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She is 91-years-old and dementia. She has gotten worse the last month. She has a caretaker come to the home in the morning and my sister goes in the afternoon for a few hours.

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I think you already know what needs to be done at this point. And yes, I'm talking about placing your mother in a memory care facility where a nurse will dispense her medications at the appropriate time.
She is no longer safe to be living at home unless she can afford to hire 24/7 care, but it's my understanding that that is actually more expensive than having her placed.
I'm sure it will be hard for all involved, but it's now come down to doing what is best for your mother and her safety.
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Your Mom cannot live alone. She needs to be placed in Memory Care if she has the money it in Long-term care with Medicaid if she doesn't. Or she pays for 24/7 care.

Yes, she should have no access to any type of medication. For my Mom my nephew was living with her. Her bottles and pill planner were put up on a high shelf in her kitchen cabinet. I never refilled the planner in her presence. My nephew gave her pills when needed. An aide should not be dispensing meds unless certified.
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Betty, It's one of the most common and saddest thing. I wish I had an answer other than lock and key for safety, but I don't.

When my brother entered ALF he was so "with it" with his dx of probably early Lewy's that I would challenge ANYONE to know anything was wrong. EXCEPT for, I was aware of the approaching paranoia, the feeling people were watching when he went to walks, signed out, and were casing his room. And he would hide the cash he WASN'T supposed to have in various places, then accuse people of stealing it even after closet was locked with only himself and admin with a key. Would later find where he had put it. Towels instead of the usual dictionary. And there were accusations of whomever he suspected, luckily kept only to me, and amounted to those he didn't like as much as others for some reason.

It was so distressing, for him, for me, and you can imagine for caregivers. I wish I had an answer other than this is very common. And so sad. I wish you luck.
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With dementia like this, she shouldn't have her medications where she can get them.

Someone else must 'hold' them, so to speak. One of my clients had PD and tho she FELT quite independent, it's only because so many people were holding her UP. Allowing her the guise of independence while being completely unable to get through any of her daily living skills.

Pills. OMGosh. Her family tried and tried to get her to use a box that was 'mistake proof' and they didn't count on her being so unaware of time, she'd claw any pill box open if she thought she was due for her meds. (She took various combinations at various times of day and then there were food restrictions for one hour pre and post-med time).

I know the family wanted her to be able to be independent. But one day I moved her recliner so I could vacuum under it--and there were piles of various meds. I took a photo with my phone-gathered up the pills and after this, the pills were kept in a location she didn't know about. We had absolutely no way of knowing what she had and hadn't taken. I'd vacuumed 2 weeks prior, so it was a LOT of pills in a fairly short time.

Any one who is hands on caring for mom, should know where the meds are kept. I wouldn't 'leave out' anything for her to get into--yes, it's more work, but better than her swallowing a bottle of tylenol and going into liver failure. Or forgetting one of her meds that's crucial.

Quite honestly, and I know you didn't mention this: sounds like she needs 24/7 care at this point.
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