Just starting journey…

homenurse10

My MIL has not been formally diagnosed with Alzheimer’s, but her mother had it and we have no doubt. She lives with my FIL, and we just went to visit after about 3 months absence. I had my doubts that she knew who we were before, but now she absolutely doesn’t know us. She calls us “hon” as a general catch all. She does know my FIL and the dog, both of which she has to have in her sight at all times or the “Where’s FIL?” questions start. “He’s on the couch.” 2 min later same question. She used to love going out to eat-she stopped cooking years ago as she couldn’t rem how-but now won’t leave the house, even if everyone else does. She’s been wearing the same clothes during our visit, and FIL says he can’t get her to change or bathe. I tried just with mild suggestions, and just get “No!”. She will only eat/drink Dr. Pepper with peanuts in it. She’s never seen a dr and absolutely refuses to go. After hearing about her non-bathing I became worried about her skin, and told her I’d trim her toenails for her “like I do for my mom.” She agreed, until I saw her foot and attempted to touch it. Her toenails are so long and thick they look like talons, and they curl around UNDER her foot and into her skin, and she’s walking on them. I’m worried that once professionally removed she’ll have sores left. She said, “Nope! I’m done” and put her socks back on. We can’t let that continue, so I called around between the podiatry clinic (suggested ER cuz she’ll need sedation) and the ER (they don’t have podiatry but a Hosp an hr away does). I feel she needs 1. Feet cared for 2. A mental status exam/dx (just for insurance maybe? We already know) 3. Nutritional status exam 4. Skin assessment. Getting her in a car/to a facility will require major fiblets, and a physical fight looms (she’s been verbally more combative). If they admit her (even if they don’t) her DH and DS are concerned about the over all trauma. I know all this is normal/expected behaviors, but I guess they’re new to us. Any advise appreciated!

M1

welcome to the forum. Does anyone hold power of attorney for her? Your husband likely needs to have it for both parents, as is seems unlikely that your FIL can continue as the primary caregiver. As it seens likely that she is going to resist care, you may have to pursue guardianship. You need a certified elder law attorney, look for lists by location at nelf.org. Sometimes an experienced attorney may be able to convince her to sign power of attorney papers (for healthcare and finances) in the context of everyone in the family doing it--ie if her husband signs too, she might consent to do so. guardianship is more expensive but may be necessary anbd unfortunately you probably have to take the legal steps first before you can force the medical ones.

homenurse10

https://alzconnected.org/discussion/comment/200733#Comment_200733

6 yrs ago my FIL was dx with prostate cancer, and at that time I remember doing a POA for healthcare. I’ve asked him to look for the document. He’s of the opinion that he’s “ready to go”, at which time the 3 boys can “deal with her”-translation, Daughter of most responsible son (me 🙄) can deal with her. I’m trying to convince him to take steps so that if/when he does pass, no one can take advantage her her. She’d sign anything.

homenurse10

https://alzconnected.org/discussion/comment/200733#Comment_200733

Would a lawyer, knowing she’s not competent, go along with her signing??

M1

The bar is pretty low. Definitely have him look and see what's there, but all documents may need updating. He doesn't sound competent to deal with her either. And unless your son holds POA, neither of you have any authority to intervene unfortunately.

harshedbuzz

Hi and welcome. I am sorry for your reason to be here but pleased you found us.

This sounds like a difficult situation all around. It sounds as if you live at a distance. Some thoughts-

1. Your husband needs to get the legal pieces together asap. His dad needs someone other than his wife as his legal representative and it's possible dad isn't up to making decisions on behalf of the wife at this point either. It's hard to say whether an attorney would deem her competent to understand what's she signing vis a vis a POA; your DH might need to get guardianship.
2. Dad might have had a cognitive shift as well. Sometimes both people in a marriage have dementia and one flies under the radar because they're not yet as impaired or are just generally more agreeable. Those toenails speak volumes about his competency in managing her care-- APS would deem her "neglected" given her diet and toenails.
3. It is probably prudent to move them nearer you where you can keep a closer eye on their care. If there's unlimited funds, you might be able to hire a Senior Care Consultant and bring caregivers into the home but that's expensive and hard to manage at a distance.
4. Both probably need to be seen by a PCP. MIL needs to start the diagnostic process to rule out conditions that mimic dementia like a vitamin or hormone deficiency especially given her diet. You mention an exam for insurance purposes-- do they have LTC insurance? If there is a POA, does your DH need a diagnosis or doctor's note to activate it?
5. Ugh, the toenails. One of my aunts had this issue. The pictures will haunt me forever. She wouldn't let her live-in DD address this and things got really bad. A PCP can refer to a podiatrist who might need to schedule the procedure in a free-standing or hospital surgical site.
6. Given her combativeness, she may need a stay in a geri-psych unit for medication before you can do anything else. If she acts out aggressively, you can call EMS and have her transported to the ER. It might be useful to know which hospital near you have a geripsych unit-- not all do. Best if she could be transported there. Good luck. This is some challenging stuff.

homenurse10

https://alzconnected.org/discussion/comment/200756#Comment_200756

Thank you for the detailed response! We have a POA for healthcare for both of them, and I’d be perfectly fine moving them here (we have a walkout apt for them), but neither would move. It’ll have to be forced after my FIL passes away, but for now it’ll be challenging. They’re about 5 hrs away. They don’t have LTC ins, but my plan was to lie to her about needing an exam for Medicare to get her to the ER-they do have a podiatrist at the ER, I checked, though it’s an hr away. Didn’t know about geri-psych specifically, but I’ll check around.