My 84YO mother has shown signs of dementia for several months, but has remained functional in her home. I live 75 miles away, but we talk twice a week and on Sundays we order groceries over the phone and they are delivered. I noticed at Christmas time things were worse (garbage not taken out, she hadn't bathed, anger then tears). We talked, it was agreed that she would have a "housekeeper"come twice a week after the new year(I had a dementia care-giver waiting in the wings, although she didn't know that). Well, now, mid-January, my mother has "gone around the bend" quickly -- she has locked herself in her home, shut all the blinds in the house. She's paranoid, says I'm a "drug-dealer" that she won't allow in her home, and she doesn't want assistance. The police have done two well-checks and have told me she seemed fine -- house tidy and she spoke very lucidly. I want my mother to stay in her home, and was told by the dementia care givers (who are continuing to try to get back into the home) that I may want to wait to contact adult protective services because once they are involved, their plan for my mother becomes mandated. What has been anyone's experience with adult protective services, good or bad?
The police did go to the right address, did they?
I know 75 miles can be quite a journey, especially in January, and especially in some states; but if it were me I'd want to go round there and do my own assessment. Can you really not?
Social workers come in all stripes. In my personal experience most are knowledgeable, professional and sensible; but for one thing I'm not in the States, and for another how flexible and imaginative they can be does seem often to depend on what resources they have to meet what demand. You may be able to find the equivalent of consumer reviews for APS in your mother's area, with a bit of digging around online. Eliminate the more technicolor horror stories, but see what you can find out about their approach to collaborating with service users and their families.
Are you the Medical POA and POA? If not, I would work on that, too, if possible.
One step at a time. All the best to you and mom!
I agree with those above on getting her checked for a UTI. Depending on her primary that may be a great way to help your situation too. I would be hesitant to bring in protective services myself unless it becomes obvious she is in danger and wont cooperate at all but we have had real success using Mom's primary as the source insisting on certain things (and often she is) or reminding Mom that the doctor may step in if she isn't cooperative with us and take this test or do this therapy, whatever the issue might be. There was a time last spring that my mom was digging her heels in and being very uncooperative about the structure and milestones that needed to be met for her to live in her house alone again, things that she had been on board with,agreed to anyway and that had been talked about and part of the plan for quite some time so not new. But she suddenly didn't agree and wasn't cooperating as she could taste the freedom, they were safety issues though and she was the only one comfortable with leaving he r alone without them in place, it got ugly. So I took her into her PCP who knows her well and mom respects, actually is a little afraid of because I have indicated she has the power to force something Mom might not want, her and let the Dr make her own assessment. Mom always shapes up for doctors, although she is comfortable enough with her PC to speak up when she doesn't like something but she is also very honest even when she's minimizing something and the doc was as concerned as I was about things particularly medications which is what mom and I were fighting over heatedly, that and having her come face to face with a real person daily and handled it all perfectly coming up with the perfect plan. She arranged (insisted) for VNA to come out asses things and make sure all the "tricks" for making things easier at home were being employed. They came out and set her up with a nurse that came 2x a week overseeing her meds and making sure she was up to doing it herself, a PT assessment and a speech therapist who came to the house 2x a week as well so a professional was seeing her at least 4 days a week (the other 3 is another story). Even though we were less than happy with that first outfit that provided VNA, Medicare covered it and I was able to go home knowing the responsibility was in professional hands and they were seeing her regularly.
Maybe if your mom can't be convinced to go into her primary for a UTI check at least her primary could be convinced to either send VNA out there to asses things and get a urine sample or just a testing service could at least get a urine sample and then go from there? If you could work out a visit to your mom's maybe you could set up an appointment with the primary for the two of you and get your mom to go along by agreeing to accepting whatever the doctor says about her needs for assistance at home. That way it takes the "bad guy" off of you and often elders will accept direction from a doctor even if they don't like it, better than from their children and I can understand that. But this way you aren't the "pill pusher" or whatever that was she called you and you can even say you want to put that responsibility in a professionals hands because the two of you have such different ideas about what's safe and best for her and you can accept that you may be looking at it wrong but it's out of love and concern...go heavy on the anxiety it causes you to be so far away and worried about her health and safety, maybe she will go along certain she is right but not wanting you to suffer so much, basically "proving" to you your concerns are unfounded (hehehe). That said if her PC doesn't know her well or isn't specialized in the elderly and you don't feel you have a good relationship with them, trust them and their judgment this might not be the best plan. Just like with the police officers the wrong doctor can be snowed, even though the people that know them see a person with dementia is behaving strangely it often doesn't look strange to someone coming in contact with them for the first time and briefly. What is off for your mom may be normal for another elderly person and look perfectly normal to say a police officer doing a welfare check. This is why hospital staff that care will encourage family to be around as much as possible when an older loved one is in the hospital, because someone them will notice much faster if their mental status changes. It's especially hard when the patient has dementia of any kind. I'm off track, my point is a doctor that doesn't know your mom or isn't versed enough with geriatrics to know how to take ques from family with them can just as easily be fooled by her demeanor as the police officers were. Well maybe not that easily, the standard is pretty low for intervention during a welfare check but still between the ease with which they seem to pull it together and the wide range of "normal" when it comes to elderly patients basing suspicion simply on behavior is subjective and not easy. Now getting someone to refer her and get her to take a NuroPsyc test would be ideal, the earlier the better to get a baseline for everyone but again that's another conversation.
Total agreement on the importance of making sure your paperwork (POA, MPOA etc) is in order too.
Good luck to you.
Your idea of a housekeeper/ dementia caregiver is good. Please try to make that happen before involving APS. I'd say only get them involved if her life is literally in danger, but that's just me. I think even CNA's are mandated reporters.
I was once told by someone from APS (in Pennsylvania) that they usually find the situation is either much better than expected or much worse, but seldom just what they expected.
Perhaps as an end result of this emergency, somebody reported her isolated living situation to APS. APS either called or visited her, explaining that they were there because a mandated reporter had contacted them.
Most regrettably, instead of finding APS's concern reassuring and helpful, the elderly lady freaked out about it and again turned to you to find out what right APS had to "interfere" in her life and where did it say she could be "forced" to accept this.
You contacted APS, quite correctly, to report her anxious (over)reaction. APS responded that if they are satisfied that she is competent to make decisions AND she refuses help, they will close the case.
This does mean that if in their judgement she is NOT competent, they won't close the case. If she is competent, they will offer help but she will be free to reject it, and then they will close the case.
What more do you expect of them?