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My mom has dementia

Birdzeye said:
What a touching story. I heard a similar story, this time about a much younger (60s) woman whose cancer had come back. She decided that she didn’t want to do any more chemo but instead to “go home.” She died under what her husband described as wonderful hospice care.
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I hope that you get to enjoy at least some moments of clarity and lucidity.
Just remind her every single day that you love her, repeat it several times over the course of the day if need be. Hugs do wonders, unless she's the "stiff upper lip" type...who knows.
Keep her busy with well loved stories from the past, especially funny ones.

I'd give anything for my mom to still be here, but at the same time blissfully unaware of current events. How would that work? But I hear her voice within me from time to time, a reassuring thing, but a little bittersweet. Lucky me, she had a wonderful sense of humor and she adored my wife.

I hope you find and keep the little treasures, the small moments that give you peace.
 
You need to remember and think of your mother as she was, not as she is now. Alzheimer's is a particularly cruel disease because it erases the person's self identity and who the person was. You can not change this. It will worsen.

The only decisions before you is what is the best care for her - a decision she can not make herself because that part of herself is already gone. Just from what you wrote, none of you could care for her in your own home in the most literal sense. You have to make a hard decision because there is not good one.
 
vesper said:
I am on Medicare and had to look it up...


They are currently under the care of a doctor and getting services under a plan of care that was established and regularly reviewed by a doctor.
They require (and a doctor must also certify that they require) one or more of the following:
Intermittent Skilled Nursing Care – other than drawing blood
Physical Therapy
Speech-Language Pathology Services
Continued Occupational Therapy
The home health care agency you choose is approved by Medicare.
They are homebound, and the doctor certifies they are homebound – meaning they are unable, have difficulty, or are instructed not to leave the home.
A doctor or healthcare professional that works with a doctor has met with them face to face regarding the need for home health services.
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The therapy angle is not likely to provide medicare coverage for very long because the underlying dementia will prevent the therapists from documenting that what they are doing is working. For example, if the goal of SLP services is to address swallowing problems common in late stage dementia, they are not going to be able to teach proper swallowing techniques to a woman who cannot remember them. If they cannot document continued improvement, then they won't be able to justify seeing the resident for long. Those therapists are useful to assess the specific problems in residents that impede them from maintaining their maximum level of independence and put in place interventions, but they will not be able to stay involved long. That same SLP will decide how serious Mom's dysphagia is secondary to dementia, and will recommend a proper texture change and viscosity change for safe eating and drinking, and watch for awhile to see if it is successful. and then he will discontinue therapy. That may be no more than a weeks time. Same for physical or occupational therapy. They can teach staff or family how best to handle problems, but they can't teach a dementia patient. They can provide invaluable short term fixes and tools, that will benefit a resident - until there is more inevitable decline.

If this same woman was suffering disability for a recent stroke, then you would be able to document and justify continued therapy as long as there was progress and stroke patient do improve gradually step by step, with daily therapy until a new baseline is achieved.
 
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btthegreat said:
The therapy angle is not likely to provide medicare coverage for very long because the underlying dementia will prevent the therapists from documenting that what they are doing is working. For example, if the goal of SLP services is to address swallowing problems common in late stage dementia, they are not going to be able to teach proper swallowing techniques to a woman who cannot remember them. If they cannot document continued improvement, then they won't be able to justify seeing the resident for long. Those therapists are useful to assess the specific problems in residents that impede them from maintaining their maximum level of independence and put in place interventions, but they will not be able to stay involved long. That same SLP will decide how serious Mom's dysphagia is secondary to dementia, and will recommend a proper texture change and viscosity change for safe eating and drinking, and watch for awhile to see if it is successful. and then he will discontinue therapy. That may be no more than a weeks time. Same for physical or occupational therapy. They can teach staff or family how best to handle problems, but they can't teach a dementia patient. They can provide invaluable short term fixes and tools, that will benefit a resident - until there is more inevitable decline.

If this same woman was suffering disability for a recent stroke, then you would be able to document and justify continued therapy as long as there was progress and stroke patient do improve gradually step by step, with daily therapy until a new baseline is achieved.
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It certainly wouldn't hurt to check into it. There very well could be some things Medicare would cover.
 
vesper said:
It certainly wouldn't hurt to check into it. There very well could be some things Medicare would cover.
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Absolutely. Especially if there are more complicated nursing issues like dialysis, or decub ulcers needing attention,that require an enhanced acuity level of care.
 
Birdzeye said:
She’s 98 yo, a bit frail, nearly deaf, and walks with a cane. She’s been living alone in her own house since Dad died 30+ years ago.

Her decline started within the past year. Last spring, she failed a driver’s evaluation and had to trade in her driver’s license for a non-driver’s ID card. At that time, I detected a bit of memory loss, but not too bad.

Now, her memory is really impaired. She’s paranoid, sometimes belligerent, has hysterical fits every day, and has some delusions. She keeps fretting about the pilot light being off on the furnace, but the furnace has no pilot light. She frets about having to order oil - for a natural gas furnace.

One of my brothers and my sister went to see her last week for an appointment with a neurologist. The day of the appointment, Mom refused to get out of bed and get dressed for the appointment. She ordered my sister to cancel the appointment, and when my sister refused, got very nasty. My brother and sister went to the neurologist’s office and asked if they could use the appointment slot to talk with the doctor. Their request was granted.

They described Mom’s behavior, and, based on that, the doctor said that 1) the behavior would not get better, 2) there is no medication to help, and 3) from what he heard, she should not be allowed to live alone.

my siblings and I are in agreement that she has to go into assisted living, and intend to sell her house to cover costs. One brother has power of attorney. Mom is adamant that she’s NOT going into assisted living. None of us is in a position to have her move in with us (for example, in my house, the stairway to the upper floor is 16 steps - too many for her). We all live at least 150-900 miles away. I fear that moving her is going to be a very disagreeable affair.
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Since the decline is so rapid, there might be another issue other than dementia. I have heard of someone who had similar issues, and it turned out to be a blood infection
 
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