What Stage of Alzheimer's Is My Mother in, and When Is the Right Time to Place Her in Assisted Living?
My mother has had AD for a while now but not sure about what stage she is in. My Dad passed away a few months ago and she tends to forget that and wants to know why she wasn't told. She calls me her sister, gets confused about which son she is talking about and recently has not been recognizing her grandchildren. She is very stubborn and does not want anyone to help her with the house cleaning and gets very angry when I do. My Dad always did the cooking for the last few years and we have to cook her dinners for her. I have realized recently that she is not really eating when we are not there even though sandwiches are left for her. She refuses to admit that there is anything wrong with her and is actually angry that we are trying to help her. Is this normal for a person to be so angry? What stage do you think she might be in? With five syblings everyone has a different opinion on whether or not she should be in an assisted living facility. I believe she should not be home alone at night and with winter coming I know I won't be able to get to her home all the time. I live out of time and work too.
Expert Answer
As you describe it, your mom's behavior is typical of someone in the middle stage of the disease. No doubt, the trauma of your father's death has sent her into a decline. Reminding her that he's gone will only further aggravate her dementia. When she asks about his whereabouts, tell her you're not sure and then immediately talk about something else, totally unrelated and positive. Trying to talk to her about her dementia will only aggravate her anxiety, so it's best to focus on her abilities, past and present.
People with AD often lose sense of their physical needs and can no longer tell if they're hungry or full. Some folks become obsessed with food and will claim starvation immediately after finishing a meal, while others will claim they're full even when they haven't had any nourishment in hours. So it's not surprising that the sandwiches go uneaten. If possible, whichever of your siblings live nearby can take turns sharing at least one meal a day with her.
Her resistance to help from you is not unusual. She's trying to hold on to her independence. When she's not willing to let you help clean her house, you can get around it by working together as a family: one of you can take her out, while another does the cleaning. People in her condition tend to cling to the familiar. She probably has things around that she is particular attached to, so you want to make sure that the most prominent items look undisturbed when she returns. If she's a hoarder, you'll want to use extra care. If you're tempted to clear her house of all that you consider junk, remember that she probably treasures it. One fellow loved to collect magazines, catalog and all kinds of printed material. We got him a basket for his collection. We systematically removed from the bottom of the basket a stack equal to his new acquisitions. He never noticed that the stack had remained the same height for five years.
Hopefully one of your siblings lives close by and can help your mother and keep an eye on her. She'll be at increasing risk, especially when she's living alone and facing a harsh winter. It may well be time to move her to the secure environment of an assisted living facility. Regardless of your decision, I strongly suggest that you work together as a family and look at possible facilities starting now rather than waiting until it becomes an emergency situation. The best facilities often have waiting lists, so the time to act is now.
Many people experience a real improvement in their quality of life once they've moved into a facility. They have access to friends and activities; they will have regular meals and oversight of their health. The secret to making such a move successful is to NOT discuss it with your mom. Instead when you've found the right place for her, pretend that she's going on vacation and staying at a nice resort. You'll want to keep up this "loving lie" until she indicates that she has accepted this as her new home; otherwise she may feel imprisoned and probably be very angry that you have forced her to leave her home. For almost seven years now one resident I know thinks she's "at the hotel" and will be going home soon. The staff at her facility has been great at sticking to the same story and she's a happy and cheerful "guest for a couple of days."