When to step in or not step in

[ConcernedSon74]

My mum is 85, lives alone and has been diagnosed with mixed dementia. I live in another part of the country and my brother lives 30 mins or so away from her. We got LPAs for health & finance done a while ago. I am a nurse so am familiar with some aspects of dementia and dementia care.

My brother and I are trying to work out when we should step in and effectively make some decisions in my mum's best interest. She is still very independent in most aspects (mobility, personal care, maintaining her home). She passed her driving assessment two days before she was diagnosed and will be re-assessed in 6 months time. Despite all these positives my mum is definitely starting to struggle with managing her day to day life. Most recently she set her burglar alarm incorrectly and the alarm went off and being deaf she didn't hear it or the neighbours trying to contact her about it. I speak with her every day and she frequently struggles to remember where I live/am. She can almost never recall what she has done in the day or last couple of hours. Periodically she presents herself to neighbours appearing confused and asking them where she has been that afternoon. She had a flood recently which my brother dealt with but one carpet was completely soaked and she wanted to leave it down until my brother stepped in and took it up. My brother and I have not been accessing her bank accounts but have been keeping track of her bills and subscriptions etc and making sure they are still up to date for 18 months or so now.

We convinced her to accept a carer for one call one hour a week to try to get her used to the idea of a carer - she enjoys their company at times but when she loses items she starts wondering if they are stealing things (they aren't, the items re-appear). I would now like to go back to the carers and change the pattern of care and get her for example two calls a day for the purpose of company, orientation and reassurance. My mum will be self-funding and has very unrealistic ideas about what care costs. My question is at what point can we step in and effectively make decisions on my mum's behalf when it comes to structuring and paying for care for her. I am aware of the mental capacity act and think that my mum would probably fail an MCA assessment because her recall is so poor. Is this sufficient grounds for us to go ahead?

 

[ConcernedSon74]

Just to clarify my mum is hard of hearing not entirely deaf. She had hearing aids which she refused to wear and then lost.

 

[canary]

Hi @ConcernedSon74

It sounds like your mum is in mid-stage dementia. Accusations of stealing often appear at about the same time that the ability to manage personal finances is lost.
If you think that she no longer has the capacity to manage her finances, then that it all you need to be able to use the POA.

The only hesitation I have is whether your mum will know/complain. There was a thread on here about someone who had registered the POA with the person with dementias bank (quite correctly as she was withdrawing vast sums of money and getting scammed), but the person complained to the bank, got the POA removed and the family had terrible trouble reinstating it.

 

[ConcernedSon74]

Hi @ConcernedSon74

It sounds like your mum is in mid-stage dementia. Accusations of stealing often appear at about the same time that the ability to manage personal finances is lost.
If you think that she no longer has the capacity to manage her finances, then that it all you need to be able to use the POA.

The only hesitation I have is whether your mum will know/complain. There was a thread on here about someone who had registered the POA with the person with dementias bank (quite correctly as she was withdrawing vast sums of money and getting scammed), but the person complained to the bank, got the POA removed and the family had terrible trouble reinstating it.

Thank you for this. I appreciate you taking the time to read and reply. It is useful to hear about the experience of that person you know. My mum's reaction to us supporting her generally fluctuates very much (sometimes open and willing other times very dismissive etc) so will probably have to think about how we manage that with the bank when we approach them.

 

[Pineapple16]

Thank you for sharing your story. It’s really hard isn’t it! I like you live 200 miles away and still work, but my brother does live with my mum. Your mums done well to pass a driving assessment . We had to sell my mums car back in March due to her having a couple of accidents and driving into the neighbours wall and taking it out completely. Yet every day, she’s convinced someone’s stolen the car and totally believes it was there earlier, because she went to work and done her shopping in it. She hasn’t worked since October last year. Us 3 children believe care would be best because of the social interaction, as she has no friends or family nearby and my brother works full time. Our issue is she still doesn’t believe she has ANY issues and is very argumentative and refuses all offers of help. We too have Power of attorney for both things. She is middle stage Alzheimers and is going downhill fast. How does that convincing her ever kick in when all we are all trying to do is help and do right by her. I feel for my brother getting told every day not to come home. He’s 42!

 

[canary]

Hello @Pineapple16

Our issue is she still doesn’t believe she has ANY issues and is very argumentative and refuses all offers of help

Im afraid that your mum has a very common, but little talked about symptom of dementia called anosognosia - where they lose self-awareness of having anything wrong with themselves and think that they have not changed at all (although they might admit to a poor memory).

Im afraid that you are never going to convince her that she is going to need help because in her mind she is still doing everything that she used to. So Im afraid that you are going to have to use subterfuge and being economical (if not downright creative) with the truth. You will have to come up with a "reason" why she should do things, that fits in with her world view. If you want her to go to day care call it a "lunch club" that she has been specially invited to. Some people have suggested that their relative has a little job there (get the staff on side if you use this). If you want to use a befriender then introduce them as a friend of yours who is perhaps a bit lonely. Lots of things can be passed off as "Something the Doctor Advises" or a "New Government Initiative". Get the idea? xx

 

[NickP]

Hi @ConcernedSon74
Your mum sounds very similar to my mother in law - she is also living alone and in complete denial that there is anything wrong - in fact she has effectively banned my husband from visiting as she is so angry at him for suggesting that she might have forgotten things/ got confused etc. She also accuses people of stealing (when they havent) and is beginning to make things up, like emails/ letters she has received about meetings in random places etc. which she then can't show anyone (because they don't exist), going to the doctors (when she hasn't) etc.
We cannot get her to accept any help at all and are also wondering at what point to step in and 'over rule' her. We have LPA for finance but not for health/welfare.
My dad has Alzheimer's too (further along than MIL) so we are sadly all too familiar with the challenges of getting Social care or GP involvement.
@canary 's advice above is really helpful - we have certainly found being flexible with the truth worked well at this stage with my dad... a carer coming to help my mum with cleaning (but then sits and chats with him), a friend of ours wanting company taking him out (a carer).