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Last September I went to check in on my parents. I live 850 miles away. I never returned home to my husband. I thought I could help my parents and get them to a stable situation. My Mom has become unreasonable and downright mean. She is demanding and will wake up the house all thru the night because she is anxious or wants a cigarette (she is end stage copd 24/7 oxygen), or something to drink or someone to sit with her. She sees no issue with not allowing others to sleep. This happens all thru the night every night. During the day she doesn’t want anyone to leave the house because she is anxious. We have told her how unreasonable and not sustainable. There are so many things she does that just are not okay but if we don’t do them for her she wakes my Dad. He has been hospitalized twice since I’ve been living there with his own health issues, yet she has no regard for anyone but herself. We are all exhausted and quite honestly fed up. She refuses to try and help herself and thinks we are all mean to her because we don’t run fast enough to her every whim. She needs mental health help and 24/7 care. Is it possible to have both? She wants it but doesn’t want it at the same time because she will lose her palliative care benefits. They don’t want to spend a dime and we have the virus going on. I am so afraid of leaving them because they are not safe or capable any longer. I’m frustrated and angry. Sorry for the venting, but what does one do when you’re afraid for them???

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Your first course of action is to inform the authorities that your mother is endangering the safety of everyone by smoking with oxygen. Good grief! That is the next medical emergency! Contact Elder Case worker now and also her physician.
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Your parents are not safe and can't be alone. Your mother is smoking with oxygen, is this correct? She could blow up the place and all of you in it. You need to make decisions now and not later. Sad with the corona and all, but safety is an issue. Talk to Elder Care Services and her primary care doc and get some advice on placement.
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Yes, she can receive mental health services while receiving pallialitive care. A good place to start to address the issue is to speak with the primary care physician regarding the insomnia and anxiety. The physician can prescribe medication to address both. Another resource is a geriatric psychiatrist who can also address these concerns. Many of them are offering telehealth visits due the pandemic. In terms of caregiving, I would contact your county or state's area agency on aging for information on private duty or facility caregiving. If resources are available, they most likely will have to pay out of pocket like it or not. As difficult as this may be, I think it's time to set your boundaries and stand firm to your intended departure. I also think boundaries need to be set in regards to depriving others of sleep. Medication may resolve the issue but if you have addressed all of her needs prior to retiring for the night, that's it. Keep whatever she needs within her reach. Due to the COPD, she may be oxygen hungry even though she is receiving continuous oxygen. I've seen some patients use a portable fan pointed towards their face and they reported good results. In addition to the psychiatrist, counseling can be offered via telehealth. Check her insurance for the mental health issue but since it will provide comfort, she should be okay.
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What you need to do is advise the medical authorities. Sounds to me that given the situation, both of them must be placed. If money is an issue, there are ways to handle that - seek out the Office on Aging which can help you. This is a horrible situation and YOU must not allow it to destroy YOU. She is mean and demanding and won't cooperate and she is causing problems for your father. This cannot, under any circumstances, be tolerated or allowed. Do you have a Power of Attorney (if not - you need to get one at once). Second, for now, if possible get some caretakers and please get them both placed before it is too late. My heart aches for you. My opinion is that when negative behavior affects you and your loved ones, then appropriate action MUST BE TAKEN AT ONCE TO STOP IT. With her behavior and dementia, her time to choose what happens is GONE - NOW YOU MAKE THE DECISIONS.
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Schedule her for an app't with a geriatric primary care doctor before going to the psychiatrist as dementia may play a part. They can also eval mental status & if unable or unwilling to treat will be able to refer you to someone. If she can't be safe @ home with the smoking & oxygen she may need to be placed & her doctor can help refer you for assistance in that direction. Someone needs her medical POA & POA in order to help you with this. If she is not willing or capable of giving this to someone you may need to go the legal route to have one appointed. You need to get help to get them both situated so that you can get back home. Mom doesn't mind you staying but you have your life to live. You have been away from your home too long. May ask doctor about Adult Protective Services if necessary. Good luck in such a difficult situation.🙏
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Smoking with O2 in the home MUST stop. The danger is super-real with horrific results. Don’t overlook this time-bomb.
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Your parents medical evaluations for several reasons:
1- to decide it they are mentally capable of caring for themselves. My guess is that they are not.
2 - to document all their chronic illnesses and develop a plan of care to address all of them together.
3 - to address your mom's anxiety/mental health issues.

If their doctor can demonstrate that they can not live by themselves and are a risk to themselves, they can be involuntarily hospitalized. IF this happens, you can work with social services for long term placements. I am not sure if they will be able to find someplace your parents can be together.
Your mother will probably qualify for a psychiatric long term care placement to deal with her anxiety. Since she is self-focused and disruptive, I don't think she will manage well with in-home care.
Your father will probably qualify for a long term residential placement - either total care(nursing home) or assisted care.
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If you feel she is a danger to herself or others due to mental illness, you can activate a Baker Act (in Florida it's called that) for evaluation and she may end up in a group or nursing home.

Please note smoking is not permitted with home oxygen as it can cause explosion. https://www.vitas.com/family-and-caregiver-support/caregiving/providing-care-at-home/demonstrations-the-dangers-of-oxygen-and-smoking/

News report: Home oxygen can explode while smoking cigarettes. Not only is this a danger to the patient, their family, but the neighbors too. https://www.youtube.com/watch?v=Ip4QLKPK8DU

Talk to her doctor about your concerns and consider Hospice care. If you decide to hospitalize her, they will put a nicotine patch on her, and she will not be able to smoke. The hospital doctor can organize hospice care as well.
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So sorry to read this. Mom has all the power in this, doesn't she?

You aren't even really aware that the monkey is running the show!

Ok, she gets mad, she gets mean--she needs a cog eval ASAP. Possibly medication to even out those moods. You need to get OUT of there!

Would dad be broken hearted if she is placed in a SNF or some such place? She sounds like a 24/7 need and neither you nor dad can made this all OK on your own.

How is dad? Just trying to keep the peace at any cost? How is his health? Would he want to still live with her?

I was a professional CG to a couple who had been in an assisted living facility. The wife grew to be a much greater problem and the facility wanted to split the couple up and put her in a higher level of care. They couldn't afford to do so, so the kids moved them back HOME with 24/7 CG's. It was a spectacular fail.

I lasted one day (she punched me--for $9 an hour I am NOT taking physical abuse)..and they lasted 2 days at home. She was sent to a much higher level of care and he went to live with a daughter.

I think when someone becomes a belligerent burden with no 'upside' to their personality, you actually owe it to your dad and yourself to get mom somewhere she can be cared for. With or without dad.

START with a good physical, including both mental and physical issues. See if your dr's office can give you links to places/ people you can talk to as you navigate these waters.
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She needs medication for her anxiety. Its not good for her to be this way either. The COPD could be causing her not to have enough oxygen to the brain. Is she on oxygen. Need to talk to her doctor.
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What would cause your mother to lose her palliative care benefit? Getting help with her mental health? Getting caregivers?

I am confused by that part of your post; I hope that you will come back and elaborate.
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Has your mother been evaluated for her cognitive issues? For her anxiety?

It sounds as though your expectation is that she should behave like an empathetic and caring person, and see that she is wrecking your life. But she's not "getting" that, so clearly, her reasoning abilities have changed.

I would have her seen by geriatric psychiatrist to treat the agitation and anxiety.

Don't ask her permission. Make the appointment and take her.

Have either of your parents assigned POA to anyone?

You are not obligated to give up your life to care for your parents. It was THEIR job to plan for their old age, not yours.
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