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My Mom is 86 and refuses to be evaluated for Alzheimers or Dementia. How do I get this done? She wants to go to Independant Living because she refuses to stop smoking/vaping in my home where she has lived for over 2 years. After trying to get her to stop, the sneaking around still happens. Rational discussions yield NO RESULTS because she cannot understand or process information from one day to the next. She is forgetting things and conversations that happened last week. She is in denial that she has ANY issues. I would like her to go to Assisted living where she will be supervised. She can dress herself, make microwave meals supervised (she nearly caused house fire with misusing microwave) or use the stove supervised. She gets enraged when we deny her cooking when she is alone in the house for an hour or two. She is been incontinent on several occasions and has accidents a few times a week. She will never admit she has ANY of these issues as she is guarding her pride. Mom cannot follow a 3 step recipe or instructions and gets confused very easily now. She has issues remembering how to get Voicemail on her cell or where to find her bank transactions on the bank website - all things she could do 6 months ago. She splits her pills(high blood pressure, high cholesterol, and aspirin) and puts all types of her 3 pills into 1 container! She has no idea or way of knowing if she took pills each day. Again she becomes confrontational at the idea of using a daily pill container. Its never her that needs help.
The reason I cannot have her here living with me and my partner any longer is because of her refusing to stop sneaking vape or cigarettes smoking at night in her bedroom. I have asthma. She goes outside all day to smoke but at night is too lazy to go outdoors. She is also a heavy drinker and drinks from 4pm (sometimes earlier) until she eats dinner at 8pm. She refuses to eat until she gets her drinking in first. Everyday. She is very skeptical and angry all day and and it gets worst after the drinking.
This has been bringing me a host of stressful health issues for both me and my spouse. We need her to be living somewhere else.
The issue is that to the regular joe who speaks to me mother for an hour they will see she appears to be very independant because she is a master of deception, she tells everyone she is fantastic and feels great! In reality though, it is the opposite. She wants to go to Independant living but I know she will not thrive there. Do they get an evaluation to see if they are fit to be there? I desparately need her to be evaluated but she refuses to get this done. What do I do?

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This is probably what Teepa Snow calls *Diamond stage dementia*. Still clear & sharp (enough to show time) & knows their own mind (will NOT give in). There will be pride as you say, but also as part of the decline, comes lack of insight.

I've found when dealing with lack of insight & lack of reasoning to work behind the scenes instead. I think in your situation I would;
1. Go speak to the Doctor on my own. For advice for this situation.
2. go visit a few local accommodation options - look for *continuem of care* with IL, AL, NH & MC on same site if available.
It's possible IL could work if supervision for meds & meals were provided... but AL sounds a good fit. Ask about an outdoor space she could smoke/vape. Alcohol would be limited to a small amount with meals. Evening cravings may need to be controlled by meds (patches, sprays etc). It's amazing how many people do adapt as long as they get that drink with dinner.
3. Ask if your chosen site does respite care or trial. Look into funding/paperwork for this. Does she have to sign? Or can you as POA sign? (Do you have enduring POA?)
4. Book Mother in! Make it a fun idea like a holiday. In fact... maybe you will be away too so she has to go.

Sometimes the first battle is just making the plan. Then being guilt free with that plan. The next battle may be discussing it - coming up against hard as diamonds NO. But sometimes once you drive up to a place, walk in the door for a tour, the nice staff serve a cuppa & then slide over a few papers to sign...

Worth a go?
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When my mom moved into the place she is living in now, (they have independent apt, independent cottages, assisted, and memory care), they asked what services she needed. Even in some things like medication management were included in assisted, but extra in independent. But because their pricing structure was dependent on services needed, they required before move in a meeting with the nursing supervisor to verify. That meeting included a cognitive test.
Mom did showtime with the best of them, so I did stack the deck a little when she I knew she needed to dio cognitive tests, like at a dr appt, or driving test
etc. I always scheduled them as late in the afternoon as possible, and made sure we had a decently busy morning, because she had more issues in the afternoon and when tired. I also made an excuse to leave the room for part of the appointment; which seemed to make a difference as she couldn't look to me for cues and extended the visit which gave them more time to observe.

One thing though, If you're looking for an official diagnosis, be sure to have POA documents signed before that.
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Beatty Jul 2020
"stack the deck a little.."

Excellent advice! I will make a note of this.

When I realised my *helping* by assisting with communication & mobility was actually *not helping* but covering the actual level of function, I stood back. What a difference! An 'independant' patient then became a 2 X assist & functional assessments were organised.
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Why do you need a dementia evaluation at this time? Is your mother resistant to the AL move and you want her declared incompetent so you can force the move? From your description your mother is in a cognitive decline (which the alcohol is making worse) but may very well still be legally competent. Your mother may not feel safe going outside to smoke during the night either because of vision challenges or balance issues from the drinking. Have you tried a closing her room off from the home HVAC venting and using a smokeless ashtray and a hepa filter in her room? We installed an exhaust fan in a frame for the window for one elderly smoker. Turning the fan on while smoking made a huge difference.

Since your mother is living in your house, I would take the view that she needs to move because her living with you isn't working out for you; its your house so you need no other reason. Take the attitude her moving is a given and you are just trying to help her find the best place to meet her future needs. Find an AL or two and allow the facility to do the needs assessment required before a resident is accepted. The formal dementia evaluation can wait until the AL recommends it or your mother is hospitalized for some other health reason.
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Even if she didn't have dementia, she is smoking in your house. Since she won't give it up, that's reason alone to have her live elsewhere.
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If she is independent and "competent" I would step away and inform her doctor in writing (via USPS, return receipt so that you have proof that you e done this).

Let her chips fall where they may. I'm sorry if I sound cruel, but I don't help folks who don't want help.
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You do not tell her she is being evaluated. You make a regular doc appointment with a geriatric specialist and have a chat with them beforehand (without mom of course). Or you call the Area Agency on Aging and request that they visit mom to do an in home assessment. Of course you do not tell mom the purpose of the visit.
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I would be checking out continuing care facilities and get them to do a needs assessment. I am sure that you can get this done as a requirement for her moving in, it wouldn't be the 1st time they have seen this.

Unfortunately you will probably have to step back and let her fail before she will get the help she needs.

Make sure that the facility she moves in to has meals as part of the deal.

It may be cheaper to find a senior apartment and hire an aid to help her with meals and other things for a couple hours a day. Help her get a place and let her figure it out while you plan for the crisis.
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