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When to go to assisted living?
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When to go to assisted living?

I decided to check the forums, see if there was a spot for people caring for an elderly parent. I won't go into a long winded story but briefly I'm an only child so no help from siblings. My Dad died over 3 years ago and my husband and I have had to step in to help. My mom is 83 yo, very negative, manipulative and critical. According to 2 psychologists she is BPD, a personality disorder that I won't go into. Needless to say I don't feel a lot of warm fuzzy feelings for her but I can't ignore her either. It would just be too cruel. But I've learned to keep some boundaries up to protect my own emotional health after a lifetime of being treated not very nicely.

As I said she is 83, according to all the doctors she's seen, she is in fairly good health for someone her age. According to her she has hundreds of things wrong with her. I've been keeping a personal journal of her behavior: forgetting things, times of confusion, not knowing what time of day it is, losing her money, etc. Overall she is not doing well at taking care of herself in terms of eating (just candy, cookies, stuff she buys from Taco Bell and TV dinners). She has trouble understanding her bills and is now 6 months behind on her bank statement. She refuses any help in the home when we've offered. At the doctor's office she does quite well at chit chat and can be funny for those 15-20 minutes. But daily living is taking a toll on her.

When do you know that it's time for a parent to go to assisted living? How do you do it? You can't just tie them up and move them. I've thought of sharing my notes with her doctor but they don't trust me either. She's led them to believe that we're taking financial advantage of her. We were quite open with Adult Protection Services and they understood it was her way of getting attention. We have no involvement with her finances at all. But now things are awkward with her doctor. She refuses to consider assisted living, swears she'll be raped there. Needless to say I'm very tired. And I never know from one day to the next whether she will like me or hate me.
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187666_tn?1331176945
Thank you so much. It is doubly difficult to care for her because of her anger and attitude and just the general effort of trying to meet her needs without embarrassing her or insulting her pride.

I never thought of asking my own doctor for advice. My doctor is wonderful and she knows the position I'm in. She would be a great source of information.

I've also been trying to think of ways to contact her doctor without causing problems. If there was some way to convince her doctor that I am truly concerned about the changes I see in her, maybe they would help. I'm not just trying to "lock her away" some place.

Again, thank you. I'll check into the info you've share.
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i also am an onlychild taking care of my 88 year old father in my home with no help from family and limited poor help from the ct home care program.
this has been going on for over a year.
I have watched my father go downhiil and now is very sick,
I feel trapped and finalyy said to his doctor where are my rights.
at times i feel like i am on the verge of a nervous breakdown. because i am so full of anger over watching my father suffer/not being able to work so there are money problem and my father has no money and no life insurance policy for me either.
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144586_tn?1284669764
Most assisted living facilities require three forms filled out by different physicians. One is the mobility assessment form. How well they can (a) walk and (b) climb stairs (c) propensity to fall.  And whether the patient requires a walker, wheelchair or cane. The second is general health. Medications especially. Some facilities do not have nursing staff certified to provide narcotics, for example. The third is a psychiatric evaluation. They do not want disruptive patients. (This is also something that many nursing homes consider when applying) In addition some facilities (requirements vary) will not take a patient who requires a wheelchair, however once the patient is in the facility, they will permit he/she to stay. Before taking a loved one to go for an interview make sure you have your ducks in order and no adverse information that could affect admission.
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187666_tn?1331176945
That's excellent information. I know she would flunk the mobility test. Partly because she has trouble walking since she refused to go to physical therapy any more. And partly because she exaggerates her helplessness when in public. She loves to have people watch her, help her and pat her on the back. At home she does quite well, vacuuming, bending over and picking up her 15 lb dog, lifting boxes out of the closet.

As for meds, they are pretty standard for cholesterol and BP.

Her attitude: she can be so funny and charming in public if someone's willing to talk to her. Otherwise, she's extremely critical and rude, complains about everything, insists that she's the only one who has problems. That gets tiring.

I'll keep all this in mind if she ever reaches the point of needing care. She's independent enough but expects me to do so many things she could do for herself.
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144586_tn?1284669764
The business of "exaggerating helplessness is very real and unappreciated. Recently I have been trying to get a patient into an assisted living facility and she was denied admission to one such home partly on the basis of "documented falls" in her medical record while in a hospital. Some of these falls were real, however she admitted "faking" falls when she decided the staff were not paying her close enough attention! When you mentioned "she loves to have people watch her, help her, and pat her on the back", you are describing the patient I know to a "T". Cholesterol meds have positives and negatives. Sometimes they are absolutely positively needed, but other times their prescription is questionable. Remember that memory is preserved in cholesterol depositions and inappropriate prescription of drugs that dissolve cholesterol may affect memory.
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187666_tn?1331176945
I didn't know that about cholesterol. I suppose it's a balancing act (no pun intended) for the elderly: to have enough for brain function but not so much that it clogs arteries. Contrary to what she says, she has no heart problems so I'm not sure why she has the statins.

I noticed she has bottles of meds backed up (multiple bottles of the same med). She blames Express Scripts for sending them too often. I checked the dates and they send them on time according to her prescription. It looks like she's not taking most of her meds anyway.

She has Zoloft but only takes it when she feels bad, treats it like it's an aspirin. Take one and feel better in 15 minutes. I tried to explain that it doesn't work that way but she doesn't get it.

I did go to a counselor for help. She gave me some more "tools" to help me deal with the emotional side of this, a couple books to read and she's available whenever I need a tune-up.  :-)  It doesn't change my mom but it's helping me cope.
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144586_tn?1284669764
The "Lott Residence" in New York City (a very good place, incidentally) has a website where they have downloads of the forms required for medical, psychiatric, and mobility clearance that are common and required for admission to most assisted living facilities.
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144586_tn?1284669764
Entry into a good "assisted-living" facility is best accomplished with "massage". That is to say a little help by someone in vouching for the person going in and assuring the staff they will not cause trouble.  Ordinarily this involves a referral by a social worker. You have to be careful you don't have one that "damns with faint praise". Eventually there is a one-to-one interview with the prospective tenant. If this is a relative, meet with them beforehand to prepare a little "monologue" and preferably accompany them to the interview. Bear in mind that many patients who would benefit from assisted-living have mild dementia. They may be asked who the president and vice president are, who is running for office, and the year and date. Recently a patient I was helping was denied admission because she could not name the president, vice president or the year. I had been with her for a time and she had extremely short-term memory, but was otherwise a good candidate. She blew the interview.  During the interview they must be careful about what they say. This is not a time for "stream-of-consciousness" and a recitation of all their problems. If you have the time "play-act" with being the interviewer. Make sure they dress appropriately. This was another issue with the patient was rejected. She insisted on wearing her somewhat wrinkled and soiled clothing and the social worker who accompanied her did not insist on her changing. Most especially, avoid them mentioning violence, suicide, or "problems" they may have had with neighbors. Tell them to imagine they are going to interview for a part in a movie and they must appear, happy, contented, have no real problems - even if they do - (except shopping alone - that's something they can emphasize). Have in hand a medical proxy and the mobility, medical and psychiatric clearance sheets. The psychiatric clearance is tricky, because even with a medical proxy you may not be permitted to have access to this document. The "so-called" confidential psychiatric clearance may blindside them and prevent them from even being considered for many nursing homes. You will never know the reason.  Typically a patient gets blackballed because they have a confrontation with some nasty hospital or rehab home staff member which results in them flailing at them with a weaklened 90 year old hand. This get's marked down as an "assault on staff". I have been through this drill with several geriatric patients and I speak truth.  If you anticipate a problem, have an arrangement with a private psychiatrist to meet with them and provide you with the clearance.
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187666_tn?1331176945
I never knew it was so difficult to get help for the elderly. It's very discouraging to know that homes created to care for the seniors are so **** picky. They want the easy ones, the people that will just sit there and cause no trouble. Where does that leave the people like my mom that complain constantly, wander around trying to remember the basics of living and converse only in a negative "stream of consciousness" style? I used to try to follow her dialogue, help fill in the blanks when she would forget what she was saying but I just shrug my shoulders now.

And what about seniors that smoke a lot, have a pet? What happens to them?

I am just so tired of trying to cope with this. My husband is feeling the pressure, my kids keep asking to spend time with us. Normally I love being around them but it's beginning to feel like another obligation. I survive (that's how it feels) the visits with my mom but it's still taking a toll on me.
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144586_tn?1284669764
Some nursing homes permit smoking, even where the home is filled with signs and the state prohibits smoking. They tend to keep this policy quiet because it isn't very politically correct. I think this is a good idea. In one home I know there is a designated smoking hour every day and residents are issued two cigarettes or small cigars by the staff.
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