APS? How do we get mom to memory care?

TaraAggie97

I spent July 4th in the hospital with my mom and dad.  My mom left AMA before having an MRI (CT was clear for stroke, etc).  We don’t know exactly what is wrong with her, but I am willing to bet that she has Alzheimer’s.  

 My mom continues to deny that there is a problem.  We managed to have a home-health evaluation (disguised as a long-term care eval) and she barely let the doctor take her blood pressure. She was argumentative and insulting to him…he wasn’t phased.  The doc prescribed Seroquel and she took one dose (won’t take more).  She also won’t wear the patch (med for dementia patients…not sure what it’s called).  She is adamant that there is not a problem and is completely resistant to anyone coming into the house to help her.  She is completely OCD about her calendar, staying up much of the night to pace, repeat to herself, and even yell to herself about how her calendar is wrong, etc.  My dad has installed cameras throughout the home and that is how we know what times she is up and what she is doing.  

To top it off: she is still driving.  My dad is not in denial.  He knows that she is a risk and wants to take charge of driving.  She is a complete b*tch (not a huge difference from her life before dementia) and becomes very agitated and yells/screams about the car.  “I can drive!!!  Leave me alone!!!”.  The only positive is that she does not drive further than a mile from home.  I have ridden with her and must admit that it is time to hang up her keys.

My question is: what are our options for getting her out of the house and into care?  I am invisioning a police car with mental health team escorting her after she attempts to harm my dad. As I have said before, so won’t tolerate anyone coming in for care (she tolerates me, but no one new), won’t go to the doctor, won’t talk to anyone for a TeleHealth visit (we have tried), won’t take meds, won’t admit that there is a problem.  

Should I call APS on her?  She refuses to stop driving, barely showers…does prepare her own meals (the same thing pretty much daily) and sleeps for 2-3 hours at a time.  Not sure it’s an APS-warranted situation. 

Thanks for any advice.

loveskitties

Hi, sounds like you and your father are really having a time of it with your mother.

Are the legal aspects in order?  DPOA, Health POA, Health directive?  

Is your father on board that something needs to be done?  If not your hands may be tied if you are not named in the legal documents.

Check with your state division of motor vehicles.  There should be a way to report her as a hazard to drive.  The source of this report is confidential, so no blow back there.  Do you think she will stop driving if she has no permit?

You can certainly call APS and discuss the issue.  If they can't open a case, they can direct you on other options available to you.

If you believe she is a danger to herself or others, then call 911 and have them transport to psych ward at hospital.  She can be put on a hold there for a period of time for observation.  Perhaps then she can be recommended for direct placement into a lockdown MC facility.

It sounds as if her pre-conditions have been magnified.  Keep a record of events and be prepared to share with any and all authorities (medical and civil) who need to help you help her.

Best of luck with a tough situation

Tauruslady511

It sounds like you and your dad may need to have some convos and get on the same page about what’s needed, if you’re not already. And even then, there still needs to be a formal POA named and get your dad’s will/POA now, as well.  

I had my mom’s license revoked. I sent in a letter, to DMV. It was routed to the correct department and I was contacted via phone. The stupid thing they did was to send a self-assessment TO MY MOM, and there was a part for the doctor to fill out. Then, someone physically came to the house. Thank goodness I was there and intercepted him. We chatted, he verified some info, and asked to speak with her, if I thought she’d be amenable. *blank stare* I told him she’d be super agitated, which she would have been (she was a pistol, before Alzheimer’s).  He said he was fine with my letter, what all I described and the doctor’s diagnosis.  They ended up revoking her license.  Thank goodness she never suspected me! 

But that didn’t end her attempts to drive.  Thankfully, the battery in her car died.  She wasn’t equipped to get it fixed.  For months, she kept her keys with her and would go sit in her car, from time to time.  Some days she was calm. Other days, it pissed her off and she’d be irate!  I eventually sold the car.

As far as getting her into care, that depends on what money is available...do they have LTCI...Medicare?  It’s a lot to navigate, but it makes sense to get on this before anything happens. You don’t want her or anyone else getting physically hurt or anyone taking advantage of her finances. 

dayn2nite2

I don’t see that APS is going to do anything.

The better question is, since this is in your father’s wheelhouse, why isn’t he piloting this ship? Is he cognitively impaired also?  Disabled and needs her to be able to drive herself?  How did she leave the hospital AMA - did she drive herself home?  If not, who helped her leave?

Until he is willing to do something, I’d probably stand back and wait for the next crisis.

Also, that patch wouldn’t help her anyway.  But she needs psychiatric help.

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harshedbuzz

TaraAggie97 wrote:

I spent July 4th in the hospital with my mom and dad.  My mom left AMA before having an MRI (CT was clear for stroke, etc).  We don’t know exactly what is wrong with her, but I am willing to bet that she has Alzheimer’s.  

 My mom continues to deny that there is a problem.  We managed to have a home-health evaluation (disguised as a long-term care eval) and she barely let the doctor take her blood pressure. She was argumentative and insulting to him…he wasn’t phased.  The doc prescribed Seroquel and she took one dose (won’t take more).  

Seroquel should level out her mood a bit and make her less combative. I would find a way to get her to take it for all your sakes. Perhaps you can hide it in a morning smoothie or dessert after dinner. Consult with the pharmacist to find out if it can be crushed- some forms of Seroquel can, some can't. Perhaps you can convince her it a new medication for some other issues. 

She's not in denial in the usual sense, she likely has anosognosia. 

Top Tips for Dealing With a Parent Who Denies Dementia Symptoms (alzheimers.net)

She also won’t wear the patch (med for dementia patients…not sure what it’s called).  She is adamant that there is not a problem and is completely resistant to anyone coming into the house to help her.  

While I would shed blood to get Seroquel on board, I wouldn't sweat non-compliance with any of the prescription Alzheimer's medications. They only work for a small percentage who take them and can be associated with side effects. I certainly wouldn't try to explain why she needs to take them/wear the patch.

She is completely OCD about her calendar, staying up much of the night to pace, repeat to herself, and even yell to herself about how her calendar is wrong, etc.  My dad has installed cameras throughout the home and that is how we know what times she is up and what she is doing.  

This is a classic middle stage (stage 4) behavior that is sometimes associated with someone who sometimes has a sense that they're slipping. 

Stages of Dementia Dr. Tam Cummings

To top it off: she is still driving.  My dad is not in denial.  He knows that she is a risk and wants to take charge of driving.  She is a complete b*tch (not a huge difference from her life before dementia) and becomes very agitated and yells/screams about the car.  “I can drive!!!  Leave me alone!!!”.  The only positive is that she does not drive further than a mile from home.  I have ridden with her and must admit that it is time to hang up her keys.

This has to stop by whatever means it takes. 

My question is: what are our options for getting her out of the house and into care?

This is going to depend on what sort of legal documents you have in place. We were able to get dad to sign a POA while he was still deemed capable of doing so. A friend had to pursue guardianship of his dad through the courts; his dad still had enough on the ball to hire his own attorney and fight it but my friend and his brother prevailed once the judge ordered a full cognitive evaluation for dad. They were really concerned about dad not quite being "there" (He'd been a PhD scientist) but some of the executive function stuff was impaired enough that the sons were able to take over.

 I am invisioning a police car with mental health team escorting her after she attempts to harm my dad. As I have said before, so won’t tolerate anyone coming in for care (she tolerates me, but no one new), won’t go to the doctor, won’t talk to anyone for a TeleHealth visit (we have tried), won’t take meds, won’t admit that there is a problem.

It would probably be best if you and your dad stopped talking to her about her problem. You aren't going to convince her and, TBH, it's kind of a cruel thing to do. Maybe I'm projecting here, but sometimes when a PWD was always difficult and there's a history of past hurts, the caregivers really have to check themselves in their approach. 

That said, triggering your mom into a meltdown might be a great way to get her admitted to a geriatric psych ward for medication management. It's unlikely you'd get a diagnosis there, but you might get her to a place where a workup could be completed and where she would accept care in the home without undue stress on your dad. 

Should I call APS on her?  She refuses to stop driving, barely showers…does prepare her own meals (the same thing pretty much daily) and sleeps for 2-3 hours at a time.  Not sure it’s an APS-warranted situation. 

It isn't. If she didn't have a husband and daughter looking out for her, APS might have some standing. But they aren't going to step in, at this point. Your Area Agency on Aging or the 800 might have some ideas about steps you can take specific to where you live. 

I would start with a CELA for you and dad as a first step unless you already have the POAs and such that you need.

HB 

Thanks for any advice.

Cynbar

I agree that APS is not likely to step in here. The first question is, are her legal affairs in order? Has she designated someone as her durable power of attorney for health care decisions (known as health care proxy is some states)? If not, that needs to be the first order of business with a certified elder law attorney. If that is all in place, the next step is to see if her PCP will invoke it, which would give her agent the ability to make her health care decisions for her. If all of the above has been done, it's possible to arrange placement without her agreement. Do some research and meet with admissions, describe her behaviors --- they do sound fairly typical of memory care patients, from your description. Most families don't find it helps to reason with their LO why placement is needed, the LO has lost the ability to make good decisions. Instead, they think up some subterfuge to get her there, then let the staff take over. I haven't gotten to placement yet, but you'll find a lot of good advice here to help get the move-in accomplished.

Jo C.

Hello and a very warm welcome; you are facing quite a significant set of challenges and I can certaintly understand how difficult this is.  First; to get a POA, she would have to willingly sign it and be competent to do so; it does not sound as though she would be willing..   You and/or your father really do need to see a Certified Elder Law Attorney alone WITHOUT telling your mother, and discuss Guardianship with him/her as well as any other actions that need to be or can be taken.

I have actually made a private appointment with my mother's physician to inform and discuss the situation.   I got a lot of support; it enabled us to, with coordination with the physician when were able, to find fiblets to get her to the ER where she was told she needed an X-ray, BUT it was a hospital that had a Geriatric Psych Unit and she was unknowingly being assessed for an involuntary GeroPsych Admission which was successful once they saw her behavior.

Confidential reporting of your mother to the DMV needs to be done yesterday. My husband's cousin, 30 years old was killed in a car accident when another car driven by an elderly driver struck his auto only 3/4 of a mile away from his home.  It was horrible.

If there is any accident, these days people are very litigious and apt to sue.  Notice the increase in ads for attorneys on TV since the start of the pandemic?  I sure have.   In a lawsuit, your father could lose everything he has managed to save and have other property in jeopardy. The lives of others are important and are of primary concern, but the financial impact is also important.  By the way, if there is an accident; if the insurance company finds that the driver was not competent to drive which the medical records would show; or interview of her would show, they may well not be willing to cover costs.  Big issues with driving under such conditions.  AND . . . the only thing she can do is make noise; why is family STILL enabling her to drive and in other ways?  The driving needs to stop; take keys, disable the car with something easy to fix when you or your Dad need to drive; and also, if possible, best to keep the car out of sight if can be done.  Yelling is unpleasant, but as said, it is only noise.  She well knows that if she keeps yelling and carrying on, she will get her way; so she continues on and on.  Time to stop that as a way to pander to her demands.  She is not competent, her logic, reasoning and judgment is badly damaged; she is NOT in control.

It is also really important to not discuss anything about dementia with her; that will only serve to increase her resistance ten fold and to irritate and agitate her.  Does she have a dementia specialist?  If she ever ends up in the hospiital, or if she can get to a dementia specialty doctor with fiblets, ask the dementia specialist to assess her for type of dementia and specifically ask that a behavioral variant of FrontoTemporal Dementia, (another type of dementia), be ruled in or out.  She really does fit the behaviors of someone with FTD; that is what my mother had.  It is like Alzheimer's on steroids and all about behaviors and demands.

Why is an accurate diagosis important?  Because treatment for one type of dementia may be contraindicated in another and make things even worse. The best specialist for type of dementia, is a good Neurologist who sees dementia patients as a routine part of his/her practice. Primary MDs are wonderful at so much, but not on the cutting edge of dementia management.   We had to use a therapeutic fib to get my mother to Neuro; her primary told her she needed a specialist for her blood pressure and back pain.  If ever your mother ends up in ER or in the hospital, have her screened for admission to GeroPsych.  If an inpatient, a Neurologist can be called in on consult.

As for APS; you mother has a roof over her head, food in her cupboard and she does not lack for care; they are highly unlikely to take any action.  However; you can place a call out of your mother's hearing and ask to speak to a Case Worker and get advice from them.

NOTE:  You can also call the Alzheimer's Assn. 24 Hour Helpline at (800) 272-3900.  If you do, ask to be transferred to a Care Consultant.  There are no fees for this assistance.  Consultants are highly educated Social Workers who specialize in dementia and family dynamics.  They are very supportive, have much good information and can often assist us with our problem solving.

I am so sorry and from my own experience, I well remember how difficult it was to get my LO to appropirate care due to her resistance; and yes, she too had a highly valued calendar that she incessantly worked and re-worked.  The day will come when the next shoe will drop and then action can indeed be taken .  I just hope your father does not develop health issues from the stress he is experiencing. 

Let us know how it is going, we certainly will be thinking of you,

J.