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I don’t want to challenge or upset her and I never know when she thinks/knows I am her son or just the guy taking care of her and who’s home she’s living in.
Thanks!

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Imho, you should still call her "Mom." If it seems to bother her, then you could change. Prayers sent.
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This is quite common. It happened with my mother, but I think sometimes she still recognizes me as someone she cares about. I visit her when I can (more difficult during the pandemic) to make sure she is being cared for, and also for myself. I still see flashes of her personality sometimes. I had to learn not to take it personally that she doesn't recognize me. Once she asked me to leave as soon as I went into her room. I went out of the room for about 15 minutes and when I returned, it was OK.
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iF INSISTING ON CALLING HER MOM UPSETS HER THEN FIND WHATEVER ALTERNATIVE SHE PREFERS. THE QUEST IS TO MAKE THEM FEEL AS CALM AND SETTLED AS POSSIBLE. THE INABILITY TO REMEMBER THE EXACT NATURE OF THE RELATIONSHIP IS NOT A CHOICE BUT PART OF THE CONDITION. MY HUSBAND DID NOT KNOW MUCH OF THE TIME I WAS HIS WIFE
I FOUND IT DISTRESSING AND INITIALLY TRIED TO MAKE SURE HE KNEW THAT I WAS . UNTIL I REALIZED THAT IT WAS BETTER TO HAVE HIM FEEL THAT THIS WOMAN TAKING CARE OF HIM MADE SURE HE WAS COMFORTABLE AND AT PEACE THAN CREATING TENSION BY TRYING TO MAKE SURE HE KNEW EXACTLY WHO I WAS. A CERTAIN PICTURE WE HAD TAKEN TOGETHER HELPED ALOT SO I HUNG IT BY THE BED WHICH WAS BETTER THAN TELLING HIM REPEATEDLY AND CREATING TENSION.
IT GOT WORSE WHEN HE DECIDED I WAS HIS SISTER AND CALLED ME BY HER NAME CONSTANTLY - ( SHE AND I DID NOT CARE MUCH FOR ONE ANOTHER) BUT EVEN THEN I LEARNED TO KEEP MY FEELINGS IN CHECK SINCE HE COULD NOT HELP NOT KNOWING WHO I WAS. AT LEAST I HOPE HE FELT I WAS A KIND PERSON WHO CONCERNED THEMSELVES WITH HIS COMFORT.
Of course I wish he could have realized that it was me taking care of him and that he was at home but no one asked me or gave either of us a choice when his disease progressed we just had to learn to live with it.
He did have a couple of lucid afternoons and the day he died he knew it was me for a couple hours and told me how much he loved me.
I cannot imagine not knowing where you are where your wife is and why is some stranger taking care of you. It is heartbreaking.
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Try both ways - calling her mom and calling her by her name. Whichever she responds more positively to is the one you should use.
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As some have mentioned, best to follow her lead. When my dad was still alive, it confused mom for me to call him dad. She thought I was referring to her dad. So I began calling him Bob, the name she knew him as, and that seemed comforting to her. It felt disrespectful at first, but I got used to it. Alzheimer's changes everything, except our love for our parents. She raised a good son and she is blessed to have you.
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As my2cents said, if you can call her that and it doesn't bother her, continue. If it does bother her, I like my2cents explanation - something along the lines of you remind me of my mother, you're like a mother to me, etc. If that works, go with it.

IF, on the other hand, it seems to bother her, then ask her what she would prefer to be called and go with that! You can always, in your mind or under your breath, still call her mom! You know the difference!

I'd also back up sjplegacy's concern about the wandering attempts. If not a keyed lock, then a sliding bolt lock, up too high for her to reach, could help keep the door locked. But, as he noted, sometimes they can really get their mind set on something and find another way out, like the windows (or breaking a slider.) During certain deeper sleep stages, you might not hear her get up and roam - perhaps having some kind of alarm or motion sensor at her BR door, that can trigger when she leaves her room might help?

Bless you for taking on this difficult role!
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Just try it both ways. If she gets concerned about someone calling her mom, just say I call you that because I've loved you like a mom for a long time. Save your strength on trying to explain to her if she doesn't happen to recognize you. It's frustrating to her (because she really can't remember) and frustrating to you because you can't explain or argue a broken brain back to what is real.
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Have you been calling her mom? If so, does that upset her? If she's OK with it there's no reason to stop. If it does upset her, just use your and her first name and not the relationship.

What concerns me more is that you stated in your profile that she leaves the house in the middle of the night. That is a significant problem. Purchase some kind of deterrent to getting out. You might try to place a large rug in front of the doors. Some dementia patients recognize this as a hole and won't step over it. You could replace the door locks with double keyed locks that require a key to open from the inside. As for me, nothing prevented my wife from leaving the house including going out the window! That's when I started looking for a care facility for her.
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I believe you should still call her mom, regardless of who she thinks you are at this point. I wouldn't argue the point with her though, and make her upset, but she is, and always will be your mom. Bless you for taking good care of her.
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Of course call her Mom. If she says "What do you mean Mom? I don't have a son" you can go from there. Gently explain that her memory is a little tricky now (but will get better.....or whatever platitudes and white lies might help. If she doesn't want to be called Mom ask her what she would like to be called. Near the end of her years, My Mom and I became close friends, as well as mother and daughter. We saw one another as human beings, not only as persons with a certain role. I called her "Francie" a nickname she had from my Dad that was affectionate, and would say I called her both by that name, and by "Mom". She loved it. It depends upon your MOM, then.Call her what makes her happiest.
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