New diagnosis and resistance to doctor's advice. What do I say to my mom?

She's entered the phase where white lies will make life easier than the blunt truth. Tell her the house is being tented for termites and she needs to be out of it for a month. The water has to be turned off to fix the plumbing. Use COVID-19 as an excuse as often as needed.

Any of these excuses may calm her down a bit, because it isn't about YOU telling her she can't go home --it's CIRCUMSTANCES keeping her from going back. Sometimes it works better when there isn't someone to blame.

If your mother has not been found incompetent (in which case, you could sue in court for guardianship), you cannot force her to live somewhere she does not.

Have you asked her what it is about living with you that makes her want to go home (rather than asking, "why do you want to go home" ask "is there something that we could do to make it better here?").

I would encourage her to call her doctor if she insists that she wants to go home. The doctor can possibly be more authoritative than you can about "no, this is not possible".

In the end, you may need to let her go and fail. She WILL have an "emergency" and you will need to say "no mom, you said you wanted to be independent; if you have an emergency, call 911, not me". It sounds cruel, but sometimes the only way to get our elders into the care they need is for them to have a fall or serious illness that puts them in the hospital. At that point, you can ask for placement in a facility.

If she still has the reasoning skills to "get" that, explaining this scenario to her might get her to stop. But in dementia, reasoning is often the first thing out the window, so don't count on it.

I have some strong feelings about these kinds of situations, and believe that it can be advisable for someone and his/her family to make adaptations to stay at home as long as possible, if that's what the elder wants.  

Taking away freedom, independence and self reliance can be the first step on  a road to decline of coping abilityand self esteem.

Why is her home not suitable, and how can you adapt it?    That's what we did when my sister had terminal cancer, and during my father's long decline.   I'm thinking now how to adapt my house, and on a more challenging basis, how to continue gardening.  The first step is to switch to raised beds to cut back on the bending.

You can take precautions such as making the home safer (eliminating throw rugs, getting a lifeline alert service, external lock for quick access by police or paramedics, and many more such precautions.)

I don't criticize anyone who will post and disagree with me; fortunately we're entitled to our own opinions.  

If I did live with someone, I would continue to be as functional as long as I could, or if I lived alone, I would take the same approach, modifying and streamlining my life to accommodate the challenges of age (which is one reason I've decided to restudy math over the winter, to keep my mind from deteriorating.)

I would also say that 4 hours of cognitive testing to me is excessive; the only exams I know of that are that long are bar exams, and I know from legal friends and workmates that that's very challenging, even for young 20 somethings just finishing law school.

If someone wanted to test my cognitive abilities for 4 hours, I would be quite blunt in telling him or her what to do with those tests.   Or I'd establish break times and expect to be treated to coffee, cider, OJ, and/or something to refresh me.    A nice salad would be welcome too.   But just testing for 4 hours - not gonna happen to this old lady.

And that's definitely not a criticism of you; it's of the doctor who performed it.

Your mother sounds still strong enough mentally to understand reasoning? You mention her cognitive reasoning still somewhat strong.
So you and any other family must sit with her and tell her once that the doctors have decided now that she is no longer safe to move into her own home. That if she insists on such a move, or threats of leaving for her home you will need to seek guardianship and have her placed in memory care for her own safety.
Tell her that you love having her, and that you are so sorry she is now diagnosed with this illness. That you will not EVER abandon her, but must now protect her. And that you will do so. Say all of this as gently as you can. Hopefully she can understand it; hopefully she will adjust. But the future will be as it will be ongoing, with all the challenge and change. And you will have to act in her behalf now to the best of your ability.
I assume you are already POA. Hopefully you will not have to seek guardianship, but you do have the full evaluations to do so. Congratulations on what you have already accomplished for your Mom; what a splendid job!

Complete neuro-psych testing takes 3-4 hours. That applies to children, adults and elders. This is the sort of testing that pinpoints exactly where the person's deficits are.

My mother scored well on MMSE's until about 6 months before her death. She had vascular dementia and her memory was still very sharp. However, she could't reason or solve the simplest problems, which what was leading to her constant anxiety and panic, which in turn was driving her BP sky high at times.

Had we not had the testing, everyone in the family would still be telling me that mom was fine and just having a pity party.

I was in your shoes five years ago. My mother was diagnosed with Alzheimer’s. She had a wonderful Geriatrician who told me she was intelligent enough to have been hiding it for quite some time. Even at the end she could carry on conversations. The reality is you can’t reason with her, her cognitive abilities are impaired and it didn’t matter how many professionals my mother heard it from, she wasn’t going to be convinced she couldn’t manage on her own. Guardianship is the only way you can force her to leave her home. For me that wasn’t an option as that would have destroyed any trust my Mom had in me. So basically we settled for her being a “fall waiting to happen”. Which eventually it did and then she had no choice but to leave her home of 50+ years since her it was not equipped to handle her mobility limitations. I feel for you, it really stinks. My mother passed away this fall, two years after breaking her hip and her femur. She wasn’t always happy not ever going back home, but we made the best of it with weekly outings and lot’s of visits. She was safe, well cared for and it allowed me to focus on just spending time with her instead of taking care of her. Know there is no one “right” way to do this. Your situation is unique to your family. Rely on the professionals to help guide you, but once you decide a course of action don’t second guess yourself. That only adds more torture to an already difficult situation.

Is it possible to “elder-proof” her home and have a daily helper to check in and provide meds? We tried this with my step-mom, it wasn’t a permanent fix but it bought her some “independent” time.

We had her gas stove turned off so she could only use the microwave or electric tea kettle (with auto-shutoff). A caregiver came by for a couple of hours every day to make sure she took her meds, which were in a locked box otherwise, and tidy up a bit. Once a week they would do laundry and assist with a shower. We replaced her glass dishware with plastic, etc. We did try to get her to wear a Med-alert device but she would forget to put it on. I was about to consider an in-home camera (I live far away) when she declined to the point where she needed assisted living.

If the MRI results are part of the diagnosis of dementia, that means the MRI scans are showing evidence of cerebral microvascular disease, which leads to dementia. An MRI scan cannot diagnose Alzheimer's disease. So your mother probably has vascular dementia, which can have a much slower progression than Alzheimer's. It's possible some Alzheimer's processes will start in her body, and then it will be called "mixed dementia." She may hover at this level of abilities for much longer than someone with Alzheimer's. This gives you time to get much more involved in ALL aspects of her life, BEFORE a crisis. You may find it much easier to prepare than you think, because in spite of whatever she tells you, she is unable to quite keep track of what's happening and remember it from day to day. One way to prepare--find out every detail of her health coverage, medical care, medical history, specialists, life insurance, home insurance, car insurance, long-term care insurance, bank accounts, annuities, mutual funds, 401k, will, trust, etc, etc. Because eventually you and your siblings will be in charge of all of it. For example, I discovered that my mother's house was owned in a trust that she no longer had a copy of because she didn't like the trust after all, but she was afraid to call the attorney who drew up the trust because she wasn't sure if she paid and the attorney might get mad at her. So use this as a window of opportunity to gather info and be much more involved, whether she wants it or not. She obviously still enjoys spending time with you. If you confront her with too much raw reality, she'll be more likely to resist. Instead, you're going to humor her and focus on her strengths, while you know the reality. You'll be on her side when she talks about that crazy doctor. You'll tell her how relieved you are that she can still shop and cook.

I went through that with my Mom and Dad. Both insisted that they were perfectly fine despite obvious symptoms. Unfortunately the myth of spending your final days in your own home and passing there is indeed a romantic myth. Its true that some may be able to afford the 24 hour care that they need, but it's not always a good thing to turn over the compete care of an elder to a stranger, but most patients cannot afford this.

My Mom for instance, wanted to back to L.A., and had even arranged someone to pick her up at the airport. I had to go so far as to pull up the airline schedule and give her the alternative flights. Essentially I had to call her bluff. I did this many times, but she never followed through.

It may be that you have to let one of your siblings take her back, and let her deal with it herself. Do not offer to go and take care of her there. Let he handle things herself. Eventually something will happen that she will figure it out herself.

In the end she will come to realize that even though she is in her home, it's difficult to function. She'll come around... just give her time.

Her very caring sympathetic wonderful geriatric doctor has dumped you neck deep in the sh*t, hasn't he?

What a pity that he failed to explain to your mother what the implications of her test results were. What a pity that he did not also hand you the necessary documentation that would support your application for guardianship of your mother.

So. Where is her home, who is nearby, and what activities of daily living does she *now* (i.e. not in the future) need support with? Because you'd best get busy setting it up.

As things stand, absent any declaration of your mother's incompetence, guardianship or enforceable Power of Attorney, you have no legal right whatsoever to obstruct your mother's return home. I agree that you do not have to participate in it, but you cannot prevent it.

If you force your mother to remain living with you at the moment, you will destroy her trust in you and wreck your relationship. Looking at her capabilities at the moment, what are the risks of her living alone that most concern you?