I received some great tips from a friend who deals with hospice patients professionally.
Back story: We have struggled and struggled with my MIL because she is extremely bullheaded and is in late moderate dementia somewhere between a stage 4 to 5. Bullheaded might not be a strong enough word. We tried to get her to wear a fall indicator. She refused. We tried to talk her into assisted living. She hears nursing home and refuses. We tried to get her to use a shower chair, she refuses, walk in tub - she refuses. Home health care- she refuses. A phone with more handsets to place around the house - she refuses. Hearing aids - she won't wear and is not almost deaf. Walker - she refused until she fell a few times. She now sometimes uses, but often furniture surfs. She hasn't cooked in 2 years except to reheat. We have tried to take her to the beauty shop for hair shampoo and trim. She refuses although she says her hair is a mess. Her doctor agrees she would do much better in Assisted living, but we can't force that to happen. My MIL is not quite bad enough to be declared incompetent. My hospice nurse friend says we are falling into a gap in the care system. She went to the ER a few weeks ago as she fell and could not get up. The ER was going to send her home without making sure she was able to walk again even though I told them this was the second time in 10 days she had fallen and could not get up.
1. Security cameras in the house so you can monitor them from your house. This is super good if LO lives far away.
2. Some states will allow doctors or family to have their drivers’ licenses yanked as unsafe drivers. They will have a chance to challenge this, which might include a retest of driving.
3. Freezer meals and easy to reheat pantry meals, meals on wheels or just stocking their fridge with grab and go food if they are not cooking. Protein shakes, maybe mixed with ice cream provide needed protein.
4. If the person is fairly inactive, they may not need many calories.
5, Foods with a lot of taste are preferred. They will go for sweet, salty or spicy foods. My MIL has been devouring fresh pickled cucumbers because of the strong taste.
6. Hygiene will probably be an issue. They may wear the same clothes for weeks. Or refuse to bathe. Or wash or cut their hair. You will have to let this go if they don't comply with offers of help. This may cause issues with infections, sores etc.
7. If you can get them to use a shower chair, that will help. My MIL refuses.
8. When they get sent to the ER, the magic words are" I request a consultation with social services." This will get them evaluated for being safe to live at home. VERY IMPORTANT. Otherwise, if they find no injuries, they ship them home as fast as they can. This is mostly because of insurance regulations.
9. Do not help them up if they can't get up. (you will spot this with the security cameras) Call 911. Have them taken to hospital. Have this on record.
10 DOCUMENT everything. Falls, eating, grooming, hygiene, changes in habits (napping more, watching less or no TV), food left out too long, unsafe activities showing lack of good judgment, confusion, repetition of same things, unable to recall events, not remembering names of familiar people, fabrication of events, any changes.
11. Take over their bill paying and finances. My MIL was purchasing car and home warranties thinking they were bills. We put all utilities on autopay.
12. Watch their mail for important documents or have their mail delivered to you.
The outcome will always be death. You won't change that. While we should want good care for our elderly ones, we can only do what they will allow until they reach a certain point. There are risks of an earlier death or serious injury that a facility might be able to prevent, but even there, falls will still happen.
Several years ago I was in the waiting room in my doctor’s office. There was a man seated next to me who looked very anxious. He started a conversation with me about his mom.
We live in a hot climate and he said that he hoped that he wouldn’t have to wait very long before seeing his doctor because his mom was waiting in a hot car.
I asked him why couldn’t she wait in the office with air conditioning until he was finished with his appointment.
He told me that he was the primary caregiver for his mom who had late stage Alzheimer’s and that she would not be able to be left alone in the waiting room while he saw his doctor for his high blood pressure and other issues.
So, he felt like the only option was to lock her in the car and hoped that she wouldn’t try to escape. I felt awful for he and his mom.
I asked him if he had any help. He said that he had a younger sister who worked full time. She was a single mom. Since he was retired he became the caregiver in the family. Apparently, he didn’t have any outside help so he could go to his doctor appointments.
He went on to tell me that one day he couldn’t take anymore and needed a break. So, he decided to lock his mom in the house and go for a walk to calm his nerves. When he got back home he was met by the police. Neighbors saw him walking and reported him for leaving a vulnerable adult alone.
It’s such a problem for caregivers and their parents who need care to be in these situations.
Caregivers will constantly be on edge. Parents don’t always know what is best. Something has to give. Somehow they have to be forced into being placed. It’s a tragic situation for many people.
1. What is the difference between springing and immediate POA?
Springing means there are conditions that need to be met before the PoA is active (usually 1 or 2 medical diagnosis of incapacity). Durable (immediate) usually means no conditions need to be met and that it is up to the agent to have the PoA's input or action.
2. What happens if there is no POA? (we do have POA)?
Guardianship either by a family member or appointed by the court. No one can legally operate in another person's behalf (financial and medical desicions, managing their affairs) without going through the courts to make it official.
3. Can their PCP order assisted living, memory care or nursing home? Who else can do that? Does that vary by state?
It can vary by state, but they usually "recommend" it, not order it. They have no legal power to enforce this. Usually the facility has to also assess someone to make sure they are placed where they can get the most appropriate level of care.
4. How does medicare, health insurance and private pay vary on how they come to live in a care facility? We were told it is better if they come from hospital to care facility as medicare will pick up some by both a lawyer and a nurse.
There is a longer answer to this question but for the most part, Medicare doesn't pay for permanent, ongoing facility care. Long-term health insurance can pay for some of it, but it depends on the policy. Private will get you anything as long as you can afford it.
5. How do you get a resistant person to leave their house? Straightjacket? Medicate them? The sheriff? She will fight tooth and nail to stay in her house.
Either they go directly from the hospital to the facility, or you have to make up a therapeutic fib to get her there voluntarily. Medication helps if the person is agitated or anxious and the doctor thinks she needs it. Stubbornness is a primary feature of dementia.
1. What is the difference between springing and immediate POA?
2. What happens if there is no POA? (we do have POA)
3. Can their PCP order assisted living, memory care or nursing home? Who else can do that? Does that vary by state?
4. How does medicare, health insurance and private pay vary on how they come to live in a care facility? We were told it is better if they come from hospital to care facility as medicare will pick up some by both a lawyer and a nurse.
5. How do you get a resistant person to leave their house? Straightjacket? Medicate them? The sheriff? She will fight tooth and nail to stay in her house.
My MIL's PCP said most people chose to go hospital incident to care facility. Also there is this diagnosis called "change in mental status" for ER admits. It is used a lot on older people.
Also I would pick up an uncooperative toddler and put them elsewhere. I can't pick up my MIL w/o risking my back or something will get injured
One of my pet peeves was that Medical staff asked my Mom. "Mrs E would u like to go to therapy, would you llke to shower" of course she said no. I told them never ask just do it. Say "Come on Mrs E time for therapy or time for a shower" My daughter has worked in NHs over 20 yrs. She allows her residents to think they decided. "Mrs E, wouldn't you feel so much better with a nice shower and clean clothes" She usually got a yes.
At this stage ur MIL should not be left alone. Be aware, mental decline can happen over night. They do become like toddlers. When she says no, think about how you would talk to a toddler when saying no.