LO with MCI who wont accept help

cboy802

I have a twin sister who is getting dementia.  Her main problem now is *no* short term memory.  Her husband died recently and she has no children so I am pretty much it to help her. 

She knows and acknowledges that she has no memory and refers to herself as "addled".  But she doesn't want help.  I am trying to get her to accept a book keeper and also to designate a POA.  I want to find a way to change her attitude so that she accepts that she needs help - without having to go through a crisis.  

Any suggestions for how to go about this?  

MN Chickadee

I would stop talking about her diagnosis and her needing help for it. Depending on how advanced it is, her brain may simply be unable to see its deficits and the need for help. Once our loved ones reach this point there is no point in reasoning with them, you have to just find workarounds and solutions. You will likely never get her permission or buy-in, and waiting for it will mean waiting for that crisis. For the legal paperwork, first find a certified elder attorney or a good attorney in your area who practice primarily elder law and speak to them first. I would frame it to your sister as something like "I've been thinking about my own affairs and decided I need to get my documents in order and the attorney said we can do it at the same time for a reduced rate. This way neither of us will have to worry if something happens, we will be able to help each other in the hospital and know our finances are protected." Or call it "financial planning" or "protecting her assets" or whatever might fly. Elder law attorneys are usually quite used to tricky situations and how to finesse them. They will play along and figure out how to get documents signed. Do it asap while she may still be considered legally competent to sign. Once legal things are in order you can take over her finances, or pay an accountant to do them or whatever you decide to do. Again, just telling her you are taking her bills and credit cards is a bad idea. You use the legal documents to work directly with the financial institutions. Once you have control of her account where income goes, you can pay all her bills from afar. Often just going online and changing billing address works great so they come to your home or doing whatever change of address the entities have. Or having all mail to her address forwarded to you. Freezing her credit is a good idea so her situation is air tight from scammers. Sometimes we leave the person some cash in their wallet to make them feel they have money but she should not have access to working credit cards or checks. These same approaches are often what works for other types of help. If you hired in home help, the aide is perhaps a cleaning lady - your birthday gift to her so she doesn't have to clean! Or a friend down on hard times who wants to help out, or someone from church doing community service or whatever.  Even if she grumbles, remember her illness is getting worse and you will need to do what it takes to keep her safe and cared for even if that makes her unhappy sometimes. Good luck and stay in touch!

jfkoc

Do you have a DPOA and other legal/medical matters is place?  If not try getting her to do them together with you.

M1

Cboy, read about anosognosia. Even if she's aware of some deficits she's probably not going to be aware of all of them. That's why what MN said is right, trying to reason with her is fruitless and will just frustrate you both.

Cynbar

As you get further into this dementia journey, you'll come to realize that the old rules have totally changed. Her brain isn't working right any more ---- you can't reason with her, you can't change her attitude, you can't make her realize she needs help. Hard as this is to accept, it is your new reality. Let go of expectations, of the way you have always related to her. You may think she's acknowledging her deficits, but she's not really getting it.  Now, for her own safety and benefit, you have to find workarounds to keep her and her money safe. One you get your mind around this basic premise, it does get easier. I spent a long time trying to reason with my DH, it only got us both frustrated and angry. Longtime posters here will agree, you have to lose the idea that she will sensibly participate in planning. It's not going to happen.

cboy802

Thank you MN Chickadee for your very direct and thoughtful reply.  It is a reality check for me.  I have wanted to be as collaborative as possible and to get my sister's participation and acceptance of decisions that affect her.  Your response makes me realize that's not possible, which does not make it any easier.  Its difficult because in many ways she seems quite normal.  She is able to function pretty well in her normal routine.  She does all the basic self-care just fine - bathing, dressing, eating, even grocery shopping if she writes down what she wants to get.  She drives herself to the local grocery store.  She can carry on a conversation one-on-one, though she usually repeats herself several times within a 5 minute conversation.  She is rational and shows shows good judgement. She does not have trouble coming up with words which is a symptom I am more familiar with.  She has been able to learn to write things on her calendar (usually with prompting) and is diligent about checking it for planned activities. 

On the other had she has gotten lost outside her regular haunts.  She can't organize things like bills and papers.  Complex tasks (multi-step) are beyond her.  The big issue is her memory.  She literally does not remember things after just a few minutes.  When her husband died I had to write out the events in a narrative so that she could read and re-read what transpired.  Even with that I don't know how much she comprehends.  She seems to remember that he died, but I don't know if there are times when she doesn't.  I suspect there are and she probably has things around the house to remind her.  

Anyway, I have gone on and on.  I accept from your advice that I will need to try to finagle ways to help her.  I appreciate that specific examples and ideas you gave me.  I will change my strategy and try to get some fundamental protections in place, by hook or by crook.   

Thank you

Iris L.

cboy802 wrote:

 I have wanted to be as collaborative as possible and to get my sister's participation and acceptance of decisions that affect her.  

Its difficult because in many ways she seems quite normal.  She is able to function pretty well in her normal routine.  

.  She is rational and shows shows good judgement. 

  She can't organize things like bills and papers.  Complex tasks (multi-step) are beyond her.  

The big issue is her memory.  She literally does not remember things after just a few minutes.  

----

Welcome cboy.  Your twin is not rational nor does she have good judgement.  This is something you will have to accept as part of dementia.  Good judgement is the first thing to go, even before memory loss is noticed.  People with hood judemdnt ask for help when they need it.  Loss of judgemdnt is not a character flaw but a sign of dementia.

As is loss of executive functions, which are inability to organize and complex tasks being beyond her.  This is a major characteristic of dementia.  This is when PWDs can get into a lot of trouble, and when ne'er-do-wells can take advantage of them, because they still look good.   The work-arounds the members describe will help you learn new ways of communicating with her.  

Normal routine is the key.  She will likely do okay within her bubble.  But she cannot handle anything new or unexpected or more than the very simple.

The memory meds might help her function a bit better and prolong this stage.  But they are not a cure.  You might want to discuss with the doctor.  

Keep reading and asking questions.  The members here know the most about what to do.

Iris L.

eaglemom

A slightly different tactic you might try is saying "we have an appointment with an attorney getting everything in order. I'm making you an appointment after ours. Won't it be great getting that out of the way?" Then change the subject. As others have said, she doesn't acknowledge she has an issue - therefore, in her eyes she's fine.

Please read different posts / forums. We are all here to help one another on this journey.

eagle