How do I best help my elderly, depressed, and alcoholic mother?
September 12, 2020 9:57 PM   Subscribe

My mom just got out of her third alcohol-related hospitalization in the last five years and is currently in respite care while we figure out the best path forward, but we don't know what that looks like yet. More details inside.

My mom is 72 and was hospitalized for 3 and a half weeks while going through alcohol withdrawal last month. While she was there, she was so delirious that she had to be restrained and put into a special enclosed bed. They ran some tests on her, including a brain MRI and a neurological workup, ruled out Wernicke-Korsakoff's, and concluded that she has sort of underlying "multifactorial alcohol and vascular encephalopathy/dementia". She recovered enough to be discharged, and went to a skilled nursing facility for another three weeks to recuperate. Now she's at another facility receiving respite care while I—her only child and only family member—figure out what to do. I live about an hour and half away from her.

My mom has had two other serious alcohol withdrawals in 2015 and 2019, both which also sent her to the hospital. The 2019 one was so bad that she didn't return home for four months, and it looked like she would have to enter some form of memory care. Thankfully, she made a significant recovery, but the experience left her at a new kind of baseline functioning that's somewhat lower than before. I've had the chance to spend a lot of time with her over the past couple of years, and over that time I've seen her beginning to develop dementia due to both her age and alcohol abuse. I think her dementia is still in the mild to moderate stages, but before this most recent hospitalization, one of the most noticeable signs was her having a lot of difficulty problem-solving, learning new things, and managing her finances. For example, she didn't really understand how her IRA worked—I basically would have to explain everything over again from scratch every time I went to see her. Stuff like that just doesn't 'stick' for her anymore.

Moreover, my mom also nearly got cleaned out by an online tech support scam a few months before her hospitalization in 2019—that was back when she had a desktop computer, which she gave the scammers full access to, along with her bank and investment accounts open in browser windows. The only thing that saved her is that immediately after, she told me about this great deal that she found on tech support software. I had her call her banks to issue an chargeback and freeze her accounts. We got rid of her desktop and got her an iPad, but she's had an incredible amount of trouble learning how to use it, even before her second hospitalization in 2019. She doesn't 'get' Touch ID, nor can she remember her passcode (it's my birthdate!) so she ended up writing it on a piece of paper which she taped to the back of her iPad. She can't really use apps besides Mail, Safari, and her bank app, either, even though I've tried to teach her so many times.

It's always seemed like there's something always going wrong, either with her iPad or with her bills or finances—there's some thing or another that she doesn't understand, which leads to her panicking and then demanding that I come drive up and fix it for her. This has led to me putting my foot down and asserting my boundaries (no, not being able to figure out how to delete an e-mail is not an issue that requires me to drop everything on my plate and cancel my meetings and drive up right this minute) which just stresses me out and makes me resentful towards her.

Lately, though, there have been some other concerning signs over this past year:

- she sometimes has problems telling dreams from reality (which is apparently another sign of dementia) which primarily manifests as her thinking that people have broken into her house and stolen things

- before this last hospitalization, she ended up going to the ER for a racing heartbeat (due to having had too much to drink the night before) and when she came back home, she saw an draft email that she had typed on her iPad and panicked, thinking that people had broken into her house and written the email

- she gets agitated when people park in front of her house to the point of leaving notes on their cars asking them to move—I told her that she was fighting a losing battle since the street is public, but she just got mad at me

- she stole cash from my wallet when I was staying at the house earlier this year, and when I called her out on it, she gave me three different reasons for why she did it

- I did her shopping during the early stages of COVID, so that she wouldn't have to go to the store, and tried to get her to come up with a shopping list, but it took major hemming and hawing, and for all that effort we usually ended up with something simple like "milk, bread, ice cream" and that was literally it. This is something which I think is a hallmark of her ongoing executive functioning issues.

- and so on.

Compounding all of this is that my mom is narcissistic, has major boundary issues, and was emotionally abusive to me growing up. She has alienated nearly all of her friends and the rest of her family save for me. I've begged her so many times over the last couple of years to think about planning for the future—say, if the time comes when she isn't able to live alone anymore, where would she want to live?—but she shut me down each time. Even when I visited her in the respite care facility yesterday, I told her, best-case, she would most likely have to have some kind of part-time caregiver to come around to the house a couple times a week, she refused to hear it. After everything that's happened, and her refusal to plan together for her future, I'm just so tired and frustrated—I've blown up significant relationships and put my PhD on hold to step in and handle things when my mom has hit rock bottom in the past, not to mention the background resentment that simmers with having to fix these minor issues that crop up (but are major to her) and I just can't do it anymore. I also have a relatively significant disability that requires time and headspace of its own to manage to boot. I've tried to explain to her very gently, multiple times, why I felt like the then-current state of affairs unfair to me and that something had to change... but she just never got it. I think my breaking point was when I asked her recently to think through with me, what we would do if I had to move away (say, for a job) and if she needed help with something—and she told me she would just disown me and find someone else to help if I moved away.

Anyway, I don't really have much to go on because my mom so adamantly refused to talk about these issues, but I'm very much leaning towards my mom going into some sort of assisted living facility. Her psychiatrist agrees with me that assisted living would be best for her. I think being able to socialize and just being around people would be good for her, since isolation is a pretty major trigger for her depression and alcoholism. I don't think my mom's at the point where she needs memory care or skilled nursing care—she can do all her activities of daily living with no issues, but it's the IADLs that she has trouble with. She is in relatively good physical health otherwise and able to walk pretty long distances She's at a respite care sorta facility right now, and while it's clean and safe, it's probably not a permanent solution for her. I've found some facilities that might be good candidates, so I guess at this point it's just a matter of reaching out to them and having them evaluate my mom. We're lucky in that my mom has enough assets and Social Security to be able to pay out-of-pocket for many facilities, so cost isn't *too* much of an issue.

So I guess, my questions are—1) how do I get my mom on board with this plan of going into assisted living, if that's even possible? 2) how do I make sure that she gets the right level of care—i.e., home care versus assisted living given her need for socialization and relatively good level of physical functioning? and 3) how can I feel secure in my decision when it's all said and done? If it helps any, we're in the SF Bay Area.
posted by anonymous to Human Relations (6 answers total) 4 users marked this as a favorite
First, I think the memory issues are absolutely going to get worse over time so you need to plan, not just for where she is now, but also where she is likely to be in 12 months. I'm pretty sure things will continue to get worse for her.

I wrote a longer response but much of this will depend on whether your mother is willing/able to maintain sobriety and if not, how an assisted living facility will deal with that.

Good luck!
posted by metahawk at 10:19 PM on September 12, 2020

1) You can't. She will kick and scream and blame you and threaten to disown you and whatever else she still has in her arsenal to manipulate you, even if (inevitably) she settles down and does much better where you place her in the end than she was at home. She will keep doing whatever works to make you feel guilty for taking her away from home as long as she has the cognitive capacity to do so. Even if she's sober, healthier, and happier there. She will never admit she's wrong or that you were right.

2) Sounds like you already know assisted living is the best thing for her. Her psychiatrist agrees. This internet stranger agrees. Is there anything causing any doubt besides your fear and guilt about the fit she's going to throw?

3) Despite the (ongoing, possibly relentless) fit she is likely to throw, I think you already know and have clearly told us what she needs. Find her the nicest place she can afford. I would bet 5 dollars your heart, mind, body, and spirit will tell you with certainty that you're doing the right thing as soon as you drop her off. Even if she's furious about it, which she probably will be.
posted by shadygrove at 12:12 AM on September 13, 2020 [9 favorites]

Well, your mum is my mum ten years ago, and we didn't get her into a home until she started to set her apartment on fire regularly two years ago. Back when she was 72, I had a lot of other things to deal with as well, my grandmother needed daily care and also refused outside help, my dad had recently died and my youngest was ten. So I simply said no to my mother and let her fend for herself for a while. After a couple of years my aunt called me furiously to say that my mother had been hospitalized again. I went over to the hospital and helped manage the proces, and she realized that she needed to have some sort of relationship with me and it wasn't going to work out if she didn't respect my boundaries and lied and manipulated. Still, she wouldn't even consider moving and she continued to drink a bottle of whiskey, at least, pr. day and double up on whatever pills she could get out of her doctor.
So, I can't really help you get your mother to move, except say to no even more than you already do. You could perhaps get her to give you POA, so you can handle her economy from your home computer. If she has dementia, you might even get that by court order (I don't know exactly how that works in the US, here it is a fairly simple proces). My mother really wants me to have it, but we have had some delays because of COVID-19, as her nursing home is sometimes closed off.
Getting my mother into the nursing home where she is now was an extremely stressful process, and I came down with severe anxiety and could only work part time. Now it's done, it's really a big relief.
FWIW, her former doctor also believed she might have dementia issues. It turned out it only seemed that way because she was taking more sedatives than we knew. Now, at the nursing home, the intake of medicine is strictly regulated and while the doctor there allows alcohol, it has been reduced to far less, and my mum is now reading voraciously and is far sharper when talking with me on the phone. She is no longer manipulative towards me, ever, and she doesn't lie.
She is not happy, but she does realize that her current predicament is the result of her life choices.
posted by mumimor at 3:02 AM on September 13, 2020 [7 favorites]

Please do check out Al Anon in addition to the suggestions in the comments above. It will help you learn to detach with love.

If you aren't into Higher Power related woo, there is a growing secular presence in many 12 step fellowships. Search on "secular al anon."
posted by Sheydem-tants at 6:21 AM on September 13, 2020 [2 favorites]

One thing I forgot: obviously, being an alcoholic is shameful and lonely. One of my mums great fears about moving to the nursing home was that she would not be allowed to drink. When I talked directly to her about this, she relaxed a lot and it was a big contributing factor to our improved conversation going forward.
I had to make a decision about that for myself too: that time when my aunt called and I went to the hospital, I still tried to get her dry and hoped she would change. two years ago I decided it wasn't going to happen, and that the goal was instead to get to a reasonable quality of life for her last years.
posted by mumimor at 7:25 AM on September 13, 2020 [2 favorites]

It's okay to let the physicians and medical professionals tell you what level of care she needs .

Primarily, a big concern would be that the more independant the living, the more likely she is to relaspe. And someone with dementia really can't make a recovery plan or build tools for healthy sobriety, that ship has sailed.

Most importantly it really really is okay to place someone in a care facility. Your mother is a handful, he ability to manage her life is poor and will get worse even if she is marginally functional when sober right now.

It is also okay to refuse to let her live with you. You do not have to do this. Don't let any medical professional try to push you into that option for a single minute.
posted by AlexiaSky at 4:34 AM on September 14, 2020 [3 favorites]

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