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My MIL is living with her daughter and her daughter’s disabled husband. Over the past month, MIL has shown signs of dementia although her primary care doctor refuses to diagnose her with anything other than cognitive impairment. We found an assisted living facility with memory care and they are holding a room for her. Even though she has exhibited violent behavior at her daughter’s house recently, resulting in broken windows, sitters being bitten, hit over the head with lamps, escaping in the middle of the night, etc. When the police and or EMS are called, she passes any questions they ask her with flying colors. She acts like a sweet old lady to police, doctors and paramedics but turns into a woman possessed with her caregivers and family members. Her attacks have been both physical and verbal. She is refusing to be moved to any care facility, refuses to take her medicine, refuses to bathe, etc. We’ve contacted her doctor, the police, the coroner’s office for an “Order of Protective Custody”; she’s been to the ER 3 times over the past 3 weeks in the hope that they will hold her for observation with a PEC. In every single case, she turns on the sweet old lady charm and they release her. We’ve even recorded her evil tirades so that people will believe us but no one wants to listen. We are at our wits end and are concerned for her safety as well as ours. My bed ridden disabled BIL is fearing for his life. Her son (my husband) has POA but we’re finding out that means nothing if she’s of sound mind and can make her own decisions. I’m totally convinced that this isn’t dementia but an evil woman who has figured out how to get her way, at the cost of her children’s mental health and well-being. Any advice would be greatly appreciated.

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Cognitive impairment IS dementia! MIL needs to be deemed incompetent, and then she can be placed against her will. She needs a geriatric psych evaluation and meds to calm down her violent behavior BEFORE she is placed, however, b/c no facility is going to accept a violent resident who bites and breaks lamps over people's heads. The safety of all the residents will not be compromised in an effort to keep one resident living there!

I'd find a geriatric psychiatrist for her immediately; tell her a story about how Medicare requires a physical/mental assessment every year now in order to keep her benefits, and go from there. There is more going on that MCI, and she's obviously not 'of sound mind'. A geriatric psychiatrist can also diagnose her with mental illness if dementia is not warranted, which I believe it IS. MCI almost always leads to dementia, and she needs a MoCA or SLUMS test to see where she scores on a scale from 1-30. Simply asking her who the POTUS is isn't enough. Her current doctor is not taking things seriously enough, imo, and a new set of doctors/psychiatrists/neurologists is in order here.

Wishing you the best of luck with a terrible situation.
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Her doctor has diagnosed her with cognitive impairment. He needs to order a neuro-psyc exam. The sweet old lady act will be trumped by "spell world backwards" and "draw a clot set at 11:10. Your husband will have the power then to place Mom where she can be cared for. It is quite a shame that the daughter took Mom in; that's complicating things. But the diagnosis is close to done. Other than that, and if that doesn't work, I am afraid the daughter is going to need simple eviction order. Mom is either suffering from dementia or she is NOT. If she is assessed as NOT demented she can be evicted and can arrange her own affairs as she likes. If she IS she should be placed for her own safety and the safety of others.
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Cognitive decline but still able to 'showtime' for professionals well. But often people cannot sustain over 24hrs.

I would call 911 for any & every act of violence. Insist on transportation to hospital for behaviour ax & neuro/psych exam.

Then the main caregiver speaks to the hospital social worker & to advise situation (again). Use clear direct phrases eg I cannot take her back my home. I cannot care for her. It is unsafe - for her, me & others.
Please arrange immediate emergency guardianship.
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Tweety22 May 2022
Thank y’all for the answers and guidance. The police had to be called out again last night. Once again, there was nothing they could do to remove her from her daughter’s house. We’re hoping to work with the geriatric psychiatric group and her primary care doctor on Tuesday. The suggestions were very helpful.
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An AL will not keep her if she is violent. She is a danger to other residents. PCPs are great. They know a little of everything but a lot about nothing.

Your MIL needs to be out on a Psychic hold for at least 72 hrs. Baker act her. With you going there and showing how she acts towards her family. And her daughter needs to tell the police that her mother is a danger to her husband who is disabled. That she will not be taking her mother back into her home. And you will not be taking her into your home. Stand your ground. There is something wrong with this person.
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Tweety, an alternative might be that the family advocate for bil, who himself is a vulnerable senior.
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It seems to me that when the police are called, the injured parties need to press charges of assault.

Does your state have involuntary psychiatric holds? She needs an in-patent workup to trial meds.
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Tweety22 May 2022
We tried the psychiatric holds on more than one occasion but she has answered the questions correctly and is released every time. They ask her if she is thinking of hurting herself, if she is thinking of hurting someone else, or if she has suicidal thoughts. She answers all questions with “of course not!”. Then they release her. So very frustrating! We’re hoping that a more comprehensive psych evaluation can be done on Tuesday. (Really bad timing with the long holiday weekend!)
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Tweety, From your responses this is seeming more a psychiatric than a dementia thing, but a good assessment would give the answer to that. Again, it's a real shame anyone took her into their home, and an excellent message to others considering such a thing--but that helps YOU not at all.
Again, she needs to be evicted and a good eviction lawyer may arrange that. Regardless of age, if this is NOT dementia, and IS psychiatric illness, there will be little to nothing to be done about it. I really suggest Liz Scheier's book Never Simple, a memoir of her years attempting with all the resources of New York, city and state, to make a difference for her mother. Nothing did, and the outcome, death, was the inevitable and only outcome. Advanced in age as your Mother is, this will be sooner rather than later in her case. She clearly is out of control, with with the calls made, the ways addressed, she seems only to THRIVE on the attention.
The answer now --the only answer I can see--is to get her out of the children's home's and to never allow her into them again. That needs to be made clear to her. Careful diaries, documentation may be needed in a court case. See to it that it is gathered.
Thanks for all your responses to us, as they help clarify your situation, and so sorry there is so little to help a family in these situations. We see it often in young mentally ill, less often in a strong 99 year old.
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I would think that video recording her when she's on a rampage might not go amiss.

Also, when you take her to the ER--go out in the hall and snag whatever Dr is assigned to her. Talk to them plainly and with no ulterior motive other than getting mom placed.

I know a couple times I had to take DH to the ER b/c he will get sick and then he has this scary panic attacks (MEN DO NOT GET PANIC ATTACKS!) (Oh, yes, they do).

The dr would come in and do a once over, and DH would insist he was 'dying'; when what he was having was a panic attack. I would go out of the room, corral the dr and tell him/her what was really going on. Not one doc in all these years has been ungrateful for the information. A dose of Valium and DH is his normal chatty self, wondering why he decided to go to the ER. Literally, this has happened 5+ times.

No Dr has told me to 'mind my own business' or to 'step down'. They have always been kind and grateful for the information.

99? OMgosh--and she'll be one that lives to 105! I am so amazed by the lifespans that some of these folks have. I can imagine she's not real thrilled to wake up every morning and find out she's still here.

I'm no psych doc but it sounds like she's a good actor...and you need to get an ER doc to see past the 'sweet little old lady' routine.
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If I were her daughter, I would take her to the ER and tell them she is not acting right. Let them do a psych eval or whatever they deem necessary. If they try to release her back to the daughter, she will need to refuse, stating that mom is a danger to her disabled husband because she has violent outburst. The hospital will have to place her. The key here will be not stepping in when it gets to this point. Placing her will be a win for all.

If she truly is of sound mind and is just choosing to be hateful because she can....let her paint herself into a corner.

If she truly has some dementia related violence going on, they can medicate her appropriately.

Bottom line is that everyone will be safe and MIL can get the care she needs and that care included medication!
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She needs more sophisticated assessment than you’ve been using in the past.

Ask the AL/MC who they use as a geriatric psychological/psychiatric diagnostician, and invite that person to her present home to “visit”. Brief that person before the visit about her behaviors and actions toward others.

A skilled specialist will ask the right questions and hopefully get useful information. Ask about the possibility of some mild medication to help her manage herself more appropriately. She will not have to be drugged unconscious to become more manageable.

Your goal will be to get a written document stating that she needs supervision.

If she DOES, you will arrange for her to “visit” the residential care center.

If she is deemed able to manage and modify her own care you will draw up a “behavioral guide”, and she will follow it or you will inform her that she will be moved involuntarily to her new care setting because she has not accepted her current living arrangements.

This forces her to be responsible for her own welfare. List everything in her behavioral guide as specifically as possible.

”You will not bite anything but food”- VERY SPECIFIC!

Also, “babyproof” her surroundings- nothing that she can lift (and throw) in her quarters.

You and her daughter have treated her kindly and respectfully. You DO NOT have to accept the role of whipping boys.
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