My physically decrepit but mentally competent Mother says she's leaving assisted living and going home. Any advice?

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We put my 85 year old mother in assisted living this summer, along with my 60 year old handicapped brother. She has been his caregiver all his life, but after my dad died 13 years ago mother started going downhill. She's fallen numerous times, and whenever she has a medical emergency, my wife and I bail her out, which typically consists of weeks spent in hospitals/nursing home rehab while also trying to care for my brother. This summer she fell and spent two days in the floor. My wife and I went and got her and moved her and my brother into long term care near us. It was an answered prayer, as we found placement for both in the same facility, with mother in the assisted living wing and my brother in the nursing home. But she's become increasingly agitated the last few weeks and is angrily demanding that I take her home and my brother with her. I have refused but she says she will call a moving company herself. I have POA for her, but she has it for my brother. (I'm second in line with him). She has been calling me multiple times a day recently while I'm at work demanding that I take her home immediately. (home for her is 3 hours away for me.) The nursing home says they can't force her to stay against her will.

I finally stopped taking her calls and that just sent her into a rage so she started leaving messages threatening to call friends back home and tell them how I'm treating her and threatening to call the police if I don't bring her car to her. Tonight I spent almost four hours on the phone with her to no avail with her demanding I bring her car to her tomorrow so she can get friends "who'll do anything for her" to come get her.

When she fell the last time at home, both her bathroom and my brother's bathroom were covered in feces. I've had to literally put him in the shower to wash you-know-what off him because she can no longer care for herself, much less for him. She can barely walk, has fallen multiple times over the years, is increasingly incontinent, can't cook anymore, but she's created an alternate reality in which they can both go home and be fine. My brother is affectionate, but thinks at about a 5 year old level. She is very manipulative and has convinced him to go back home with her. Problem is, she's still mentally competent. A touch of senility for sure, but no Alzheimers or dementia. She's very aware of her surroundings and tells me she's going crazy being "locked up in jail", even though her assisted living facility is very good. She's always been a loving mother and grandmother, but has now turned mean and accusing. I'm furious that she would put not only her own health at risk, but the well being of my brother. Getting him placed once was hard enough. If he goes back home, next episode she has, which could be a stroke, broken hip, etc., and my wife will be back dutifully working the phones trying to pull their butts out of the fire once again and I'll have to be a one man U-haul miracle worker yet again. But mother doesn't even acknowledge that such a scenario is any big deal. Only thing that matters is "I'm going home." (home health doesn't work because she simply fires them after we set it up.)

We've exchanged words that I never wanted to say to my mother, and hoped I wouldn't have to. But I'm going crazy myself worrying about all this. She's not going to change her mind, and the normal Alzheimers "change the subject when she talks about home" hasn't worked because she still has her mind. She's methodically plotting to get them both back home and I'm desperate for a way to at least keep her from taking my brother with her. Any advice would be greatly appreciated.

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How about some therapeutic lies at least to postpone her for a bit? "Mom, we are doing a few repairs on the house... Can you please stay about another few months while we get things ready and set up." Or "there is a termite issue v we are trying to take care of"

It might work for a bit.
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You say your mother is mentally competent? Are you absolutely sure about that? I do wonder if perhaps, being so closely and continuously involved in her care, you're not seeing the wood for the trees.

Wanting to go home even though it is impractical is NOT what I mean - there's a world of difference between being pig-headed and losing your mind! But ringing you several times on the trot to rant about the same topic? Creating that 'alternate reality' you mention? An almost 180º turn in her personality from loving and devotedly caring to mean and failing utterly to meet your brother's needs?

If your mother were frail but competent and determined to go home, surely this isn't how she would go about getting her way. She may be able to speak fluently and coherently but still have suffered significant loss of reasoning. I suggest you speak to the facility managers and her doctor, stress the behavioural and personality changes, and ask for a formal assessment of her mental state.
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Does your bother have any sort of case manager through the county Department of Disabilities? If so, call him/her and advise them of the situation. If not - get him one.

I have a disabled son living with my husband and me - what you’ve described is my worst nightmare. I want to keep him with me and care for him as long as I possibly can. However - I also have Plan B for when the day comes that I might not be able to give him the care he deserves. It’s a heart wrenching situation for a mother to be in. But I always, always want what’s best for him.

I’m assuming your mother feels the same. That she can not recognize the fact she was and would continue to compromise his care at home tells me - no, your mothers mind is not all “there”. Have they tested her for a UTI? They make the elderly absolutely crazy-delusional- it’s something hard to believe if one hasn’t seen it for themselves.

Also - your four hours of banging your head against a brick wall conversation with your mother also tells me her mind isn’t all “there”.

The Golden Rule of Dementia: You can not reason with dementia. Period. So quit trying.

I had a similar conversation with my mother after she had been asked to leave AL because “her needs are too high” and placed in a nursing home.

Mom insisted I come get her and that she would managing perfectly fine in a small apartment on her own. The woman couldn’t change her own soiled Depends without covering herself and the entire bathroom in “you know what”. So I understand what your going through.

Does your mother have a doctor that she likes and trusts? If so, can you get him/her involved? My mothers medical needs were what I was able to use to get her to stay put “until you get better/stronger” - for a while. 

Then I got to work getting my mother into see a geriatric psychiatrist- who prescribed medication that made my mother 1000x easier to deal with. Mom was not a medicated zombie- just much easier to deal with. Sounds like this might be a long shot with your mother. But if you can make it happen - it could make all the difference.

But in the mean time - do get your mom tested for a UTI and get your brother a case manager. BTW - who is your brothers legal guardian?
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I agree with Jeanne. It is a sad situation. When my Mom was in nursing care it broke my heart cause she, for the most part, was still somewhat cognitively sound and was aware of where she was and who she was surrounded by. She really had no peers to speak of there. She would tell me "a little old lady came into my room today and I had to steer her out" I thought but didn't say "you are a little old lady too Mom"

It's tough when physically, they can't possibly take care of themselves properly and yet they still in their head feel like they can. My Mom had to learn the hard way. She too would send the Home Healthcare people out the door. When she kept falling and one day was too proud to phone me she called an ambulance who had to break the lock on her door to get in. She finally came to the realization herself that she just couldn't do it anymore.

You could maybe let your Mom see for herself that she would fail by letting her go home but that might end tragically. Probably it would. So, I don't think you have much of a choice. Follow Jeanne's advice.
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So sad. My heart goes out to you. I hope the resolution brings some serenity back into your life.

Let's address Brother first. He is a vulnerable adult. He is offered some protections by the state. Removing him from a place where he is getting appropriate care may be considered elder abuse. Discuss this with Adult Protection Services.

Now, Mother. Don't be so sure she is mentally competent. She has delusions of what life will be like if only she can go home . These are not ideas that a cognitively normal person would be having. For a loving mother to want her son (functionally at 5 yo) to move in with her when she can't cook, can't take care of his hygiene needs, is a high risk for falling, and refuses all in-home help is just not a sign of mental competency. As you say, she is living in an alternate reality. Ask at the facility how you can get a competency evaluation for her. Perhaps this is something APS could help with.

Unless/until she is deemed incompetent, she is right, she can leave anytime she wants. (I don't know if she could take your brother with her. You may be able to get a restraint against that ??) But she has no authority to insist that you help her move. She has friends that would do anything for her (really?) so perhaps she could call on them. She is probably entitled to have her car back, but not to force you to bring it to her. Are you healthcare proxy for her (medical POA) as well as financial POA? You can say that as her Medical POA you don't feel she is safe with a car and you will not deliver it to her. All of these tactics may at least buy you some time for APS to take a look, possibly to contest your mother's POA over your brother, perhaps get her declared incompetent, and maybe arrange some additional care for her if she does seem to have dementia.

Get APS involved first, and let us know how that goes. We learn from each other!
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