How do I help my Mum?

[CisMyArse]

She's 78 and has always shown traits of unstable mental health. This has worsened with age and she's incredibly difficult to spend time with.

Coupled with this is a huge dependency on strong opioids (fentanyl, pregablin, oxycontin) for complex bowels issues. She's a typical revolving door patient and is incredibly difficulty to talk to (delusions of grandeur, exaggerated emotions, hysteria).

She lives alone (widower) and is a typical hoarder. Lovely new home is now smelling, old rotting food, obsession with TV shopping so boxes everywhere, masses of 'stuff' everywhere.

She's difficult, demanding, irrational, won't listen to reason. She also cannot take care of herself - has terrible sleeping patterns, a terrible diet, self medicates her pain killers to the point her eyeballs are rolling.
She's vulnerable and I'm her only contact. I don't know what to do.

I'm seeing her GP to say that things cannot go on as they are. I want some advice as to how to proceed but her GP usually fobs her off with more pain relief. I think she's unstable but don't get the opportunity to yell anyone.

Any advice greatly appreciated.

[Bluelady]

What a horrible situation. To be honest it sounds as if she has dementia and needs 24 hour care. How easy that will be to arrange depends on her finances. And if you have power of attorney.

If she owns her flat and you do have poa, it will be relatively easy on a practical level to find her a care home place and move her into it, selling the flat to pay the fees. The flaw with this is that she could live another 20 years and the money would presumably run out long before that.

If she doesn't own the flat, you'll need a diagnosis of dementia and a social services assessment for her care to be local authority funded.

Alternatively you could arrange a care package and cleaner which she would have to pay for if she has £23.5k+. Or if she has less than that SS will put a care package in place which will be sub optimal.

If she has assets that mean she has to pay your biggest problem, if you haven't got poa will be sorting the money out.

[retirednow]

She needs a environmental home visit for the hoarding and a mental health assessment both can be done by GP, occupational therapist and social services. If she has a mental health team you could contact them if the GP isn't interested. You can also call the safeguarding team at her local social services, age UK are also helpful.

[Needmoresleep]

1. Getting a POA will be vital going forwards. For her too, if she wants to have you looking after her affairs rather than Social Services. Engage the help of anyone she might listen to, to help persuade her. You don't need a solicitor.
   

1. Once you have this ask the GP to refer her to the memory clinic. This will help confirm whether there is dementia as well as the effects of medication.
   

1. Speak to adult social services and ask for an assessment. If you have a POA this is useful as it will inform any future discharge decisions. If she absolutely refuses to grant you a POA, SS need to be aware she is vulnerable.
   

1. Once you have POA and depending on memory clinic findings, take control of her finance and limit her access. It's the initial sorting out that takes the time. And the earlier you do this the less chaos you have to unravel. Organise a small debit account for her and use mail redirect. This ought to help keep a lid on hoarding and help ensure utilities are paid.
   

1. Once you know how much money there is and how much is coming in, and have outgoings under control, you are in a position, with social services and her landlord if need be, to decide on care, etc.
   

If she won't give you POA what you can do is limited. Recognise it will probably get a lot worse before anything happens and do everythimg you can to preserve your physical and emotional energy. It will have been her decision and she will have to live with the consequences.

[CisMyArse]

I can't thank you enough for this

She's quite
Challenging again this morning - refusing to sleep in bed, lucid one minute and saying she's suffocating then really drowsy the next. There is an incredible amount of opioids in this house and I have no idea what she is or isn't taking.

Phoning the GP next to request that all her meds are in a container. Also want to take back all other meds to
Minimise her abusing them.

She tells me she can't cope then gets angry when I suggest POA.

On a practical note - her phone has received over 20
Texts saying that there are shopping channel deliveries arriving today. I already have 40+ large boxes to somehow send back. Can I refuse to accept delivery?

I could cry. Then I feel selfish because this isn't about me.

[CisMyArse]

I'm also
Hoping that the 5 day course of 5mg diazepam will calm her enough and things will seem better afterwards. Am
I wishing for too much here?

[Bluelady]

I know it's been said that you don't need a solicitor for poa but using one makes the whole process easier and removes stress from you. I was dreading it but the solicitor breezily told my parents they might as well get it sorted when they made their wills.

It's vital you get it sorted for all sorts of reasons, not least to knock the shopping on the head.

[retirednow]

The GP must come to see her at her house, this is ridiculous, keep giving her more pills, diazepam is terrible stuff. I would gather up all the tablets and take them to the surgery so they can see they themselves. She needs a up to date controlled drug prescription, a small amount prescribed at a time and a sealed container box from her pharmacist, they will have experience of this. I would ring her GP today to sort this out as she can't just not have any tablets. With the parcels today, are there phone numbers you can call back and ask their advice. I guess they are all paid for but ,you will need to ask them what their returns policy is and just put them somewhere she can't open them. It's very difficult because you are only doing thee things in her best interests although legally you can't control her life. I would push again for poa, her gp might be able to persuade her to do this. Once the money one is regisrered you can take control of her finances straight away. Did you get a chance to speak to social services, or age uk, they need to know she is vulnerable and can help,with getting a home assessment done.

[CisMyArse]

Spoken to GP. He won't do a home visit.

That said, he spoke sense. We both agreed that her anxiety is possibly because she doesn't manage her medication properly and that he is contacting the pharmacy this morning for a dosset box. In the meantime, he's going to do an urgent review of everything to see exactly what meds are needed and what aren't. I've told him that it very much looks like she hasn't touched most of the nerve pain medication but that she's erratically taking others.

He also told me that she's recently developed type 2 diabetes (addicted to coke and sugary cereals, sweets etc) so something else to factor in.

I expressed concern about the diazepam and he's reassured me that it's a strict 5 day course to see her through this anxiety. Once 5 days is up, by then she'll hopefully be more stable in her meds and he wants to refer her to a memory clinic. He is querying possible onset of dementia.

She's been difficult my whole life - really bombastic and disagreeable and I anticipate tough times ahead. Thanks for all your advice.

[Needmoresleep]

Bluelady, the point though is that if you are dealing with someone who is fundamentally contrary, fickle or obstructive , a solicitor may not be able to breezily tell her anything. Also solicitors may demand better evidence of capacity than can be provided.

I have been down the same track as OP. Essentially we roped in the priest, who knew my mother well and who understood that we needed a POA. He was able to sit her down with the forms and explain that she really needed to sign. She trusted him. Others have found that a GP or even men in uniform - one poster gained a breakthrough when a fireman strongly advised a parent that this was what was needed. My cousin found it was one of her dad's contemporaries who got the message across.

I also know the mail order as well. It was impossible to enter my mum's large second bedroom because of tat she had bought. I filled a skip with catalogues and charity begging letters. It is awful.

OP take a step back. There is no point pushing at a door that wont open. Instead think of other ways you might get access.

When you see the GP:

1. Get him to stress the need for a POA and see if he can make headway. Will he be witness and sign? Ideally you get the POA before any dementia diagnosis. The Court of Protection process is awful and expensive. If you had a very nice Doctor he might even warn your mum that if she wont agree to you having POA he will have to refer to SS, for them to intervene, as she is no longer safe.
   

1. Referral to memory clinic. You will then see memory specialists who will be able to spot Alzheimers patterns, and presumably if this and other common forms of dementia are eliminated be able to suggest potential adverse drug reactions. A diagnosis is a good first step to unlocking first Attendance Allowance and then Council Tax exemption, both of which will help pay for a small amount of care - or cleaning...
   

1. Ask for medication in blister packs. GPs don't like this because it is more expensive. I used the need for my mum to take Aricept "the medicine that is going to make your memory better!" to get a carer in daily to give a prompt. Even my mum spotted the irony of needing to remember to take memory pills. If you have someone coming in daily, blister packs will fit in the the cheap safes you can get in Homebase.
   

If you don't get anywhere I would be tempted to phone adult social services, perhaps anonymously. They may have more ideas. (The lady on the phone where my mum lives was brilliant both when my dad was dying and when it first really kicked off with my mum, but I suspect it is a matter of luck.) They will not want to see money that should be being used for future care, frittered on tat. Nor will they want to see family support drain away. I also got a lot of support from my mum's bank, who again were worried about signs on vulnerability, as she also had a habit of giving away bank details over the phone. One immediate thing they did was give me the forms for third party access to her bank, which then only took a couple of weeks to sort out, essentially as she had a fall and was incapacitated. I suspect though that your mum wont want you to know how much she spends.

Oddly when I got POA and moved my mum to sheltered housing the hoarding stopped. No more charity shop finds, or tins of make your own marmalade. I think she was lonely, frightened and depressed and the mail order catalogues (often kitchen equipment or vitamins) offered her the chance of becoming the perfect and healthy 50's housewife.

But whatever her problems your mother is not allowed to steal your life. Yes give her the help she needs, but she needs to give you the tools to enable you to deliver her better quality final years, by meeting you half way.

[Bluelady]

That wasn't actually my point. What I meant was that having a solicitor handle the mechanics of a poa makes the whole process easy an stressfree. Obviously there will be more suitable people to get her to agree to it in the first place.

Otherwise, your advice is absolutely spot on.

[retirednow]

You don't need a solicitor to register a poa, they will charge several hundred pounds for it. You can call the office of the public guardian and they will send you the forms free of charge. All you do is decide who will be taking over and have someone preferably the GP sign as well and put in a section about capacity, they can do a capacity assessment at the same time, obviously if there is lack of capacity you can't proceed and decisions will go to the court of protection who can appoint someone. Regarding finances if she allows it you can visit her bank and arrange to be a third party to manage her accounts. She Must have seen a GP to diagnose the diabetes, I wonder if the nurse would visit her at home if the doctor won't. You could sign up for the preferential mail service so a lot of scrap doesn't come through the post. Wishing you all the best.

[Needmoresleep]

Almost better not to use a solicitor. Not just the money, but the fact that you can prepare the forms in advance (they are not difficult and OPG is helpful) and the (persuasive) witness can visit her on familiar territory so with the best chance of getting her to sign.

Sad but true. My mother is always more amenable if I arrive with a small gift. Custard creams work wonders! Taking her out for afternoon tea, keeping the conversation pleasant and then bringing up admin towards the end, also works.

It is such hard work...

[retirednow]

If you use a solicitor youd have to take her there which could be difficult.

[lostmyslippers]

@CisMyArse I really feel for you...please look after yourself too. Thinking of you

[epicclusterfuck]

Some solicitors will visit clients at home

[Needmoresleep]

Not my mum's. She tried for a year to sort the POA herself. At one point she apparently found herself outside the solicitors office but then forgot why she was there and went home.

The issue with dementia is that the person suffering is often the last person to recognise a problem, so don't see the urgency. So can react negatively to pressute from family. Solicitors, because of their professional liability will want to do everything by the book, so may shy away from accepting the wishes ofsomeone with dementia, however much a POA is in their interests.

We were very lucky that the priest's professional resposibility was to a different authority and he knew my mother and her circumstances well. He was able to take her through the issues and she signed willingly and has had no cause to regret.

I will also confess feeling a bit uncomfortable when I found earlier correspondence where the solicitor had suggested she became Attorney. My mother is high net worth, but I know how many hours I have put in free of charge.

[pigshavecurlytails]

GP visits are only for those who are housebound, but you could take her to an appt at the GP.

[Bluelady]

GPs vary. A lot will do home visits regardless of whether a patient is housebound or not. Especially if the consultation is likely to need more than ten minutes. Solicitors do home visits too. As I said my parents' solicitor charged £200 apiece for their poas. I guess some people will see that as money wellspent, others won't.

[retirednow]

Our GP would do a home visit in these circumstances as they can assess capacity and make sure the person understands what it is all about, they charge 100 pounds.