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My cousin's mom is outright mean and has brought her to tears. Cousin was estranged from mother for many years. Now she's responsible for helping mother stay in local facility and the visits are fraught with anger and downright meaness.

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CarolLynn is right. Your cousin should make observational visits where her mom doesn't know she is there. That way she can be reassured that her mom is OK, but not have to be verbally abused by her. Interaction visits can be cut down significantly, leaving your cousin with a more peaceful situation. Incidentally, it may be that your cousin should not visit directly with her mom for several weeks. A friend of mine did this for 6 weeks - just did observational visits once or twice a week, no interaction, and it totally turned things around. Her mother was much less agitated and my friend was able to heal emotionally and get her own life back on track. Once she did that, it was much easier to visit her mother once a week or so and when the abusive behavior started, she would just leave immediately without saying anything knowing her mom was well cared for. Interestingly enough, after several times of her just leaving when the abuse began, her next visits lacked that component. So, even if someone does have dementia, it is still possible for them to learn from experience in some cases.

In addition, your cousin should have a non-specific answer to "Take me home!" or "When can you take me home?" or "Why did you put me here?" which is, "The doctor says you have to stay here until you are better." That completely takes your cousin out of the picture as the focus of her mother's anger and puts it on the doctor. Of course, it will be forgotten moments later, but then this excuse can be used over and over again until your cousin's mother stops asking.

A final thought on the situation, if I were your cousin, I would speak to the nurse and ask her how often my mother was agitated. If she is sundowning and nasty to other people, not just your cousin, then medication, such as Risperdone, could really help to calm her down. I had to do this with my own mother who was extremely agitated starting in October of this year. The reason for the agitation is the progressive brain damage and mom was suffering. Unfortunately, she was so angry, she was also making everyone around her suffer as well. So I asked her doctor to put her on medication for this. He started at the lowest dosage of Risperdone and we saw some minor improvement. It takes several weeks for psychotropic drugs to build up in the patients system. So for the first 4 weeks, we only had minor improvement. At that point, we went back to the doctor and told him we were not seeing enough improvement and he increased the dosage and the very first day we put mom on the increased dosage, we saw a drastic and wonderful improvement in her behavior. This improvement seems to have lasted, at least until now. Of course, over time, the dosage may need to be adjusted again. But if your cousin can make sure that her mother's agitation is being medically dealt with, it may make things better for both her and her mother.
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Sorry, I just noticed she has dementia. Could be the root of her problem and not much she can do about it except learn skills as to how to deal with her mother's changing personality. However, you did say they were estranged for some time. So I suspect there is a long standing problem.
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Your poor cousin. I know what this is like and I can tell you people don't change with age instead they get more like themselves. Your cousin is probably used to being hurt and humiliated. That is what she has been taught.

If I were her I would do as StandingAlone suggests. Then take a good look at herself and see what she can do to repair the damage her mother has done. No adult should be made to cry by a mean, selfish old parent, ever. If the problem is mental illness, learn to deal with that. If it is dementia or another age related problem, learn to deal with that as well. But if it is just meaness, well, she needs to keep her distance and learn to heal from that. Good luck to her.
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Does her mother still recognize her? When I was caring for my in a nursing home and later in hospice, I wanted to be more "present" and observational of her interaction. but when she knew I was there, she would become an agitated then hostile that I wasn't "getting her out of there!" which of course with out of the question.

I'm just wondering how far along your aunt is in her dementia. I came to realize that my aunt did not recognize me unless I announced myself to her, something I just always did in the beginning out of normalcy. But when I walked in and acted like I belonged to somebody else, she quickly ignored me and I was able to watch her either eating or communicating with others, etc, and better evaluate her status. Usually around 5 or 10 minutes before I was ready to leave, I would announce to her, go up and say hi, then visit as long as I could before the agitation begin to set in, at which point I would come I say that it was time for me to go.

Before realizing that I could "get away with this", when I left quickly just because she was agitated, I felt as if I have been chased out without doing my job of properly care taking her. This way worked out really well because I never felt that I was leaving without having gang the knowledge that I came for which was how she was doing.
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Tell her not to visit often and do what she's got to do mostly from a distance. Problem solved.
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