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Read my former post for more context. I have some caretaker duties for my disabled mother. She moved close to me recently, but her negative attitude continues and she has been treating me very badly.





Before she moved closer, I told her that moving closer did not mean I would see her more often, but that it would be easier to help her, and I would try to come and make dinner twice a month. I have kept my word.





Every time I see her, it seems she wants to make me upset by either ignoring things that need attention or by saying things that elicit a negative reaction.





1. She and her apartment are in a poor state. She won’t ask the PSWs to help her – I think it’s pride.
- floor has food and spills
- soiled bed underpads haven’t been replaced
- wears visibly dirty clothing and the same brief for multiple days
- sometimes refuses to shower for 5+ days (selective about PSW)
- having accidents on her lounger and denying it (I put a test sheet on and it got soiled, so now I have been putting disposable underpads on it)
- we hired someone to come every 2 weeks to do some cleaning and cooking





2. Will not address major health issues on her own.
- very bad swelling and redness in her legs
- said that a nurse told her to keep them up and soak in cold water (she is diabetic – foot soaking not recommended)
- went nearly 10 days in this state before I strongly encouraged her and took her to the hospital
- refused T3s and howled in pain for hours at emerg
- doctor said it’s cellulitis due to a small cut on her leg
- needs 2 weeks of IV antibiotics
- refused to stay overnight and was sent home with no guarantee for a nurse visit
- luckily did get a daily nurse visit for antibiotics
- legs are better but are still red and swollen - she doesn’t want to go back to the hospital





3. Zero critical thinking – forgot about 911.
- slipped off her bed with her phone and couldn’t get up
- has a medical device and tried and failed to get through to someone
- tried to message me very early then called me 2 hours later asking what she should do
- I asked why she hadn’t called 911 directly – she didn’t think of that
- she cancelled the medical device service





4. Forgetting the obvious – she cannot drive.
- she referenced driving in the near future
- I reminded her that her license was taken away after the stroke
- she said she still has it
- I reminded her that it was taken away because she has paralysis on one side
- she said she doesn’t need that side to drive





5. Inviting danger/risk – intentionally talking to online scammers.
- was contacted by and accepted social media scammers as friends
- I showed her how/why they are fake profiles
- she believes one is actually that person and asked if I would drive her to meet him for lunch, after she initially was going to invite him to her address!!
- keeps accepting more of them as friends, and now I am getting requests (and I’m sure her other friends are too – I hope they don’t fall victim)





7. Get her a cat because she said so.
- keeps demanding I get her a cat
- cannot care for it (feed it or scoop litter)
- I cannot take it if something happens to her
- demands that I care for it since I live close (not going to happen)





8. Being an entitled jerk – drop what you’re doing and help.
- demanded I come on NYE to fix her dvd player (disc was stuck)
- I told her I couldn’t and had been drinking
- called me the name of someone we know who is particularly rotten to their own mother
- next day I asked her if she was going to apologize and she said no, that I was the rude one for not helping her
- I hung up on her





Is she just mean, in denial or is she losing it? I cannot just cut her off since I feel obligated to help and she can’t function on her own, but now all I want to do is bare minimum to avoid being near her – it’s sad.





TLDR; My mom, a stroke survivor with paralysis, doesn’t care about her health or acknowledging that she needs help, and is being verbally and mentally abusive to me.

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I went back to the beginning of your thread and read that your “mom will not willingly move into any kind of assisted living or nursing home”. This is clearly because what is happening now is ‘good enough’ from her point of view. It will only change when what is happening is NOT ‘good enough' from her point of view.

Have you thought about how to get to that point, preferably without danger to her and while protecting you too? Propping her up to 'just good enough' is not doing either of you any favors.
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SoloSheGoes Jan 19, 2024
I think NOT good enough will be a dangerous point. Other than the hospital visit with cellulitis, I think with additional personal care, which she is willing to do, it is manageable. During her assessment, they also requested a nurse visit to do check-ins (we discussed monthly) and clarified some of the duties she needs done. Hopefully these will come to pass. They also added her on the wait-list for AL.

A lot of the issues stem from her behaviour. I would be much more inclined to help if she wasn't so rude and inconsiderate when I do. I have had to walk out of hang up min multiple instances because she loses her temper to a level that is not acceptable.
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Was it a neurologist or the PCP who gave the test?
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SoloSheGoes Jan 19, 2024
It was out GP - she didn't seem very concerned and didn't suggest further assessment. I did specifically use Vascular dementia vs. dementia on the email I shared.
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How often do PSW’s no show ? That doesn’t sound good …
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Beatty Jan 10, 2024
Depends very much where you live & how big the agency staff list is.

A smallish problem if client is fine to reschedule.
Much bigger problem if client cannot get out of bed, use toilet, feed self or take medications.
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Update: She did the memory test (MMSE test) at her doctor's office and passed with flying colours. I did share in advance a list with the doctor of the above outlined concerns in summary via email (for internal reference only) and she didn't indicate any concerns during/after the test.

Seems either from the stroke or from just being herself, this is not related to memory issues, according to this test... I do not understand it at all based on her behaviour (unless she is specifically choosing to be this way, unclear why someone would do this/act this way).

She does have a home care assessment coming up, so we will see what comes of that.
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Beatty Jan 10, 2024
Fantastic Job getting Mom to the Doc!

Screening tests like MMSE are just one tool. Others like kidney function, bloods, infection delerium all can be screened out too.

By the way, the MMSE does have some limitations. From a MMSE website:
'A high MMSE score does not necessarily mean that you don’t have cognitive impairment. Similarly, a low score does not necessarily mean that you have dementia'.

In my (limited) experience, memory can still look ok but it is planning & reasoning that become 'tricky' with Vascular Dementia.

Family can notice subtle changes 2 years before a clinician does. (I did).
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Solo,
Please see my response to you below my original comment on this below.
Heart out to you! Alva
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Solo, I guess your next steps are to have a good think about how involved you want to be.

Report a vulnerable elder to APS.

Attempt to get Mom to her Doc for that 'check-up' (for discreet short cognitive screening tests). Attempt to gain enough trust & influence to get Mom to the next stage of neuro testing. Get knee deep in her finances, get financial advice & see what is adfordable in the world of Assisted Living.

Stage a takeover, either by discussing & gaining POA then running her life. Or full legal Guardianship through the courts.

My gut feeling here, since you mentioned twice a month dinners being your thing.. is get OTHER PEOPLE involved.

Basically, decide if you want to get other people to see the reality & help tow her little boat safely to the shoreline or row the boat yourself.

No judgement! (I jumped ship years ago).
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MargaretMcKen Jan 4, 2024
If OP has limited contact to 2 dinners a month, it doesn’t seem appropriate to suggest “gaining POA then running her life. Or full legal Guardianship through the courts”. Surely OP doesn’t want that level of responsibility?
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Another medical term to research is Anosognosia. It is quite common after stroke.

From the net;
"Anosognosia is a self-awareness disorder which prevents brain-damaged patients from recognizing the presence or appreciate the severity of deficits in sensory, perceptual, motor, behavioural or cognitive functioning, which are evident to clinicians and caregivers."

It was dx in my LO post stroke, who has many of the symptoms you described.
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SoloSheGoes Jan 5, 2024
Helpful, thanks - I'll run this by the GP :)
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I saw your response to my response, I hate to tell you, but it's your expectations that are wrong. Forget everything about a normal relationship because you are dealing with someone whose brain is dying. You will never know which parts are going to be powered at any given time, Which memories or behaviors will be triggered.
For example, with dementia and with brain damage, when you bring up something, they very will often acknowledge it, but that is a social function of the brain and not a realization or agreement. They will still not understand.

Your mother needs to be diagnosed ASAP, and she needs a neurologist, not her PCP, to do it. She needs someone to be her guardian because from what you wrote, she is past deciding on a POA. And then the guardian (or State) will decide where she lives. Momma doesn't get to decide anymore because her decisions leave her at high risk.
Also, her finances need controlled, which would keep her from getting scammed.
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SoloSheGoes Jan 5, 2024
That's the scary part - I am working on getting her diagnosed/referred to be diagnosed via her GP, but it's a sensitive issue because apparently the patient needs to be made aware that they are doing a memory test and being assessed. She is going to lose it on them if this is the case.

I am POA of her bank account, so I went yesterday and removed her telebanking option from the account and took away her debit card and checkbook (she doesn't go out anyways due to mobility limitations, so hoping she won't miss these). The bank said this is the limit of what I can do as a POA because they can't remove her from her own account. They said even if someone comes in with dementia and wants to send a money transfer, so long as the person answers the reps questions to try to make them think twice (e.g. How long have you know this person? Are you sure you want to send this money?) and they still wish to proceed, there's nothing that the bank will do to stop them. I was pretty shocked to hear this.
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Well, look. Mom never should have been moved closer and expected to live "independently." She clearly can't do that (but good for you for sticking to your plan of going over only twice a month and making dinner.)

Yes, stroke can cause brain injuries that worsen. She could be having ongoing silent strokes. She could have mixed dementia, meaning that it's more than one dementia affecting her brain. In other words, stroke injuries to the brain plus Alzheimer's or Lewy Body dementia. It's hard to sort all of that out, and you may not need to. They are progressive conditions and won't get better. You'll be treating her symptoms, not the diseases.

Mom needs 24/7 care and there's no point in thinking that can be accomplished in her home. She has to go to a facility where professionals take care of her. Start discussing this with her medical team and get her there somehow. What you and mom are doing isn't a viable solution.

Good luck.
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SoloSheGoes Jan 5, 2024
Thanks for the advice - I am working on next steps with the doctor on assessment while tippy-toeing around her.

I visit her for "social time" twice a month, with a focus just on making dinner and spending time together. I actually visit her 1-2 a week outside of this, as I have to deliver groceries, deal with medical appointments and calls from PSWs and nurses, do tasks the PSWs won't do, do laundry and help with cleaning. It's very draining, especially with this behaviour and attitude to try to manage at the same time. :'(
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You know how I feel about PCPs, they know a little about everything and alot about nothing. Get Mom to a neurologist who will give her a complete cognitive test. Your Mom has Dementia and can no longer make informed decisions. She has lost the ability to reason. She does not see how serious her health is because she is not there in her mind. Its OK if you can't or do not want to care for her, so she needs to be in a facility. MC if she can afford it, LTC with Medicaid if she can't. I hope you have immediate POA, if not get it invoked ASAP. Its no more asking Mom what she wants its "just do it" on ur part. You make the decisions, its now what she needs not what she wants. It made my life easier when I realized that I now had to make the decisions. I was POA, so no running everything by my brothers. A decision needed to be made and I made it. Good or bad.
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SoloSheGoes Jan 5, 2024
I have a POA document, but I am here in Canada, so I'd have to even check with the doctor how this gets enforced. I really don't want to go there though (see reply to AlvaDeer below) - she will not take it well at all.

Waitlists for LTC and assisted living here are long, but I am trying to work with the doctor to get her assessed and figure out next steps.
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Call APS.
This is a senior severely at risk and you can do nothing about that.
Let them know all the above. Ask them to visit and open a case.
If you are POA I would consider having APS help you resign that and would place Mom in the care of the State. If you are NOT POA, don't accept that duty, or guardianship or conservatorship.

Your Mom needs placement.
I doubt she will allow that.
All things given, your telling us all of this and with the addition of the infection, Mom may well pass of sepsis, which is a relatively fast death. You may be looking at end stage of life for her without treatment.

I do not think there is a lot you can do for your mother. I know that you know that putting a helpless cat into this is nothing short of animal cruelty. As Mom likely cannot get out to get a cat, hopefully that is the end of that portion of this tale of woe. If she DOES get one, please remove it to a shelter before it suffers.

I do not know if your mother has been diagnosed with mental illness, with dementia, or with both, but it does sound on the face of it all that this is what is going on here. Given her adamant nature I do not think you will be able to do anything about this other than report her to the authorities for care. Once a Fiduciary is put in place your Mom will be cared for and you will be free to simply visit her.

Sorry about all of this. Can't imagine it. Couldn't function in it and doubt anyone but the State will be able to. Sometimes things cannot be fixed. They can lead to death, but that is where all paths lead to in the end.

PS.............if there is a car it needs disabling.
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SoloSheGoes Jan 5, 2024
Thanks for you reply Alva - I would feel so guilty making that call (I am in Canada, so slightly different process, but still). I know she is at risk and even before things got worse, she was aware as well (I posted 1.5 years ago about health concerns too) - she has no concern for her health and for all she cares, she would prefer to get sepsis if it means she doesn't have to go to the hospital. I am currently working on getting her to go to the ER - her nurse said she needs more antibiotics, but our the family doc will not issue more antibiotics without seeing her and we are far from their location (plus she pissed off the receptionist and doctor today being rude apparently and demanding that she speak directly to the doctor so she doesn't have to come in...). I hope they don't remove her as a patient for her behaviour.

I only have POA on her banking account, nothing else. Things will not end well if I enforce it for all other areas of her life. I would seriously worry about suicide if I did that (since she's brought it up before).

I have asked the family doctor how we can approach getting her tested - patients are made aware when they are doing a memory test, so I'm trying to work it in as a 'routine' check. We'll see if the doctor agrees (if she'll still see her).

There will be no cat - she can't get one on her own and I won't do it for her. She will nag until the cows come home, but I won't do it. She does not have access to a car directly, so should be ok there.
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All I can say after reading all you wrote is....OH MY!
I do hope you realize(and if not reread your own post)that your mom should NOT be living on her own as she now appears to be suffering not only from her stroke, but also from some form of dementia(more than likely vascular).
Her brain is not only affected from her stroke but now also from the dementia, and things will only get worse.
She really needs to be placed in the appropriate facility where she will receive the 24/7 care she requires and will be safe. She is no longer safe to be living on her own. Period.
I wish you the very best in finding the appropriate facility for her .
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SoloSheGoes Jan 3, 2024
I agree with you. I've brought it up before and so did her medical team after the stroke - she completely dismisses the idea of even considering assisted living or a home of any kind. Waitlists are also years long and even subsidized, it is still expensive - not sure what she would do in an urgent situation.
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"My mom, a stroke survivor"

This.

Stroke is a brain injury. It can cause damage to cognition, apathy, depression, lack of insight, lack of reasoning.

Some stroke survivors recover very well. Others are left with many deficits.

Vascular Dementia can cause strokes or alternatively stroke can cause Vascular Dementia.

No-one on a forum can diagnose - has there been any cognitive assessments after the stroke?

What does Mom's primary Doctor say about her living alone?
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SoloSheGoes Jan 3, 2024
I am aware it is a brain injury, but can it worsen over time and in this way? I have recently asked her family doctor about a dementia/memory test and am waiting to hear back about how we can do this assessment without her getting upset (suggesting a "routine" check). I was not aware at all about Vascular Dementia, however, online it says it is hard to diagnose separate from dementia - I will definitely flag this as a concern.

Her family doctor is new and I'm sure has reservations about it based on what she's seen. However, my mom will not willingly move into any kind of assisted living or nursing home. She was against it when her medical team suggested it after the stroke and still is to date, but even more stubborn...
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Do you realize that as a stroke survivor...your mother has brain damage? She has a very high likelihood of having vascular dementia, as well.
She may not be able to realize things are in disarray or filthy. Her brain damage will cause her to be at higher risk for being scammed.
She may have areas of her brain that causes her to have a nasty personality because that might be the only part functioning.
Have you had her abilities tested? Have you arranged occupational and physical therapies?
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Beatty Jan 3, 2024
Just saw you had the same ideas.
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