How Do I Get My Mentally-Ill Mother Permanent Help?

October 29, 2016 6:56 AM

The situation described in this question has gotten both better and worse. I'm stuck in yet another bind with regard to my mother, who has been hospitalized but cannot live by herself. They may release her on Monday to her home, where she has no supervision and is being evicted. I know that I shouldn't be the primary caregiver - I do not WANT to be the primary caregiver - but I am, and now I need to make sure that my mother has a safe place to unravel. More details within.

I'm really sorry about the rambling.

On Thursday, my mom was at the supermarket when she suddenly believed that she was locked out of her apartment, and called one of her friends to help her. She apparently also said something to her brother via cell phone, who then called the police. The police and her friend escorted her home leaving her car in the supermarket parking lot - she was still driving, and the cop rightly determined that she should no longer drive. When she got home, they watched her get into her apartment successfully. She then started into what *may* be a delusion about how a close friend sexually assaulted her two days prior. The friend told me this when I, inevitably, was called by her brother to check on her, as I am her only relative in the state (NJ). Her siblings are in NY.

I saw for myself that she was having delusions; about an hour after I talked to her, she began pulling me aside and whispering that Oprah was gifting her with $100k as part of some "Women in Technology" program, but that I couldn't tell anyone. Among other delusions. She also became impossible to placate and refused to sit down, a behavior that presented itself in force when I finally got her to the hospital. Though the two residents from my mom's practice tried to have her discharged (because "while there are strong social reasons to keep her here, there aren't any medical ones"), I fought it, and the hospital agreed that she couldn't go home - she lives alone, and is a danger to herself. The residents also neglected to tell me that she has a UTI which, according to the hospital RN assigned to my mom, could very well exacerbate the dementia. She is still there; according to her doctor at the hospital, she will be held until Monday at the very least.

I took her car key, went to her apartment and discovered several things:

a) Her AAA auto policy has been cancelled for nonpayment, and she is now in eviction proceedings for not paying rent during the month of October.

b) Her attorney has full authorization to use her bank accounts, and ALL of her bank statements are not only with him, but being forwarded to him; a problem, because the one (very safe, highly-recommended) place that is willing to have her transferred from the hospital to their facility only needs her financial documents to get started. But -

c) That attorney, when advised that she was in the hospital and that I desperately needed to talk to him about her care, declined to speak to me directly and had his secretary "send his regards." I checked her phone when I later visited the hospital and he did not attempt to reach out to her to confirm, either.

My dad successfully divorced my mom a few months ago. Like my mom's out-of-state friend, he has basically given me a comforting pat on the shoulder and a "good luck shouldering this burden" talk. My mother's siblings are refusing to take responsibility for this and have expected me to become my mother's guardian, which would at least force the attorney to give me the documents that I need for the end-goal facility. That process is $1500; I told them that it wasn't possible for me to become guardian (because all $20k of the joint savings account that I was using to cushion myself in between jobs got taken by my father to start his business), and now they're pissed off and being supremely unhelpful.

I've missed 2.5 days of work already, and my performance has suffered immensely (it already was for reasons that would require a separate post; I submitted my resignation and was going to leave in another month). This is dangerous to my mental health and I need to be relieved immediately. That's not gonna happen because my relatives literally do not give a shit about my wellbeing OR hers enough to step up, and the thought of my mom being turned out onto the street triggered suicidal ideation on Thursday night that hasn't stopped. The only thing that might make that stop, short of me magically getting tranquilizers in the next 24-to-48 hours, is knowing that she's going to have a permanent home with 24-hour care.

How do I make that happen? Where do I start? Adult Protective Services has not been helpful and it is unclear if the social worker at the hospital can help me get her Medicaid (she has Medicare). Assume that I don't have the money to retain an attorney for any reason and do not qualify for Legal Aid - I don't, and there's no one willing to contribute financially to same.

Thank you.

posted by Ashen to Human Relations (10 answers total)

Getting your mother the care she needs is not going to be a quick process. In the meantime the hospital is going to release her. At this in-between stage where she doesn't have care setup unfortunately you really only have two choices. You can shoulder the responsibility of taking care of her while simultaneously doing the research on permanent placement or you can throw your hands up and refused to claim responsibility for her. If you do the latter she will be released home to her apartment and as her life continues to disintegrate police will get involved again and she may be taken to the hospital a few more times for evaluation holds. I went through this process with both of my parents. There was no community help for that in between time and it was a very difficult decision for me to get involved because my parents were not kind to me but very abusive so there was not only issues of money and taking time away from work but great emotional turmoil to be their caretakers. And for each parent there came a time when they were very sick years later close to death in the hospital but technically not needing Medical Care at the hospital tried to pressure me into signing for them to take them home and I refused. They called me all the time they said terrible things to me and tried to guilt me into doing that because they didn't want to have to keep paying for my parent and having them take up a hospital bed when they didn't really need hospital care but instead needed end-of-life care. I stood strong though because I didn't have the resources financially or emotionally to care for my parents during those times. So the bottom line is you need to figure out how much of this you can handle and if you think you can do it go ahead and meet with the hospital discharge staff and being involved in the plan for her discharge and for you to be her caretaker and if you think you can't do it let them know that's not an option. I wish you all the best of luck and I'm so sorry that you're in the situation
posted by TestamentToGrace at 8:09 AM on October 29, 2016 [4 favorites]

A solution for one of your minor inconveniences: sign your mother's accounts up for Mint, so you can log in and see everything. That's how my husband monitors his mother's accounts to give her advice after her husband died. To actually pay bills (not just see if they're paid or not) you'll have to set up online services for her checking account, but that would probably be worthwhile. Paper statements will still be under her control (though you can usually print out copies from the site), and the online access doesn't have to involve her at all so she won't even be bothered.
I know that doesn't address the main problem at all, but every little bit helps.
posted by aimedwander at 8:52 AM on October 29, 2016

I went through something similar last year with my adult daughter. First and foremost: focus on getting your mom to accept that she has issues that she cannot handle by herself. With this, you will have options. Without it—I am so very sorry to tell you—you could be in this battle for years.

My experience re involuntary hospitalization: (I'm in IL) assuming you can demonstrate she is a danger to herself, you can contact the State's Attorney and ask for a hearing to have her hospitalized for evaluation, which does not require an attorney. This was presented to us a practically surefire way to ensure Daughter would get the care she needed. This turned out not to be true.

Someone from SA's office helped her father and me put together the necessary paperwork and make our "case". The judge cleared the courtroom prior to the hearing (for the sake of privacy), listened to what we had to say, and agreed that she needed an evaluation. Unfortunately, this is when we learned that this required that she be picked up by the police and taken to the hospital—we could not take her to the hospital nor ride in the squad car with her, which did not help our already compromised relationship with her.

SOP in these cases is that at the end of the 7 day evaluation, everyone returns to court to make decisions re long term care. At this hearing, the client/patient is represented by a court appointed attorney. However, after my daughter was admitted to the hospital, she agreed to cooperate with the evaluation, which meant it was no longer a "court-ordered" evaluation and the decisions re her care were solely in the hands of the doctor she just met. Daughter, of course, would not allow her doctor to communicate with us. And since she could "present well" for relatively short periods of time, she was working on her release plan within 48 hours of being admitted and was released less than 6 days after the hearing.

Btw, she had been admitted to psych/behavioral units (following being taken to the ER for psych issues) twice before the court-ordered evaluation and there were 3 more ER trips in the 2 months after the evaluation. In every case, after 3-5 days the crisis had passed and the hospital had no reason to keep her. Regardless of the fact that she was clearly in precarious shape, if she wasn't an immediate danger to herself or others, she was released. (Fortunately, my daughter's issues seem to have passed and she's in relatively good shape these days. I have no idea what to attribute this to, which makes me nervous about the possibility things going south again.)

Contact NAMI. They can put you in touch with local resources. Good luck to you and your mother.
posted by zombies puppet at 9:10 AM on October 29, 2016 [2 favorites]

Is she in a medical hospital or a psych hospital? If she is in a medical hospital, push for the docs to have her transferred to a psych hospital for further treatment of her delusions and obvious psychiatric issues. With Medicare, as long as a psychiatrist signs a statement saying she requires the psych treatment Medicare will cover acute inpatient treatment (as long as she has psych days left). That will give her approximately 14 days to get psych treatment and time to find a permanent placement. Once in the psych hospital get her therapist or discharge planner to look for a place for her to go live. That's part of their job but you have to communicate with them...if she says she has an apartment and they don't know she's being evicted there's no way for them to find that info out without family telling them.
posted by MultiFaceted at 9:26 AM on October 29, 2016 [6 favorites]

Just went and looked at your previous question. If she has a dementia diagnosis start calling long term care facilities that have "memory care" units (they call them different things) and start inquiring about the admissions process. Those units are locked so she can't wander away but also offer a various spectrum of independence based on the patients needs. If you find a good admissions coordinator at one they would probably be able to give you a list of facilities that could care for your mother if they couldn't. Most facilities keep tabs on who does what in the area, both for marketing/business planning purposes and to make referrals for people. Don't be afraid to ask.
posted by MultiFaceted at 9:32 AM on October 29, 2016

Step back. Tell the hospital no. Tell the attorney when eventually he calls, no. Tell your brother no.

Pick the very, very few things that you can manage, the choices you can make and live with for years and sleep on - don't let people bully you into "it has to be today, it has to be now", and make room for your mom within your life but don't let your life be swallowed up by your mom.

You can't save her or mend her by breaking your life. You can't exchange your happiness for hers. There are many circumstances where it is possible for to support an aging parent with grace and love, but yours are not. You are drowning and you need to let go and swim to shore.

Go out with friends, go watch movies, clean your place, walk in nature, do things that will calm and refill your spirit as you get through this and keep saying no until you find something you can truly safely say yes to.
posted by dorothyisunderwood at 12:20 PM on October 29, 2016 [13 favorites]

I hate to add to your troubles, but there is a non-trivial possibility that your mother's attorney is stealing her money. While there are significant limits to what he can tell you due to attorney-client privilege, and he probably shouldn't act as your lawyer, nonetheless, if he has power of attorney, he ought to be willing to meet with you and discuss arranging payment from your mother's accounts for your mother's care, or at least what he would need you to obtain from her or a court for him to be able to do so. It sounds like the information/money he has is something you need fairly urgently, too, so you may need to be very direct. Call him back and tell him that if he is not willing to meet with you, you will have no choice but to go to your state bar association's disciplinary committee.
posted by praemunire at 3:45 PM on October 29, 2016 [4 favorites]

Response by poster: Thank you for your replies, everyone.

My aunt and uncle are looking into guardianship now. They tried to guilt me into "taking leave" from my job, but I said no. They shirked all responsibility for my grandmother when she got Alzheimer's, leaving it to my mom to pay for care, to make visits, to manage home aides and doctor's visits - even though my grandmother lived in the same state as them. I won't allow them to do that again.

Frankly, ceasing to cover up my instability seemed to have helped. My father got spooked and is calling on my siblings to back me up. My mom's friend is getting more involved. My aunt and uncle have been text only and haven't seen me, but the uncle will see me tomorrow. And if that doesn't work, maybe I'll "vanish" for a few days.

Praemunire, we suspect that. I looked at some of my mom's bills and he GOUGED her for billable hours, draining her of the very money she was going to use to survive. My aunt managed to get at him and while he claimed that he doesn't have power of attorney, he claimed to be helping my mom with "some other matter." My aunt, uncle, and a friend of my mom will be calling on Monday. If he doesn't realize that we're not going away and declines to meet with any of us, then he will once I approach the disciplinary committee. My dad's attorney threatened to report him himself, for dragging out the case for one year longer than it should have taken.
posted by Ashen at 5:43 PM on October 29, 2016 [5 favorites]

I thought your mom had dementia? Did that diagnosis change? If she has dementia, the hospital social worker can look for placement for her based on this, much easier than for a mental illness. I agree she should no longer live alone. (Dementia is not a mental illness. It is brain damage.)
posted by Riverine at 6:17 PM on October 29, 2016

Tell the doctor who is discharging her, you need her to take the Allen Cognitive Index test before she is discharged. You need to know the level of care she needs in her life, and what level of care you have to give her. The Allen Cognitive Index is administered by a Speech Pathologist. That is one of the standard measurements for assessing dementia. Ask the attending physician to get Speech on this right away.

You can't do this all alone. She needs a placement. She has to have a three day inpatient stay with medicare to get into some long term care, and she has just had it. This is a critical juncture, with regard to cost.

She is allowed to own her home and be a medicaid patient. The medical staff has to make this happen, they can do it without the attorney. The attorney knows she is incapable of decision making. Protect her from him, using the medical establishment.
posted by Oyéah at 6:32 PM on October 29, 2016 [2 favorites]