How do I roll with the Jekyll-Hyde transition my mother-in-law is going through?

I have been reading some other postings and will take the recommendations and use them. I think for now, to preserve my sanity, I am going to pull back quite a bit, and observe her from afar and let her do her own thing. If she asks me for help, I am there, but I am going to let her fend for herself. If she forgets to drink her water, so be it, if she forgets to take her vitamins so be it, if she forgets to eat one meal out of the day, so be it. I cannot have her disrespecting me in my home when I am the one who provides 99% of her assistance. It is true that the person who is being cared for will treat their caregiver poorly because they know that their caregiver will always be there no matter what. She is capable of doing things for herself, she just doesn't, and I feel too responsible for her so I do them. Let's see how things go if she really has to fend for herself. I will be there is she needs me.

What kind of dementia does you sweetheart's mother have? How long ago was she diagnosed? What kind of treatment is she receiving?

You say that she can do more for herself than she does. What is the nature of her disabilities?

What is she like when you talk to her and it doesn't have anything to do with what she should remember or be doing or not doing? For example, if you sit and talk to her about what it was like when she was rasing your sweetheart, or whether cakes from mixes are as good as cakes from scratch, etc., is she pleasant then? Does she have other adults to interact with once in a while? Does she go to church or the senior center or an adult day program?

Sorry to have more questions than an answer, but more details might spark some additional suggestions.

Her short term memory is lacking, her long term memory is excellent. If talking about anything other than her to do's, etc., she is pleasant. When talking about her grandkids back in Chicago, she is almost giddy. She cannot balance her checkbook, but I am not sure she ever could. She cannot recall what meds/vitamins she takes when we visit the dr. She cannot recall her doctors names and what each one is for. She cannot recall what the dr tells her during her visit once we get home. She canot make decisions regarding her health and turns to Mark and I to make them for her. She forgets to return phone calls. She has trouble dialing the telephone and leaving a sensible message. She gets frustrated and impatient with clerical people in person and over the telephone. Often times she reads her bank statement and cannot understand what she sees. We have to sort through her mail and take out the magazine subscription offers because she will order them, send them a check and then forget that she ordered it so when it comes she says she does not know why she got it. The other day we went to the ATM and she could not recall what her card looked like. She wanted to use a deposit slip to withdraw money. She rifles through her wallet for her ID and Kaiser card at the dr and it is right in front of her. She often wears mismatched clothes and shoes, and dresses inappropriately for the weather. She was tested two years ago by her PCP but she rose to the challenge and passed the tests. She is physically able to do most anything, but she sits in her chair all day every day unless we take her somewhere. She will wait for others to do everything for her before she will do anything for herself, and when she does it is half way. She won't prepare any meals for herself, but will settle to make herself cereal. She won't make her bed with the clean sheets but rather lay them on top of the bed and lay on top of them. When she wets the bed, she will lay in the wet sheets and then let the wet sheets dry and still sleep in them. Her room reeks of urine but it does not bother her. She wears adult diapers at night and during the day. We have had a few accidents during the day but it was when she chose not to wear the adult diaper for some unknown reason. She will wear dirty clothes rather than do her laundry. She will let her hair look like a mop rather than run a brush through it unless we are going somewhere. She won't pick up her room until the housecleaner comes twice a month. She won't put her dishes in the dishwasher, she won't use soap to wash then by hand. If you did not know better, you might think she was lazy. She forgets to take her pills sometimes and we have tried and tried to get her to drink more water (she has had problems with gallstones this year on three seperate procedures). She forgets to eat three meals a day unless someone makes her lunch. She watches the TV all day and sort of zones out. She sleeps 12-16 hours a day, yet her drs don't seem all that concerned. She recalls alot of things regarding Marks childhood but yet he is continually surprised at some things she does not remember. She loses track of time, what day it is, etc. She does not help with the cooking, picking flowers, vegetable we grow, giving the cats food and treats, loading and unloading the dishwasher, preparing to eat, cleaning up after eating, etc. I take her grocery shopping with me and she pushes her cart around with me but doesn't suggest anything, express interest in anything. The other day I had her select flowers to bring home and she could not make a decision so I had to say "how about this bunch?". She does not drive, and even though she has lived with us for two years, she cannot figure out where places we go all the time are and she looks around and is lost all the time. She has been to the senior center a few times, but had not wanted to go without one of us and now not at all. She used to be very social but not any more. We go with her and she sits and listens but doesn't say much. They all love her there and want to see her, but..... She has no interest in church lately, she says she does not get anythng out of it anymore. This is a cradle catholic mind you! She lost her balance and fell a month and a half ago while we were visiting relatives in Oregon. Tonight she almost fell again as she lost her balance and fell sideways into her recliner. She has a deluxe walker so Mark told her she has to start using it. She has had it since February but doesn't use it. She agreed. So she has not been officially diagnosed, she is on an antidepressant and has been for about a year. It has helped some we think. She started at 20mg and is now up to 100mg. Fall and Winter are the worst for her, she becomes quiet, withdrawn, isolates herself and does not talk to family or friends, no interest in anything except zoning out on the TV, no desire to get dressed, eat, etc. Spring and Summer she perks up and this is when we see the gradual transition from cooperative, obliging, appreciative, working well with us to the snarky woman she has become in the last couple of days. Yesterday she was snarky yet today she recalls none of it. Same the day before. If you ask her about it she recalls the events entirely different than what actually happened. Then about the end of October she starts going downhill again. This is how it is basically.

Wow! What a thorough description. Thank you. So, basically your MIL has dementia and that is the reason she needs care. Personally, I think you should take her to a specialist (not the PCP) and try to determine what kind of dementia she has and get a treatment plan started. Ignorance in this case is not bliss. (Knowledge, alas, isn't bliss either, but it can help improve both the patient's and the caregiver's lives.)

Of course she doesn't recall her snarkiness yesterday. She has dementia, remember. :)

Setting boundaries with someone who has dementia is very different than doing the same thing with someone who has no mental impairments. Letting her skip meals is not going to teach her to remember meals. If she could do that, she would be doing it. She may remember the meal she had on her 9th birthday, but she may not remember whether she has eaten lunch today or not. It is not her fault. Can't you just give her lunch while chatting about something pleasant. "Here's a nice grilled cheese sandwhich. I loved those as a little girl. I wonder if your grandkids like them?"

How about making the bed with her, or having her son do it with her? Making a bed takes more than physical ability. It is a process of many steps, which must be done in the correct order. This is beyond many people with dementia. Depending on what kind of dementia she has she may have visuospatial impairment which would make it very difficult to put dishes in a dishwasher and do many other tasks that she seems like she should be capable of.

If the pills are not important to her well-being, I'd stop buying them. If she benefits from taking them, then letting her fend for herself with them would be, to my way of thinking, cruel.

Could you minimize the amount of talking you do about the help she needs? Don't ask her if she's taken her pills. Take charge of her pills and give them to her each day. Serve her lunch. Give her a nice glass of water or occasionally lemonade or gingerale, and give her another one when that one is empty. She does not like the fact that she cannot remember these things for herself any more than do you. If most of your talk is about pleasant things (Mark's past, the grandkids, her childhood, your childhood, etc.) and you do minimal talking about what she is doing or should be doing, maybe she'll relax and be a little less snarkly. (And maybe not. It is worth a try, though.)

Please, have her evaluated by someone who won't be fooled by her showtime efforts. Give that someone a thorough description of what she is like at home. I think that all three of you would benefit from an official diagnosis, and an appropriate treatment plan. Then you and Mark can read up on how to cope with dementia behaviors, and you can also begin to think ahead about how you will deal with the inevitable progression of the disease.

I agree. This is a roller coaster ride that isn't any fun at all.

Thank you very much for the insight and helpful suggestions. I think I was in a bad place when I said I was going to back off. I am still paying very close attention to her needs she just does not realize it. I have ceased talking to her about her to do's and she is fending for herself very nicely so far. I am also having Mark remind her of her to do's and such as she is willing to listen to him right now over me. There will be days however, when she will forget and I will take over. I know that you are right when you say she doesn't like what is going on with her, I know she knows she is different, and I can see how her snarkiness is her way of venting her own frustration. Getting her evaluated will be difficult but we will try. She was very upset with us when we had her PCP give her some tests two years ago. But I agree we do need to see where we are at exactly so we can start a treatment plan of some kind. Thanks so much for the help, we need it.