How can I help my mother with depression if she refuses all help and isn't ready to be declared incompetent?

Amour asked...

My mother is 88yrs old and living alone in Florida and I live in Alabama. She has been widowed for 2 yrs now and wants to die. She has early/moderate dementia. She's not taking care of herself ie eating,exercising(which she always did before),messing up her meds etc. She stays extremely depressed, spends most of her time in bed and therefore the combination of all the above is making her weaker (trouble walking) and her health is deteriorating. She is in total denial of the situation and refuses help. We have tried everything;getting her an aide(was fired), counselor (attended 2 sessions), grief support group (didn't go),Life alert system (doesn't wear it),moved her in with me for 6 months (she was impossible)and made everyone around her nervous wrecks, etc.etc. The entire family knows that this situation must change. She needs help. Everything has failed!! I am now looking at a possible continual living facility which is extremely nice and that she can easily afford. I'm planning to go see her shortly and present her with the fact that living like she is can no longer be a viable option.I has been 2 yrs since my father passed and there is more regression than progression. I do have POA, and she does have a living will indicating myself and my daughter as decision makers in case of incapacitation. How can I present this to her and what do I do if she says no to everything? She is not ready to be declared incompetent. She has lost purpose in living and this is of her own choosing. She refuses all help or options presented to her.Total denial!!! I'm at a total lost and am very tired of the whole situation and something has got to give.

Expert Answer

Ron Kauffman is a certified senior advisor (CSA), senior lifestyle radio host, syndicated newspaper columnist, and the author of Caring for a Loved One With Alzheimer's Disease. In addition, Kauffman is also the primary caregiver for his mother, who has Alzheimer's.

Dear Florida/Alabama Caregiver:

I'm sorry you're facing the challenges of long-distance caregiving for a parent with dementia.

In addition to her existing diagnosis of dementia, while not a doctor, I'm reasonably certain that your mother is clinically depressed and needs medical intervention and help.

The death of your father seems to have exacerbated her dementia, and is adding to her difficulties of grieving and dealing with her loss.

Because of her diagnosis, your mother may be best suited for assisted living rather than living alone and unattended in her own home. She certainly is in need of socialization at a minimum, and more than likely, counseling and anti-depressant drugs to treat her withdrawal and depression.

My first suggestion is to hire a Florida-based geriatric care manager (GCM) to do a full assessment of your mother's situation. A good GCM armed with the background information you can supply should be able to complete an assessment of her present condition and situation and convince your mother that she can help her to deal with the issues that have her so upset. The GCM becomes the buffer between the patient and the patient's family, whom your mother may see as too controlling.

In our GCM practice in south Florida, we have had several cases that are similar to this exact situation. In virtually every case, we have been able to establish the rapport needed to help the client to make strides to rebuild her quality of life, and/or to help place her in the appropriate living situation.

The best way to go about introducing a GCM to your mother is to visit your mom, sit down and say to her that as her adult child, you love her and are very concerned about her. Then say the following: "Mom, I have someone I'd like you to meet and talk with. Her name is "“ GCM's name - she'll call you tomorrow to set a time to meet you."

This isn't a point for discussion, it's going to take place, and you can inform your mother that you won't be present. Once the meeting takes place, there is a good chance the GCM will gain your mother's trust. Over time the GCM can help your mom to rebuild her life, as that's what the best GCMs do. Hopefully that will happen and lead to your mom taking the steps needed to treat her depression and assess her current level and stage of dementia.

It's possible that the neurologist you mother sees may prescribe medication to deal with her depression and dementia, and s/he may also suggest that the GCM continue working with your mom.

The neurologist may collaborate with the GCM and determine that your mother would be best served by living in an assisted living facility. The GCM can be very helpful in that transition if required. In a perfect outcome, your mother will agree to talk with the GCM and everything you wanted to see happen, from a medical evaluation to having help brought into her home or making the move to an assisted living facility will, over time take place peacefully.

If it's any consolation, I too had to do exactly the same thing with my own mother after the death of her husband. Ultimately we placed in the facility in which she has now lived and thrived for the past 4-years. It can be accomplished, and in our case, my wife being the GCM was an added plus.

If you would like to contact me for a referral to a GCM in Florida, I am happy to provide you with the name of a reliable professional, depending on where in Florida your mother lives. Obviously, I don't have direct contacts in every city, but in south Florida in particular, I can be of assistance to you.

There are other steps that might be taken, but my suggestion is to follow this course of action first. If it does not get the desired results, you can again contact and ask for further assistance if necessary. Hopefully, that won't be required. I wish you the best of luck.