How do I handle early cognitive impairment or dementia in my 88-year-old mom?

"I never quite know what she can handle and what she can't." And that really is the ongoing challenge we all face! We want our loved ones to be an independent as they can be, and we want to protect them from their own shortcomings, and it is often VERY hard to strike a good balance. In more advanced stages it becomes clearer, but few of us wish for that as a solution!

The accompanying problem is that the loved one doesn't know what she can and can't handle! You might set a guideline like "Mom, before you buy anything over $100, please call one of us first." But she'll be in a situation where someone is selling her a $1000 item over the phone or asking for a $500 donation, and she'll forget the guideline or she'll think it doesn't apply to donations, or she'll be in a defiant mood and think "my daughters don't own me." Sigh.

Since she was so upset at what she had done, maybe you could try establishing some guidelines that she agrees to, and see how that works out.

Know that often one of the first abilities to go is to handle finances. It may be that if someone steps in to handle that aspect for her she will be able to be independent in other ways and stay in her condo longer. But she'd have to give up her credit card, only have a checking account with a small balance, rely on an allowance of cash, etc.

Shared POA is the pits. Sorry. One in charge and two backups makes sense. Decisions by committee suck. Would Mom be willing to reconsider that, while she is still competent to?

As you and your sisters are considering what to do next, it is perfectly appropriate (and essential, really) that you each keep your own boundaries in mind. If someone needs to "just do it for her" that needs to match what someone is willing and able to do for her. While you are all busy making decisions for Mother, keep in mind your own needs and your rights to make decisions for your own lives.

Good luck!

Hello, Jeanne. Thank you so much for your thoughtful response. I was with Mom last night, and after dinner, she way extremely angry about a financial matter. She had read one of her bank statements and noticed that the amount her financial institution deposits each month (from IRAs) was lower than it was for her and my late father. I tried to explain to her that she and I had sat with her financial advisor and discussed this. She wouldn't believe me, and kept getting angrier and angrier. I am beginning to wonder whether she is competent. She was venting at me until I cried. She just didn't understand wha I was saying, AND didn't care that I was crying. She just seems to go off the deep end sometimes. I hate to leave her when she's so upset, but it doesn't seem to help her or me if I stay. How and when does one challenge another person's competence. She is very belligerent about "being in charge," which is her right. What are my rights? One sister is going through a break-up and "cannot deal with anything" right now. The other sister is just plain unpredictable and rarely comes out here to help. I really don't know what to do. I talked to my lawyer and he suggests I talk to mom. As you can see from my example, that just isn't going to work. I'd appreciate any thoughts or suggestions.

This is so hard! How terrifying it must be to still be able to read a bank statement and recognize changes, etc. but not to remember the story behind them, and then to have someone you thought you could trust telling you things you things that can't be true -- because if they were true surely you'd remember it. The prospect that the loved one is telling the truth means you're losing your mind, and that is even more terrifying than thinking she is lying. In some ways the early stages of dementia, where the person knows something is very wrong but doesn't know/can't accept what is going on, are the most heartbreaking.

So my sympathy is with Mother. The question is, how to protect her from making huge mistakes that could negatively impact her quality of life for years to come?

Is your lawyer a specialist in estate planning or Elder Law? If not, I wonder if getting a referral to such a specialist would be worthwhile.

Are you willing to take over Mother's finances?

Maybe "talking to your mother" should start with discussions about changing the POA so that one person is in charge. Only attempt this when she is in a good mood and a fairly stable frame of mind. It is Mother's decision. Would your sisters, who can't/won't be bothered with Mother's care right now, be willing to have this happen, and encourage your mother to make them back-up POA instead of co-POAs? I can't imagine how you can move forward making day-to-day financial decisions if all three of you have to agree on everything.

As for dealing with her outbursts, a difficulty is that she seems lucid and seems like a person able to reason, so you are naturally trying to reason with her. That doesn't work with people who are losing their ability to reason, and that sounds like where your mother is at. You could say, "Hmmm. You are right, Mother. That amount is less than it used to be. I'll call the financial planner in the morning and find out what is going on. ... Did you get any other interesting mail today?" In other words, humour her and diffuse the high emotional content. This usually works better if the person is also losing memory. Often people in this state won't remember to ask you tomorrow if you've talked to the financial planner. But if she does, I'd repeat what the planner said months ago. And if she insists on making her own calls? I think I'd have a little talk with the planner so he or she knows what to expect.

In other words, you are no longer dealing with a "normal" mom, and you'll have to learn new techniques of dealing with her, for her sake, and to retain your sanity.

I think I would be inclined to leave impossible conversations before they get to the point of you crying and your mother ranting. At the first sign that Mother isn't able to be rational on a topic, I'd try changing the subject, or simply leaving. "Mom, I can see that talking to me about this is very upsetting to you. I'll be going now, and maybe we can talk about it more tomorrow, after you've thought about it some more."

You are in a very hard situation, and not one of your own making or choosing. My heart goes out to you.

Awwh, my dear! You are right - sadly things will not get any better. The best thing to do when a Dementia or Alzheimer's afflicted loved one is in the grips of worrying or raging over something, is to agree with them and assure them you will handle, say calling bank for explanation, etc., because no matter that you know and have the explanation for them - it is not going to make sense to them no matter how you try to break it down for them. They are fixated on what they are questioning or believe is/or should be.

Sadly, if you and your sisters are not in a position to keep up with taking over and handling her expenditures more directly, and having say a live-in caregiver for her, it sounds like time for her to be in an assisted living facility, of which there are alternatives in B&B style Residential Care homes mostly ran by RNs and Drs which are becoming popular and wide spread - not sure what area you are in, but here in the DFW, TX area we particularly have many.

My cousin's MIL just moved to one, and it has been a blessing for all, and she loves the "real house" setting, and small set of companionship with fellow residence in home, and she can enjoy the back yard, etc., well being fully cared and catered for. You might look into this option in your area.

All the best! Keep us posted!

I greatly appreciate these answers, but there is still the issue of shared POAs. Two of us might agree where Mom should be, and the third does not. What do we do then? Unless I physically move away or severly restrict my time with Mom, I'm afraid we will be stuck in the current pattern. I really don't want to move! So I guess that leaves me one option -- just do less. Does that sound like the best option, given the circumstances?