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Doctor referred Mum for a re-evaluation to measure cognitive decline since 2/2017. Observation of her communication skills and cyclical agitation and confusion, give us reason to be concerned. Older siblings, out of the country, have POA.


Mum claims she knows her own body and says she is “better now”. She is refusing medical treatment and self-medicating. She does not remember her Major Cognitive Impairment diagnosis and Dad is in denial. We have shared the information with siblings with POAs. We have heard nothing back from them.


They have been living with my wife and I since June.


What to do next? Where can we get some advise?

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Chittman, I asked on your original post in September what led to your wife's parents moving in with you in June. What was the reason for deciding they needed to do that?

So your wife's brothers have power of attorney, and your wife has taken on the responsibility of her parents' care. You have updated the POAs on the medical front and been ignored. Your FIL, meanwhile, is being protective and your MIL is on the defensive, and both of them are pretending that all is well.

How much longer do you plan to tolerate this intolerable situation? Your wife and you have ALL of the responsibility, and NONE of the authority to act. It makes caring for your parents-in-law simply unfeasible. What are the alternatives?
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Chittman Oct 2019
They were on their own in another state in their own house. Mid 80’s and not able to physically or financially keep up with house maintenance. We opened our home, made space for them, planned to handle big tasks like cooking dinner and laundry. We didn’t agree to be caretakers. Now it looks like that’s what we’re in for immediately instead of 5+ years down the line.

We are both still actively engaged in our careers and work full time. There is not time or energy left in our days for taking care of each other and our marriage, much a less caregiving.

We revealed the elephant to dad today. It was a difficult conversation, but ended up with understanding. Hopefully, visit from medical POA brother next month, will pave the way to a solid plan for the future.

i know we should have made all of these plans before moving them in, but we had no idea this is what we were in for. It is what it is, so now we celebrate the good days!
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Once you have the diagnosis, what is the point of re-testing? Do you suspect other issues like TIAs are impacting her cognitive decline? You do not need a full re-evaluation to determine competence so you can redo a POA (since she is living with you) or to spring a POA. Is Dad really in denial or just defending his wife from someone wanting to push her into re-taking tests she found uncomfortable the first time around?

Sometimes people with cognitive problems have difficulties explaining why they want or do not want to do something. Sometimes the "reason" makes no sense because it's the result of a faulty cognitive processes. Sometimes the "reason" is completely reasonable. Often it's somewhere in the middle - something in their life experience is pushing them toward a decision that a person without that experience doesn't easily understand.

Many times the hardest part of being a care taker of someone with cognitive issues is accepting the person with cognitive issues has made a decision different from the care taker's choice. Please consider some medical test or procedure you found unpleasant to painful, then ask yourself "would I want to repeat that knowing it would make no difference to my quality of life"?

"Mum gave the report to read because I understand such things because of my profession. I understood it clearly, but mum and dad are oblivious of what it says and the implications. That makes it very difficult to have honest conversations with them." Please remember conversation is a two way street. I'm guessing (from personal experience) you might be "ready" to have this discussion at noon on Saturday cause it's your day off work and you're a planner who wants to get ready for the future. So you sit down with Mom and Dad and open the conversation with something like "...about that doctor's report..." Not wanting to talk about something right now (or when someone else has determined he/she is ready to talk about it) and not responding to their attempts to have an unwanted conversation is not the same thing as being oblivious; it's passive resistance. Since you are the son in law, you might want to let your wife have the opening conversations, maybe one on one with each parent and then together. If the POAs who are not responding are your wife's siblings, they may be more responsive to a sibling than an in-law too.

Please remember the people on this forum are responding to what you posted. We may be very far off track because all we know about is what's in this limited post. Sometimes our reply can be completely off base; sometimes only a portion of it is. I'm picking up on some frustration on your part. Perhaps you feel you and your wife should have been told about the cognitive impairment diagnosis before your in-laws moved in. Perhaps you want to plan for the future more than your in-laws or maybe even your wife as a way of reasserting control on your future? Or maybe you're more like me and just like to "plan" in general? Maybe you're posting here because you feel you're not getting enough response from the people around you or they don't seem to consider things as seriously as you do? We will read your posts; we will hear you. We will ask questions to seek better information for recommendations and at times we may challenge your thinking. Most of us already think a man that willing moves elderly in-laws into his home is a great guy.
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Chittman Oct 2019
I truly love the brutal honesty of some replies. Thank you for that. I understand, more than most people, issues with behavior disturbances in people with cognitive delays and impairments. It’s my specialty. At work! I wasn’t planning on it being my life at well.

I’m on this forum to have conversations to help me wrap my head around this. No one forced this on my wife and I, we offered willingly, out of love and compassion. We want to move forward and make plans with compassion.

I think it’s kind of funny and I’m not offended at all, but I am my wife’s parent’s daughter-in-law. Mum gave me her report because some days I’m the favored daughter. Some day I’m trying to interfere with her life.

Please feel free to keep challenging me, this is more helpful that telling me my, “situation is unbearable”. It’s difficult new territory for my wife and I, but we are not quitters. At least not yet!
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So, the neuropsych is going to tell you that the cognitive decline has advanced to dementia. You don't need testing to tell you that, do you?

Get mom to a geriatric psychiatrist. In my mom's journey from Mild Cognitive Decline and Vascular Dementia, the BEST "added value" we got along the way was from geriatric psychiatrists.

The agitation, the paranoia and anxiety can be smoothed out with meds. Hope you can find a good, compassionate doc as we did.
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If you're not their PoA you have no power. If you want to be their PoA your parents can sign a new form naming you as such (which makes more sense since they live with you and the others are out of the country).

The only other option I see is if your mom would allow your wife to drive her to her next medical appointment. She can discretely pass the doc a note to do a cognitive eval (and maybe also test for UTI for good measure). They get this all the time and would be happy to do it. If you live in the states, while at the doc's office your mom can sign the HIPAA release for your wife (or you) so that their staff can release and accept medical information to you. Then at least you'd know what is going on with her. Good luck!
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Chittman Oct 2019
Thank for the reply :) Mum and dad already included my wife and I on the HIPAA release, so we are covered there. She is becoming more paranoid and accusing me of interfering, because we are communication with her doctor (something she approved, but most likely doesn't remember).

I'm not sure what I am seeking by participating in the blog, maybe just support and a knowing that we are not alone in this. We were not aware of the dementia diagnosis until after we moved them in with us. Mum gave the report to read because I understand such things because of my profession. I understood it clearly, but mum and dad are oblivious of what it says and the implications. That makes it very difficult to have honest conversations with them.

The big reveal of the elephant in the room and the ensuing conversation to plan how we will deal with it, will be long and painful for my wife and I and her folks! Maybe I am seeking some cheerleaders and a lot of prayers to get through this intact :)
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In all truth, she might not, even if you got her there, be able to participate and to cooperate in evaluation. She would likely need some decent medication for MRI scans to see about frontal or temporal changes. And I would bet anything that what you are seeing is telling you enough. Are you the only sibling who is living near to them (actually WITH them at present)? Is Dad impaired with any dementia or mobility problems?
The awful truth is that this won't get better, but will get worse, and I think carrying for both of them may be more a burden than your family can safely take on without drastic repercussions. With this is can be helpful to have a diagnosis, but there is often nothing to DO but treat symptoms. That I know of there is no proven medication for any dementia, and it is surely what you are dealing with.
It is time to family conference with the family able to participate. Sadly that doesn't mean Dad because of the level of his anxiety. There may need to be in future placement of them, hopefully together and hopefully nearby. So sorry for all you are going though. There is honestly little TO do next, but go day by day and make the best decisions for YOURSELF first, and then for them, that you are able.
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Chittman Oct 2019
Thank you for such an honest and realistic answer. I hope my wife’s siblings will understand when we have to make the decision to move them. The eldest will be coming for a visit next month, and our plan is to make a plan when he is here. For now it will have to be one day at a time 😃
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It would be great to get her to the re-eval because a lot can happen in 2.5 years. And I think you need to find out if she is still deemed competent or not. You may have to tell a theraputic lie to get her there, but so be it. Small price to pay for getting the information needed.

How is she self-medicating? Does she have any conditions that require more than that?

How is your dad's condition? Can he help her or have enough problems of his own? How old are they?

Sounds like you and your wife have your hands full. Are you both retired? Either way, consider getting some help around the house to help your marriage and your sanity.
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I will pray that you can get your in laws the proper care, whatever that looks like.

I will also pray that they realize that they moved into someone else's house, meaning they are no longer head and mistress of the house.

This is something that is overlooked by all parties, until it hits everyone like a runaway freight train.

It's good that you have a plan.

Welcome to the forum.
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