How to ask my mom to take a test for dementia?

My mom is a severe alcoholic and has had BAC of 4.08 and 3.57. I think one of these times she had a stroke (shows up via a MRI). She got a DUI and hit and run at 83 yrs old and had to move in with us. Her house also a shambles as had a sewer leak in the house that didn't know about (not sure how she couldn't smell it as my brother said he smelled it when he walked in). Anyways, my brothers finally on same page and while she was living with me and my husband signed her up for medical. got her to go to Neurologist and Neuropsychologist by telling her we needed to find out what was causing the memory issues and how to help her with the issues. Has been diagnosed with alzheimers. Unfortunately the next step isn't so easy as she refuses to stay or move into an assisted living facility. 3 medical professionals have all said not safe for her to live at home alone and did not recommend home care. She has over 3200 sf home 2 story on 1/3 acre lot (with HOA so has to keep yard up or else plus she is still on the committee that enforces that in her community so looks bad if she doesn't). Have DPOA but you still can't force people to move without additional legal steps - at least here in Washington state. Found out she ridiculed her friends who moved into retirement homes. I new she had been saying she wasn't leaving her home. So just recommend trying to get her to have evaluation and then be prepared for more to deal with. Best of luck to you.

Mom is still in the hospital, yes?

Wants to go home, right?

"She had refused to talk to anyone at the hospital but yet wants to go home"

Mom is not understanding her situation. No blame. The mix of current uti & blood clot, previous strokes & diabetes.
Confusion would be expected. (Or 'lack of insight').

Whether dementia is also present is unclear at this stage. (Note: stroke survivors have a high risk of Vascular Dementia).

Your Father will need make decisions for her at this stage.

Have you & Dad discussed her recovery with her Doctor?

Have you & Dad discussed where to after hospital with the hospital Social Worker?

I would be waiting out this 'acute' illness stage. Then push for rehab for Mom to regain her strength. After that, home if she has regained enough strength & health - or if not, an alternative like skilled nursing care.

Give Mom the best chance to get back home. But be realistic.

I agree with the paramedics advice. She may not wish to return to a hospital for any testing or treatment and you should discuss with her case manager whether it is time to move into hospice or palliative care situation. If she is still competent to make this decision it is hers to make. If she is no longer competent but is not diagnosed then you will need to tell her that without a good diagnosis of where she is at baseline, she cannot continue to live with and be cared for by you; that you need to know whether she needs full time 24/7 care or not. That her choices are simple: either move into a nursing home and make own decisions, or go for a neuro checkup to make certain things are stable.

Up to you really what you will put up with. Once you take a senior into your own home this is often where it ends up. Not sure what else I can tell you but that you are going to have to be honest and insistent with her.

Chances are, you won't need to "convince" or worse, "trick," Mom into getting evaluated for ALZ. It may be better if you don't even mention this. If she has an appointment already for diabetes, a blood clot, or anything, the physician will most likely look for symptoms of ALZ too, (esp. if you clue him in privately about your concerns.)

Mom may wonder why he is asking her such "unimportant" questions as What is the day and date today? Often the Doctor will give her five words and tell her he will ask her about them later. It is done matter-of-factly, but is actually rudimentary testing for ALZ. If she is hospitalized for the blood clot or its effects, he or the nursing staff may notice signs of dementia. She is certainly due for exhaustive medical exam since her mental symptoms may be due physical illness.

The paramedics gave her sugar medication and OJ + kidneys not working well + numbness in her lower legs... so is your Mom diabetic?

I tried reading through all the posts and responses below and just found a description of her symptoms but not the word "diabetic".

At 66, the type of dementia she would most likely have is ALZ (like my cousin started to show clear signs of by age 68). But this doesn't account for her other medical problems. Diabeties can create dementia-like symptoms. Is your Mom also obese?

With all the info and responses provided, do you now have a different question for us about your Mom's care, other than focusing on a dementia test?

I haven’t read the whole thread, but have you just asked them? “It would be good if you had a full work-out about how ageing has affected you now, and what the future will probably hold”?

I wouldn’t be offended if either of my daughters said this to me. It's not a loaded question!

Does anyone have her POA for health? If so have them call 911, and say, something like "I am her husband. I have POA, she is not thinking clearly and she needs to go to the hospital for evaluation" see if that works.

You need a dr for the blood clot. You already know she has some form of dementia, so no real point in having a dr diagnose that. She has it. Next time you call EMT's, explain away from them that she has memory loss and has ability to sound quite coherent when new people in the home. Tell them about blood clot and that she needs to go to ER. At that point, you can find out how much damage there is due to the clot and get her on meds for it.

The change in sleep pattern is common w/dementia. When she get wound up late in the evening, it's called sundowning. Very common. Dr may be able to add an anxiety or sleep med to help her, and you, get some rest.

At 66, why isn't she already on Medicare? Did you mean to say you're trying to get her on Medicaid? Medicaid has really low income limits so that my determine if she's eligible or not. You can look limits up online for your state. In-home care will be limited, so be prepared that it might be time to hire your own in-home help.

I believe your involvement/decision making depends on what legal documents you have in order, along with an MD / medical provider diagnosis that your mom can no longer make decision in her best interest (due to dementia).

I realize that you are asking how how you proceed / get your mom to an MD when she doesn't want to go. My experience suggests that NO ONE wants or is eager to get a dementia diagnosis ... to hear that they do not have control over the life any longer nor can make decisions about what they do in their life.

People make decisions based on (one or more)
* feeling overwhelmed, depressed, suicidal 'tired of living"
- She may need medication adjustment
* Not caring about their self anymore (above)
* Brain chemistry changes (dementia) and they cannot make decisions any longer.
* Yes, she will be mad, cuss at you, complain - she is SCARED and FEARFUL of the unknowns - which are here now.

How do you handle these emotional outbursts? You first educate yourself in dementia and behavior - and then you feel compassion for the person knowing they cannot help how they are. This awareness will 'ease' your emotional reaction although likely not completely. It is not easy to navigate.

* You do not argue (ever).
- You listen, you offer reflective listening ("I hear you saying xxx")
- You do not try to convince as this is a losing battle.

* You leave - for a minute to an hour to a 1/2 day or a few days.
- You get caregivers in to give yourself a respite.

* You might / need to see an attorney / someone who sets up legal documentation to ensure you are the decision maker (for her).
- You need legal advice.

* Rather than knock your head against a wall over and over again, you learn to realize that you can do 'just so much' and then the chips fall where they may - or in another way, how she decides is left in God's hands - not yours.

* You take care of yourself - you can easily - if not already - can fall apart and let yourself suffer. You need to take care of your emotional health / well being (exercise, get out and walk, go to the park - something). Move ... yoga, jogging, dancing. Meditate ... eat right.

If you do not take care of yourself, you will not be able to support the best care for your mother.

Find / develop your support systems / neetworks. i.e., Next Door, church, meet-ups, therapist, group support through dementia association.

Study up on dementia with TEEPA SNOW. She is one of the country's leading experts on dementia and how to interact / work with the changing brain. When you understand your mom cannot help how she is due to her brain changing, you will shift into an OBSERVER mode vs a daughter trying / wanting to have a conversation with her mother about the best way to proceed.

As an OBSERVER, you can make clear(er) decisions on what YOU do -
(as outlined above).

This is not easy to do. We care about our loved ones. We want to do the best for them and we want them to do the best for themselves.

P.S. When my companion-friend of 20+ years likely had a stroke, he didn't want the paramedics to take him to the hospital. They asked me if I was his POA. As I was, they said to him "She made this decision so we need to take you to get checked out." He had a stroke. He soon after went into a nursing home. He did not return home (he was in two nursing homes over the last two years of his life). So... having this 'legal authority' matters.

Gena / Touch Matters

Cutlass101: The blood clot is a medical emergency. It must be addressed immediately via a call to 911. She should have been Medicare eligible at age 65.

When a patient performs miracle personality changes, that's called, "show timing." The only way to prove these performances is to have a witness or, better yet, video the performance(s). Get out your video tools and present them to a neurologist or Adult Protection Services (APS).

Set up Zoom meetings if at all possible.

Mom has signs of Dementia before her fall with her head being involved and stitches. After her Dementia accelerated. I did not ask her if she wanted to go to a Neurologist, I just took her. TG she loved him and he was so kind. He gave her a short test, which she did well on. I sat behind her and when he asked her a question and she answered, he would look at me for confirmation. I took along a list of what had observed. I made it 1, 2, 3 and one line, double spaced, 14 easy to read font and one side. He referred to those notes. I never told Mom we were seeing a doctor until she was dressed and ready to get into the car. If she asked before I told her.

Sadly, you or any other family will most often be met with the resistance you face from your mother. Having her PCP refer her to a rehab facility for a period of time is actually not a bad idea to consider. It will give her 24/7 care, rehab from many perspectives and, including staff to observe her mental status and cognitive abilities ( dementia assessment included). They can give a more complete current " level of care needs assessment" and everyone can go from there with options. Meanwhile you and your father get a much needed REST and respite from the situation you describe. Be sure all POA decisions and papers are in place. Call her PCP today about the rehab facility placement. Do not let them talk you into rehab coming to the house. If you think your mother has any change in status call 911, insist that they transport her to ER and go from there to get her admitted either to hospital or rehab ...

It sounds like you are dealing with three or four separate issues, and each has a reasonably simple answer if you look at each separately. I own a boutique home healthcare agency in Boca Raton, FL, and I deal with issues like these!

Let's tackle the young doctor first. Would you make your mom go to a restaurant she didn't like? Of course not! So why are you forcing her to go to a doctor she doesn't like? Find a new doctor! Hopefully, that will be a big step forward toward resolving her health issues.

Getting mom to accept Home Healthcare is a bit trickier, but if you stand shoulder-to-shoulder with her, looking at the world from her perspective, you may see the answer unfold on its own.

The thing about home healthcare is nobody wants it. Nobody wants to feel like they are dependent on someone else, are losing their freedom, and can't take care of themselves anymore. Mom has to decide she needs someone on her own. There are many types of conversations you could have with her, but this one works very well most of the time:

Sit mom down and tell her "X" wants her to have a helper, and the helper will start in two weeks. "X" can be the insurance company, her doctor, the church, or whatever will give the conversation credibility. (If you feel you would be lying to your mom, ask "X" first, they will say yes.) Now, it's not you or Dad who is forcing her to get home healthcare; it's "X" giving her a helper. (See the difference?)

She's still going to be resistant, so don't worry about that. The next question is, "What kind of help would you like the helper to help with?" Whatever she says is PERFECT! Write it down exactly, don't be judgemental, don't argue, and don't say that's not the helper's job! Just listen! If she says things like take care of Dad, clean the garage, or re-roof the house, it's not a problem. If she says things like emptying the dishwasher, cleaning the kitchen, or helping in the shower, you are off to a fast start. Going back to cleaning the garage.... we will need to narrow that down a bit, so the next question is, "Mom, what could the helper do to make your life a little bit easier?"

Notice, we are having a slow and easy CON-VER-SATION! You may be leading the conversation, but Mom is in charge. On your part, all there is to do is to listen and ask the next question. If she's not in the mood to have the conversation today, no worries; you can come back to it tomorrow. NEVER ARGUE!

At some point, she may get worried, upset, or even curious about who the helper will be. Calmly reassure her that it's just a few hours and a few days as a trial (then we will report back to "X" and reevaluate).

Pro Tip: People our parent's age (especially if they come from affluence) are used to having "people" in the house. It's rarely an issue of having people; it's almost always an issue of trust or fear of losing their independence.

If you did a reasonably good job of having your Mom see the benefit of having a helper, now you have two weeks to find that "mythical" person. I know the naysayers will say it's impossible, but I promise there are good agencies out there and great caregivers! You need to know how to screen them.

You know all the questions to ask. Assuming you will private pay, the first question to ask is if the agency takes Medicare or Medicaid. If they say yes, hang up! Next, read them the list you made with Mom (including cleaning the garage) and ask them if they have caregivers who will be okay with that work. Finally, you want to find out if they will send the same caregiver or a different one every shift. If mom only wants an "X," and they say they might send an "X, Y, or Z" they are not the right agency for you. (In my company, our view is the client is inviting a guest into their home. They get "X") Ask if you can interview the candidate and find out what happens if Mom isn't happy.

Pro Tip: Never hire private aides. They don't come with a guarantee.

I am out of space... I hope that helps. ~BRAD

Your mother might need something more than Home Health Care. Home Health Care is something you arrange and pay for; it is not ordered by the doctor not is it covered by Medical Insurance unless she has been in the hospital at least three days. If she is on Medicaid, the rules about Home Health will depend upon what your state allows. Other than that you can hire someone anytime you want to and it sounds like your mother needs more care and intervention than you and your Dad can handle.

I began participating with my mom to her PCP and other doctor appointments when she was in her late 60's but still working and very mentally active - she did her own stock assessments, then contact her financial planner to place the buys and sells.
We, my brother, sister, mom and I, discussed the value of having one of us participate in these visits and reached an agreement. She/We understood that 2 heads were better than 1 to try to recollect concerns and questions at these visits.
I've said it before and I will continue to say it, our parents and we their children at some point need to stop acting in parent/child dance. We need to assert our adult status and help them like us as adults who are their to protect and help them just like they did when we were children. Not that our parents are children. The relationship needs to be respectful as adult to adult.

Hire a elder attorney and get their advice. Is your father willing to sign so you can become POA, Healthcare and Financial POA to make decisions on their behalf? You are in a situation if it's been over a year to get her to an ER and let them know all that is taking place and ask for a social worker. I know when my MIL went to the doctor they had an ambulance come and admit her to the hospital. A blood clot can turn deadly for your mom. Does your father have any say? Is he doing what your mom wants? Id throw up my hands and say, I can't do it anymore and leave. They will have no choice to get help or go to hospital. Why hasn't she signed up for Medicare? She is going to have to pay penalties for anytime when she turned 65 until when she signs up. That's crazy! Unless she is wealthy! You do not have to feel guilty as your parents are being unreasonable. Its due to the disease. You have to realize you're the parent now and their health and safety is the most important thing right now. You can't continue to do this alone. Tough Love is needed. You need expert advice and professional care regarding their health and care. Get a different doctor or clinic. A geriatric doctor is the Best for them now. Good Luck! Remember you are not any good to them if your health is suffering. You may be the one ending up in a hospital.

We got mil to do dementia testing. She refused saying we wanted to put her in a nursing home. I said that we were wanting to see if there were drugs that could help her with memory. She saw the sense in that and agreed, as she knew there were issues with her memory. The medicine helped her memory for the last few months of her life.

Go see her Doctor with her - Before the Visit tell the doctor you need help and if a social worker can get Involved at the Visit . This Gives you an extra Person to help advise her . Have the Doctor send a VNA Nurse to your home so that person can witness what is Happening with the Clot and report back to the doctor . Ask the Doctor to give her a Pre cog test . At some Point get a Neurologist referral But the clot is More important .

My situation may have been different, but I avoided using the word dementia or any thing like that. I simply informed my wife that our family doctor had made an appointment for us to see a gerontology group because of our advancing age. The doctors there took it from there.

There are falls and episode where you can call EMS and have her transported to ER. If you have to LIE and say she is confused, combative, whatever, then DO SO.
Your mother needs both physical and mental diagnosis as to what is happening to her and so do you, and sadly she likely will require placement as she gets too difficult to deal with. Whether her strokes have caused her mental incapacity or whether she has dementia (or BOTH), SOMETHING is very wrong here both mentally and physically, and if this "new young doctor" is ignoring all of this with no diagnosis then you and Dad are going to have to go rouge to get one!

As soon as she is at hospital get social workers involved to tell them that you are getting no medical support, that your mother has no diagnosis of severe physical and mental changes and that must stop now. Tell them that they can either help you get the consults and diagnosis you need or they can deal with getting a state guardianship for a woman who has lost her mental capacity and is diagnosed with a probable and untreated "clot".

Sorry, but you are going to have to become the squeaky wheel from Hades to get this done.

Does she realize this blood clot can kill her if it goes to her heart? Not being able to reason is a sign of Dementia probably caused by the strokes. This blood clot could cause her to become a vegetable and then she will spend her days in care.

I am pretty sure it was explained that Medicare is not an option, per se. If she does not sign up at 65, there are penalties. I guess she is not on SS because Medicare is automatic at 65 if u started receiving ur SS payments prior to 65.

It sounds like your mother does have a blood clot in her leg. A blood clot is a very, very serious condition and needs IMMEDIATE medical attention as the blood clot could travel to your mother’s lung and her heart. Call 911 immediately and get your mother to the ER as this is a life-threatening situation.

Contact a Medicare broker to get her signed up. This needs to happen.

You won't be able to force her to get any medical care if she doesn't have a legal representative like a PoA or guardian. This should also happen before she gets a cognitive exam.

If you are willing to be her PoA (it will be easier/cheaper to get this done online through Legalzoom.com or Rocketlawyer.com), then you will need to tell her a "therapeutic fib" to get her in to see a doctor: "Mom, you'll get free healthcare with Medicare and once you sign up you will need to have an intake physical to get your benefits activated." Whatever doctor she picks, whatever fib she'll believe -- whatever it takes to get her in to be assessed for her clotting problem, and discretely given a cognitive/memory test, and also checked for other common problems like a UTI, thyroid function, vitamin deficiency, etc.

If your Mom does indeed have dementia or cognitive impairment from the stroke, she can no longer use logic and reason to convinced to do anything in her best interests. She also is less and less able to have empathy for other people's burdens in providing her care. From now on therapeutic fibs is how you will get her to do anything. It is moral and ethical since you are trying to get her the help she needs.

If you can help get these things in place you will have a much better chance of helping her.

Who's in charge here? Mom, Dad or you?

Mom needs an urgent ultrasound to look for a blood clot? But ahe won't go, is that right?

So she doesn’t seek medical help... May or may not have a blood clot, may or may not get a PE or Stroke. May or may not get ill, disabled or even die.

Does she understand this? Be able to weigh this up & decide for herself? Is she stating clearly she wants 'no more medical treatment'? Is happier for Mother Nature to take over?

If she does NOT understand, is NOT clear about 'no treatment' then who is the responsible person to decide instead. Dad? Or you? Who will take over?

If you & you decide FOR treatment, either bribe her to get to the appointment or call EMS again & inform them Mom has dementia (un dx as yet) but lacks capacity to understand such matters or decide for herself.

I skimmed your past posts. What has changed since Aug 2022 when you first started posting? Good suggestions were given in response to your past posts. Have you followed any of them?

You are 46 years old, unemployed, with back problems (and an ear problem was mentioned in one post). So you have no income coming in. Do you have health insurance?

You should be earning money and establishing your own financial future. It seems that you are sacrificing yourself now for your parents. What is the end game for you?