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Mom was diagnosed with Alzheimer's a little over 2 years ago. Over time she has been getting worse, with very significant changes this last 6 months. After many stressful discussions my brother finally agree to letting me have a home care giver in. We started with several hours a day, but have had to go to 5 days a week. I bring mom to my house most weekends, as without someone around she doesn't take her meds or eat right. She also is supposed to use a walker for a worsening spinal issue, and is very unsteady on her feet. Her doctor thinks she really should have more continuous supervision and has suggested Assisted Living. Mom refuses to even consider the idea, saying that the doctors and I are crazy, and that there's nothing wrong with her. She now is at the stage where she gets very confused, can't really focus on a meaningful conversation, gets frightened very easily and is very agitated most of the time. She gets angry and mean for no reason, and has started accusing others of all sorts of things. My brother, who thinks he's an expert in everything comes to visit for a couple days, and bases his "assessment" on a snap shot in time. As of a few months ago she was still able to "fake" her way through the visit. He agreed to visit an AL with me while he was here, and totally rejected the idea of moving her because he "just can't wrap his head around it". He then proceeded to tell her where we had gone, and of course she totally lost it. She tried to lay huge guilt on by saying that if we put her into a home, she'd run away so no one would find her, and probably kill herself. He told her that we just went to "look" and that it would be a very long time before any decisions would have to be made. He is being totally unreasonable, and tries to block every attempt at discussing it. It's not easy for me to make this decision, but in my head I KNOW it's the best place for her. My heart aches at the thought of her not cooperating and making the move even more difficult, but is know it's the time to do it. How do I get my brother to understand that he's not seeing the day to day behaviors, confusion, agitation, anger and depression, and that being with a care giver is not the best way to keep her active and engaged. She loves people (or always has), and makes friends very easily. She love's being social too. But she's already pulling away from her friends some and many of her activities because she is very aware of how she's changing, but is still openly in denial. If she were in an environment where activities, staying engaged, and socializing with people her own age, and with similar interests, she'd do so much better. ANY SUGGESTIONS??

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Why is it up to brother? Does he have DPOA, controlling the purse strings?
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Technically I have POA, with him as the next person if I can't perform the role, but the agreement was made long ago that we'd discuss and act together in any decisions regarding mom. We both have online access to her bank accounts, but only my name is on all her accounts. I don't want to create "bad blood" between him and I since he's the only brother I have. I know I legally can make the decision, but would much rather have his support.
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So while you are being so considerate of your brother, you are stressing yourself out? This is one reason these joint responsibility situations can be a drawback and block timely decision making. If your brother wants equal voice in this decision he needs to wear some equal ears and do some listening. If he can't bring himself to take the advice of you and her doctor, he needs to do some real research and care enough to spend some serious time taking care of her so he can make an informed decision with you. Just being your brother isn't enough, he has to be a responsible party in this joint decision relationship and take the time to actually familiarize himself with the situation. While ultimatums are not productive relationship builders, you can either throw one out there and demand he spend several weeks taking care of mom in his home -or wait for the big crisis that proves you were correct. BTW he won't feel guilty after the big crisis, his excuse will be that he had no idea it was that bad.
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What is Mother's attitude toward assisted living?
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I believe she said in her original posting that her mom's response was to threaten to run away and possibly kill herself. So not the best of attitudes.
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Ah, yes, she did. All the more reason it is important to have Brother in on the decisions.

Has Brother actually talked to the doctor, or does only have your word for it that she needs ALF?

OncehatedDIL is right. Brother really needed to be informed, not only about ALFs but about Mother's real current state. If she could stay with him for a couple of weeks, (with the same level of in-home care she has now) that would be ideal.

You could also email him daily with what goes on each day -- the caregiver said she was pleasant but very confused; she was awake all night; she refused to eat and later was eating raw bacon -- whatever happens each day, good and bad, so he gets a better feel for how life really is.
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Dabs, it seems to me that your bigger issue is your Mom's reaction to a possible move. Can you increase the caregivers time with your Mom as an interim solution? Sadly, at some point, your Mom will pass the point where she will understand where she is. At that point the AL will be the only choice. A dementia unit will provide a safe (escape free) solution. Also, at that point, your brother will accept the inevitable. Those of us dealing with the daily issues, (and using this website) understand what is coming in the future and are ready to take the next step. Your out of state brother can't really see the future and has probably never looked at the ALZ site never mind this one.

My Mom went from being fine on her own to AL in less than 9 months! Your job is to protect her as best you can. Bring in more help and start to visit the ALs so you know which one you would choose when the time comes. AND, make it close to you. The need for visits only increases as time passes so choose a good one and make it convenient for yourself.
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Dabs, I have 7 siblings. I've been helping father caregive mom (dementia) since I was age 23 (24 yrs ago). I have always been a letter writer. In all these years, before I got a computer, I wrote to all my siblings by letters via the mail, everything that happened. Father and mother, my life, work, etc.. When I got the computer, I emailed to those who had computers. With one brother, I text to him because he's not into emails but FaceBook, and I refuse to have FB. So, I always update fam in the states and here on island. All my siblings know the true situation here. When father was beginning to forget to turn off the stove, I told everyone. When he sometimes forgot sis' name, I told everyone. Let's just say, that as the years went by, my siblings saw how the parents were going downhill mentally. No one was surprised about anything. It does make a big difference when you update the siblings every time something "new" happens. I even remember emailing that father will only shower once a week. Then a few months later, I recalled telling them that he now wil only shower once every 2 weeks. The last time I emailed them (before his stroke), was to tell them that it was going on 3 weeks and he refuses to shower. If you keep updating on the small stuff - it adds up to the Big stuff.
....Maybe you can ask for a Holiday away from mom? Ask bro if he can "babysit" mom while you're gone? That would be an ideal time for bro to learn what's happening - hopefully!
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Have your brother come stay with her for a few days.
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Thanks everyone for your insight.
I feel as though my brother is an overall control freak. Even though I manage mom's care and her finances, he thinks he has to TELL me what to do. Obviously I'm an idiot. He's younger than me, and in a high power position in his career, so everyone is inferior to him.
As to updating him, I do either email him for call him about once every week or so. I absolutely agree that he should have her at his home for a few weeks. My husband suggested that right off the bat. Two problems here.....his wife is "too busy" doing her thing(she doesn't work) to look after mom, and she won't have a stranger in her home.....OH PLEEEEZZZZ. A total princess... The other factor is that for the past year now mom won't go there to visit unless I go with her. She's not comfortable in there home, and gets so nervous about being there that something always happens. My husband and I were actually up there with her when my niece got married last year, and mom was bringing her pills into the kitchen to take them and one of their dogs jumped on her leg (small dog) and startled her. She dropped her pills and yes, the dog gobbled them up. TOTAL CHAOS!! It was an accident, and at that time she was still very functional. They yelled at her saying that she may kill the dog, etc. and the entire day was spent with her worrying about the dog who had immediately been taken to vet. Mom cried and cried, and kept saying how sorry she was for being "bad". It broke my heart. The dog was treated, and fine the next day.
He actually is coming for a visit next month, and I insisted that he go with me when she sees her neurologist (an Alzheimer's specialist, and one of the best in the Southeast). I spoken to the doctor about his attitude, and he's the one that told me to schedule her appt. around his visit. Hopefully he will advocate for AL, and this will resolve the issue. I certainly hope so.
It will be very interesting to see if he pays attention to her behavior and her symptoms while he's here. The care giver is wonderful, and mom loves her, and she adores mom. She has cared for patients like mom in the past and understands the progression of the disease. She and I have discussed the situation, and she realizes that mom would benefit from AL, but she also wants to keep her job. She's afraid of my brother because when he call moms house and talks to her, he intimidates him with his "corporate" tone. If she tells him about something she's noticed changing in mom, he tells her that she's the care giver and should see to it that the days go smoothly.....What do you think about me giving her a week off while he's here, and let him and the princess deal with her care? That would mean taking mom wherever we go while he's here. If she's gotten to the place where she can't "fake it" as well as she's done in the past, he'll love watching her do and say things over and over, and witness first hand how frightened and agitated she can get when she realizes that she's loosing control...
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By all means, give the caregiver the week off when your intimidating brother is there!
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Dabs4Mom, I thought Geewiz had some good comments, major one being that the bigger issue is how Mom would feel about being moved from her home to AL. I agree with comments about having the caregiver, who your Mom loves and is doing a good job, to add more hours of care if needed. And when she does come to that point where she won't really be as aware of what's going on, it would be the time for the dementia wing in AL. You mention how social your Mom always was, and you think she needs more stimulation w/ people around and activities scheduled, rather than stuck w/ one person/caregiver all day. That's what I thought with my Mom, who also was a very social person and people lover. But it wasn't the case at all. I made the move of having her leave her home and go to an independent care place close to me. She had a nice apartment that she loved withing the facility, and many activiites were scheduled, and meals provided in the big dining room, etc. Sadly, my Mom isolated herself alone in the apartment, as she was intimidated to go to the activities, and meet people, because of her deteriorating memory. She was aftraid she may lose her way back to her apartment. She couldn't remember the names of the people she met, who always referred to her by her name. It made her quite anxious, and very lonely surrounded by people. Your Mom is very against moving from her home. It could be very stressful for her, and increase her anxiety and fear. It seems to me she would better off to stay put with this loving caregiver, and see how things progress. AND, the idea of her going for a two week visit to brother's house is not good. It's unfair to your Mom. (sure, it'd be a rude awakening for your bro and sis-in-law, but at the expense of your Mom) because sadly, it would quadruple her level of confusion. I thought about doing that w/ my Mom.....sending her to my brother and/or sister for an extended stay so they'd "get it." But, my poor Mom would get the brunt of the experience. Better idea, I think, is to get the brother to come to your Mom's place and stay for a week. That way it's more realistic, because it's on her turf. Good luck on that, however, because I haven't been successful in getting my siblings to come to my place to take over Mom care for a week or two so I could get a lovely and much-needed break. They're always just too damn busy. Of course! Anyway, good luck. I hope you'll wait on the move to AL. The doctors are always pushing that, I think. But they have no emotional ties to patient being uprooted. :(
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I have found that getting my sibs to take my Mother for a couple of hours is the only way they can witness firsthand when she starts to lose it. She can hold it together for awhile so they don't really know what is going on unless they are alone with her and something goes "wrong" and then she starts to unravel. The problem is getting them to be alone with her.
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Siblings who care so much about each other are usually blind to their love for a parent

Is there an issue concerning the relationship between siblings?

Inferior or not- the parents did what they could to demonstrate their love of the
children

It is really clear to me that the brother who is not in the home directly is depending on observations from the brother who is there-

What is inspirational is the way these situations bring out the best and worst in realtionships between one another
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Set aside brother for a moment and focus on your mother. What are her Activities of Daily Life? Can she eat by holding the fork and spoon by herself? Can she dress herself? Can she go potty ( raised and handle-barred) by herself? Can she wash herself, using all the faculties available to one handicapped person?
If the answer is Yes, then she can remain with you for awhile longer..... You'll know when the time has come for her to go to an ALF.
p.s. The inability to walk is NOT on the list of Activities of Daily Life.
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N1K2R3, activities of daily living are one gauge of being able to live alone (dabs4mom's mother does not live with her) but they have to take into account how dementia impacts them. A person may be able to feed herself just fine -- but forget to eat, or forget they have just eaten. A man with dementia may be able to get dressed by himself, but put on shorts and a tank top and go outside without a jacket in Minnesota winter. Granny may be capable of washing herself but with dementia has become afraid of water. My husband could do all the activities of daily living almost up to the end, but he really would not have been safe living alone since his diagnosis with dementia, nine years earlier.

So in this particular situation, dabs4mom's mother HAS DEMENTIA, lives alone, gets help from a paid caregiver during the week and from her daughter on weekends. Her doctor, a well-respected specialist in dementia, says she needs more supervision than she is now receiving. This is not about whether she can handle a fork and knife or go potty by herself. It is about how to maintain the best quality of life for her as long as possible.

All caregivers share some experiences and some emotions. But caregivers of loved ones who have dementia have different challenges to face and different emotions as well. Different standards apply to decision making, and different levels of care are needed as well.
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Of course, dementia is a huge consideration. All healthcare is multi-faceted.
I personally believe that no one over 75 should live alone, but that's just me.
At least one other person in the home is recommended, not necessarily round-the-clock, but available. I'm sorry but I thought that Dabs4mom was living with her mother at this time....guess not, after re-reading her post..
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75?! Really? Wow, I'd better alert my kids that they should start planning ahead for a few years from now. Of course they'll point out that Gramma lived alone until she was 92, and her sister, who was working full time at 75, stills lives alone at 97 (both dear ladies with lots of family support, but definitely living in their own apartments.) So unless I become disabled or get dementia I don't guess I'll be able to sell the kids on the idea.

I personally believe that there are very, very few "one-size-fits-all" solutions or guidelines for the elderly, but that's just me.
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Thanks to everyone who has posted comments. All good things to think about. Since mom does have a care giver with her during the day, she manages in doing her bathing and dressing, etc. She needs prompting sometimes, and wants to wear the same clothes all the time, but over all her daily living skills are still functional. The biggest problem is that since it's just her and the care giver, she give the care giver a hard time about everything. When she gets agitated everything escalates into a "scene". The care giver tries to diffuse her, but is often unable to get her to cooperate. Her doctor thinks she's still functional enough to try and take more pride in her appearance, and be more social if she were in an environment with peers. Being with one person all day, in her own home actually begins to be a form of enabling type of situation I guess.
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As POA, YOU and only YOU are responsible for her! If something happens to her while at home, it will come down to you. I have a sneaky suspicion that what this boils down to is your brother is worried about money, believe me it always comes to that. No matter how well off he may be! It's a good thing that you have an appt set up when he is town, maybe the doctor can speak openly and honestly with your brother. I would definitely talk to the doctor prior to the appt and ask the doctor to be frank with him. Someone needs to stand up to your brother. It's easy to give advice when you don't live close to the relative and not see how they are day to day. By your sister-in-law's response, it sounds like they are very selfish people. Trust me I have been in your situation, sure the family was angry with me, didn't talk to me for a few years but in the end they came around and told me it was the right thing to do. While your brother is in town, I would leave him with her for a few hours, tell him you have an appointment that you can't get out of. After a few hours he get the message loud and clear!
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Again, I stand by my posted commentary.... After age 75, a person either has to have someone check in on them, or live in a stepless, one-floor arrangement, or wear a life-alert monitor. Jeanne, you are fortunate to have had a Gramma and a Great Aunt who lived to be in their nineties. Not everyone is so fortunate. Hope you live to be that old and in good health.
Did I hear you say that you have kids who would check in on you?
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N1K2R3 - Going to have to disagree with you on that age thing. I live in the Palm Springs, CA area. It's very popular with the retirement folks. One of the local comedians calls it "God's Waiting Room". Whatever.....they are very active, social, and OLD! They have access to wonderful healthcare, great weather, great golfing, and they're out and about until well in their 80's and 90's. Without a caregiver.
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Can you do any videotapes for brother of what is really going on when he is not there? Maybe video of a clinical interview with a geriatric nurse or doctor?
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Donnarae,
I hear you loud and clear.... I also think it's about the money!!! And yes he has plenty of his own. That doesn't change the fact that I think think he's more concerned about how much he'll be able to add to his own "retirement" account than he is about what's really best for mom. Since I handle all her banking (but he has online viewing access to her account too) he questions me about every dime she spends. He even gives me crap about not "allowing" her to buy things. HE has instructed the care giver that if they go our shopping she isn't to let mom buy anything except grocery items and things she really needs. Heaven forbid he sees a charge to a department store or Walmart. Always wants to know what she's buying and saying things like "she doesn't need a single thing", or "why does she need to buy clothes". He even checks to make sure that if I write checks for her to give as gifts, especially to his kids or mine that they're for the same equal amount on birthdays or Christmas. She is very close to my son, and he adores her, and she always wants to do a little more for him because my eldest son tragically passes away at 14 (when my other son was only 6), and she has always said that as far as she's concerned I'll always have 2 sons, and that if she wants to give Ryan a little more it's her business and that she would have been giving to to his brother if he were still alive. My son is the youngest of the grandkids, single, still working very hard to establish his business, etc. and both of my brothers kids are married, all have extremely well paying jobs, and have gotten just as greedy as my brother. I'm so tired of the whole thing, there are days when I could care less if our relationship tanks when this is all over.
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It is so sad how money tears a family apart, I've been through it myself. Please keep me updated as to what happens. I am hoping you have contacted her doctor and the Dept of Aging since we started speaking yesterday. Like I stated, I worked at our mental health facility here in Milwaukee and it is a horrible place! Most facilities are not equipped to deal with the elderly, they usually have them on the units mixed in with the general population. We all know how dealing with the elderly can be, they get confused, they get agitated and so on but in the mental health facilities their answer to everything is to medicate. This is a dire situation, you need to get your mom out of there, you need to do what is best for her and do what you feel is right. If your brother does not like, oh well, let him leave his cushy life and live with mom for a month, he's have her in a nursing home so quick! If you would like to email me privately I will give you my email address if you like.
My heart goes out to you!
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I don't know if it is about money. I have a dominant brother who is dPOA, but really has no interest at all in what is going on. My mother can showtime for him the few hours she sees him each year. If I call to say there is a problem, the only answer is hang in there, sis. He doesn't want to be bothered with any responsibility. He rarely calls and never visits. Lord knows why he was chosen as POA -- I think because my mother thought the word attorney sounded like a man's job. She is of the old school.

I get the feeling that sometimes the golden males of the family just pull back and let their "girls" handle everything. As long as the girls are handling things well enough, then why be concerned. We can be intimidated by the management style personalities, but we have to put that aside and do what is best. My brother actually goes to the level of arrogant. I know him, so don't pay it any mind anymore. If I thought my mother needed a higher level of care, I would see about getting it -- I'm healthcare POA. And my name is on the bank accounts, so I can pay the bills.

It is easy for elders to appear normal for a day or two at a time. My mother does it by staying quiet. She also will not go anywhere without me except maybe to take a walk. So it's actually me that is appearing normal for her. Since my brothers are no involved in her day to day (or even her month to month), I wouldn't pay any mind to their thoughts about what she needs. IOW, dabs4mom, do what you feel your mother needs with an eye to what she can afford long-term.
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dabs4mom, I think it is time for you to exercise the POA you have. Brother cannot dictate to the caregiver over your authority. If you tell her it is OK to take Mom to buy some clothes or something frivolous then it is OK for her to do that. Brother can stew and fret and complain, but he can't order. Your mother picked you to have power of attorney. Honor her choice and act in that role.
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Dabs4mom, I agree with everyone. Since brother is like that, please make sure to keep all receipts spent for mom. I'd photocopy or scan it and store it safely. If it's for clothes, and the receipt is not so detailed, write down on the receipt. If the receipt's name doesn't match the store's name - write down the store's name. Just remember to leave papertrail of her money. And watch your back. From what I read here, sometimes siblings get so upset over the money, they sneakily change the POA or outright use the legal system to take it away from you by lying. Document Everything. Boy, what kind of shopping is that if you only buy what you Need and not spend for the sake of a trinket or a pretty blouse that catches your eyes?
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You all can't imagine how much help it is to hear you all say such similar things. It breaks my heart to see mom get so upset when she's told that she "doesn't need something" and therefore can't buy it. This is a lady who has always loved and appreciated nice things, and looking pretty. My dad worked very hard for many years, made good financial decisions, and made sure mom would be secure after he passed away. They were by no means wealthy in any way, but lived comfortably. I think I mentioned before that because of my dads generous pension, she doesn't have to depend on her investments very much at all. Like most elders, if she had to depend on that money only, it would run out before she passed. The two sources of income will be able to take care of her until she dies.
I do tell the care giver not to listen to my brother because he is just trying to throw his authority around.
I think JessieBelle has a point. That the dominant male family member assumes that the "girls" will handle things, but still wants to have the last say so. She is dead on about how mom acts in his presence. She fakes her way through his visits and his phone calls. He buys it because he wants to, and refuses to see the reality of her day to day behaviors. He'll be in for a big shock when he and his prissy wife are at her house for nearly a week, and the care giver goes on vacation.( I told her it would be fine). I can't wait to hear my sister in laws reaction to having to clean up a mess mom makes in the kitchen because she can hardly manage to scramble an egg, let alone prepare a meal. Better yet, I wish I could be a fly on the wall when Mom needs her bottom cleaned because she waited too long to get to the bathroom. Mom wouldn't think of allowing my brother help her, and miss prissy pants will freak out! I'm laughing out loud at that visual.
I know I sound angry and bitter, and I'm sorry to dump, but I AM angry, and more than a little frustrated.
Last night (Valentine's Day) mom wanted to take my husband and I out for dinner, and wanted her care giver and her husband to come too. It was so sad to see her struggle with deciding what to order, then accusing the server that he brought her the wrong food. I had to talk her down. She spilled her water, which upset her to the point of tears, because she was just so overwhelmed by the whole experience and the unfamiliar environment. She tries so hard to be "normal" but I think she realizes that she's getting worse and it scares her beyond belief.
Once my brother gets here next month, it'll all hit the fan.
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dabs4mom, he may be ready to put her in AL by the end of the week. What I'm secretly hoping is that the caregiver can extend her hours, so your mother can have the best of both worlds -- assisted living in her own home. I personally think it is the ideal if the home is safe and a good caregiver or team can be hired. I know sometimes it gets beyond that point, though, and the only option is a skilled facility.
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