Ask a Psychiatrist and Get Answers to Mental Health Questions ASAP
My 72 year old mother is quickly sliding into dementia possibly Alzheimer's. She is the primary care giver for my 43 year old brother who is currently stable on medication. The one Twenty years ago my brother was diagnosed with paranoid schizophrenia. The family unit living at the house consisted of my mother, grandmother, brother. My grandmother became incapacitated with dementia in her late 70's and died at 91 with Alzheimers. My grandmother was the primary caregiver for my brother as well as maintaining the house. In a difficult reversal of circumstances my brother became my grandmother's caregiver. He explained to my mother that he could not keep doing it. That it was too overwhelming a task (including bathing her). My brother had an episode and required hospitalization. My mother kept insisting he return to care for my grandmother, disregarding his crisis. My sister and I decided to keep my brother at a group home for 6 months to give him a breather. My grandmother died later that same year within a few months of his return. As my grandmother became more incapacitated the house fell into complete disrepair. My mother has been an extreme hoarder for almost 20 years. When my grandmother was stronger she would brave the wrath and clean at the risk of harsh verbal abuse. As she became older and less aware the house became floor to ceiling clutter. Not just with my moms unused household items. My mother adds things she would find on the street, donations she would offer to drop off for people then bring home. The last room not cluttered, my grandmothers room, was overrun within a month of her death 2 years ago. I have made offers, incentives, over the years. Home repairs in exchange for clutter removal, air conditioning, new furniture. Personally cleaning out the kitchen cabinets of rot and filth until I was asked to leave for throwing out too many plastic bags. It became apparent when she was extremely verbally abusive that she had borderline personality or bi polar. I created distance and saw her only on holidays. Which brings me to now. My mother is more and more unstable. Apparently going to the bank several times a week withdrawing money because she is paranoid of the bank stealing it. Bringing into the cluttered house. Opening different bank accounts. She is so forgetful she asks for numbers 4 timer in 15 minutes. She says she knows where it is. I doubt it. If its lost or she threw it away I can live with that even though it would have been nice to protect it for my brother's ongoing care. My sister and I are not intersted in an inheritance. Our goal would be to preserve it through a trust. My mother has messed up her accounts terribly and I am helping her with that. However i can't leave it at that once Ive straighten it out. The kitchen is unusable and she has lost a lot of weight. The rest of the house is worse than ever. My brother is stable now but having to provide increased care could put a lot much stress on him. The right answer is an alf which I am considering seriously and researching. Is there a way I can find an independent living 2 bedroom alf or an alf which would take them both? I am sure she will not leave the house without him. Is there a way to speak to her doctors to have then test her to see how debilitated she is to help me explain the need for assisted living. I cringe at the thought of calling the city to come into the house and having her declared incompetent. But I feel the suitation is getting worse and a fall or fire in that house will be catastrophic. I am trying for a POA but she is very suspicious and paranoid despite the mess she has made. Is there a private social worker that can help me address all of these issues and help me find the right resources. I own my own business and my days are extremely busy. I would really need assistance to make the right choices for my mother and brother.
My name is XXXXX XXXXX I am the moderator for this topic. I've been working hard to find a Professional to assist you, but sometimes finding the right professional can take a little longer than expected, as the Professionals come online at varying times. I wonder whether you would like to continue waiting for an answer…hopefully it won’t take too much longer. Please let me know, and I will continue my search. If you’d prefer not to wait, please tell me, and I will cancel this question for you. Thank you!
Camille - Moderator
I work for Just Answer as a mental health professional and also as a full time manager for the Dept of Aging. Your question immediately caught my attention when I signed on.
Capacity issues such as what you have described here with your mother can be tricky. However, I hope to clarify some things for you and offer some assistance.
In Florida, the local Area Agencies on Aging can be of immense help. This link can help you locate the one appropriate to your mother's address.
When you contact them, ask for a care manager and a level of care assessment for your mother. These care manager assessors can evaluate mom at her home (and they are used to situations like this so even if mom is very reluctant or even unwilling they often find ways to assess the risk factors involved.)
This assessment will make any services or placements into an alf (or PCH) much easier, and will determine if mom's needs should be met in an alf or in a higher level of care. The care manager can also link you to services and even offer resources for legal assistance to you so you can gain some control over this situation.
In Florida, POA is very difficult if not impossible to gain if the person is unwilling to sign the POA papers. And the person must be fully capacitated to sign a POA, which your mother may not be. Instead, a partial Guardianship may be more appropriate as this avoids the limitations of a POA and it allows person's named as guardians to make choices that are legally binding. This process is usually initiated through Family or Orphan's court and although there is some cost to it, it tends to be reasonable in expense and far more effective than a POA. (A POA is easily revoked).
Further, a care manager can determine if mom has exceeded reasonable risk to herself and is now at imminent risk. This means that Older Adult Protective Services can step in and determine if the risk is too great for her to live on her own and take the heavy burden of telling mom that fact away from you and onto them. (Better she is angry at them than family). They also can link you with physicians who make capacity determinations (and psychologists) and get the ball rolling on either placement or guardianship. If this does not happen: Yes, she needs to see a family doctor with you telling the doctor ahead of time that you are worried about mom being capacitated. Although the doctor cannot tell you anything about her care, the law allows you to tell him/her anything that would help a medical assessment of your mother.
Your brother: On a case by case basis alf's will admit two family members. However, if your brother has a chronic MH issue, sometimes the alfs will be reluctant to bring him in unless they are convinced he is stable: Or if mom has dementia...they may admit both but keep them in distinctly different parts of the facility. (Sometimes state regulations require this as well or limit admissions of MH adults, only after a more in depth assessment is completed.)
Again, here the Area Agency on Aging can help as Ombudsman (professional advocates for long term living such as alfs and nursing homes) will (if asked nicely) give you the inside track on what facilities are more open to this arrangement and which ones look nice but in fact are not. Ombudsman are wonderful resources in and after placement and I would encourage you to talk with them prior to talking with alf's of any type.
This is difficult situation for certain as mom is right on the cusp of being incapacitated by law. But with the Area Agency on Aging's help and assistance (or even a professional private care manager) this confusing system can be navigated and mom given the help (and your brother the respite) that is needed. My best to you and your family. Steven
The Ombudsman is/are a National (USA) service that can be accessed via your local Area Agency on Aging. Their services are free.You can go to www.n4a.org which on the right hand side of their web page offers a search feature to locate your local agency. This agency will also link you with care manager resources and even the names of private care managers.
However, you can also locate a private care manager via this link: http://www.caremanager.org/
Although this process may involve a phone call or two, most private care managers are able to mediate, which is what you may need to get mom into a better situation.