Out of state sister with early Alzheimer's is stubborn, petulant and resistant to help.

JoanEK · May 31

I am her HCPOA and DPOA. Neurologist explained her diagnosis to her, and told her she needs 24/7 aides if she wants to remain in her home, that she may not drive or be responsible for her medication, and must use a walker (many falls.) But she states she does not have Alzheimer's, is rude to and fires every aide we hire, insists on driving, won't use the walker, and won't take her medication. We've hired an excellent nurse patient advocate who our sister likes, but even with her she is snippy, stubborn, angry and resistant to being cared for. Help?

JeriLynn66 · May 31

Sorry for the need, but glad you found your way to here. Read about anosognosia. Your sister is not in denial. She truly (because of the disease) does not believe or understand that anything is wrong with her. There is a resource on this site for newcomers under "Groups". Much useful information there.

All the best to you,

sandwichone123 · June 1

If she were able to understand the problem and take effective action, she would not need care. The problem is that, while she still looks and sounds like the same person, she is no longer able to understand. She feels attacked when people tell her that she is not functioning effectively. She is unable to make wise decisions and carry them out. These are all the reasons she needs someone to care for her.

You will not be able to convince her and she will not be able to take wise action. Someone needs to take charge, make a plan, and carry it out. You will need to find a way to have her go along with the plan, but explaining it to her will not be helpful. It's really hard for everyone when it's the brain that's not working correctly.

weareallunique · June 1

You won't be able to convince her so you need to work around her for her safety. Not bringing up things you know she won't agree with or comply with will keep her calmer. And dealing with someone over the phone when they have dementia is like a parlor game - you can't depend on what they say , they can be cagey and showtime saying what they think you want to hear or get really angry and hang up.

Did she have her documents drawn up with an elder law attorney? Having a talk with them would be the best way to get guidance on how to protect her based on her documents. Some areas to discuss could be :

Since you hold her DPOA - if it is in force-does it require Doctor's note(s)? is what you have enough already ? -

I assume you are managing her assets and keep her access to her finances limited to a debit card if needed and have removed her access to on line accounts, checks etc. If not the lawyer can advise .

Driving - check with her state's Dept of motor vehicles - is her doctor required to report her ? Can you? With you holding her DPOA you are required to protect her assets - and a car accident could wipe her out financially- aside from the human pain to her or those she hits. Or her caregiver if she is driving her . Can you have the car disabled or removed & sold [assuming lawyer agrees].

Her auto insurance may not be in effect with what the doctor recommended in her medical file .

Finally , the time it takes to over see a family member with dementia just grows and is not something you can schedule- like a monthly trip to get things sorted . Have you considered moving her closer to you ?

Hopefully the lawyer can give you advise and you won't have to file for guardianship through the courts. Which could be messy if two states are involved .

This is a very difficult time for you- trying to respect her as an individual at a distance yet having to take away her independence for her safety- which is the goal & she may never agree, see a need or, sadly express gratitude. She fortunate to have you overseeing her care.

JoanEK · June 1

I'm grateful for your response and your kind words. You've helped me understand better how to interact with her, and given excellent advice, such as about limiting her access to finances to a debit card (she's been spending a fortune on credit card catalog shopping sprees!) The car issue has been a big problem, but looking at it from the perspective of protecting her finances is logical, and I'm going to take action on that as we oversee her finances. In Texas, a family member can report a driver to the DMV, and we should also report her diagnosis to her insurance company. In general, we've been letting her run the show too much as she is strong-willed, determined and controlling, trying to avoid angering her, but now I understand that we need to be more proactive and strategic about her care. She does not want to move from her home in Dallas. I live in Ohio and our other sister is in Massachusetts. I have been down to see her, and we're planning another visit. We are fortunate to have found a highly respected and trusted nurse patient advocate who sees her daily and controls her medications, appointments, and day to day finances. We also (currently) have day and night aides with her. Yes, we arranged for her to work with an elder care lawyer to draw up all her documents, and the DPOA is in force. She chose me to be her legal guardian and I have the forms to begin the process, but all involved feel it's too early for that. This truly is a lot to deal with, especially from far away. She's the first family member to have dementia, so this is all new to me, so I especially value your advice. Thank you.

weareallunique · June 1

"She chose me to be her legal guardian and I have the forms to begin the process, but all involved feel it's too early for that."

You may wish to discuss with another elder law attorney in Texas with you, acting as holder of the DPOA etc., as the client. Her attorney has her as his client so they may lean towards "freedom" but with the Doctor's comments it doesn't sound prudent to keep allowing her access to her funds- if she is scammed , signs a check, - how could you recover the assets you are charged with protecting?

If a person has no family to serve as DPOA etc and a professional private fiduciary /conservator is appointed they have their own attorney ,paid for out of the PWD funds,to advise them .The patient has legal representation in court during that appointment process so getting advise to protect you as protector of her assets isn't out of line.

And sadly , PWD , especially the feisty ones can be magnets for scam artists- even at the caregiver or attorney level so what are you waiting for as the trigger to protect her- after the first scam? The scammers are pros , it isn't their first rodeo.

A consult with an attorney can provide insight to avoid any possible financial exposure to you if something goes awry in this limbo period. Good luck.

[Based on comments in this Forum what your sister's doctor prescribed is pretty far along compared to how most Doctor's gingerly approach the issue with their patients . And it is easy for family to mistake force of personality for strong mental function. If someone dithers you may think they aren't focused but if they say "I WILL AND WANT " whatever that is still the product of a decaying brain ].

Out of state sister with early Alzheimer's is stubborn, petulant and resistant to help.

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