Should an insulin dependent diabetic with dementia live alone?
My mother-in-law was recently diagnosed with "mild congnative impairment" after 8 months of testing. She is only 65 years old but she is a type 2 diabetic. The Neuro Phycologist that did the testing said that he believes she is very close to "vascular dementia". We think she is much much worse and is a master at hiding it from the doctor.
She lives alone in a 55+ apartment complex. She can no longer drive (but insist that she can) She cant remember to check her blood sugar, or take her insulin when she should. She is supposed to take a short acting insulin after every meal, and long acting insulin at night before bed but she forgets to take them sometimes. We check her testing meter every few days and her readings are wildly erratic. 52 in the middle of the night 505 in the late afternoon. We have tried so hard to get her to fill out a chart (which we hung on her fridge) listing her glucose readings, meals, and insulin doses, but she can't remember to do it.
She eats a lot and eats carbs and sweets often. We started grocery shopping with her about 8 months ago but she gets her friends to take her shopping and buys junk.
She can no longer pay her own bills, or balance her checkbook. She has no short term memory longer than a few hours. She does not know that she has dementia and does not understand why we come over and call her so often. She has been told by the doctor, and by my husband and I at least 75 times! We can sit down and explain it all to her and she gets upset and cries but then an hour later she has no idea that we were even there! This seems way worse than "mild impairment" to us!!!!
This all started about 8 months ago so it's still new for us! We have no other family to help out with her care. I've had to take time off from my business to take care of her but
I can't keep this up! Should we continue to let her live alone? We tried hiring an aide but my MIL keeps telling her not to come or doesn't answer the door or phone. When we call or go over to check her sugar she gets irritated! We are losing our minds and don't know what to do next :(
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A person with dementia beyond the very earliest stage should not live alone.
A diabetic who cannot manage her disease needs help.
I agree with you that MIL is further along than the doctor recognizes. Sounds like she can successfully "show time" at the doctor's office.
MIL MIGHT be able to continue in her apartment for a while longer, but only if you can work out a system of getting her to take her insulin appropriately. That might be calling her at each mealtime, having an aide come in at least once a day, having a full-time aide, or some combination. (If she can do her own shots and only needs someone there to remind her and to see that she does it, the in-home help would not need to be a nurse.)
I am not very confident you can get this worked out. Poor MIL doesn't understand the need to cooperate. She isn't being deliberately difficult but she is putting herself in danger. Even without the diabetic consideration, she may be unsafe (or soon will be) around the stove, getting in and out of a tub, and making judgement calls -- like letting people into her apartment or giving money away.
Dementia is always very sad, but it always seems to me especially tragic when it appears in someone so young.
I'm afraid that you are going to need other arrangements to keep MIL well and safe, and you may need them soon.
if she is resistant you may do a little fibbing to get her placed. Most places are used to dementia residents yelling about going home but the admin folks will usually accept POA and a letter from the treating doc stating mental incompetence. Worst case, you'd have to go through guardianship process.
Sorry you are going through this. I'm in a similar situation. Take action. Don't let this ruin your lives. And remember, there is only so much you can control. Her dementia is only going to get worse. Things are going to happen no matter how much you plan and take precautions. It's not your fault.
I'd call this week and see if the initial assessment is being scheduled, and to ask for one if it is not. (Husband may need to make this call, as POA.)
The Medicaid worker can explain all the options. States vary on how they handle Assisted Living. Nursing Homes are fully covered.
I'm so glad you've taken care of the Medicaid application.
I agree that the huge challenge and stress now is getting a 65-yo woman who believes she is perfectly fine to accept 24 hour care. I hope the case worker can help with suggestions.
We do have a POA for health and Financial matters. Thankfully we got that just after she was released from the hospital. I pay all her bills for her via her checking account. She still has access to her checking account and keeps spending the bill money on QVC and Home Shopping Network. She has also started spending double the normal amount at the grocery store.
How do we tell a 65 year old woman that she needs to go live in a nursing home when she truly believes that she is perfectly fine? She is in complete denial. She will tell anyone who will listen that she is happy, healthy, always eats healthy, rarely eats carbs, keeps a tight control on her diabetes and swims laps every single day for exercise!
The reality is that she eats junk, goes to the pool about twice a week and sits in the hot tub (not swimming!), the rest of the time she sits in her LazyBoy recliner. She will not clean her apartment or do the dishes, she has expired food in her fridge all the time. Sometimes she looks like she hasn't showered in days. Her sugar is all over the place, Her A1C is 7.1 she is obese at 5'2, 250 pounds, she has sleep apnea and can't keep the mask on, she is Hypothyroid, High BP, High Cholesterol, has Arthritis in her hands and lower back. She had 5 way heart bypass surgery 10 years ago and never changed her lifestyle. She was addicted to pain pills and xanax until we took over her medications. She is still getting xanax and pain pills from her "friends" which is making the dementia worse. So basically her health is TERRIBLE for a 65 year old.
I know I keep rambling... I'm Sorry! I'm just so frustrated and emotionally drained!
She should not live with you. Even in ideal circumstances that is a tough row to hoe, and these circumstances are not ideal.
I believe in assisted living they could at least monitor her blood sugars and manage her medications. And they can help her keep to a schedule. She'd still be able to eat erratically and inappropriately but it would be easier for her to eat well and on schedule.
If that isn't adequate, a nursing home placement might be necessary. I hate to see that at her young age, but there are some places that are quite nice and could be pleasant for her.
Does her financial situation support play for a care center?
Some may mention Dementia Care. That would be appropriate if/when she is a wandering risk, or if her behavior is/becomes disturbing to others. It doesn't sound like that is the case at this point.
I think you have a lot of research ahead of you. Dementia impacts the entire family, and I am sorry you are facing this.
Now that we are getting to daytime in the US others will be along and you'll get a variety of opinions. Mine are, no, she shouldn't live alone, and no, she shouldn't move in with you.
Not enough.
Until you can get her approved for Medicaid than some arrangements need to be made.
Does you husband have any siblings? They can take FMLA since you said they don't live in the area and help out.
Good luck.
I got an appt with the Medicaid case worker for this Thursday. So that's good. Maybe she can guide us to the level of care she needs and help us find a facility that accepts Medicaid. We are not financially able to help with the cost of AL or SNF.
My husband and I spoke further and after the last few days he is now in agreement that AL or SNF is needed. Keeping her in her home would be great if she would allow the aide access, but she is forcing our hand at this point.
To answer a few questions... We have full POA in my name and my husbands equally for medical, legal, financial (everything). I am the joint account holder on her checking account (which I need to lock her out of) She has no assets, other than her old battle tank car (that I guess we need to sell). She does not own a home. Has no savings.
I honestly don't know how many of you have dealt with this so long! I am in awe of your patience and compassion. It's only been eight months for me and I feel like I should be in the fetal position, in the corner with my crash helmet and drool rag! LOL
Thank you all for your amazing advice. I have noticed a difference in myself in the last few days just from sharing my thoughts and concerns with this wonderful group.
(My daughter works at an ALF. I recall her being upset one day because when floor staff looked at the care instructions for a new resident it said she was a two-person transfer. "But we are not staffed for that! We are licensed for that! We don't do that! How are we supposed to work this in to our regular duties for our other residents?! Fat lot of good it does if they are charging more for this service, if we don't have staff to do it!" Etc., etc. The people who actually do the work were none too pleased how marketing had sold this contract. Which is why it would be good to talk to the director of nursing before getting very far with serious consideration.)
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