Parent refusing care

jnmiller324

My mom with EO is refusing to move into assisted living. I brought her to tour a place last week and she threw a fit in the parking lot & the facility said she can’t come back without a psych eval & meds. On the way driving her back to her home she attacked me in the car. I called adult protective services & they said she was fine. After conversing with her Dr, we agreed to have an ambulance take her to the ER for an eval. The ER was aware & on board and then last night when she arrived, they said she was fine and sent her home. 

She is not safe, she refuses to go willingly and she’s being verbally abusive to me & family. I have POA and a declaration of incapacity and I feel helpless. I can’t get her into a car with me. Additionally, I don’t want to do this anymore. My kids, husband & job need me. I’m not even 40 and I don’t deserve this. She’s been a terrible abusive mother my whole life. I’m trying to help because I feel the moral obligation to help, but this isn’t worth my mental health. I just don’t know what to do. 

loveskitties

Your first moral obligation is to your children, husband and job.  If you don't take care of those things, nothing else matters.  And a physical attack on you, particularly while you are driving, is unacceptable.

Not sure how your POA is worded, but it may or may not allow you to "take over" if medical and protective services are saying "she is alright".

You say she is not safe...how so?  

In my opinion you have several choices...1. would be to notify your mother in writing that you no longer wish to be her POA., then notify protective services and her doctor  that you are no longer involved with your mother's care.  2.  would be to back off and wait for the inevitable crisis to occur than then step in with POA.  3.  In the mean time you could do tours on your own so that you have places in mind if/when the crisis occurs.

If she physically attacks you or someone else, or if she threatens self harm, call 911 and let them take her to ER.

Wishing you luck with trying to deal.

Jo C.

Hello jnmiller and a very warm welcome to you.  The first thing I would like to share is that the Alzheimer's Assn. has a 24 Hour Helpline available 365 days a year and can be reached at, (800) 272-3900.   If you call, please ask to speak to a Care Consultant.  There are no fees for this service.  Consultants are highly educated Social Workers who specialize in dementia and family dynamics.  They are very supportive for us, they have much information and can often assist us with our problem solving.

Apologies for the length of this, I am throwing thoughts out there based on experience:

How old is your mother?  Where does your mother live now?  Does she live alone? Does she have a helper other than yourself?   On a daily basis how much do you need to do for her?  Has she assets to pay for care in a facilty?

This really is a difficult challenge and it will take a little maneuvering to get resolution, but it can be worked out.   First; does your mother have a dementia specialist?  If so, it would be good to get an appointment on an urgent basis to have medication adjusted; if not, it would be a good idea to reach out and make an appt. with one.  We used an excellent Neurologist who saw dementia patients as a routine part of his practice; that is important.  Getting her appropriate medication would be a good first step to all else. Placement will not happen until she has her agitation and physical lashing out under control as facilities will not usually accept such a person into their care as the risk to themselves and others is increased.

NOTE:   Do call a few acute med centers around, or do a bit of research and find out which hospitals closest to you have a GeroPsych Unit.  Medicare and many other insurances pay for Geriatric Psych or regulary Psych Inpatient Care.  Next time she needs to go to the ER due to over the top behaviors, ask the ER physician to have her seen for GeroPsych admission whether at that hospital or whether she would have to be transferred by ambulance to another hospital.  Also; your mothers primary care doctor or dementia specialist if she has one, can also make a referral to a GeroPsych Unit for admission.  They will be able to monitor her on a 24 hour basis to assess her for her problem issues and also to confirm what type of dementia she may have and to initiate medication monitoring for efficacy and side effects.  There are multiple different types of dementia which Alzheimer's Disease is only one.  An accurate diagnosis is important as meds for one type can be contraindicated in another. 

If she is admitted to a psych setting as an inpatient, it will be far easier to transfer her to another care setting for residence when discharged/transferred from a hospital setting.

NOTE:  If you cannot get her admitted to GeroPsych because of her age, then a regular Psych Unit would be the next step; not as what one would wish, but necessity is what it is.

You mention that your mother has been terribly abusive to you all of your life, but that you feel morally obligated.    I will share my personal beliefs regarding that sort of dilemma.   If feeling obligated but not wanting to, you would by my personal measure, only be obligated that she has a safe place where she will receive care with food and shelter.  You are not obligated to please her or to make her "happy," that is in all probability not achievable anyway, nor are you obligated to take her into your home.  Sometimes the state must step in and take action to place a person who is a danger to themselves.  Since this has been a lifetime issue, is it possible that you mother could have an as yet undiagnosed mental health disorder that would be a complication with her dementia. . . . this is something to think about; it would make her a dual diagnosis patient requiring specialty care with a geriatric psychiatrist perhaps who can also manage dementia, and GeroPsych or regular Psych Unit may be helpful.

You need a dementia diagnosis to be stated as well as a physician statement declaring that your mother is no longer competent to format her own plan of care nor is she competent to conduct her own business.  I had to ensure we had that for my own mother who was a severe behavioral set of issues that lesser measures did not help when she was refusng all care.  NOTE:  While a person can state their wants, that does not  make them competent to format their plan of care or conduct their business.  Big difference.

It does sound to me as though your mother would not do well in an Assisted Living Setting even though she is EO.  May I ask again how old she is?   Do you know her specific type of dementia and how it affects her ability to conduct her own care and daily tasks reasonably?  By now, it does sound as though she profoundly lacks judgment and reasoning due to the severity of the damage to the brain.  If that is so, medication cannot restore that.

It may be that your mother would do better in a Memory Care setting or other setting that can accommodate persons with dementia.  There are also Group Homes that specialize in persons with dementia where five to six people may live in a group setting with care IF severe acting out behavioral issues have been addressed.   This is something to speak to a social worker about.

As for Adult Protective Services, their action comes when a person has no care; no food, no running water or roof over their heads or are being financially compromised by someone.  They really are of no assistance in such a situation as this; I too had to find that out the hard way.

Here is the hard part for a caring person:   Sometimes, we exhaust every single effort to do anything at all.  When that happens and you have a person refusing all care, etc.; sometimes as I was told by a Social Worker, you have to leave that person be and let them do what they are going to do and wait for  the next shoe to drop, and it will  . . . .then one can step in and do what needs doing.   You will have to gauge where you are on such an issue. 

You are young, you have a husband and children; this needs not cause deep discord in your lives; sometimes we have to learn to let go a bit;.   There is no perfection in all of this; there is only what you can do under the circumstances with the challenges at hand and you have been more than doing that.  At some point, you will have to make some difficult decisions.

There are times family must go to court to gain guardianship of such a parent so they can make the hard decisions themselves.  That of course requires an attorney and court fees and can be a bit pricey, but one can research that to find out what it entails.  

 NOTE:  We here are big believers in seeing an Elder Law Attorney in these sorts of situations who can guide us through the quagmire of tangled threads and get a plan into place as much as possible.  That may be helpful in your situation.  Such an attorney can also discuss guardianship processes especially when funds are low if that is the case.  However; there are still attorney fees.

If you can get your mother to appropriate medical care either a specialist or admission to a mental health unit such as GeroPsych; that will be a huge step in management.  There are medications to help with such dynamics but it will take a professional who works with this to do best practice for what your mother is exhibiting.  It may be that the ER will be an entry point for this.

You are a lovely caring person who has gone above and beyond; please let us know how you are doing and how things are going.  I will be thinking of you and we truly do care.  We are all here in support of one another and that now includes you too.

With warmest of thoughts and best of wishes being sent your way from one daughter to another,

J.

ewell

any advice on how to give liquid meds under the tongue in someone who cannot respond to commands to lift up their tongue?

loveskitties

Ewell, best to ask the doctor who prescribed the medication.

Quilting brings calm

JN - 

Quoting  a poster above ==  If feeling obligated but not wanting to, you would by my personal measure, only be obligated that she has a safe place where she will receive care with food and shelter.  You are not obligated to please her or to make her "happy," that is in all probability not achievable anyway, nor are you obligated to take her into your home. ==

This is exactly what I have had to do.  My situation is a little different than yours.  Im dealing with two parents. One with dementia, one just an abusive individual.   They are in their 80s and in assisted living( the last two years).  I retired the end of  last year- partially due to their demands on my time.  Partially due to my spouse, who is on disability.   Was just being pulled in too many different directions and I was totally stressed out.  Being retired didn’t really help as they all felt free to monopolize all my time then. 

After some specific behavior  issues in September 2021 with my step-dad( the abusive one), my parents’  doctor recommended I step back for my mental health. He reminded me they are safe in assisted living,   So I still handle the finances, coordinate and attend medical appointments, call my mom daily.  I only visit every 7-10 days or less.   Dental, eye and hearing appointments I leave totally up to them.  

I recommend you get her medicated and fast.  Her doctor should be able to do that for you.  Then I recommend  you tour facilities on your own.   I also think you should not pursue guardianship.  I have moms full POA, only medical on my step-dad.  He won’t give me full POA even though I’ve explained what can happen if the state takes guardianship over him. I’m certainly not going to pursue guardianship for him. 

jfkoc

If your mother haas been declared incompetent then the POA is not longer valid  unless it is a DPOA.