How do you have a parent evaluated for Dementia when they are unreceptive to the idea?

Do you have a good relationship with your mother otherwise? How about siblings? If you have some legitimate concerns, I would suggest writing them down and sharing them with her Physician. There's no guarantees, but it may help. Document everything. You may also try talking to a Social Worker at the hospital.

Your Mom's "control my life" comment is similar to one I heard my parents say. They didn't understand then, and their dementia has progressed since then. Time will reveal more, dear. And if she's well-cared for in the hospital, prayer will open the doors and give you the answers you need. Take care of you.

Unfortunately, we do not have a good relationship otherwise. My only sibling died 8 years ago, so no help there. I do have concerns. My question I guess is, how in the world do I communicate with her dr? Aren't there confidentiality issues that would prevent that? Same issue with the social worker. And how do I keep my mom from finding out? I'll keep praying.

Thanks

Hmmmmmmmmm. I don't think you can force an evaluation on anyone. At least, not someone in the early stages of Dementia. And they never think they have a problem. Or they may suspect something is wrong, but adamantly deny it, or become very secretive, for fear of others knowing or what may come next. Often fear is a huge factor.

I was told, by my wise Pastor, because I was struggling getting help from the medical community, thereby doubting my own perceptions, who told me that time reveals things. He believed me more than her doctors did. And he was absolutely correct! It wasn't 6 months before Mom's symptoms grew worse, and she could no longer hide her true condition.

But, my situation is a bit different than yours. My Mom was also hospitalized, but for blacking out behind the wheel of her car, then hit a truck. She lost her license for 6 months, and due to Alzheimer's, so did her husband. Therefore, she needed my help, and had no choice but to cooperate. She signed a Release of Information, which allowed her Physician to talk to me. What I didn't tell you at first, was when I shared my observations with him, he read my 8 page list out loud to her at her next appointment! This did not help my cause in the least!!! So Mom raged at me, and denied what I wrote. 4 months later, my Mom blacked out again, losing her driving privileges for an additional 6 months.

In the meantime, I obtained Guardianship for both parents, and switched doctors. (Long story.) The next doctor didn't listen to me, either; nor the one after that. It seems they believed Mom and not me. Dad's Alzheimer's was very believable, but my Mom's condition was entirely different. She evokes sympathy and compassion in the unsuspecting, and somehow elicits their support. Let me tell you, it reinforced me questioning my own perceptions. But, like Chicken Little, who screamed, "The sky is falling," I remained convinced that there really was a problem, and finally found a competent physician to listen. It seemed a long road, and wearying battle. I even had proof for my claims, and witnesses, too. At first, even my sister didn't entirely believe me (she lives far away), but today, she's on the same page, and supportive, but not until the doctors came around, and actually gave credence to my claims.

My Mom was even calling the police and legal entities to "report" me, in an effort to hide the truth. I started recording our conversations. I took pictures of her home, and made copies of financial evidence to prove my point. It was a terrible ordeal, and actually scary. I even questioned my own sanity some moments. I kept asking my husband if my perceptions were correct, checking to make sure I wasn't delusional, or overreacting. My perseverance paid off. As Mom's symptoms and conditions grew worse, and she needed more help, I was able to get more doctors involved, and finally found one astute enough to refer her to a Geriatric Assessment Clinic for an evaluation. That way, it wasn't coming from my insistence, but by asking and asking for help, and seeking and seeking for guidance, which eventually paid off. Finally, others see the problem more clearly, too.

Waiting is hard and frustrating. We try telling people, "The road is out!" But someone else says, "It's not." Like an attorney, we have to have a good case to try, and sometimes that takes time.
Prayer will give you the answers you seek. God does things on his time schedule, and in his way. We don't always understand it, but it's best when we rest in him, and let him guide. Easy? No. But worth the effort, and worth the wait. Sorry you've met some road blocks. It won't always be that way. Keep your Mom's best interests first, and others will see that. She may resist and refute, but as long as you love her, and want what's best for her, at some level she'll know that, and God will help you. I'll keep praying for you, too.

I was also thinking... If you ask to speak with a Social Worker, she may not be able to discuss your Mom's confidential information, but she should listen to your concerns, and may take heart at what you're saying. I'm sure this is not uncommon. She will know how to direct you, and handle your Mom. Take care, and let us know how things are going for you and your Mom.

Unfortunately there is no way to avoid having your mom find out if you attempting to discuss evaluating her for dementia. Although it is frustrating the system of confidentiality in healthcare is there to protect people. All you can do is gather information and ask all of the questions you will have. You cannot force the issue without her consent unless she has put herself in danger, so you might focus on supporting your mom as she 'controls her life'...dementia is a funny thing. It doesn't hit all at once, in some areas they seem just fine. Many people in early stages are self-aware enough to know something is 'off' and develop compensating strategies - it is self protective. You might consider treating her carefully and taking baby-steps in setting goals. Your first goal probably should focus on supporting her in making her own healthcare decisions. You may find she softens a bit if she doesn't feel pressured. Everyone who is a patient needs a family advocate to coordinate care and translate - take notes, ask questions. Since she is confined to a hospital bed it is a good time to help her think and write down her wishes for healthcare should something happen.

If you are allowed and able to visit her at the hospital, talk to the nurses. They will not be able to answer direct questions, however they are the ones who would make observations for follow up by the attending & her doctor. Most nurses are fairly pragmatic people and have seen it all.

You mentioned you did not have a good relationship - is there someone else that she has better communication with that can help? If not, you might talk to the social worker attached to the care unit she is in. The social worker most likely has been in to see her, and asked if she has a durable power of attorney for health on file. She would be the one to help your mom coordinate if she wanted to do one.

If your mom is developing dementia, you have some time to start researching what you need to know. This site is a good place to start. Welcome

Thank you all for the advice. This site hase been a wonderful insight. If I don't get answers, at least I know that I'm not alone. And for a long time now, I have felt so alone. I will keep praying for my Mom. I have decided that it would be best just to let time reveal. And I will do what I can to help support my Mom. Some humor? Maybe one day she'll forget how much she hates me!

By the time you suspect that your mother has dementia she most certainly has it and there is no urgent need to have her tested. Focus on how to care for her and get professional help. Don't force things as it will make matters worse for you both. It's a tough job and there are no easy answers. Take good care of your self.

Update! Just got a call from my Mom at the hospital, from which she has completely banned me. I think for fear that someone may think she needs "help". She told me that "if I have had anything to do with what is going on with the doctors, that she will never forgive me". I have no idea what she may be referring to. She refuses to give me any details. However, I'm thinking this could be the beginning of the revelation. Could it be someone has seen the signs of Dimentia in her? Possibly the social worker? I wonder if they are concerned about her because she never has any visitors? (her choice) She has been alone there for exactly one week now. Keep in mind, with no toothbrush or any other personal belongings. Not because I haven't offered to bring them, but because to her, it's not worth the risk of someone such as a dr or nurse having a conversation with me. I think this is so sad. And the feelings of guilt are in describable. But I will press on!

Yes there are those darned HPPA laws, but you can still offer your opinons to her doctors/nurses. Before my parents signed affidavits at their medical offices allowing me to receive medical information about them, I simply called the office asked to speak with the doctors head nurse, told her I wasn't asking her to reveal any information but I had some things I would like to share with her about my parents physical and mental states. I was able to tell her things they had not shared; like my mother is a bleeder which was a life saver at her upcoming surgery and that my father will always say he is fine yet has no interest in anything anymore. By just offering to share info and observations the doctors were able to treat my parents more thoroughly and once my parents did sign the OK the doctors have even called me to get additional my reactions to their prescribed treatments. You don't have to tell your mother you have done this and you can even tell the nurses that your mother has been very much against your interest in her health, so it might be better if your name was left out of it. Most medical professionals appreciate any help they can get and the fact that adult children have concern for their parents health and welfare. Blessings to you.

Dear khinson, I do feel for you, and can relate. I doubt your mother hates you; she may just be reacting out of fear. Sometimes they push others away to avoid being "labeled," or worse, abandoned. This doesn't have to make sense. It does sound like there's something your Mom wants to hide, and she may have legitimate reasons for doing so (in her mind). If she has dementia, remember their thinking is skewed, and often can't reason like a stable person can. Sometimes dementia is caused by medical factors, and is not always permanent, as well. Thank God she is getting help in the hospital, and hopefully they will meet her every need. You can still contact Social Services there at the hospital, share your concerns, and request they look into things. I believe they are required to do so. Perhaps another relative or neighbor or family friend can back you up, and reinforce your cause. Prayer will see you through this valley, and open up the doors God wants open, and close the ones he allows. God is ultimately in control, anyway, so faith will help you. Let us know how things are going, and how God answers the prayer of your heart.

Hi Kristi,

Hang in there. Don't let your mother's banning you from the hospital bother you too much. Last night when I suggested you support her I should have continued on to say that support is different than enabling or co-dependent behaviour. It is recognizing and accepting that that is what she wants to do as an adult that you are emotionally attached to. If you must to stay arms length for now, accept it but stay in contact with her doctor's office and hospital staff - stick to the facts and stay calm. Hosptial staff have seen all kinds of family dynamics and will make certain that they A). observe and record observations in her chart; and B). make the necessary and appropriate referrals. Remind them to put your contact # in her chart and that you are her next of kin / daughter. Leave it at that & trust what you can't control is being handled by others.

If you are unable to assist her, then professionals who do not know her will be evaluating her abilities prior to discharge. If they believe she has mild impairment, or is not going to be safe they will have to document it and work with her on it -up to contacting you.

As far as support goes - one of the best ways you can support your mom is to not let her actions get under your skin. You must learn to detach any emotion - it is not about you. Peoples actions are about them not you - - if she doesn't want you there then take this break as a respite and don't beat yourself up. Start deciding now how you will handle things should she decline, but don't be too quick to jump in if it will cause conflict that ultimately will wear you down.

I don't recall if you mentioned it - do you live with your mother? What are the other concerns that are affecting you right now? Sometimes when our lives are tightly intertwined everything takes on an urgency that would not be there otherwise.

Hang in there -

Cat,

Thanks for the kind words. I will take all the advice I can get at this point. I don't live with my mother. And quite honestly don't know that I ever could again. Other than her state of mind, I really don't have any other concerns. I know that she is getting adequate care in the hospital, so no need to worry about that. But mentally, it is taking a toll. She is depressed and seems convinced that there is a conspiracy to keep her there. She has been removed from here life of isolation, lists, and routine and she is struggling to function. She let me bring her some things today and she was crying when I walked into the room. It is heartbreaking, but I am at peace because she is there. What a strange statement! How can I feel heartbreak and peace at the same time? My brain hurts.

It happens - I've been there myself with the same question. You are very centered and strong - you will be OK.

If your mom is depressed part of depression is anger and acting out as well as crying. Ask the nurse if you can speak to the hospitalist (physician on staff) about getting her a psych consult - if they can evaluate & help stabilize the depression while she is observable, it may help her alot. Whether or not she has dementia or not - depression symptoms & behaviour triggers a cascade of problems, which are made worse by age & isolation. Kind of like shooting yourself in the foot and then saying you don't need help. If she is depressed and they are able to start her on something to stabilize her mood (which will take a while to work) other problems she is having may be easier to solve.

You take care. Let us know how things go with this - and how you are too. THis board is a "DRAMA FREE ZONE" - yay

What a wonderful thing to hear your mother allowed you to visit. That had to feel comforting to see her, instead of being banished and wondering. So sorry she is struggling, and it makes me sad to hear she is. Sorry for your struggle, too, but glad for your peace. You have a lot of support here, and lots of prayers. The Lord bless you, and your mother, too.

I just wanted to make a comment on how to get a parent to the doctor for an eval. I called my mom's doc and told him everything I had witnessed. I asked if he could call her in for a check-up because it had been a while. He did and while she had a general check-up, he also starting asking some memory-related questions. At the end of the check-up, he told both my parents (my dad took my mom to the office) that he felt my mom had AD and prescribed Aracept. She didn't believe him, but he also recommended an appt. with a neuropsychiatrist. My dad told her that if she didn't go, he was leaving. She went and the AD was confirmed. She still didn't agree, but at least we all knew what we were dealing with. Good luck, it can be done!

If the social worker talks to the Dr. and they feel a geriatric assessment is needed, it won't come from you. I know how frustrating this is, but hang in there. We all have been down somewhat of the same road and are here for you. My mom has Parkinson's and the advice I have gotten on this site has been a great help. Cat and SecretSister are right, you can't force her, but if you develop a good relationship with a social worker, it will help pave the way. Mindingourelders, helper on this site has some good advice too. Go to her profile and ask her for some information.
Linda

khinson1, while she is in the hospital is the perfect timing to share your concerns with her doctors, or a head nurse on the unit, or ask to speak to a social worker at the hospital. Even if you do not have medical power of attorney for them to be able to discuss your Mom's medical condition with you, there is nothing to prevent you from reporting a patient welfare concern related to your Mom, to those who are treating her now while she is hospitalized. The fact that she allowed her symptoms to escalate, plus what you have to share, may just open their eyes to her current medical status and need for further clinical evaluation prior to release and/or subsequent to discharge. What they do with the information you share with them will be very telling. I hope you do share your concerns. If you don't, you will continue to have a heavy heart and feel entirely powerless, waiting for the next shoe to drop. The other option is to ask the unit staff whether they have a Patient Advocacy program, and speak to that person, or the hospital may have an Ombudsman program for patients. Someone who is trained in handling sensitive issues need never mention your name if your Mom is already in their care as a patient. They have an ethical responsibility to determine whether she will be able to care for herself without assistance upon being medically discharged from the hospital. Hope someone will at least listen to the red flag alert you are trying to effect. God bless you, and keep sharing. It gets scary sometimes, and you may get to feeling all alone. You are not alone. You just have to identify those who are best trained to assist and steer you right.

I am an R.N with a degree in business, and experienced in opening and working dementia units. I am burned out with the focus on corporations making money and not caring about the daily cares of my residents/patients. I would like to open up a business to provide third party assessments, recommendations for care, and teach families what Medicare and Medicaid can provide for their loved ones. I have no desire to get rich, but as a business person I understand that I will incur some start-up marketing, and maintenance costs. (supplies and payroll) Do you think that this would be a resource people would pay for?

Berrie,
I don't see why people wouldn't pay for this service. I'm wondering though, especially with these tough times how they could afford it. I have no idea what arrangements my mother has made regarding her care once she is unable. So if there is no money, the responsibility will be mine. Newsflash! I don't have the money either. I had a good start on my own retirement until my 401k tanked like everyone elses. So I have to work hard to rebuild that for me. So that being said, people definately need to know what resources are available to them and thier parents, but may not be "able" to pay for it. I think you are great for truly wanting to "help" people. That is unusual these days. I actually had a RN roll her eyes at me when I asked if she would speak with me. I was shocked. I called her on it, and of course she said it was directed at something else. I had to wonder: is she burntout?, is she just in it for the money?, and most importantly, is she going to treat my mother with the same disrespect?. Nurses have very hard jobs, so thank you again for really wanting to help people.

Gosh, as a caregiver, like Khinson I have felt a bit frustrated when the same thing happened to me. That is why this community board on Agingcare is primarily for caregivers to share information freely.

Berri, since you have shared with us that you are a nurse looking to start a business, perhaps you might start a new thread if you really want to ask burned out unpaid family caregivers to be your focus group. Good luck in you endevor - - lots of people on this board are also in healtcare.

Every pt. should be seen by a social worker or discharge planning nurse within 24 hr of admission at a hospital call the social worker and ask to meet with her or him to discuss your observations-you are closeses to her and your views should be listened to and also involve the nurses in conversations they often pick up things a social worker might not get in a 5 min visit-unfortuntly you may not be listened to my husband definitly had brain damage the last year or so before he died because of trouble he made but it always came about that I was the problem I had mentioned it to the social worker the last few weeks of his life and to my family but no else picked up on it I have noticed docs do not want to get very involved nowadays with what may be a problem if they do not have to-my husband had severe brain damage when he died among other problems including massive infection-so I did feel like even though no one listened to me that I was right all along.

The family knows best what the changes are in their loved one. My f\Father in Law had a stroke while recovering from an operation. No one would listen to me when I visited him and saw the change. He died. Why is it the the family is so often discounted just because we don't have a medical degree??

Austin, glad to hear from you. I will be gone for a week,(vacation) but you are always in my prayers.
Linda

God bless medical providers. Our stories and points are all proof positive that they are more than overwhelmed and sometimes not active listeners. All the more reason we need to keep our caregiving patient advocacy cymbals going to wake them up when they fall asleep at the wheel. Scary, isn't it? Then, there are the clinicians that take off at 100 miles per hour, family, or no family. God help us to be as clear-headed as we need to be when we are advocating on behalf of our loved ones. Can anyone imagine all of this under the new, super-improved healthcare government overhaul? If no one is listening now, government bureacrats will not be listening, I am convinced! Mercy.

Caregiverslight, your posts are always refreshing. Yes, God bless medical providers. And pray he gives them wisdom, too. You brought up an interesting observation. Can you imaging politicians reforming health care, and our loved ones being cogs in the machine? Protocol...versus caring concern and compassion. Economic-based decisions, versus need-related provisions. Scary thoughts! (Look at Canada.) As our loved ones advocates, we indeed need to be informed, alert, vocal and vigilant. Who will be making life changing decisions for your parent, spouse or child? Who will dictate how these needs will be met? Mercy, indeed!

When we are not involved, someone else is making those decisions. The squeaky wheel gets the grease, and the thundering drums get attention. Pray for wisdom and discernment, and don't be intimidated or shy. Speak up, and exercise your voice on behalf of your loved one's health care.

I agree with you in terms of exercising our voices and not resting until we are heard. This discussion thread just reminded me of how vulnerable we are, not to mention our loved ones. The system is messed up now, and will entirely neglect the most infirm among us if the recommended changes are allowed to pass. Government needs to steer clear of the health care business. They are entirely ineffective in terms of regulating patient abuse and neglect now, much less quality of care, in spite of regulatory authority. The federal government does not need added control over our lives. They need to enforce current laws. If they do, patient care will instantly improve and spending waste will be significantly reduced. Now, wouldn't that be an awesome start to overhauling healthcare? Thanks for your kind words, SecretSister. We are all in our caregiving path together. I very much enjoy reading and learning from everyone here.

You, precious lady, have hit on an important issue. But the government wants total control! (Over what we can say, do, what we drive, where we work, how much money we can make and what we do with it. How we educate our children, and against all opposition.) It's a "money" belongs to the government mentality, and they want to tell us what they will do with our money. Do you get to choose how your parent's health care dollars are spent, and on what services. Insurance companies control it now. I'm not saying the government is all bad. But it is not doing what it was designed to do. It has overstepped it's bounds, and wants to continue, until it has control over every aspect of the lives of those who support it [them]. We are the government, in terms of: there wouldn't be one if we didn't vote them in. But how much voice do we, personally have over the decisions that are made? The system is grievous, and doesn't always work properly. How can we help? I don't have adequate answers. Many of us are so weary and distracted, we don't even notice when important events have occurred that will affect each and every one of us. I appreciate your concerns and voicing them. Some will not.

I am thankful for the medical profession, and that some of it is working. My parents are well-cared for, in my opinion, and a product of excellent health care benefits. So, I'll not complain too much about it.

I think we got way off track with this thread, though, and perhaps we could carry the current conversation to it's own post. I think the topic at hand centered around evaluating for dementia. I believe several addressed this, and hope the questioned asked was answered. If not, forgive us for the diversion, and post if anything is still unclear so your question gets the attention it deserves.

Great idea to start a new thread on healthcare administration! Sorry for digressing, all.

Go for it!

Will do when I come back online in a bit. Thanks for being an encourager, SecretSister. Whenever I type your name in response to something you have said, I really do feel like I have a secret sister in my heart! You are truly wise in your counsel, I feel. Thanks for being here.

You all are great! I agree totally with your opinions on government run healthcare. And I do worry about the care my loved ones would recieve if the government were running things. Hell, I'm worried about the care I'll recieve. It is scary, but I guess we should focus on that which we can control.
So here's today's events. My mom allowed me to visit again today. I'm thinking mostly because I could bring her some things. She seemed more at ease than yesterday, not raging about conspiracies or anything. Actually, she seemed sort of lucid. She talked to me a bit about some strange questions she had been asked earlier in the day. She said it was a nurse, but I really am not sure. So tell me what you make of this. She was asked if she knew where she was? And this question that I think is so strange. "Do you know the difference between a fish and a dog"? Is this a normal assesment to find out if she is ready for discharge? I know you guys can't say for sure. But maybe one of you has heard these questions before and knows exactly what is going on. By the way, she is not so far gone that she wouldn't know the answers to those questions. Is that how bad she has to be in order for anyone to recognize that there is a problem? I'm hoping that someone noticed something and that is what provoked the questions. Probably wishful thinking. Still haven't worked up the nerve to talk to anyone for fear that she will find out about it. Maybe tomorrow.

the difference between a dog and a fish would be a simple question that might be asked as an assessment question. They have to assess people's orientation to name, place, etc routinely each shift.

As far as healthcare, and many other topics go - I do hope it goes to a separate conversation thread where the previous posts can give the topic all of the attention it really deserves