All necessary input relative to the initial discussion about my Aunt received. None further needed.

housefinch

I suspect you’re confusing your aunt’s ability to talk and express opinions with somehow being less severely affected with dementia right now. I’m no neuropsychologist but would bet my next mortgage payment she would fail neuropsychological testing and be found to lack capacity if evaluated by a psychiatrist who does those evaluations. Loss of abilities can sometimes appear patchy when a person is actually profoundly impaired. My family insists my stepdad still recognizes them (dementia stage 7, bedridden, in hospice, fully incontinent) because his face lights up and he smiles when they enter his room. He probably just knows vaguely that they’re people he associates with positive emotions. A month ago he was walking, swinging a walker above furniture and his head, and 6 weeks ago he was in a tux dancing at a social event. My mom actually believed he could socialize because he smiled and could say hi, how are you, so good to see you, etc. Several of us felt he would have been happier in MC for the past 2 years, instead of agitated, Sun downing, not sleeping, etc, and having to showtime hard core daily to prevent other family from facing his real deterioration.

ButterflyWings

@three4rd Thank you for updating us and for sharing that my caution about her inability to properly manage meds was accurate. No one here likes to be able to say “I told you so”. There is no joy in that and when I take time away from my own declining beloved to post here, it is usually in hopes I may be helping someone who has asked for advice— even if my 2 cents is not exactly what they were hoping to hear. We are sharing our experiences so others can maybe avoid the same pitfalls.

I see your frustration with what you are taking as personal criticism here, of you and your family — it is not. No one benefits from talking down to other members. There really is more of a spirit of being in this together, and sometimes of tough love if it will help someone cut through denial. Especially because it may save a PWD from unneeded suffering, and ultimately the family members as well. This is about her after all, primarily— right?

What you have learned about her skipping meds alone, is enough to confirm it is time to urgently provide your LO with supervision and protection. You can be assured there are predators who have accurately assessed what you all are still on the fence about: (is she safe alone) and they will not hesitate to deplete any assets while you wait - (another 3-4 months?). Please don’t.

I would urge you to read her POA documents, not 2nd guess what they allow (or require) by comparing some other generic POA interpretations. If there is any permission granted to make decisions on her part, please do so now. Maybe there will be nothing left to inherit after paying for MC, but so be it. You guys will have done the right thing.

We learn here that you must be guided by the PWD’s worst day, not their best. And at nearly 100, even without dementia, with the things that currently are happening, she needs 24/7 support.

Options include having her evaluated for hospice support (no waiting), or find a 30 day respite location to start, if you can’t convince your sibling to sign her into a MC permanently yet. But please, Just do it.

Here is one example of a scam that targets people left “independent” after their judgement is no longer good:

https://alzconnected.org/discussion/69649/a-warning-re-pwds-and-others-who-live-alone

Quilting brings calm

@three4rd

I’m not sure why you can’t get detailed info on the MOCA online because a quick internet search brings back various sites with examples of the test. I’m not able to copy the links here. I was able to copy the link below that tells you what a test score of six means. I want to call your attention to the lines for a score < 6- which she will be at in a short time as scores dip 2-4 points a year.

Profound impairment of cognition / function
Severe memory impairment / disorientation
Spoken language limited or lost
Incontinence
No capacity for making judgements
High dependency on others for personal cares
Unable to contribute to household chores
Often unable to recognise family members
Increasing loss of psychomotor skills
Frequent behaviour or psychiatric complications

https://healthify.nz/media/1707/summary_recommendations_from_dementia__driving_guidelines_2014.pdf

She’s way way past you trying to discuss her care with her, let alone making decisions. She should not be living anywhere without 24/7 trained staff- period. She has the mind of a toddler. Please please stop denying the reality that people here are telling you.

housefinch

Get ready for a fistfight with a cactus if you plan on discussing anything with her. You are in for a much harder time and will cause her more suffering than if you arrange everything beforehand and do the move as recommended by most people here and memory care staff. Best of luck, because you are going to need it.

Phoenix1966

From my personal experience with a 95-year-old grandmother, eventually everyone she “trusted” in her orbit became the devious enemy plotting behind her back. It’s clear you feel very strongly about involving her in discussions about her care, bringing her caregiver into it will probably end up with the caregiver getting blacklisted in her mind, too.

I have been where you are and it is very, very hard to take over being the caregiver/parental figure to someone who was an authority figure for you as a child. But it is what has to be done. I wish you good luck.

harshedbuzz

@three4rd

Wow, that is a stunning score given your descriptions of your interactions with her.

MoCA is easier than SLUMS, I'm told, but slightly harder than MMSE.

https://championsforhealth.org/wp-content/uploads/2018/12/MOCA-8.1.8.2-English.pdf

Piling on with the opinion that sitting down with auntie to have a discussion is foolish at best. It will only upset all involved and make the process more painful than it already is. I can appreciate that you feel this is hardcore and even disrespectful. I can also appreciate that this is supremely uncomfortable for you. I struggled mightly with this myself— it felt traitorous.

https://tala.org/wp-content/uploads/2019/04/Tam-Cummings-LLC-Handouts.pdf

A MoCA <10 is considered severe cognitive impairment. On the DBAT, that would likely corelate with stage 6. I don't like the concept of infantilizing adults with developmental, cognitive or intellectual impairments, but will admit that the "Age Equivalent" included in the DBAT is useful in decision-making for LOs with dementia. That said, I wouldn't say a PWD has "the mind of a toddler" exactly. A toddler is growing and learning new things constantly; a PWD is the opposite of that. But both need loving care to keep them safe.

As for logistics, I would select a place and make the move on-the-fly. I might come up with some therapeutic narrative, were I you, around the doctor wanting her in rehab/nursing care for some short-term care. This allows you to validate and commiserate with her when she wants to go home claiming it's her doctor's decision. I wouldn't include the caregiver; it's best to keep her "clean". The CG could be a tool for helping auntie adjust and settle in at the MCF by visiting a couple times a week to bring a treat and take her to an activity. CG can be your eyes and ears if you can't visit often.

I Love the "keep your feet…" expression. That's a keeper, for sure. But it's pretty clean it's pretty clear that you've reached an end point. You mention a PA Dutch heritage; would auntie be comfortable in a Mennonite run facility? A dear friend of mine's mom lived in a CCRC near Lancaster that was affiliated. Both mom and friend gave the place high marks. I can't say whether it would be prudent to place her where she had access to mom. I could see that go either way. In their old age, my mom and her closest sister have become frenemies of sorts each jealous of what they perceive of the other one's situation being "better". It would be easier for you.

HB

concerned_sister

Three4rd, something you said caught my eye, ""She has the mind of a toddler"….not quite a fair assessment, do you think? A toddler can't converse on an adult level." I swear to you the following is true. When my granddaughter was in pre-school she was very conversational. My son relayed to me that one night at pick-up one of the staff told him sometimes she has to remind herself that she's talking to a preschooler and not an adult.

Being conversational, is not the same as having good judgment. I'm sure you already know this. I just wanted to share a word of caution about this. H.B. shares a story of how her step-dad, despite all of his problems, remained conversational up to the very end.

I'm sorry this is falling on you and your brother to deal with, I imagine it must be taking an emotional toll. Please remember you're doing this "for" her, and not "to" her.

harshedbuzz

@concerned_sister said: Being conversational, is not the same as having good judgment. I'm sure you already know this. I just wanted to share a word of caution about this. H.B. shares a story of how her step-dad, despite all of his problems, remained conversational up to the very end.

For the record, he was my biological dad. And it's true that his conversational abilities persisted until the very end. The day he died of aspiration pneumonia (because he wasn't swallowing well), he was evaluated by a SLP for swallowing issues. During the eval, he told the SLP and I about a visit he'd had from my sister. His update included how busy she was with her daughters, that she'd been promoted at work, and that she promised to visit more often. It was a normal-sounding conversation in terms of vocabulary, prosody and structure. The SLP was impressed by his speech given how dysfunctional his swallowing was, but she was stunned when I told her my sister had been dead for 25 years.

And since I waded back in here, I should tell the oft-told tale of dad's last MoCA. This was done with me in the geri psych's office about 6 months before he died. Dad did surprisingly well. I don't recall his exact score, but it was in the 20s; he struggled with word recall and the clock drawing portion but could do serial subtraction faster than my mom. The geri psych commented on how well he'd done. TBH, I was shocked myself because he was typically more confused.

The entire way down on the elevator he bragged about his test result telling us over and over that he was "off-the-charts". When we got down to the valet stand, I turned my back to hand in my ticket for a second turning around just in time to watch him toddle over to a car waiting at the curb and proceed to get in with a random woman driving it. We'd driven his car that day as he preferred it to mine. Off-the-charts indeed.

HB

concerned_sister

I hope you've seen the handout that divides the observable behaviors into 7 stages that correlate with a person with dementia's decline. Perhaps you can print a copy for the care giver to check off her observations. That might help with the thoroughness of her answers.

I had to take a deep breath before posting imaging all that your currently going through. I hope you find time through out the day to settle yourself and take a few deep breaths. Teepa Snow, a dementia guru with many videos, speaks of the importance of doing this.

Quilting brings calm

Unfortunately there’s no real treatments. Especially not with a score of 6. Most medications to mask memory loss symptoms are for the early stage and are stopped around the moderate stage. There are medications for delusions and agitation etc. those are normally prescribed by a neurologist or a geriatric psychiatrist.

With a score of six, you want to be researching Memory care facilities.

There’s a resource in this site called Groups. One of the groups is set up to be lots of information for our newer caregivers and members.

A good book to read is the 36 Hour Day. Another resource is an online free PDF called Understanding the Denenria Experience.

I found the following site helpful to explain stages of dementia and their average duration:

Dementia care central.com

For some reason, I can’t copy the link to it here.

harshedbuzz

@three4rd said: Yet another thing that sort of bothers me. OK, I can accept the results of the test. Accurately administered by professionals and all of that; however, is that it? Is there nothing more definitive in the way of diagnoses to be forthcoming?

There is a gold standard protocol that would include blood tests to rule out infections, hormone issues and vitamin deficiencies. Imagining looking for lesions or gross structural changes would be done; so far mom's done a contrast MRI but dad did a PET scan to differentiate type. A more extensive neurocognitive battery would also be done. This takes about 5 hours, typically broken down into 2 days with a wait for scoring and can give more clues to type of dementia and a sense of the stage in which a PWD is. This is more often done for a person a bit on the younger side of things. We were discouraged from doing the 5-hour testing as dad wasn't cooperative by this point and many patients find it exhausting and distressing. In our case, it wasn't going to change anything.

My dad was on two different medicines for his dementia. Can't recall either of them at the moment. Granted that, from what I've read, meds for these ailments often aren't even prescribed for PDs of my aunt's age, and I can accept that too.

The oral medications do seem to help only a percentage of those who take them function better. They do nothing to stop or slow the disease process and many folks discontinue them because of unpleasant side effects. The newer infusions have not been shown to be remarkably better than the existing options and seem to be even less effective for older women and people of color.

Dad's neurologist declined to prescribe a dementia medication in part because he had some features of FTD and the Alzheimer's meds can exacerbate behaviors.

But, just seems lacking somehow to have had her take the test - which was all of like 15 minutes or so - be told that she's in severe cognitive decline, also told that there's no need to even bring her back for any sort of follow-up consultation (as was the original plan), but rather just tell us that she shouldn't be alone any longer and should have 24/7 care either at home or elsewhere, send us on our way, and that's it. Done.

I remain suspicious of the quick screening tests, but they are carefully constructed to tease out the specific areas of impairment fairly well in a short period of time. Dad did do badly on the parts of the test we would have predicted but it's hard to tease out things like executive function and impulsivity on paper— that's something typically reported by someone who spends long periods of time with the PWD.

Because my parents lived a distance away, I stayed a couple days 24/7 when I saw them. This gave me an opportunity to get a real sense of dad through the day. In a short visit, he could showtime (hold it together briefly to appear less impaired than he was) but he could maintain it for 72 hours. It exhausted him and he would routinely pick fights and offend me to encourage me to leave early. If one of you could create an excuse to spend a couple days at her home with her, I suspect you'd see things you don't know about.

Somehow, with taking her to a "geriatrician" who's supposed to be especially skilled in all this, I just expected a bit more 'meat' to the evaluation rather than just having her do 11 cognitive exercises and being told (essentially) that they don't want to see her anymore. Doesn't seem like any sort of specialized summing up that couldn't have been done in the office of her GP. Worth it to follow up with this clinic she went to?

I felt like the specialist was great for the diagnosis part; dad had a mixed dementia and one kind wasn't super commonly diagnosed so having him seen at the university affiliated memory center by a team of specialists was worth it. After that, they didn't bring much to the party. His geripsych was awesome. My friend whose mom was 93 opted out of a specialist consult and remained with her PCP monitoring her.

Having to leave her home at almost age 99…man, that's a total bummer! My Mom was (only!) 93 and in much better shape than what my aunt is experiencing now, and so we felt fine about taking her to a place that's only AL. But, as mentioned earlier, this just seems a different situation.

It's absolutely a bummer. It's a rare individual who is able to live out their lifespan "at home" without a level of support most mortals can't make happen given the logistics and cost.

HB

harshedbuzz

@three4rd said: I don't know what sort of facility I should be looking for. Certainly memory care at the least. I truly can't speak to how she falls on the ADL scale. Just not with her enough to determine any of that. I will check with the caregiver though and ask if she's aware of any bathroom issues or even asking for help with that.

I would assume Memory Care. There are 2 old saws around these parts- 1) By the time family is willing to consider assisted living, that cruise has sailed and MC is needed and 2) Care needs to be appropriate to a PWD at their worst and not some aspirational and ideal alignment of the stars good day.

If she could potentially run out of funds, I would look at only places that will convert to a Medicaid bed when money runs out. If she made need Medicaid, and you live in a state that doesn't fund MC (like mine), you'll also want to tour the SNF side of the facility to make sure it's OK.

In touring, look out for the common traps set by the LTC industry.

There's the bait and switch where the facility accepts your LO in AL knowing fully well that they'll crash and burn and be transferred to the secure MC side within weeks.

Pay attention to the pricing structure. Some places are very ala carte (like your mom's) and will nickel and dime families while other have a set fee. Dad's was the latter; the only extras were field trip, a weekly take out lunch and incontinence supplies.

Ask if there are any circumstances in which a person would be asked to leave.

Ask if a person can age-in-place which is a nicer way of saying "die here". If so, ask if family would be asked to provide additional private aides or engage hospice at some point and what that trigger is.

Good luck.
HB

harshedbuzz

@three4rd

I'm in PA, too. Suburban Philadelphia. PA does not allow for Medicaid payments for AL/MC. If Medicaid is/may be needed, it complicates things. This is where a crystal ball would have come in handy.

In planning for dad's placement, we had a couple factors complicating things. I figured he had enough funds for about 2 1/2 years in a mid-priced MCF with mom as community spouse. Dad had made some bad financial moves early in the disease and lost $360K was earmarked for care.

In factoring a budget, one thing I looked at was life expectancy. I read somewhere (I can remember, sorry) that a LO PWD basically has a life expectancy of about half of what it would be without at the time of diagnosis. Looking at U.S. actuarial tables, at 82 he had a life expectancy of just under seven years. Since I felt he wasn't diagnosed until he was in later stages (I fought with mom over getting him evaluated for a decade), I figured his actual life expectancy was a little less than half. My hunch was correct— he lived 20 months beyond his initial dementia diagnosis.

https://www.ssa.gov/oact/STATS/table4c6.html

Many places here have a business model which relies on a family being self-pay for about 2 years before converting to Medicaid and transferring to a SNF bed. Unfortunately, many LTC facilities which have MC operate as free-standing "Personal Care" licensed units with AL on one side and a secure (aka locked) MC on the other. These places don't have a SNF attached, and they don't accept Medicaid. There are some CCRCs around, but some of these offer MC as an afterthought that isn't up to the standards of the rest of the campus. And a few of them have a cognitive screening for admission— both a MMSE/MoCA and an interview.

Another complication is that these freestanding MCFs tend to be places which cherry pick residents favoring the cooperatively befuddled. There is also an expectation at most places that a PWD entering a community needs to be ambulatory (my aunt's MCF did allow a wheelchair if the PWD was used to using one) and self-feeding as this helps balance the workload for staff.

I toured a dozen or so places. My top 3, the state veterans home had a 4-6 month wait list, a freestanding MC only facility that would convert to a SNF owned by the same parent company and a CCRC near mom that denied him admission on the potential for behaviors given his diagnosis.

I would err on the side of MC if you feel she'll need to move within a year. The staff ratio will be better and theoretically better trained. They'll get to know her while there's more "her" still. And, frankly, she's likely to take a step into the next stage of dementia with the move.

HB

PS The chain we settled on was Promedica's Arden Courts. They have several in the state. I was very happy with the care dad got. They were great. There was another member in the central part of the state whose husband was in another location was also pleased with his care.

harshedbuzz

@three4rd

Run. Seriously.

I would be very cautious around either of these “services”. Any placement service that’s free to you is operating under a business model in which the professionals and facilities on their lists/tours pay a substantial fee (kickback, IMO) to be included. Generally the referral fee is about a month’s rent at such a place which is reflected in higher costs to the consumer. This is the very model A Place for Mom uses.

The down sides beyond additional costs are that these places tend to be facilities that cherry pick for the pleasantly befuddled. In my area, most do not accept Medicaid should it become needed. And worse, you could miss out on very nice places that can fill their beds on the strength of their reputations spread word-of-mouth at from friends and in support groups. I can’t speak to the @Arden Courts near your brother, but the 2 near me don’t advertise in this manner. They don’t need to.

For me the worst drawback is that once your contact information is given, you lose control of it. Some of the facilities associated with APFM were really hard-sell and pushy. Any turnover of sales agent meant the new guy would call to check in. I had one bozo call me a few months after dad died with mom in the car. It took weeks to convince her I wasn’t planning to place her too.

Word-of -mouth is your best resource. There is no shortcut to touring.

HB

It’s a bummer that they closed Hahnemann. Drexel runs the medical school now but they closed the hospital rather abruptly.

harshedbuzz

@three4rd

The facility pays the referral fee when the resident family signs the contract and pays. Facilities do not pay an annual fee to be included which might be considered a form of advertising.

Some of the places on the local list seemed very nice. Many fit a mold of putting on an elegant facade with decor and amenities to appeal to the families who are the decision makers in this situation. IME, it is better to focus on the training and retention of staff because a place that invests there will offer your aunt better care. The parking lot is a great place to research— ask family coming and going from visits how they feel about the place. Check out the employee parking lot- does the facility pay staff enough that they are driving decent cars?

When I say family loses control of their information, I mean there’s a risk of your contact information and situation being given out to an unknown number of people and facilities for an unknown period of time. I got calls for over a year from all manner of places even those offering levels of care inappropriate to dad’s needs or an unreasonable distance away.

I wondered when you said your brother took aunt to a “memory center” for testing what you meant. Dad’s memory center was a medical center specialty department employing physicians, CNPs, and psychologists offering diagnostic services, treatment and support. I have also heard the term used to describe a residential facility which may or may not have someone on staff who has taken the training and certification module which is only an hour and someone qualified to interpret the results a point around which the company is more vague. FWIW, the certification requirement is relatively new since 2019. I wouldn’t necessarily assume the worst of a free MoCA but it seems like one of those marketing tools where someone offers free roof inspections.

HB

ButterflyWings

I am trying so hard to not jump back in here and repeat myself. "But"…as family members and POAs of a 99 year old who has delusions, with evidence that she cannot self-administer her meds properly and nutrition is in question — MOCA, MMSE, etc are really moot points at this stage. Someone needs to step up. She can't. I believe your family may be doing so but boy, I am wondering how she's doing right about now. Not my business, I know.

Quilting brings calm

I think you ( and maybe your brother) are overthinking things. I’m guessing you have a type of job that requires you to do that. I was a systems analyst and I was required to think of all contingencies, paths , etc. My spouse gets annoyed with me for doing similar thinking at home. You need to move forward without the full knowledge because you are only going to get it as you go along.

The facility pays agencies like ‘A Place for Mom’. Your loved one will pay a community fee at some places to move in- it’s not refundable.
A major problem with using agencies like ‘a Place for Mom’ is that they only refer you to facilities will to pay the referral fee. They will also accept your( or your loved ones) word about the level of care that is needed. So the facility you go to might not be the right one. That was the case for the first facility my parents moved to. The agency took my mom’s word that they needed independent living. A week after they moved in, the facility’s housekeeper called me because mom was confused about her medications. Five weeks after they moved in, we moved them back to our home state on an emergency basis. A $2000 community fee down the drain. Mom spent a week in the hospital, a month in a rehab facility, then we moved them into assisted living. This is why you want to do your own facility selection.

housefinch

Yikes. I can’t imagine what’s actually happening at her home. She’s paying the caregiver cash she is getting from an ATM or account? As someone who employed an in-home nanny and paid all taxes, social security, Medicare, and had a worker’s comp policy for her, I paid an outside company to handle everything because it was too overwhelming and I didn’t want to make an error. Your aunt is in scam nightmare territory here. The fact that you even think she can handle that financial transaction or her medications and is merely choosing not to take them means you are vastly underestimating the dangers and overestimating her abilities. My stepdad, a retired MD, can apparently discuss quantum physics per his daughter. He is bedridden, stage 7, doubly incontinent, and keeps saying he hasn’t eaten in 48 hours. He is given 3 healthy meals daily at his memory care facility. She’s going to be found down somewhere after wandering away. Someone needs to move in with her 24/7 until she’s placed in a facility unless you want a family tragedy.

harshedbuzz

https://alzconnected.org/discussion/comment/215177#Comment_215177

I would consider that a very reputable center. Assuming your aunt cooperated, her MoCA is likely an accurate reflection of where she is cognitively.

Iris L.

You have received the very best guidance and advice for a caregiver family member of a declining, vulnerable 99 year old PWD. Yet you keep bring up excuses about why you can't go forward or are slow in going forward. You're not sure of how she gets cash. The cg is "very trustworthy". Probably so, but there is a reason why embezzlement occurs via trustworthy persons. (Because everyone around them thinks they are so trustworthy.) I am not saying anything about this caregiver, but everyone needs to be diligent with employees. Just saying. An elder in my family was followed home from the bank and was mugged on his doorstep. He was not frail, still strong, but not strong enough to stop a young mugger. He had just withdrawn $1000 in cash. Fortunately, he was not hurt. I hate to think of two elderly ladies going to the bank alone to withdraw cash. I am super-cautious myself, I try to go inside and work with a teller instead of the ATM. I am very aware that I am a vulnerable older adult, alone at the bank.

As the responsible family of a vulnerable adult, it is your collective duty to be be sure of everything that is going on with her. I know this is controversial, but you could regard her as a five year old child that you are responsible for. I don't believe you would be so lax. (I know she is not a child.) The members here, who are very experienced because of their own hard-knocks experiences, are trying to tell you that you are too passive. You have to take charge if you don't want a disaster to happen. She is already losing weight. PWDs who live with a family member often ddon't eat, they have to be coaxed and monitored, the same way you would with a toddler. This may sound bad and demeaning, but this is how it is with a vulnerable adult. This is the type of supervision of mealtime you should expect from a Memory Care facility, making sure that the PWD eats sufficiently or know the reason why not.

You are not the only one who has been reluctant to take the reins. But you have to. It's not a complaint about you personally, because everyone understands the reluctance. But you have to gather the where-with-all to move forward before the crisis. Sometimes, when there is strong resistance, family members are told to wait for a crisis, when their LO must be hospitalized and after authorities have gotten involved. It's harder then, because the LO may be injured, important decisions have to be made quickly, and the family members may be pushed to the side and lose control. I know it's hard. All of us know it's hard. Take deep breaths and stay strong! You can do it!

BTW, weight loss in a vulnerable adult is a criteria for hospice. You might begin to interview hospice. But I believe first she needs 24/7 supervision of her eating and daily activities. Do weekly weights. Also, does she need all those meds? Please read about polypharmacy in older adults. Some meds or combination of meds may decrease appetite. I'm not saying that this is the case, but it needs to be investigated by a geriatrician and/or a pharmacist familiar with meds for older adults and the BEERS List for Older Adults.

The above is not an accusation, but is meant as a wake-up. Please do not take this as an offense. You cannot find better advice than here. You mentioned something about relying on a go-ahead from the PCP, you don't have to wait for them, they don't know much about caregiving.

Another story: one of my great aunts was found asleep outside her apartment. Apparently she had locked herself out and didn't know how to call for help. At the time she did not have any diagnoses, this was a few years ago. Her doctor said she shouldn't be living alone. This was news to my cousins, who were looking after her and weren't aware thar she was that bad off. But she hadnt gotten that compromised overnight. They had just been observing from afar (figuratively speaking, because they lived in the same town) and had been relying on her attestations that she was doing fine. The moral of this story is that we cannot rely on self-reports of a vulnerable adult, because they all think they are doing fine. This is true for all of them, not just the ones with anosognosia. They need a discreet in-person welfare check, including checking the refrigerator for expired food, or even no food. (Ask me how I know this, 😉. )

Iris

Iris L.

You are retired, can you move in with Aunt for a week or so to get things moving? "Aunt, I miss you and I want to spend some time with you". This is basically what I said to my own aunt who was in dire straits. I found she had six month old milk containers in her fridge, among other scary things wrapped up in aluminum foil. I think once you see more things with your own eyes it will light a fire. It did for me.

Iris

Iris L.

Another story: I had another elder who was living alone in her big home in a well-to-do area of Long Island, NY. Her family moved her across the country to a luxury senior facility. The story they used was so that she could be close to the grandchildren while they were still at home. She did not have a diagnosis at that time. She complained often to me about missing her lovely home on Long Island. Why did she have to live in an apartment? But even I knew it was too much for her. Her unit was beautiful and the facility was a luxury facility, with many amenities. I wouldn't mind living there myself. But I realized that she was in no condition to make a rational decision about a safe living situation for herself. I did not discuss this with her children because it was obvious that they had made the right decision. Instead, I talked up her new home, about how nice it was and how so many people would love to live there. It was not a lie.

Iris

three4rd

As can be seen, I have deleted everything I've ever posted. I feel that simply too much pressure and stress has been added to my life with the sometimes very criticizing and worrying comments made here, albeit most are well-meaning. I've been made to feel like I'm an irresponsible child myself or else a very neglectful adult, and in many ways I'm very put off by that. It has added to an already growing depression over all this.

My brother and I are doing the best we can (and obviously need to do more) with this situation in the face of many other issues that we both face in our own lives, not the least of which is my wife in slow recovery mode from surgery back in November yet, along with concerning results from recent blood testing, and now additional surgery a week ago. I'm not at my best here for sure. My brother still runs his own business at age 79 and manages all the paperwork, etc. for both my Mom and Aunt. It just works out best for the most part since he lives much closer than I do to both of them. And, I sometimes question the state of my own health since I become so easily fatigued of late. All of this is really working on me mentally and physically, especially my meniere's disease symptoms. If there was another family member that was in a position to help or even take most of the reins on all this, they'd be more than welcome to do so. But since that ain't gonna happen, it's on my brother and I. The CG is doing all she can, and more, but has her own health problems to deal with along with those of her husband. It's easy to tell me to get moving and get all this done, but it's a process that I'm trying to work through best I can and still juggle everything else.

For my own sanity (and probably everybody else's here), I will not respond beyond this point, so a moderator can feel free to close the discussion to further comments and/or just delete the entire discussion. Actually that might be best. I think the discussion has run its course.

Thanks to all for taking the time to respond to the initial inquiry. I know it was all intended in my best interests. I will not report on further progress since it'll likely just be critiqued as probably being inadequate.