Elderly mum refusing help but needs it

[FestiveBake]

After having looked after MIL with dementia for a few years, it seems my mum is declining in a very similar way, quite quickly.

She has other mental health issues and her GP describes her as ‘eccentric’. After two hospital admissions, district nurses now visit every day to administer diabetes meds as she’s too chaotic to do this herself.

She is incandescent that this is happening, denies she can’t look after herself etc. She hides the medication they leave in her house and blames the nurses, makes their life terribly difficult. Has much medication from previous years and randomly gives herself extra doses of insulin - it’s a miracle they’ve always managed to realise this before an accident has taken place.
I receive a call at least twice a week to let me know how difficult she is and what she’s done this time.

Her house is horrendous, she has hoarding issues but it’s filthy. Particularly around food, there is decaying food all over. The nurses have called me twice already this week for this issue. She won’t let me look on her fridge or throw food out. The nurses think there’s flies in the fridge (so possibly maggots?)

She refuses to have help and is massively over any threshold for free help (which I think she could be persuaded to have if she didn’t have to pay). I have financial POA but nothing else. Her GP has been to assess and says she has enough capacity to make her own decisions but acknowledges she is quite a risk to herself in many ways. She has been reported to adult safeguarding on a few occasions but I haven’t heard from them.

What happens now? It really is a matter of time before she either burns her house down with smoking, has a diabetic coma, poisons herself with food or something else.

We don’t particularly get on, she has terrible narcissistic tendencies and I have withdrawn other than occasional visits, calls every other day. She tells everyone how awful I am (professionals - thankfully they can see through her). She would however love me to offer to do housework but I have a demanding full time job as well as my own young family and just can’t. She’d let me pay for a cleaner but I can’t afford to - she’s much wealthier than me.

Im just not sure what happens now - I think if something happened, I’d feel terribly guilty.

Folding paper in half isn't part of a capacity assessment, it's part of a 3-stage command task on the mini mental state examination.

Capacity comes down to whether a person can retain, understand, weigh up, and communicate information relating to the decision being made. It has to be decision specific.

If that's literally all they asked her, it doesn't sound like they've done a capacity assessment, more a functional/cognitive assessment

That’s not all they asked her. The GP has carried out the assessment and says she has capacity. Which actually I agree with - at the moment - she is absolutely oriented in time/place, it’s the odd behaviour (of which I have only mentioned food hoarding, leading to beetles crawling on her worktops and flies in the fridge) that’s worrying and indicative of a wider issue with her mental state.

Capacity isn't an all-or-nothing, it's very clear in the guidance that it is a decision by decision process, and up to the person asking the question to check that the elder has capacity. Your capacity to decide whetehr to have tea or coffee, or what clothes to wear for the day, is separate from your capacity to decide which account to put your savings into, or understand and sign a DNR form.

Either way, OP's mum isn't getting the help she needs.

I have been where you are almost exactly, and I only wish that I could offer some help, but when I was at almost exactly this stage, my mother was admitted to hospital after a fall and as far as I can tell decided she would rather die that have help.

What I now know is that there is a name for this - Diogenes Syndrome - although that doesn't get you much further as it's not the same as not having capacity. But I did find that naming it made me feel better, as I realised it wasn't my fault and I couldn't sort it all out. Not even the doctors can.

This is quite an interesting read on the whole subject of elders, DS and capacity. Again, it doesn't solve anything but might make you feel a little bit better.

If you want to DM me, do.

You’ve done what you can and have been met with firm resistance. It’s honestly not your fault. Step back and let things unfold. Don’t make yourself unwell over this.

It does sound very dangerous, this woman could take out the whole neighbourhood if she blew her house up 😳