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scrabblequeen Asked July 2021

Montreal Cognitive Assessment score of 11 for Mom living at home alone. How do I prepare for the next step?

She is determined to live in her home but it may not be practical at some point soon. She is almost 95 and the decline in her faculties has been pronounced in the last 6 months. Is there any way to predict what losses she will endure next and how fast I need to move to prepare for them?

golden23 Jul 2021
Good answers below. I would just add that what Mom wants and what Mom needs may be in opposition to one another.

As my mother declined, I (her POA) worked with her doctors to see that her needs were met, and then as many of her wants as could be accommodated.

Prepare for future eventualities now. She could have a major decline any time,

I totally agree that the caregivers needs must be met too. It is a very challenging and draining job. You need to look after yourself as well.

Beatty Jul 2021
It can be hard if you are a 'planner' & there is no set timeframe, known outcomes or plan. (I am a planner).

I would say plan for what you can control. Try not to over worry about the rest - you will figure it out as you have to.

Some things that could make a plan easier & faster to roll into place for you may be;
* Having contacted a care agency (recommended by friends) & know how to proceed
* Having a care agency already in place you can stepup hours & services
* Finding out what residential respite services may be available in your area
* Having 1 or 2 NH or MC facilities you find acceptable
* Having your hospital of choice worked out
* Having paperwork completed regarding end of life wishes / acceptable treatments / DNR.

But most importantly, what really matters to your Mother?
What does home mean to her?

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Geaton777 Jul 2021
My personal philosophy is that the caregiving arrangement must not be onerous to the caregiver or the arrangement is not working at that point. If what she wants is just not practical, rational, affordable, etc., then another plan must kick in. There is no way to predict what comes next as dementia is experienced differently in each person: some may go through all the phases, others not, some in a clinical order, and others not.

Who is her PoA? This person needs to read the doc to see when the legal authority is activated. Elders mostly do not relish change and more so when they are sliding into dementia and change is happening fast. They lose their ability to reason, so waiting for consensus or acceptance would not be a fruitful use of time and energy.

Now she needs either in-home care or to be transitioned into a care facility local to the PoA. Her sensitive info (mail, banking, investments, checkbooks, deeds, passwords, acct numbers, etc) all need to be secured from prying eyes of anyone entering her home. Also any prescription medications for pain (visitors will look into bathroom and bedroom drawers searching for things like Oxy).

The PoA needs to determine what her financial condition is in order to know what the "next step" is in her care. She may need Medicaid (as people often do nowadays). If she becomes unsettled by the changes it is ok to use "therapeutic fibs" to keep her in a calm state of mind since it is for her own benefit. I wish you much success in helping to protect her in the coming journey. May you gain peace in your heart through it all.

Grandma1954 Jul 2021
There is no way to tell how fast a decline will happen.
If Vascular dementia is also involved a decline can happen overnight.
It is a good idea to plan as far in advance as you can, expect the worst to happen at any given time.
I would say plan now for the what if's.
She should not be alone.
Staying in her home is a possibility if it can be arranged that someone is with her at all times.
That the house is safe for her. Are there stairs to worry about? Is the bathroom large enough that she can get into it along with another person that has to help her and a wheelchair or a Hoyer Lift? Is the Shower one that is easy to get in and out of, or is it a bathtub that you have to climb into in order to take a shower? Is it possible to make changes or would the cost be more than it is worth?
Everyone would love to stay in their home where they are comfortable but for many it becomes impossible. It is up to you to decide when it is no longer safe for her.

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