Mom with mild dementia chooses who to be nice to and who to berate. Want to give mom ultimatum: be nice to caregiver or move into ALF.

I'm a little more harsh. You say you have "four adult kids at home"? Sounds like mom and two of the kids need to be in facilities. The other two need to get out and support themselves. Why are you the doormat for everybody?! Who do you think is going to take care of them if you are worn to a frazzle? Better to plan ahead so everyone doesn't end up on the streets!

My mom and  I got along great until Alzheimer's hit. She'd tell me to, "Drop dead and go someplace warm." The first time she said this I was appalled. The tenth time I was still somewhat mortified, but by the 20th time, I told her I better bring sunscreen and a hat. My husband had to mouth the words to me, "She's not really your mother saying these things," and he was right. I knew she wouldn't deliberately say those things to anyone, let alone me, if she could control it. I tried to find the humor within the situation. I even wrote a book about our travails called, "My Mother Has Alzheimer's and My Dog Has Tapeworms: A Caregiver's Tale." It's especially hard, I think, when you're caring for kids (of any age) as well as another adult. My advice would be to not take insults personally. I tried to reason with my mom, and remind her that we got along so well, but I just don't think that the Alzheimer's brain can reason the way it used to. Best of luck.

Maybe it's harder for adult children to talk back to their parents, and it is for me. I get plenty upset with my mother but can't do much except go inside my van, close the door, and scream.

My mother's sister (my aunt) has so such problem. When my mother acts up and starts getting aggressive with her, my aunt would scream right back and puts mom in her place. Mom behaves much better with my aunt because she knows/remembers my aunt will not put up with her non-sense, Alz or not. I have a harder time getting mom to bathe, drink water, take med, etc. No such problem with my aunt.

Aunt tells mom: "If you don't bathe, you won't get to go out, and I mean it."
Mom: "I'll take a bath now."
Me: (smile)

I suppose if you can be very firm and deliver consequences for bad behavior, then you can get her to comply more.

Thank you for your responses. Sometimes you don’t realize that your situation is not unique until you read what others say.
My mom was not verbally abusive before, critical and kind of controlling, yes. Cared more about how I looked than what kind of person I was. Growing up I just remember her always being in the basement sewing beautiful gowns for herself to wear to parties. I mean she looked like a movie star, and she was always in competition with her friends. I had to marry a guy I “looked good with as a couple”, comments on my weight, hairstyle, clothes, how to raise my kids. She’s a perfectionist, always apologizing for a meal she cooked that didn’t quite turn out right. Then of course we would say how delicious it was. Yet, I felt loved, because I was well taken care of, but she never told me she loved me. And NOW she tells me she loves me (twice, but she says “you know I love you”, not just “I love you”) and demands I tell her back. I could go on and on.
So to clarify some items, I have one brother who is not helping with care. I am the POA, all finances are in order. She is begrudgingly paying for her care. She laments spending her hard earned money and it really bothers her. She does not expect me to pay, but worries about running out of money. If we sell her house she will have enough for a decade of caregiving.
I would like to try a mood stabilizer, but she is so sensitive to meds, I am afraid of side effects. Her anxiety is through the roof and she takes Xanax but doesn’t feel it always helps now. I will have to reconsider.
The caregiver is a younger (76 year old) friend of my mom’s who she used to do volunteer work with and who has been a caregiver for 20 years. Advantage is that she speaks my mom’s language and cooks her traditional food, but I think she just doesn’t know how to deal with accusations and outbursts. She rolls her eyes at my mom’s OCD like behavior and takes what she says personally. They were both happy with the arrangement until they started to live together.
So I have enlisted my brother and therapist sister in law to mediate. They are coming Tuesday to talk to each one individually. Hopefully they can clear the air on some issues. Honestly it’s petty stuff. Caregiver asks my mom what she would like for lunch or dinner a couple hours ahead. Mom is frustrated because she doesn’t know what she will want, she doesn’t know what’s in the fridge (apparently caregiver won’t let go in the fridge by herself), she doesn’t know what the caregiver bought. Caregiver allegedly always seems to be eating better than my mom; mom just gets some gross leftovers. Mom tells caregiver to wash her hands, do a better job washing dishes. Mom knows caregiver gets angry and allegedly yells at mom, so she tries to avoid her making her angry, meanwhile caregiver afraid to trigger an episode. Both are on eggshells, both complain to me.
The past caregivers were thought to be temporary while I had was traveling a lot, she hated them all, accusing of lying, stealing, so we went through a few.
Mom felt she can stay on her own, but she fell three times in 2 weeks. So back to the hospital and decision was made she needed permanent 24/7 care, and was too much for me to take on.
I bring mom to my house to spend time with her, give her a change of scenery, get her out of the house, give caregiver time off. She is better emotionally, but will start in on me at least once a weekend about being a different person, so uncaring, no compassion. She says I must be going through the”change” or I’m really sick. When I get her back home she is very agitated and starts in on both me and the caregiver, and she feels we gang up on her, even though she is right. The more I stay away from her , the better.
I think I have to learn to respond to her as well. I’ve already learned to ignore the personal comments. I’ve got other people to take care of too, but I am concerned for her well being.

Bottom line is what is best for her safety? Also, you might tell her she will run out of money a lot sooner with 24/7 care than living more independently in AL facility.
Couple of suggestions on meds. Buspar (buspirone) is a lot safer than Xanax. My dad took in in am and pm and really helped. But also a lot of the SSRIs like Zoloft are excellent for anxiety. My dad became a mush calmer and more pleasant man. I believe he has had generalized anxiety disorder his entire life. He also had feelings of inadequacy similar to your mother. I think it’s well worth a try. Know that it takes many weeks for an SSRI to kick in but the Buspar takes effect immediately.

I believe our approach to deal with any type of clients must remain same disregard their medical condition.Active listening is key. Remember the dialogue must be client-centered. I don't believe in magic solution. The solution must coming from our clients. We must not ignore clients' style and culture when we deal with their emotional issues. The confusion from the environment is another aspect to consider. Sometimes we ignore people who can help us because of that environmental confusion. We should not ignore our clients' needs, wants and desires before judging them.

We all make mistakes. But, we must learn from our mistakes. Repeating the same thing many times is not recommended. If we have to change our approach to deal with our clients we should not hesitate to do so.

I think Mom could be more compassionate and sensitive than we thought. Do not underestimate our barriers including lack of communication and understanding. Finding a way to communicate with Mom is a must.

Harpcat, thanks for the suggestion of Buspar. I will ask her doctor to give it a try. She has been on Xanax for maybe 15 years and has had a lifetime of anxiety. I always felt the Xanax contributed to her mental status. No one in her family has any dementia, and her sister is 94 and mother lived to be 97.
Someone suggested Seroquel, but that seems to be a high risk of stroke in dementia patients. Ugh. Hate drugs but sometimes they are neede.

Just want you to know what I learned after having my mom in a supposedly "good" assisted living. What you get is daily meals, poor laundry (usually everything goes in one load on HOT", and poor housekeeping. They don't like to dust unless all surfaces are clear. Any other things are extra cost. Since my mom was getting eye drops 4x a day, I assumed they were checking on her. They came in, gave drops and rarely asked how she was. She fell two different times and I only found out when she told me. As long as residents don't cause a problem they don't pay much attention. If I hadn't come 2 to 3 times a week who knows what they'd get by with. It was a great place when we moved her in. New people took over and things went downhill from there. When she broke her pelvis we had to move her to a small group home where she wouldn't be lost in the shuffle. (92 and dementia)

Dorthy from the wizard of oz was right when she said "No place like home". So keep her at home. She seems to have plenty of money so what you can do is have CNA's because they are trained on how to deal with this, are not overly expensive.
Just have them in the daytime and as long as she is still sleeping at night have just about anyone sleep over there with her, maybe one of your kids and if there was any problems they could call you. This will save you a lot of money and there is no need to pay a professional to watch someone sleep.
You can buy a mat that will ring a bell in the other room as soon as she steps on it like when getting out of bed. This was a god sent for us.
PS. If she has dementia why isnt she on aricept and/or Namenda? This helps usually! Also make sure she doesnt have a UTI.

Given how your mother berates you, and the family situation you yourself are in, I would not allow her to be in the home one single second longer than now. I don't care if people have dementia or other problems, if what they are doing is causing a negative impact or effect on the rest of the family, the decision is made - they cannot stay there. They must be placed. Give her an ultimatum and I assure you, it won't work but at least you have tried. Start thinking of yourself and your family before you are totally destroyed by her behavior. There is no other choice. And shame on your brother for not helping.

If your mom is treating you and the caregivers that way it is very possible that if you place her in a facility she will do the same to the staff. A long-term care facility (skilled nursing home, assisted living, residential care) can discharge a resident within the first 30 days without a reason. So if you are going to place mom in a facility you need to make sure she will be OK for at least 30 days after that she has legal protection under the federal discharge regulations.

That being said since she has some dementia maybe you should look into a memory care facility. Both skilled homes and Assisted Living facilities have memory care. Often people with dementia due better in a "memory care" because the staff are trained on how to deal with their special needs, they are usually smaller, usually have the same staff and often times have a higher resident/staff ratio and these units have very regimented schedules which most residents with dementia need.

I would explore memory care first. You must put your family and their needs first. You can't help her if you don't take care of yourself, you will only learn to resent her. It sounds like your family has special needs of their own, put them first, place mom in memory care.

Finally, if you need help finding a place or making a decision on what to do you can hire a Geriatric Care Manager. They can meet with you and also with her and they will coordinate the care so you can step back and take care of your needs as well as your families needs. You can go online to Aging Life Care Association and find a Case Manager.

I hope this information helps, let us know how things work out!

These people that say they wouldnt allow your mother to berate you dont understand that is teh dementia, NOT your mom. Its like saying to kick out a kid out of your house who has autism because he is throwing a temper tantrum, They are just igonart about dementia, you cant blame them, they just dont understand. I wouldnt kick out my mother with dementia because of what she says to you just like i wouldnt kick out a disabled kid out of my house for have a temper tantrum. Would you kick out your mother if she had end stage cancer and was mean complianing about pain? A stroke? No of course not! Neither should you kick someone out for dementia!

Allie you are right! All of the benzodiazepines, of which Xanax is one, are implicated in dementia. So yes it’s highly likely it contributed to your mom's. They are all acetylcholine inhibitors as are many of the antihistamines like Benadryl, Zyrtec, etc. if these are taken long term they inhibit choline which is necessary for the brain's memory function. So even though I occasionally take a Klonipin, it is very judiciously and only when absolutely needed. Same with antihistamine. I would never take a pain med containing Benadryl (such as Tylenol PM) on an ongoing basis.

I read all the comments here. And I will say this again and again until someone listens. If the patient, no matter who it is, including God or the devil, and anyone else, behaves in ways that are causing great harm to the emotional, physical, financial, etc. of the remaining family who now are having the turn to live THEIR LIVES, first you make it well known the behavior is NOT going to be tolerated, no matter what. You can do that kindly. But I doubt anything will change - it will only get worse. So, what do you do? You can choose to allow yourself and your own family to go down and literally be destroyed and have no life. Or you can place them somewhere where people are trained to take care of them so you can lead a better life. They have lived their lives, they are old and have physical and mental problems. Not everyone can be, or is willing to, a caretaker. If there are other family members who won't do their fair share, then that is all the more reason - they must be placed. There is no pretending they are who they once were. They are no longer that person. Sad but this is a fact of life. I personally have absolutely no family but if I did, I would make it known to them that if one or all don't equally want to care for me (their choice), then, especially if my behavior is bad, remove me at once - no if's, and's or but's - because by that time I would deserve to be removed. Don't let yourself be consumed with guilt and remorse and confusion and anger. You are worth far more than that.

Things are always more complicated than they seem. First of all, she’s my mother. My grandmother lived with us for 12 years, but she was healthy as a horse. Back then, the choice was nursing facilities, not assisted living or independent living, and were not affordable nor of the quality they are now. Old European ways, multiple generations live together. That’s when my mom began taking Valium, to cope with grandma. That was in the 70’s and 80’s.
Lately she has been quite lucid and more calm ( maybe the magnesium is helping), and she has told me on several occasions that she is living under great tension because the caregiver yells at her a lot, like right in her face. She is afraid to tick her off, but she can’t take it sometimes. She is acutely aware that her memory is not great, and she is depressed because she feels her life is ending, but she is generally in good health, only BP meds, and anxiety, which seems to be lifelong, most likely PTSD because she grew up in Europe during WW2 and was forced to run to Germany without her parents in her late teens, never to return.
So enlisted my brother, who does nothing and is the golden boy, and therapist sister in law to try to access the situation today. They need to talk to the caregiver about whether or not she plans on staying, whether or not she is capable of letting personal comments roll off, and CALMLY respond to mom’s outbursts of frustration.
I asked mom over the weekend what we should do if caregiver leaves. I mentioned ALF again, told her it was like a hotel, not what she is imagining and she said she wants to go see it. Woohoo!
I know that no solution is perfect, but I really just want her as happy as she can be during her last years. This is all an adjustment for her; in the past year she stopped driving, has fallen, been hospitalized twice, cannot walk without a walker, several Med changes until BP got under control, memory failing, frustration with life, full time live in care since thanksgiving with the realization she cannot live alone. She just wants to die. I’m trying to get her be more positive, to be grateful for what she does have.
She was social before, but now is too tired to go to church. She always said people are her medicine so maybe ALF will be a godsend.
Thanks all for the comments. It helps so much to feel supported.
BTW for the person who said I am a doormat for having my adult kids at home. My two oldest have been dealing with untreatable debilitating conditions. Oldest is suicidal due to a type of headache that is continuous 24/7 since age 20. Absolutely nothing gives him a second of relief. My second son got a virus at 14 that knocked his autonomic nervous system out of whack. He couldn’t stand up without passing out. Spent high schools years bed bound. It’s taking both of them longer to figure out life. Both are working, but without college degrees due to their illnesses, they cannot afford to move out yet. Believe me, they want to be on their own. Because we live together their struggles are a daily issue and it’s heartbreaking for us parents. Our two youngest are in college so they are in and out but not launched. We are a family and do what we can to help each other out. It’s not the life we dreamed, but in some ways, the crosses we must bare make us grow in ways unimaginable, for which we are better people, I hope 🤞.

My mom has been this way her whole life (even before the dementia). I recently learned she suffers (well we all suffer from her narcissism!) from narcissism and I've been her scapegoat all my life. She is rude to anyone she doesn't like or anyone that tells her something she doesn't want to hear. When she moved in with us, we had to put her on an anti depressant because she would argue with us every single day. It was just a huge blow up over nothing. That helped tremendously. Fast forward 2+ years and she started the arguing again, pacing, agitation, trying to leave the house on several occasions. I called her family dr and he prescribed a low dose anti psychotic medication that is helping to curb the nastiness. She has aides that come in and shower her and she is never nice to them, so I get it. We are embarassed by her behavior. The aides are pretty good about it and just ignore her or distract her and change the subject. My thoughts are that you are never going to change what is ingrained in her. You can distract her and just pretend like you don't hear her or shoot back a snide remark as that will sometimes shock them! They need the assistance and I'm not able to help her with a shower so I'm not letting her sit in uncleanliness just because she's nasty! I think they think if they are rude and nasty, they get their way because people just run the other way or concede and don't assist with a shower or walking or things that keeps them more active. With narcissism, I really don't know where mom ends and dementia picks up because she has ALWAYS been nasty. She should have sought help years ago for it as it just drove her kids away. But I don't think anyone realized it had a name/condition and you could possibly get treatment for it. I often avoid her since she is in my home now. My husband also resents my mother because of the way she treats me. EVERYTHING under the flipping sun is my fault. I've read that they can turn the narcissism on and off even when they have dementia because the pattern has been set for years. And boy does she! On mother's day she was staring arguments with me and the moment my brother arrived, all smiles, hugs, I love you, kisses on the lips, holding hands on the couch (gag me) and the moment he left, right back at the nastiness! My husband is self employed and works from home and is her daytime caregiver as I work outside the home. He is a saint. But he loses his
cool when she begins attacking me. He has to leave the room and ignore her. This is not an easy path. I would recommend going to a support group as well. Most of the memory care facilities have them for relatives of those with dementia. Good luck!

On the internet you will find someone that will agree with you no matter what you want to do. Good or bad or indifferent. I think a lot of times people will use the internet to justify what they are doing or want to do because eventually they get a comment from "iscreamforicecream" screen name who says they would do the exact same thing that you want to do.
Everyone has there own opinion. In the end, forget about what all us strangers who dont know you or your mother or your living situation says and do the right thing for your mother.
Whats the best thing for your mother? I hate to tell you this sweetie, but YOU know better about your mother and your situation than the 50 comments from strangers.

You are correct in saying many years ago NH was the only choice and many then and now are not the best place for anyone. Some are good, some okay, some not so good. Same goes for AL/MC facilities today. Check them thoroughly, ask a lot of questions, determine what is covered in the cost, what their "rules" are before signing on! In your mother's case, NH isn't really where she needs to be (they are for people who require specialized nursing care, although some have MC units, they are still more likely for those who need specialized care AND MC.) My grandmother also lived with us and mom's sisters, taking her every few months, but she didn't have dementia and was easy to care for.

I can relate to the behavior where she minds her Ps and Qs with some - mom was like that, you don't air dirty laundry! However, if you got her dander up, watch out! When PCP merely said 'it isn't safe for you to live alone', oh did she get nasty! We were trying to keep her in her condo with oversight, initially just a 1hr (minimum for agency) to check she took her meds from a locked dispenser and a sanity check - she didn't need any real hands-on care (diet was an issue for me as she was resorting to packaged foods and microwave meals.) In her case, that lasted only a few months and she refused to let them in. So, dementia may be the underlying cause for mom (still able to control herself some) or it could be other factors.

You do know your mother better than the rest of us. If she wasn't really like this before, it could be the dementia at work. The caregiver, as you described her, is not likely trained for dealing with dementia. In order to stay, she (and you) will have to learn to let mom's verbal assaults roll off. There are methods for redirect, to change where mom's current focus is - sometimes it works, sometimes not so, but one has to try.

Is there a way to install cameras, so that you can monitor the situation? Her accusations might be true, but they might not be. Dementia can distort how she views/reacts to what the caregiver says/does, as you have seen her take you on for no good reason. It is also possible that the caregiver loses her patience with mom when she is being childish (also can be a dementia trait.) This is where understanding the condition and training come in.

IF mom truly wants to see the ALF AND agrees to go, problem solved, mostly! In our case, AL was in mom's plans, until dementia kicked in. She refused to consider moving in with one of us (not a good idea all around anyway) and when AL was mentioned, PAUGH, I wouldn't live in one of those places! However, even if she agrees to move, she might continue this kind of behavior. Is it possible to try getting her off the Xanax? Reading about this med on Wikipedia, it indicates it is for short term use and has many side-effects, some of which may be causing her falls, hostility, drowsiness, death wish and disinhibition (lack of restraint, although it seems somewhat selective, but that could be due to other factors.) 15 years is a long time! She also should not just stop, but rather reduce dosage/usage over some time (work with doc.) There might be other meds that would help, or it might be better to get her off it and see how it goes. Dementia is going to contribute to some behavioral changes, but once off this med you'll have a better idea where she is really at and perhaps the doctor can try something else (seems most/all anti-anxiety are basically the same.) 

Also, try to ignore those who put you down, just like you have to learn to ignore mom's "barbs". It is NO ONE ELSE's business why your kids are living at home.

My dad had dementia and behaved like this. Ativan worked wonders for us. Many times they get agitated for no reason at all. They usually will take it out on those they know or see the most. Thankfully he was on hospice and they believe in keeping them calm and comfortable. She may have pain she doesn't even realize she has. When hospice told me this is common in elderly, to have pain they don't realize, I laughed. But it was true. They gave him ativan and norco, after a week he actually said he felt better and he was nicer and calm.