Where do I get simple help for meds and eating

Ann PB

My mom is still at home. She is doing physically very well. She is active in the community, volunteers, plays bridge, goes to church and drives. However, she has meds for diabetes, memory and high blood pressure that she won't take on a consistent basis, mostly out of defiance. This, along with not eating well, leads to obsessive behaviors like hoarding or heading to the bank for irrational fears about her money; which I manage. My sister fills her meds cups but can't be there to watch her take them. I have reminders set in the house she ignores. Does anyone know how I can get basic care to make sure she takes her meds and eats some food? The places that I have called in her local community only offer more hourly care or care she doesn't need at this time. I don't know where to turn. I live 90 mins from her and go as often as I can but I can't live with her to watch her eat and take meds. I manage all of her other needs but this I can't do. She is defiant and always has been about meds so this is very difficult. Thanks

Quilting brings calm

I do not think that your mom’s behaviors - defiance, hoarding or irrational fears- are caused by not taking the particular medications you mention. These behaviors are common to people with anxiety, depression, dementia. She needs medications to manage anxiety, depression, etc.

If you want someone to make sure she takes medications and eats, then someone needs to be there at medication time and mealtimes. Yes, having more hourly help would make it possible for a person to be there. However those people can’t force her to take her meds or eat.
There's really no way to make sure she takes her meds and eats if she lives alone.

SDianeL

if your Mom is taking medication for memory loss she has dementia or Alzheimer’s. Being defiant, hoarding and having irrational fears are behaviors associated with memory loss. She can’t stop those behaviors. Sorry but no amount of trying to reason with her will work. Reminders won’t work. She may not be ignoring them. She may not know what day or time it is or she may think she already took them. In my opinion she should not be alone and should no longer be driving. If she has a diagnosis of memory loss and she is in an accident, even if not her fault, she could be sued. She needs a caregiver familiar with dementia who knows how to get her to take her meds.

harshedbuzz

@Ann PB said:

My mom is still at home. She is doing physically very well. She is active in the community, volunteers, plays bridge, goes to church and drives.

Are you certain this is still the case? Many PWD self-report a much the active and engaged social life they had before the onset of dementia. Often social interaction in these settings can be difficult for a PWD and cause them to withdraw. Sometimes the loss of their social filter leads to being dropped by their social group. Apathy is another common symptom with dementia that can interfere with socialization. Not for nothing is a "lack of interest in hobbies and things they used to enjoy" on the lists of signs of possible dementia.

FWIW, dad always spoke of his active social life in FL— swimming, going to the gym, playing golf, dinner with friends. I knew he'd become a pariah in MD; it's why my folks bought the FL place and started spending half the year there. When I moved them here and sold their place in FL, a number of neighbors stopped by to ask after mom. The only one who mentioned dad said he'd been run out of the golf and dinner group 5 years ago and rarely left the house.

However, she has meds for diabetes, memory and high blood pressure that she won't take on a consistent basis, mostly out of defiance. This, along with not eating well, leads to obsessive behaviors like hoarding or heading to the bank for irrational fears about her money; which I manage.

I agree with Quilting that these are garden variety dementia behaviors that have nothing to do with her current diet or medication. Dementia is about so much more than memory loss— it can also remove a social filter and enhance challenging personality traits.

You mention driving. If she no longer has the judgement and executive function to manage her own money, she should not be driving. Full stop.

SDianeL is correct that this activity to be disastrous should she get lost (At a certain point PWD get lost in their own homes) or if there's an accident. If she has a diagnosis in her medical record, it very likely voids her policy which could wipe her out financially. If you or your sister has a POA and she has an accident driving, you could be found liable as well. If she were sued, it would take some time to get to court during which her cognition will have worsened and her medical records including prescribed memory drugs will be on display for a jury. The optics of protecting mom's money but not safety would not go down well.

My sister fills her meds cups but can't be there to watch her take them. I have reminders set in the house she ignores. Does anyone know how I can get basic care to make sure she takes her meds and eats some food? The places that I have called in her local community only offer more hourly care or care she doesn't need at this time.

There is no life hack or technology to replace a human being for this kind of thing. I can't say whether your mom needs full time in-home care, but it does sound like the answer here is to hire an aide to dispense medication and do meal prep for her. This will get expensive as there's generally a 3-hour minimum. Our agency had a 2-hour for morning meds and/or evening meds so long as you used at least 15 hours/week. Pre-COVID, we were paying over $30/hour through an agency. You might find someone through Care.com who is more flexible, but you'd need to do vetting and payroll.

Moving her into an AL with meds management and food services might be more cost effective especially given that you and your sister don't have a lot of availability to drop everything and cover a no-show aide.

One of you could also move her in with you or the other way around.

I don't know where to turn. I live 90 mins from her and go as often as I can but I can't live with her to watch her eat and take meds. I manage all of her other needs but this I can't do. She is defiant and always has been about meds so this is very difficult.

Have you or your sister recently spent a couple of days 24/7 with her? Often a PWD can showtime and seem more capable for a short period which can leave family with a sense that they're coping better than they are. I once flew to FL because mom was hospitalized and I got a call as her emergency contact. Dad, prediagnosis, was MIA from the hospital so they called me. When I got to their home after seeing mom, dad was hosting happy hour with a couple of neighbors wearing nothing but a bath towel. The next day, he crossed wires trying to jump a car battery knocking himself against the wall and 5 minutes later put a fork in the toaster. A friend whose mom lived down the street from her was shocked by things she found in mom's house when she finally decided to move mom in with her and was prepping the house to sell.

Good luck. This is a difficult stage to manage.

HB

Emily 123

Hi Ann,

Great advice here!

As others have said, use caution when assessing dementia behavior based on how your person used to be. If your mom wasn't like this before, then these new behaviors and reactions will be caused by the disease eroding her brain's ability to intake, recall, and process information and emotions. Early on I'd have struggled less with understanding Mom's behaviors If she had suffered a brain injury, because that would have created a link between a visible event and the decline. Dementia can often leave your person fairly social and looking the same outwardly for a long time, though they may be struggling to get through their day safely, and no-one can tell, especially them.

I found these things helpful as I started my own journey with Mom's dementia—it'll help you anticipate the challenges if you can understand how she may be seeing the world as the disease progresses. I apologize, but you may have to cut & paste the YouTube links…the site makes them wonky.

understanding-the-dementia-experience.pdf

Tam-Cummings-LLC-Handouts-2.pdf

Moderate stage changes: https://www.youtube.com/watch?v=6cZTgG6kDjs

Stage 4: https://www.youtube.com/watch?v=coiZbpyvTNg

5 other losses: https://www.youtube.com/watch?v=awBm4S9NwJ0

Careblazers:

https://www.youtube.com/watch?v=ncKhXQtnyfI

https://www.youtube.com/watch?v=rO50pVUOlbE

Teepa Snow-multiple videos 

https://www.youtube.com/playlist?list=PL2E2lPBsUeBjA1Utglo8q6yANAijEf8cX

Good luck,