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I have proof through literally hundreds of voicemails my mother has left for me that she is showing signs of dementia. Both of these people refuse to meet with me to see and hear the evidence that shows my mom has dementia. Or let me rephrase that, they will meet with me to discuss, but ONLY if mom is present. According to the executive director, mom is "of sound mind" which she is not and this person would realize this if she heard the multitude of voice mails that I have. Even the nurse of the assisted living has said that she is able to pass the "quick" test but if given the more in-depth testing, she knows she would fail. Yet I am unable to get her to administer the more in-depth testing. And now the nurse has backpedaled on her statement since the executive director stepped in. What do they have to gain? I have a signed medical POA but I cannot get them to hear my evidence and get the POA invoked. Every day mom threatens to leave the assisted living and go back to her hoarding house which is not safe and 7 hours away from me. I am an only child so it's just me, my husband and my 3 kids as her only family to take care of her. As long as they won't invoke the POA, she could literally walk out of there at any time. She is talking about driving again even though she has cataracts. It is NOT in her or anyone's best interest to leave there. Why can't I get these people to understand? All the proof is there. She never knows what day it is, what time it is, calls 20+ a day, calls and leaves the same voicemail over and over, calls at all hours and wakes us up, calls and leaves harassing messages, cannot compose a grocery list, tells us one item so we go get it and drop it off, next day another item, next day another item, is confused about everything. She wants to spend money she doesn't have. My husband has financial POA over her and according to a local attorney, it is in force, but she doesn't realize that even though he has helped her with paying bills since her stroke in 2011. We have explained repeatedly the amount of income she has each month and she cannot remember/comprehend. She thinks she gets twice the amount of social security than she really does. She threatened to kill herself so they took her to the ER. After that she was scheduled for a psych eval, which she then cancelled. I feel like not only is my mother insane, but so are the people running the assisted living. We talked to an attorney about guardianship/conservatorship which is going to cost $5,000+. It just seems ridiculous when if the nurse/doctor over that assisted living would just do their job and invoke medical POA, it wouldn't cost us anything. My family and I are at our wits' end with this. We just run in circles and we don't get any further. Mom is a big "showtimer" any time she is being assessed. So talks a lot and has them convinced that her mind is intact even though we as her family see 50 examples to the contrary every day. Can these people just keep running us around, never agree to meet without mom present, keep denying that she is showing signs of dementia, and keep refusing to look at our evidence that proves it? I don't want to get into a big lawsuit as I don't have money for that. I just want them to DO THEIR JOB. A co-worker was in a similar situation, same state and everthing. The doctor approached them and said "You're now POA." It was that easy. We used to compare notes on who was crazier, my mom or theirs. They were both showing equal signs of dementia. My co-worker has everything in hand and under control, doing what needs to be be done. I continue to flounder with people at the "assisted" living that refuse to be of any "assistance" at all. I am betting nobody here as been through this! But can someone please advise?! How can I get this accomplished without spending a ton? Mom needs to stay where she is. We've already moved her twice. It is taking a toll on us financially, mentally, emotionally, physically. Our life is pure hell.

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Its not up to the staff at the ALF to test your mother to determine whether she has dementia or not! It is, however, up to them to be sure they are exercising HER resident rights to be present at a meeting where you want to have her deemed incompetent.

Residents at Assisted Living have a right to come and go as they please. The staff has no right to force them to stay there if they want to leave. The resident can call a cab or get in their car, or in someone else's car, and take off if they sign out.

If you feel your mother has dementia, then you need to have her evaluated by a medical doctor who can give her the proper testing to determine her cognizance level. Just bc you have POA doesn't mean you get to say she requires a certain level of care at Assisted Living which they are likely not even equipped to provide her. That's Memory Care Assisted Living and another ballgame entirely which has locked outside doors preventing the resident fro m leaving. A medical diagnosis of one of the dementias or Alzheimer's is required to be accepted into Memory Care. I, as my mother's POA, can't simply say "I want" her in Memory Care; her doctor has to agree she qualifies to be in there or it's a no-go.

Frantic voice mails and irritating behavior in general does not constitute "dementia" on its own, not until there's a formal diagnosis in writing! And a truly demented individual cannot Showtime their way into passing a cognitive exam, either.

Again100 is right.....your mother needs a doctor not affiliated with the AL to administer a cognitive exam to your mother, and THEN give a dx and a recommendation for Memory Care. In all of the ALs I've dealt with, NO doctors work FOR them, but come into the facility independently to care for residents. None were equipped to give cognizance exams either.

When I had the situation you're in now, my mother went to the ER for the umpteenth time for vertigo. I knew she was suffering from dementia so I literally begged the ER doc to admit her for further testing AND to look for Alzheimer's and dementia due to her behavioral issues. She was living in AL at the time, but I knew it wasn't THEIR PROBLEM, IT WAS MINE to resolve. The doc admitted her, she failed the cognizance test with a score of 18, and I finally had an answer. She didn't need Memory Care for another 3 years, however, bc it's a last resort. Elders need to be pretty bad with at least moderate dementia before MC is warranted. That's a subject for another time, though.

I agree that the AL isn't handling this matter professionally and giving you a run around. But, now YOU have to swoop in and take mother in to a doctor or neurologist yourself to find out a diagnosis and go from there. POAs are pretty useless UNTIL the elder is IN Memory Care at which time WE get to make all the decisions for them. In AL, they get to make their own decisions and be part of all the discussions pertaining to them. That's how it's been for my folks and I (only child) since 2014 that they've been in Assisted Living and 2019 in Memory Care.

Good luck to you.
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Of sound mind generally means that person knows who s/he is and perhaps where they are and the year. It's a really low bar.

So while your mom may be driving you up the wall, it doesn't mean that she doesn't have the right to hear what's being said about her.

The facility is not refusing the meeting. They are refusing to abrogate your mom's rights.

What are you afraid might happen if your mother heard you say "we think our mom has dementia"?
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Why won't you agree to a meeting with your mother present?
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Dementia diagnosis and mental capacity testing are part of what doctors do. Please schedule your mom for an appointment for cognitive evaluation and treatment. Usually, a neurologist is a better option for this type of evaluation than her primary care doctor. Your mom needs to get evaluated for which type of dementia, treated (yes, medications can help), and documented if she has reached the point of being "mentally incompetent". You can only invoke POA once she has been deemed "mentally incompetent." This is why the facility will not meet with you without your mom being present.
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“How can we discuss that someone is demented with the demented person sitting right there?”

You can, it is just uncomfortable. She will be mad. It stinks, but it looks like that is what you need to do.

Also, if the facility isn’t seeing most of these behaviors and she isn’t hopping the next plane to fly the coop, you may just have to wait. And, if she is functioning fine at the AL, they are handling it. It may be that, for now, you just block her calls at certain times or whatever. She may seem frantic on the phone, but that isn’t showing up when she goes to meals, interacts with caregivers, etc. As someone else said, AL may be the proper level of care for where she is right now. The AL would be all over you if she was giving them grief.

However, if the dr at the facility is her primary dr, he should definitely be willing to do testing. He may be more comfortable arranging a neuropsych eval instead. Either way, he does have an obligation to hear this feedback.

But, as bad as it sounds, you do have to be willing to say these things in front of her. It will be really, really hard. No one wants to face their mom and share info like that because they don’t want to be the bad guy.

It does prove to them that you aren’t being shady.

And the dr is the only one who the voicemails as “proof” might matter to, not the admin.

Interact with her less and when you do stay calm. She is safe and cared for. Could she leave? Yes. But, she hasn’t and she hasn’t suggested she was planning to to her caregivers, so she may just be dumping on you to get you to do something she wants. We have all been there and it is no fun.

If she is spending away her life savings on a criminal, that would be a problem. Your DH has the POA for finances, which sounds durable, so he can do what he needs to do.

It sounds like you are coming to the place where it is good to take a step back. Look at each thing individually and realize that a lot of aging care involves things you can’t control. I say that gently and kindly. It is easy for us to see potential problems, but many are our own projections.

The calls and possibly the money are the “is”. The moving home or talking about money are the “maybe” problems. Not bad to see them, but you may not be able to fix them until she gets bad enough that the AL staff that take care of her everyday see a problem.

Or you have to be willing to address it in front of her. Adjusting expectations might help. It’s tough, no doubt. Best wishes.
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your Mom can’t physically move without your cooperation… so put that thought on the back burner to reduce your stress..

i don’t understand why you need to meet with the director. my mom is followed by a company called Bluestone . Nurse practitioner sees her at least monthly. That’s who gave my mom the test. The DR who oversees the NP was the second physician. Director not involved at all. Contact whomever is in charge of your moms care and get it done. Leave director out of it. If the person who oversees your moms care won’t step up, take your mom out for lunch, by way of another physician appointment. And yes get her checked for a UTI.
When you make the DR appointment be sure they know why your coming in, and that you what an appointment for the second dr following.

as a side note the director and the facility nurse do not have the credentials to deem someone incapacitated…
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katepaints Feb 2022
Great advice to suggest that the doctor knows why she’s there. Often people with dementia suddenly know it’s show time at the doctor’s and they pull off an act that makes them look okay. My brother is out of state so before his appointment I wrote a letter to the neurologist to spell out the problem with specific events to illustrate the symptoms. When my niece brought him to the neurologist the doctor didn’t have to do the clock thing to check his thinking. Because he already knew what had been going on, the visit lasted only ten minutes and orders were given for an MRI. Ultimately it was found my brother had a massive brain tumor and it wasn’t early onset dementia that I’d been thinking it was.
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It is not the AL:s responsibility to test for Dementia. You need to arrange a doctor's appointment for in-depth testing to obtain a diagnosis.
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I've had to have VERY difficult conversations about cognitive issues and other things with the affected person sitting right there. It's rough, but once I was at the end of my rope emotionally/spiritually/physically/psychologically.... it was pretty straightforward to just tell the truth - even with her right there. Sometimes her responses (or lack thereof) to what I was saying actually helped make my point. My LO can showtime like it's going out of style to the point of smirking at me while she does it.... I couldn't take it anymore. I was all about getting it out there: good, bad, and ugly. And all for HER benefit and wellbeing. This would include: trips she never took, people she never met, jail time she never served, sexual relationships that never happened, a portal that's (not) in her closet, and a medical study that she was never part of (and probably was never even being conducted at all). I could go on all day with examples - including repeated phone calls and/or hangups. During one cognitive assessment, the expert asked "What's the phone number you call in an emergency?" My loved one proceeded to rattle off MY home telephone number. The expert thought that was just darling.... didn't seem to "get it" that the woman didn't know the answer to the question was "call 911." That's the kind of showtiming my LO would do - manage to give a "cutsie" answer with a flutter of the eyelashes that disguised the fact that she really didn't know the real answer. Don't be shy about saying whatever you need to say right in front of the person. You're trying to help them for heaven's sake. Patients do have rights and I'm sure that's in play here as well. I do agree that UTI needs to be ruled out if it hasn't already. Elders with a UTI can say, do, and believe all kinds of things. And, at some point, it becomes "fact."
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I am probably repeating what everyone says but its not the Directors or an RNs job to test Mom. They aren't trained in that field. A neurologist is the only one that can do the testing needed to determine if Mom has Dementia. He will give a more in-depth test. And EEG and an MRI to determine if dementia is present and what type. If you read your Financial POA and Medical POA/Advanced directive you may find that one or two doctors need to make a formal diagnosis for your POAs to become in effect.

I am really surprised that the RN and Director did not explain from the first time you asked, that they are not qualified to determine if Mom has Dementia. Its also not their responsibility to see Mom gets to a Neurologist. I do think, from what you have said, that the staff caring for her is aware of changes.

Assisted Livings are residences. As such, the staff is limited in what duties they perform. Yes, they have transportation. But usually the resident sets up their own appts or a family member. A staff member, like a CNA, does not go with the resident if the resident uses the facility transportation. The driver of the van gets the person to the appt but just drops them off or takes them in to make sure they go to the right office. Once settled in they may leave or wait depends on their schedule coming back later to pick up.

If you find Mom has a Dementia, you may find she needs more than an AL can give in care. The next step would be Memory care or LTC depending on how much money Mom has.
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As has been pointed out, AL's offer "assistance " only. They can't test for dementia. It is not the AL's responsibility to schedule these visits for her. You need to schedule an appt with her PCP, a geriatric psych doctor and a neurologist to get a complete mental profile: you need to play the recording of her behavior for all of them .
If she goes to the ER again, play the recordings for them however, be aware that if she doesn't act out in front of the staff they will have no choice but to release her back to the AL (if they will accept her) if she doesn 't agree to be seen by specialists such as a neurologist.
She definitely seems to need a care level higher that what an AL can offer and if she is trying to leave it will need to be a secured MC. I'm not sure what ploy you can use to get her to see the new doctors but folks here are a wealth of information of "manuver" modes.
Good luck on this road.
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