How to get a parent presumed to have dementia to a geriatric evaluation when they refuse?
I am a long distance caregiver with a parent in an independent senior living facility. Dementia seems to be getting worse and there is talk of possible eviction. Parent thinking I am trying to have them committed.
vstefans...I feel the same about the change and hope medication (which she has previously refused) will help. Unfortunately, up to now she has carried the stealing paranoia with her from home to the senior facility and has only gotten worse and more dramatic. Hoping this evaluation, proper meds, a new start and more attentive care will do the trick. We'll see :)
Mman, I hope this all works out for the best...and it probably will if you have a good SW working with you to help. Many years ago, my MIL needed a geropsych; she never really did great, but she really needed to be out of the hoarded, horribly unsanitary home they rebuffed all help with, and my FIL relieved of trying to take care of her in it. I did better by my mom by keeping her out of one; she had acute medical issues that caused the increase in seemingly irrational behavior, and presumably they will do a good medical eval for your mom too. Sometimes medication is desperately needed, and something ought to be tried to see if Mom can have some relief from the paranoid delusions...people with those often suffer intensely as they live with great fear and hypervigilance. Sometimes a change of venue is the best thing in any event, even if the person is less confused they will associate the old one with their distress and never adjust or readjust, even if it was basically a good place.You sure have my prayers things will go better from here on out.
Thanks for your helpful advise and sharing common experiences, really helps knowing how others have gotten through similar experiences. Since I posted question, the problem got solved in a most unusual way. Mom was trying, in her own way, to cause trouble for her senior facility...she called 911 to complain of abdominal pain claiming she was not being fed and they were abusing her. Paramedics were quick to see she was irrational and not making sense with her rambling. Once she went through tests at the hospital that came out fine, the Health and Wellness Director from her senior facility made the Dr. aware of her past behavior, let it be known that she needed more care than they offered and needed to be evaluated. She is in an independent living senior facility that offers assisted living. She was transferred to a hospital that offered psych evaluation and is currently being held on a 5150 which is an involuntary hold for 72 hours. The best part for me is that she facilitated this on her own, even though I'm sure at some point it will get twisted around and I'll get the blame. It is one big hurdle overcome and she will get the help she needs. Now I will wait for the next chapter and work with the social worker to find a suitable facility.
I should explain that the senior facility had a large folder on my mother. She had been calling every state official ,ombudsman and policeman with delusional and paranoid thoughts. There was lots of documentation to back up their claim. Her last obsession was with her clothes. She was convinced the staff was wearing her clothes and returning them dirty...she saw track marks on her arm where they were shooting her up to keep her asleep so they could turn the lights on to get her clothes. She didn't sleep for 3 days while she continually washed her clothes. She claimed the phone would ring every 15 minutes with them trying to see when she left the room. We all knew she was way overdue for an evaluation.
I forgot to add this part about being a long distance caregiver....as I am one too....and one of the best things I've worked out with Mom's physicians is to get their fax numbers, and/or email addresses. Then, I don't have to travel to go to every app't and I can fax or email her list of concerns that she has plus put in my own areas that I think need to be evaluated too....and it all stays confidential and not totally shared with her too. I do have the medical POA which helps with this. But operating from long distance, you really need to establish acceptable ways to communicate with MDs before during and after the app'ts. Her primary care doctor will often phone me during the office visit to summarize what she is telling Mom or to ask an additional question...which is very helpful to both of us.
Ferris1 has some great points per my experience with 3 dementia units in the past year. An AL facility or a nursing home cannot properly care for dementia when it reaches a certain point. My Dad is doing very well now that this third facility does NOTHING except dementia care. And it has MDs who specialize in geri-psych/dementia care. They do make house calls and know how to utilize meds much better than the docs affiliated with the last two places. And re: the mental health testing for dementia. We had to have my Mom tested last summer and I knew she was enough of a pistol that she would never agree, so I approached her MD about ordering it and making it part of an assessment as to whether or not Mom was able to stay at home without a caregiver coming, since Mom wanted no more caregiver in house helping her, once she could walk without her walker again. I even took all the paperwork for the referral and filled out as much of it as I could for the doctor, just to make it easier....and it was the doctor who suggested that Mom have the eval. I arranged for the eldercare caseworker to offer to take Mom to the app't to assure that Mom would not cancel it too. Worked great, except the psychologist never contacted me for any input or history so there's lots wrong with it based on the history she gave the doctor....but they did diagnose early dementia and my mom was totally angry and still doesn't want to believe it. They want to reassess her in six months which will be in January and I'm sure I'll be dealing with this again as Mom will want to refuse to be tested again. She had a very difficult time focusing on 3 hours of testing at one time and remains angry at the results! I intend to ask to be consulted this next time, to point out changes in behaviors/memory and correct historical data given the first time. So I say, work with her doctor and get the doctor to suggest the testing.
Why would the facility want to evict, other than they are not a complete care facility. Trying to care for dementia patients takes strict guidelines and definitely a gated facility. There are doctors who make "house calls" and the standard test for evaluating dementia is pretty basic and has pre-set questions and diagrams. Talk with her doctor to do the Medicare dementia test. Start researching places just in case your mother is evicted. Good luck!
This is how I accomplished w/Mother. Though I 'lucked-out' on this aspect, there are -will be- others situations that have not fared so well. Creativity is needed, which is a known element for us here and those that will follow.
Having been introduced to a former co-worker of Mother's time with 'Meals on Wheels' program, this person now works with NYS dept. of Senior Protective Services. Then, after discard from Mt.St.Mary's (five times this year alone), Catholic Services had 'home visits' for two weeks after. Also as mentioned prior, there is Dept. of Aging resources. Another avenue that was used in Western NY, was CSC in NF.
With all the attention Mother received, though she was quite reluctant at first, information was shared and received. This has garnered acceptance that various people will be coming and going, in and out, to assist in helping the situation. The cost of the testing is approximately $150. In our case, we were fortunate to have someone come to the residence and perform the testing. That was a Godsend; because it was Mother's 'home tuft' and less stressful for her.....so much so, that it was 'fun'(?). When Mother said it was 'FUN', that was a shocker. Anyway, the results did confirm the lack of cognitive memory.
It maybe to late to attempt this your situation, but worth a shot. As for the "talk of possible eviction", there facility can not, by law in most every, just toss a resident to the curb. There are legal procedures that must be followed, including the possibility of court appearance w/judge.
My sister and I faced a similar situation before a stroke forced Mom from her home into an assisted living facility. We wanted her to have a geri-psych eval because of her paranoia (i.e., calling the police every day to report "stolen" things). We were afraid the police would appoint a guardian if we couldn't get her some help. We got around her reluctance by coming out to where Mom lived at the time and bringing her to a full-workup geriatric clinic at a nearby university where they did a swallowing test, checked all her meds for interactions, did diabetic nutrition counseling, gait/balance test, etc. The psych eval was part of the package, and since she was intensely interested in the other stuff and liked the focused attention, she actually was agreeable to having it all done. Does your parent understand the implications of eviction -- that it's coming from the facility? Is there someone from the facility who will sit with them and talk about this? We have to do that NOW with Mom, at the ALF. Her behaviors there are about to land her in Memory Care (which would kill her; imagine paranoia in a place where you can't lock your door! Not to mention a tiny room for a claustrophobe!) so we have to set up meetings a couple of times a year where the head nurse and director explain to Mom how she needs to conduct herself in order to stay on the "right side" of the Memory Care door. It helps to hear it from someone besides a family member. Blessings to you as you deal with this. Any chance of moving your parent closer?
9 Answers
Helpful Newest
First Oldest
First
ADVERTISEMENT
I should explain that the senior facility had a large folder on my mother. She had been calling every state official ,ombudsman and policeman with delusional and paranoid thoughts. There was lots of documentation to back up their claim. Her last obsession was with her clothes. She was convinced the staff was wearing her clothes and returning them dirty...she saw track marks on her arm where they were shooting her up to keep her asleep so they could turn the lights on to get her clothes. She didn't sleep for 3 days while she continually washed her clothes. She claimed the phone would ring every 15 minutes with them trying to see when she left the room. We all knew she was way overdue for an evaluation.
Having been introduced to a former co-worker of Mother's time with 'Meals on Wheels' program, this person now works with NYS dept. of Senior Protective Services. Then, after discard from Mt.St.Mary's (five times this year alone), Catholic Services had 'home visits' for two weeks after. Also as mentioned prior, there is Dept. of Aging resources. Another avenue that was used in Western NY, was CSC in NF.
With all the attention Mother received, though she was quite reluctant at first, information was shared and received. This has garnered acceptance that various people will be coming and going, in and out, to assist in helping the situation. The cost of the testing is approximately $150. In our case, we were fortunate to have someone come to the residence and perform the testing. That was a Godsend; because it was Mother's 'home tuft' and less stressful for her.....so much so, that it was 'fun'(?). When Mother said it was 'FUN', that was a shocker. Anyway, the results did confirm the lack of cognitive memory.
It maybe to late to attempt this your situation, but worth a shot. As for the "talk of possible eviction", there facility can not, by law in most every, just toss a resident to the curb. There are legal procedures that must be followed, including the possibility of court appearance w/judge.
Stay strong and be ye ever vigilant.
https://www.agingcare.com/articles/legal-documents-to-make-healthcare-decisions-for-your-parent-146623.htm?utm_source=Notification&utm_medium=Email&utm_campaign=Recommendations&rid=B00BC0BD-4325-4A14-B0DF-0E4F5EE1ACBD
Your will need to convince your parent to sign a Medical Power of Attorney in case he/she becomes unable to make those decisions; it is easier to convince them if you use the example of a sudden stroke rather than the onslaught of dementia. Good luck.