Found AL mom says she doesn't want to live now

julysun

It's been awhile helping my mom and I finally found an AL place for her. I thought she wanted to move to this place, I told her about it, she was going on and on about when could she move. Today she was all upset and crying on the phone and almost hysterical and then said she didn't want to live anymore and wanted her life to end soon. I tried to console her.

After we got off the phone I called her nurse so that someone could go talk to my mom and also so her doctor would be notified. I then left a message with the agency that had been helping me find a place, and also the place I found as they would want to know about this. Then I called my mom back, she was angry, said she was joking, said it was just a fast passing thought. Well, I told her I had to report what she said she was thinking about.  I mean, just the basic, let them know so she could be talked to, maybe to inform her doctor so they would know, as they should.

No idea if the new place will let her move now, I am not comfortable with her mentioning this and me not informing those who could help in this, and it isn't exactly right to have her move if she is that upset, and also the place she is moving to or was, they have a right to know the situation.

So, this is going badly. She can't just stay in skilled nursing forever she is there since she fell. Frankly I would report this again if it happens again, I am not going to hear that comment and not say anything.

But I am angry if she did this for attention, there is so much that has been done to set this up, meds moved, addresses changes, a LOT of things set up. I don't know how this can be done if she is going to go into a hysterical fit when she realizes the move she agreed to is proceeding.

I do hope she is spoken to to see how she is feeling, and if she is contemplating this, I hope they check her out, this looming comment of wanting her life to end, how can she just pack up and move after saying all that in a hysterical fit?

Has anyone else had this happen? I feel like backing off, far from this, it is out of my realm of how to deal with it, I am not wanting to make this worse.

And this must be the explanation for her walking in the road with her walker when I took her to lunch  this week, I mean very close to the cars, when I asked her to walk to the sidewalk she was furious with me.

harshedbuzz

julysun-

A SNF is probably not the best option for your mom longterm at this point, but it is likely a hospitality model AL is no longer an appropriate fit either. Given her dementia and reactions, a secure (locked) facility with higher staffing levels and more interaction is probably where you should be looking now. AL is best for people who need minimal help but are mostly self-directed.

For most PWD, is is best not to try to reason with them or to discuss changes you will be making in their lives. It seldom goes well to consult about or seek approval on things like a move. Assuming you have the legal power to act on her behalf, you just make it so. For most PWD, a move to MC needs to explained using some sort of fiblet that presents the move as a temporary stay in rehab or a senior apartment/hotel at the last minute. 

A number of people have had their LO discuss ending their lives. I suspect for some there is enough cognitive reserve for this to be an actionable desire but in every case, it is something to be acted on as a caregiver. In your shoes, I might get her in to see a geriatric psychiatrist asap. If she is truly stuck on ending her life, a trip to the ER in your area which is affiliated with a geriatric psych unit could be an option. Medication could help her feel better.

You being angry brings nothing to the party. If she has dementia, she has a broken and diseased brain that can't boot up to reason or even recall much of her stored memories. Even if she had always been the Drama llama mama, this is less under her control now and likely mostly a function of the disease.

This might be useful around understanding how dementia impacts thinking and emotions.

12 pt Understanding the Dementia Experience (dementiacarestrategies.com)

Good luck. This is tough stuff.

HB

Cynbar

I think you did exactly the right thing in contacting the facility staff. They can talk to her and assess what is really going on. The first goal is to determine if she actually has any thoughts of harming herself. It is common for people, both with dementia and without, to be upset and sad and angry and grieving when faced with big changes and declining health. The filter is gone with most dementia patients so they are quick to verbalize their feelings. But it's another thing entirely if they want to end their life vs. saying they have nothing to live for, wish it was over. Your post suggests she is in the second category, which is good. If that's it, her MD will likely add an antidepressant or otherwise adjust her meds. It's also helpful for those close to her to be supportive and consoling but not too upset ---- I don't think it was attention-seeking, it was probably just her expressing what was on her mind at that moment. But it can become attention seeking if it generates too big a reaction. Luckily, she is in a place now where the staff should be trained to evaluate whether she is danger to herself, or sad and grieving.

Quilting brings calm

My Mom says this….but she’s not going to act on it.  There are no knives in her AL apartment, no stove.  Her medications are locked out because the AL manages them.  She doesn’t drive. So she is protected from herself. 

She has enough awareness to be in our reality.  She’s just miserable and feels like she is losing her mind. Which, lets be honest, she is bit by bit.

I’ve heard many elderly people who are dealing with chronic physical limitations say this too.  

I just try not to overreact to it.  

jfkoc

Being old...not well...having to move to AL...

All difficult and any one of those things could lead to thoughts of not wanting to live. I think it perfectly normal.

Perhaps the best way to console is to listen and to hear the emotion behind what she is sharing.

Not always easy to do. We would rather not "hear" the dark thoughts. We would rather change the subject but please do validate her feelings.

Emily 123

This seems like a sudden change.  Have they checked her for a UTI?  There could be a physical cause underlying the reaction to the upcoming change. 

BassetHoundAnn

One thing I was surprised to discover about my mom early on in the disease was that she had lost all comprehension of how her words and behavior affects others, especially those who love her. She has no understanding of all that my husband and I had to go through to move her out of her house, move her to our city, struggle to take care of her ourselves for months and find a suitable placement for her. Nor does she comprehend all the things we do for her every day. Her sense of empathy and social awareness is gone, utterly gone. She's like an infant suddenly landed on earth. 

She also keeps cycling through the "I'm going to kill myself" routine. It's pretty upsetting. I've talked--no begged, pleaded with her doctors and their nurses. They just won't take these threats seriously. I finally got a prescription for anti-depressants for her but it doesn't seem to have helped. I don't think she's going to act on the threats, but it's still incredibly upsetting to hear over and over because it's a reminder of how much pain she's in.

And that's what you have to remind yourself of when her behavior is upsetting, she's in pain and has no comprehension of how her words and actions are affecting others. 

King Boo

If you really felt Mom was in danger of harming herself, you need to take her to a mental health crisis center.  However, as she is in snf right now - good job alerting her current snf care staff.  

Telling the AL where you hope she will live is not going to do anything.  Until she is there, she is your responsibility.   An AL might decide against admitting a resident if there are complicating factors (not a bad thing, because it means they don't meet your needs).  But most PWD have a very, very brief stay in AL; this type of reaction, unless it is passing - is a flag for higher acuity needs of MC.

So, for example, what our first choice of AL for our LO, when I mentioned he had been dumpster diving - they had no interest in admitting us.  We moved on to a better fit, but at the time, I did not understand that a facility interviews the resident for 'their fit' as much as we are interviewing them.

Evaluate and proceed accordingly.

King Boo

So.... a few things.

You really need to take the reins if you have concerns about this.  Telling everyone does not relieve you of the responsibility as decision maker to act.  Telling the agency and the AL where she is applying is not productive unless it is a confirmed problem.  You may have created an unecessary barrier to admiting her.

Now, of course, this could be a good thing.  They may not have the ability to take care of this.

Most persons with dementia have a very, very short stay at the AL level.  MC is more suited to dementia.

WWID?

Ask for her to be seen by a Geriatric Psychiatrist MD to assess her to get a feel for whether it was truly a suicide threat.

You are correct, don't blow it off.  But it is also a very common phrase and could also be attributed to the dementia.

Only THEN; would I make any consideration of sharing the information with the AL, and then, it would be with an eye as to 1.  what type of monitering/room checks do they do and 2.  Are Geriatric Psychiatry services available on the grounds.

The agency that found the facility is going to be interested mostly with earning their commission, so I wouldn't rely on them for any casemanagement.

Informing everyone isn't going to get the evaluation your Mom needs.  You need to advocate.

Good luck.