How can I help keep my delusional, elderly parent off the streets?
August 4, 2016 9:25 AM   Subscribe

I am the sole support person for one of my parents. They have no contact with any family members or past friends. In general, my parent is friendly and decent; however, they keep fleeing and/or being kicked out of housing due to their paranoid delusions. How can I help?

Said parent is 70+ years old, low income and currently relies on me to supplement their Social Security for rent, utilities, and major household purchases. In the past five years, my parent has left 5 vastly different living situations in 4 different states because they believed their roommate (or an unknown individual) was breaking in and harming them. This has occasionally left my parent homeless.

My parent now lives in the same city as I do and I see them every few weeks. I hoped that my emotional support and some socialization would help calm their anxiety and reduce their paranoia. No luck. They believe that an unknown person is breaking into their new apartment, stealing things, poisoning their food, and laughing behind their back. I would know if this was happening. This is not happening.

My parent isn't a danger to anyone, so I can't have them forcibly evaluated/treated. They do not seem out of touch with reality in other ways. They are also afraid of being discounted as "crazy." However, I had some success convincing them to see a physician and they have an appointment in a week.

What should I tell the doctor beforehand? If you've been in this situation, what helped? Any other advice?

(Note: I'm in the United States. I'm also low income. My parent cannot live with me.)
posted by anonymous to Human Relations (9 answers total) 3 users marked this as a favorite
Honestly, the paranoia is a textbook symptom of dementia. My mother went through something very similar in the early-to-mid-stages. She seemed to be totally normal, but would come up with some paranoid delusion out of the blue.

That's a real tough point in the disease, insofar as treating and accomodating them. They aren't bad enough to need to be in a lock-down memory-care ward and are still very aware, but they're just bad enough to where they really need some form of monitoring.

Tell the doctor everything. Don't leave anything out, no matter how insignificant it may seem to you. Also, get their legal papers in order. Make sure there's a signed POA on file. Just in case, for the future.
posted by Thorzdad at 10:26 AM on August 4, 2016 [10 favorites]

My MIL was convinced that the guy across the street was stealing her mail, spying on her, etc. She spent a couple of days in a hospital under observation, they they got her sorted out with some antique antidepressant. She was like 85 at the time. They got her fixed up and she lived another twelve years with no problems. Tell the doctor what's up, make sure you have your durable POA, health care directives, etc. Also, maybe you could ramp up your visits/phone calls? Every couple weeks seems like not enough.
posted by fixedgear at 10:32 AM on August 4, 2016 [5 favorites]

I imagine that this is tough on you, I'm sorry. When it comes to mental health and risk, danger to others is only half the issue - a person can also be compelled to be evaluated and treated if s/he is a danger/risk to him/herself. I would suggest that repeatedly endangering housing to the point of homelessness via behaviour such as you've outlined may qualify your parent for involuntary evaluation if necessary.

For now, make the most of your appointment with the doctor. I might consider sending the doctor a document outlining the history even before the appt so s/he has a chance to review it before you meet. Thorzdad made a good suggestion in not leaving anything out, even if it seems insignificant. Copies of e-mails, letters, pictures, etc. can also be useful. Making sure that legal affairs are in order is also important.
posted by analog at 10:40 AM on August 4, 2016 [8 favorites]

I ask this with the full understanding of the escalated burden it would be to you, but - is it possible that you could go from seeing your parent "every few weeks" to checking in on them every day?

I ask that because that's what my own father did when my grandfather was in his last years. Grandpa lived at home, and Dad had power of attorney and all other legal control and just would check in on Grandpa every day during his lunch break. He also made a deal with the next-door neighbor to check in on him in the morning too (it was her idea, actually). Grandpa's mind was definitely going - one time he called Dad when I happened to be there, and I spoke to him a bit - but I could tell that he didn't really know who I was and was uneasily playing along and pretending he knew me. But with my father, he actually had a degree of lucidity; Dad always asked him a couple of mental-check-in questions each time like "do you remember who the president is" and stuff, and Grandpa was usually more or less right. Dad also would check in with him about what he remembered about family, and even though Grandpa didn't recognize me on the phone, he did remember he had a granddaughter who was living in New York and doing well.

So I think that the regular and reliable daily contact was actually helping a little. And they weren't super-long visits that I'm aware; just during dad's lunch break at work. He'd go by, visit, talk with Grandpa a bit to keep his mind active, see whether anything at the house needed tending and go back to work.

Again, I realize that this would be a dramatic increase in the amount of time you spend visiting your parent. But in my family's case it did seem to help; Grandpa died peacefully at home at the age of 88, and had one of the most graceful deaths I've ever heard (he had come down to the kitchen table to wait for the neighbor to come by and make him breakfast, dozed off while waiting for her, and never woke up).
posted by EmpressCallipygos at 12:04 PM on August 4, 2016 [6 favorites]

Another option is to hire someone like Visiting Angels to check in on your parent more regularly and help with basic tasks.
posted by rainbowbrite at 12:18 PM on August 4, 2016 [5 favorites]

I would ask your parent to give you HIPAA authorization (so their doc can talk to you, you can make appointments, they can share test results with you, etc.) and make you their medical power of attorney (so that you can make decisions on their behalf should they become unable to do so). I would ask the provider ahead of the appointment to include those discussions when they meet, and ask them to have the appropriate forms ready there and then so your parent can sign them if they agree.

I'm sorry you and your parent are going through this.
posted by headnsouth at 1:17 PM on August 4, 2016 [6 favorites]

I would suggest that repeatedly endangering housing to the point of homelessness via behaviour such as you've outlined may qualify your parent for involuntary evaluation if necessary.

Unfortunately this is far from true. My mother was a paranoid schizophrenic with active dementia who repeatedly refused treatment and was removed from numerous housing situations including nursing homes and shelters due to aggressive behavior. In spite of getting orders from her doctor and a judge, she was repeatedly declared capable of making her own decisions regarding health care. Mental health care officials would not, and could not, involuntary evaluate her or provide care. I was often told how ridiculous the system was in this regard by mental health care professionals.

It wasn't until she refused to leave a public area on a 105 degree day after months of homelessness was she finally involuntarily committed and received the care she needed. It is a terrible and unfortunate reality in the US. By the time my mother received the mental health care she needed, she was in the terminal stages of kidney cancer, and finally submitted to nursing home care.

The POA is about the only thing that can help you. It will at least allow you access to help with her finances and will usually open doors to her doctors and other health care workers so they will at least talk to you. It allowed me to pay my mother's final expenses with her banking account. It does not allow you to make her do anything.

I hope that you have a better experience than I did but this is a hard, hard road. I'm sorry that you and your mother are going through this.
posted by tamitang at 1:39 PM on August 4, 2016 [4 favorites]

Look at your state's law re: involuntary commitment. Your mother may fall under a category called gravely disabled, meaning that due to a mental illness she cannot provide and/or utilize food, shelter, clothing. The food case can be made if she's not eating b/c she thinks her food is poisoned; the housing argument can be made by fact she's unable to utilize shelter b/c she thinks others are after her.

Also I'd recommend a geriatric psychiatrist. If your mother refuses, then at least a geriatrician.
posted by namemeansgazelle at 10:14 PM on August 4, 2016 [1 favorite]

A geriatric psychiatrist would be a great idea if your mother would consent to it, although I expect that would be a challenge.

I absolutely agree with the excellent answers regarding trying to get POA, healthcare proxy, etc and at least if you cannot manage those things, being in communication with her doctor - if you are not the healthcare proxy and your mother has not consented to it, HIPAA prevents them from sharing information about her condition with you, but it does NOT prevent you sharing information on her condition with them, which is crucial in cases where the patient is an unreliable narrator (although it sounds obvious enough that I doubt this will go undetected). It's important to consider how to deal with the situation when she is no longer able to take care of herself/is no longer safe at home and trying to have a plan in mind for that almost certain eventuality.

One other thought would be to file a report with Elder or Adult Protective Services in your locality. These people could help evaluate the situation and see if they could provide any further assistance or services that your mother might qualify for.
posted by treehorn+bunny at 9:54 PM on August 5, 2016

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