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Very disappointed as mom wants to talk to someone about the lunacies she believes really happened/happening. We’ve told her to hang on as we seek out a therapist. Because mom’s attention span is short, inability to sometimes answer basic questions and being contradictive therapist said she’d not benefit from talk therapy. As a therapist there are goals set and she felt no path could be established for mom and justify insurance billing. She suggested maybe hiring a “companion” to spend time w/her and be a listening partner. Mom has also just been diagnosed w/a rare terminal form of leukemia, yet I’m more concerned with her mental health management. How to help mom have someone to share her horrors with, without family having to shoulder (delusions are explicit and include our deceased father)?

Unfortunately talk therapy, which is psychotherapy, is not helpful for dementia patients nor would it be effective because you cannot improve dementia. My mother had a volunteer through hospice who visited once a week and listened to all of mom’s complaints and stories. She absolutely loved “the nice lady who comes to talk to me”. Realistically, that’s the best you can hope for. If you did find a therapist claiming to be able to improve your mom’s dementia symptoms through psychotherapy you should steer clear of that person. I’m sorry there isn’t much of anything you can do but love her and protect her.
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Reply to RLWG54
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My grief counselor’s hospice contracts with several homes. The nice Ageis one has him come in every week even though Medicare only requires once a month. The Medicaid one is once a month. Most of the people have dementia and he is there as the chaplain to hear their dementia stories. It’s kinda talk therapy for them , or at least a visit whereas someone actually talks to them.

If mom has cognitive failure she likely would not benefit from oncology. Have you looked into hospice?
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Reply to PeggySue2020
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I honestly don't think that a therapist can help someone with dementia.
Talk therapy is for someone who can work towards getting better; that isn't the case for a person experiencing cognitive decline, who is incapable of applying reasoning, and cannot retain information.

I'm really sorry, but I think that the therapist was correct. It isn't just about money and insurance, but the fact that this wouldn't benefit your mum in any way. In fact, it could make her feel worse because she wouldn't feel heard or understood by the therapist who couldn't, in good conscience (or code of practice), validate your mum's delusions.

I think that the advice you were given is good. Take it. And speak to your mum's doctor about medication to help with the hallucinations (not lunacies), as well as her low mood and aggression.
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I would get a second opinion.
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Being able to bill insurance is a big thing. It has to be coded a certain way. My thyroid lab was not included in my last two check ups. Was in the first. I asked for an order. When I got to the Lab I was told Medicare would not cover the cost the way the order was coded. My Mother and her Sister had Thyroid problems so I could too. I wanted to catch any problem before it got bad. Guess Medicare does not allow for predisposed conditions in this area. The cost for me would have been close to $300.
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In reading your responses to others, I think you would benefit from learning more about dementia.

"And I am considering palliative/hospice, tho mom is not a fan, as dad had hospice and she thinks they caused him to pass, even tho I’ve explained their purpose many times. Everyday is a new situation and we’re jumping to try to help alleviate all that ails her (not enough space on this page!), and guess we need to make peace we can’t solve everything for her…tortured mind being the worst of it."

You cannot keep reexplaining things to someone with dementia and memory impairment -- you will exhaust yourself emotionally and physically. Also, people with dementia have trouble dealing with pain, identifying what's happening with their bodies, and being realistic about solutions. It is 100% unproductive and you need to economize on where your energies are spent because you are now in a marathon, not a sprint.

Teepa Snow has an excellent video series on YouTube. I learned so much from them, especially how dementia changes our LOs and great strategies that will help you have more peaceful and productive interactions with your Mom.
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Reply to Geaton777
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Of course your mom wouldn't qualify for any therapy at this point and going forward as her brain is not only broken from dementia but also from years of mental illness.
If she has the "inability to sometimes answer basic questions" how in the world do you think a professional therapist could possibly help her?
You must be realistic now and understand that your moms brain is broken in more ways than one and that therapy in the common way we think of it, just won't help your mom.
I would instead with your moms recent terminal cancer diagnosis, bring hospice on board, and perhaps let the hospice social worker talk with her.
Hospice will be extra sets of eyes on her in her AL, and will be able to provide any needed medications to help with her hallucinations.
And all of hospices care is covered 100% under your moms Medicare.
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waytomisery Jul 17, 2024
My Mom with dementia and mental illness had talk therapy in AL . She loved the person who came , he validated her complaints . She got to complain about everything and everyone to someone every week and she looked forward to it ! She told me he agreed with everything she said . Mom refused any meds for her mood . I was grateful that something this man said seemed to help calm her down and stop berating me . It helped Just having someone Mom thought was “ on her side “ about her anger over placement . So it can be helpful , although maybe not in OP’s case .

Mom did not realize he was a psychotherapist. He just told her he checks in to see how residents are doing. Mom assumed he was a nurse. Unfortunately , another staff member mentioned how “ nice the psychologist is “ right after he left Mom’s room . From then on Mom refused to talk to him stating “ I’m not crazy “. I was upset she wouldn’t do talk therapy anymore , it helped Mom’s mood , and it helped my visits be better .

Agree , Hospice on board would be a great resource . As you said a social worker could be the sounding board for the mother etc .
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My DH aunt has dementia, on hospice in a SNF. She has had a “therapist” from a group who primarily visits patients in a nursing home. I wasn’t told about this initially. The charges showed up on her insurance which paid for it. I had mixed feelings about it but decided it was a visit for aunt and to leave it alone. Her roommate also saw the therapist and told me she liked her. The roommate has since passed. I no longer see the billing so they must have stopped the services. The NH doc had ordered.

I have spoken to a Licensed Clininical Social Worker who said she has had patients in SNFs so you might find one. Aunt is not willing to communicate for the most part but if she were, I would pursue.
People with mental illness often have group sessions in psych hospitals. Might be helpful in assessing calming meds etc.
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Your profile says your Mom has a history of mental health problems (hoarding is mentioned specifically) and also a history of not dealing with it, hence a 20-yr long estrangement with her children. Hoarding often stems from trauma. Is hoarding the only/primary mental health issue she had?

You listed your question under Alzheimer's and Dementia... so, going just by what you describe she certainly seems like she may have it. If so, I am doubtful that talk therapy would be any benefit at all to her, especially if she doesn't retain it. For talk therapy to benefit, one has to be able to retain AND properly process what is being discussed. Dementia robs people of their reason and logic, their empathy, their filters, their sense of time and place, their self-awareness, and more. This is why so many people with dementia require medication to help them through depression, anxiety, agitation, aggression. They can no longer bring their own selves to a place of acceptance, contentedness or peace. They need meds to achieve this, and it doesn't always work -- but should be tried. The last thing that she should be doing is sharing her horrors continually. She needs her mind lead to safe and less stressful places, even if it seems she doesn't wish to go there.

My Aunt with advanced dementia often had dark thoughts and delusions. It made her very stressed and agitated. We had her only movies (mostly oldies or animated) that had very little dark content. And it didn't take much to reach the "dark" threshold for her. She couldn't watch the news or any shows that were violent or negative.

The best thing we can do for our LOs with dementia is to protect them, make decisions in their best interests and keep them calm. I'm sorry she's going through this plus damnable leukemia. If she doesn't have a diagnosis for cognitive and memory impairment, or has never been tested, I'd do this straight away. You may be able to discuss meds for her mental health with her primary doctor. I wish you peace in your hearts on this journey.
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Plumhead Jul 17, 2024
Thank you -yes listed this under dementia/Alz area as not a title that covers all that ails her. Mental illness was always a thing for mom due to a trauma as a child never addressed, stoic upbringing by her parents and never sought professional help, and us kids estranged from our parents for many years as a result of their unwillingness to address or help themselves. She has been diagnosed after being found a couple times wandering the streets at 3:00 am afraid their were people in her home pointing guns at her and “prior to our intervention” due to dad’s death in April, psychosis, depression, paranoia, dementia, etc, but as mom never took care of herself or followed up w/these docs, nor took her meds….we are now struggling with her safe in AL to get her with professionals that will assess her meds and get the right mix. Found a highly rec geriatric psychiatrist that has accepted her as a patient -but her first opening isn’t until mid-Nov. Your comments are helpful-thank you and confirm where we’re trying to go in keeping mom comfortable and at peace. Not easy….
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It might help to be clearer about what you are looking for. ‘Talk therapy’ sounds like therapy with talking. Therapy is about making things better. Talk is just that.

You would probably like something ‘therapy’ to disillusion M about “the lunacies she believes really happened/happening”. However it sounds like M is not a candidate for getting better. That’s why no goals can be set. If M has dementia or any other mental problems, you probably need to accept that you are going to hear a lot of ‘lunacies’ before she dies. It’s very common.

If M needs/wants to talk about her delusions, think about what response she needs/ would like. Does she simply need to talk herself? What would she want the hearer to say back? How could you find someone to listen and respond in a way that would soothe M? This may be the best way forward, if you can accept that M is NOT going to get these delusions out of her mind.
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MiaMoor Jul 21, 2024
Talk therapy is what people with mental health issues, such as depression or OCD, have to help them deal with their illness. You have to want to at least try and get better for it to work, and you need to be capable of putting the work in yourself.
Yes, it is talking, but it isn't aimless. It's conducted by a trained counsellor, or a psychotherapist (most often, the former).
Talk therapies have helped me immeasurably. I have had both CBT and generic counselling.

Talking therapies wouldn't be appropriate for someone in Plumhead's mother's condition. Severe hallucinations require anti-psychotic drugs, not counselling.
The delusions along with the short-term attention (memory?) and aggressive behaviour point to cognitive decline, which cannot be fixed, nor can it be helped by counselling.

A counsellor couldn't go against their training and validate the delusions of a client/patient, so talking therapy could actually make the mother feel worse.

It's not the same as the delusions of a mentally ill person who is capable of getting better. Plumhead's mother will not be able to apply reasoning and will not respond well to her delusions being challenged. Instead, she needs reassurance and to be made comfortable. She needs medication.
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I would assume the short attention span and not able to answer basic questions would prevent Mom from making any progress . Sounds as if Mom may have dementia on top of her mental health issues.

Another thought is , are these lunacies new ? Is she on any new meds ? Has she been tested for a UTI ? ( A UTI can cause behavior , mental changes in elderly ). How is her mental illness being treated by the doctor , any meds ? , maybe a med change is needed to calm her .

Goals are required in order to bill insurance , much like it is to be approved to be a candidate for PT etc. People are also refused PT , OT , rehab if it is not felt progress would be made or goals would be met .

Find some companion who can listen to Mom and agree with whatever she says . Perhaps someone who is experienced with people with dementia .

It is unfortunate that she’s not a candidate for talk therapy . At least the therapist gave an alternative to try by suggesting a companion , Mom just wants , needs to vent , and be validated to calm her .
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waytomisery Jul 16, 2024
Perhaps you could ask for a second opinion from another therapist .
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Sorry for the loss of your Father.
You have really had to take the oars for your Mother & steer her to safety. It's a lot.

So many folk want their parent to WANT talk therapy - your Mom does but doesn't 'qualify'. That seems very unfair.

I know nothing of the billing/ insurance but I feel for you in this situation.

I could see the benefit of a 'companion' aide.. but, it would need to be the right person. Someone with REAL listening skills - not some distracted person nodding vacantly & checking the time.

Do you have a local Cancer or Leukaemia Organisation? Would they have ideas?

I am reluctant to add it, but if Hospice was appropriate, they may have ideas or resources too.
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Plumhead Jul 17, 2024
Thank you for these kind thoughts. Yes it would def need to be the right type of companion to handle her stories. And I am considering palliative/hospice, tho mom is not a fan, as dad had hospice and she thinks they caused him to pass, even tho I’ve explained their purpose many times. Everyday is a new situation and we’re jumping to try to help alleviate all that ails her (not enough space on this page!), and guess we need to make peace we can’t solve everything for her…tortured mind being the worst of it.😓
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It makes sense to me that someone with dementia doesn’t meet diagnostic criteria to bill insurance for care.

But maybe others will have different input
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