. It is like a cave inside, cold and dark in the winter, warm and muggy and dark in the summer. She keeps the heat at 64 and refuses to use her air conditioner until temps break 90. Her freezer is packed with food that she no longer prepares for herself. I arranged Meals on Wheels to come for her M - F (which has turned out to be a Godsend). I order groceries online for her to eat on the weekends. My MIL has no friends. She has called the police on all of her neighbors for imagined wrongdoings, to the point that the neighbors have ceased communications with her. The police at one point were calling us as often as weekly to update us on her accusations, all of which were unfounded. She has accused the neighbors of poisoning her trees, of flying helicopters overhead and dropping pine needles from the copter... the lawncare people of sneaking onto her yard in the middle of the night to spread grass clippings about... the grocery store delivery service was accused of stealing a spatula, toothpaste and a mirror from her wall. We had to find an alternative food store to order groceries from for her. Now she is accusing either that food store or one of us of sneaking into her home in the middle of the night to steal her yogurt. The police calls seem to have quieted down lately. Now she is accusing myself and my husband of stealing candle stick holders from her. She accused my stepdaughter of stealing $1500 in cash which she stated was in a bag in her closet, along with her "pretty silverware", which she states my stepdaughter replaced with "ugly" silverware. She also has accused one or all of us of having stolen corn cob holders, a mixing bowl, mixing spoon, pictures off the wall... and on and on and on. We have seemingly good conversations over the phone, my husband calls once a week, I call once or twice a week. We no longer encourage our daughter to stay in touch, she is now 24, but was the brunt of accusations when she was 19 and we feel it is unhealthy for her to be exposed to the abusive accusations. Last summer her condition reached a low point, she was not eating, had elevated blood pressure and was more disoriented than usual. We arranged for her to see a doctor, (she had not seen one for 5 years, after her GP died) She strenuously objected to seeing a doc, however we were able to convince her that by seeing one, she would increase the likelihood of her being able to remain independent in her home as she strongly desires to do until she passes away. She was diagnosed with mild to moderate dementia, although she aced her cognitive examination. The doctor was able to discern through talking with her that she was very depressed and that many of her responses appeared practiced and, well, artificial. So, she was prescribed Remeron, Aricept and Lisinopril for the blood pressure. The doctor also decided she was best suited for home visits from him as well as a psychiatric nurse to visit once a week. MIL refused any additional intervention (aide, companion - refused ). She has been a Model patient for the doctor, answering questions appropriately, etc. She has occasional issues with the psych nurse, who calls whenever there is trouble. The problem is usually non-compliance with meds. MIL believes that since she didn't need meds 10 years ago, that she doesn't need them now. To date, I have been able to make MIL understand how important it is to take her pills and to see the nurse. Oh...there is so much to say.... so many issues....I could go on forever... She is currently calling me a crook to my husband, calling my husband a crook to her 93 year old ex-husband (who no longer will speak on the phone to her, because of her abusive ways - she leaves vicious messages about my husband, my step-daughter and me for him to endure listening through... he will not block her calls in the event she needs medical assistance or something should she reach out to him for that, he elects to remain somewhat available so that he can alert us should the need arise). At the time I am writing this she will not speak to me or my husband on the phone...I would not be so concerned were she living closer to us or if her mental health was not declining so. I really do not know what to do to help her and I worry about her social isolation and increasing paranoia. The doctors concede she has dementia but have stated she is still competent to make decisions for herself, which in itself is questionable as we have had to unravel multiple incidents involving irresponsible spending and investing with disreputable people (one of whom is now in jail for ponzi scheming millions from people just like and including my MIL). I think I mostly needed to vent my frustrations and get this stuff onto paper, however any suggestions or ideas to make life easier for everyone involved is most appreciated. Thank you for listening.

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Sunnygirl1, I Pray that my MIL's story can parallel your loved one's :) As far as finding an alternative practitioner, this office is one of few who do home visits. As my MIL is not driving, this becomes necessary with us 200 miles away...
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Man, Dilofthedevil, to think her doctor handles cases liker hers all the time. It does make you shake your head. What kind of place is that? So sad.

I would keep a close watch for changes, because once your mom's level declines, she may be in a better place for you to step in. I know that with my loved one, she was at first extremely disagreeable and confrontational. I stepped back and let her be on her own. When I got the call to check on her, she was no longer able to resist help anymore, so I was able to step in with the DPOA and make medical appointments, get her into care, clean the house etc., because she didn't have the ability to even realize what I was doing.

As her dementia increased, I was able to convince her to get the help she needed, because she didn't have the mental ability to reason against it. And she forgot she didn't want the medications.

Hopefully, at some point, you can intervene. I do think I would find an alternate doctor at some point. I would be very skeptical of the one she's seeing.
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The physician's office which sees my MIL does in fact specialize in geriatrics. They have advised that were we to contact APS, that APS would intern contact them to perform the cognitive and functional assessments. You are spot on, vstefans, we do not at this point anyway, seem to qualify for guardianship as MIL is, apparently in the eyes of the law anyway, still able to care for herself (her house, while dank and dark, is Immaculate... she spends all of her time cleaning, I guess... I think the biggest frustration for us is the knowing that we must sit back and sadly wait for something bad to happen. I think Sunnygirl1 has wrapped it up neatly with her final paragraph, "When someone is out of control and not dealing with life anymore, there's not much you can do about it, except stay out of their way, don't argue and wait until you can step in to help". Very Frustrating, Indeed. My hope for our seniors is that this mentality changes so that unnecessary hardships and injuries need not occur before proactive measures can be taken to protect our loved ones from themselves.
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Welfare checks with Adult Protective services would be a possibility should your level of concern heighten further, e.g. refusing food deliveries or otherwise having indications she is unable to care for herself rather than just being delusional. Beign delusional but able to care for yourself and not being a danger does not get you qualified for guardianship. Maybe a different doctor - a real geriatic specialist if that's not what you have - plus the financial misjudgements if they are severe enough and not the kind of thing anybody could get scammed into...but it does not sound cut and dried enough yet. And you are in that sad boat many of us have been in of just waiting for something bad to happen. Wish it was easier.
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It's really sad that your MIL is so ill and her doctor is oblivious to it. Does he have any other dementia patients? It sounds like he's in denial.

I know that when I went with my cousin to see her doctor, she tried to put on a good front too, but after she answered the questions, I stepped out with the doctor and let her know that most of the answers she gave were incorrect. Of course, the doctor had already seen how severe she was anyway. Maybe, your MIL's doctor needs to know the whole story. You do risk ticking MIL off though if you challenge him and she could revoke the DPOA. That makes it really hard when she takes a downward turn.

Still, you are smart to be concerned that she could get angry and revoke the DPOA, so I don't think I would push the matter. If her doctor supports that she's competent, then what can you do. You can file with the courts, but the court will want to know what her doctor says and if he says she's okay, you are not likely to win. You might confirm this with an attorney to weigh your options. In some states if you win the guardianship, you can recover your legal fees from her estate if she can afford it.

Can you get on a waiting list now for a facility? Maybe by the time she has a serious incident and your husband begins as DPOA, the place will be available if you are on the wait list. Maybe someone here knows about wait list. I don't know much about them.

When someone is out of control and not dealing with life anymore, there's not much you can do about it, except stay out of their way, don't argue and wait until you can step in to help.
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Yes, jeannegibbs, thank you for raising that point. Our daughter has a healthy understanding of her Grandmother's current health status - we frequently discuss the differences in her Grandmother's demeanor then versus now and daughter prefers to enjoy the wonderful memories she has of visiting her as a child, before these behaviors became so intolerable. At 24, she has a layman's understanding of and appreciation for the negative and numerous effects of declining mental health. Yes, Dementia is certainly heartbreaking for all involved, whether they have direct or peripheral contact with the afflicted party. One more word about daughter: every time we see her, she not only asks about her Grandmother, but also shares another of her many past memories of times spent with her. I think she is in pretty good shape, all things considered... I do not think it is of any value to her, however to be on the receiving end of the current abuses that are occurring at ever increasing frequency, with ever increasing passion.
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About your daughter: I don't have a problem with her detaching from her grandmother at this point, but this is a good opportunity for learning something. Dementia's true victim is not just the person who has it but also those who love and interact with him or her.

Daughter should learn that the accusations were definitely Not Her Fault in any way. Not only did she not do what she was accused of, but she did nothing to bring on the accusations. And also, the accusations were Not Her Real Grandmother acting -- they were the result of a damaged brain. Dementia is heartbreaking. Dementia is becoming a larger and larger reality in our society. The sooner each person learns about it, the sooner we can end some of the heartbreaking consequences.
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The physician's assessment was validated by the visiting nurse, who both have only seen the tip of her vast iceberg of volatility. I sometimes feel like the doctors, nurses and case managers who have interacted with her on the superficial level of interaction also known as a "home visit" think that my husband and I are exaggerating her mental health status. I will say, on a "good day" she can fool even me, who has seen her in action. I can hang up the phone with her convinced that she has somehow defied all logic and overcome her dementia diagnosis. That said, I have never had to wait more than a day or two after having a lucid conversation with her before she starts back up with the accusations and verbal abuse to myself or my husband. It is obvious to me when she is and is not taking her medication. My husband has POA, however it is apparently revokable and only useful when my MIL is deemed incompetent. We have heard the process of obtaining guardianship is a difficult one and it might be tough to convince a judge of incompetence when she is still quite capable of playing the "sane card" when she feels compelled to do so... I have looked into facilities in our area, most of which require an individual admit as an independent before being eligible to become part of their assisted living environment. Others are disreputable, to say the least. Still others have a three to four year waiting list. We live in New York state, central/upstate New York, specifically. MIL lives in Pennsylvania, where I believe the quality of care is superior to that of New York... I strongly agree that she does not appear to be safe living alone, if only I could convince the geriatric healthcare professionals of this sentiment... very, very frustrating, indeed.
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A person with dementia past the very earliest stage is not safe to live alone. That is a simple fact.

Your MIL should have in-home care or be in a care facility. The care facility is probably a better idea, and it would provide interactions with other adults.

Living with you would be a crisis waiting to happen. Living in a care center close to you might be the best solution.

So ... how to get her into a care center?

It sounds like you've already started that process. You can keep trying to persuade her and influence her decisions. Or it may come to a point where someone has to take charge. Would your husband consider becoming her legal guardian? Then he could force the issue of where she lives.
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