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My mother, who has vascular dementia, is receiving home health care a couple hours a day. She has gotten increasingly worse over the last couple of years. She does not think she needs to bathe, her house is cluttered and dirty, she is confused about pill taking (even though pills are set up for her in a weekly container). She'll wear clothes that are soiled and with holes. She won't throw out old food in the refrigerator, or let the aides do it. She basically uses her aides as a taxi service since she lost her drivers license. She is receiving these services under her LTC policy which I had to fight hard to get for her (even filing a complaint with her state's insurance bureau when they initially rejected the claim.) I am thinking the time has come to get a guardianship and put her in assisted living. I assume as guardian I could enforce her getting showers? My sister wants to avoid conflict and wants to ride it out. Mother is happy. Still plays bridge with friends and is very sociable. I do believe she needs more supervision. Any suggestions? My sister and I both live out of state.

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It may be time to check the LTC policy and find out when and how the visits from the caregivers can be increased and more duties assigned.
If she can no longer manage to take her medications and the caregivers are not making sure that they are taken. If they are not helping her bathe. If they are not helping her clean and making sure she is in a safe environment I sort of wonder what their "job description" actually is.
If there is any way to get the caregivers more involved..say "We can not go play Bridge today until after we get cleaned up"...then a shower or bath and clean clothes.
Your Mom may be confused as to what the order is to getting cleaned up and dressed. So if some one can prompt her that might help.
It sounds like it might be time to get guardianship. (and I am not a fan of Guardianship by any means)
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The mixing up and missing meds is the deal breaker in my opinion. I'm glad her friends still include her even though she is dishevelled, there is no reason to think they would abandon her if she was in assisted living, in fact they all might breathe a sigh of relief that she is safe and looked after. I wouldn't go the guardian route unless it becomes a last resort, take time off to visit so you can try sitting down with her and laying it all on the line, your worry, her meds, anything else that might persuade her to be reasonable. Do your research and have a few AL options picked out. Book tours, stay for lunch. Many ALs offer short term or seasonal stays so she could try a "holiday" there, she may decide she loves it, especially if she is social. Good luck.
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OH, and no you cannot enforce showers. My sister lives in a group home, and sometimes they ask me to shower her, when she refuses for them. Some of the aides try to start with the shampoo. Shampoo is better done last.
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As a Guardian, yes you can place her in Assisted Living. Make that part of the petition to surrogate's court. You may have some difficulty finding an AL that will accept Medicaid. Most places want you to prove you can afford private pay for two years. We did that by renting out mom's house.
Showering-- your best bet is to get her a walk-in shower. The cheapest way to do that is to do a tub cut and add grab bars, a shower chair and a handheld shower. Get a trained bath aide or watch the youtube video by teepa snow on how to bathe someone with dementia. You start at the feet and slowly move up. You protect modesty at all times. Instead of shocking the back with water, you put a washcloth on the back and get it wet slowly. You only wash the areas she can't reach, like the back and feet.
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