cecilia-ford-phdDr. Cecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for us in many articles over the years. Here she counsels a beleaguered daughter whose 82-year-old mother suffers from dementia—but refuses help.

 

Dear Dr. Ford:

My father died suddenly three years ago at 85. Since then my mother, who is 82 years old and in generally good physical health, has had significant cognitive deterioration.  She still lives alone in a two-story house; her bedroom is upstairs. She fell recently but did not fracture a bone! Her GP knows that she cannot remember basic things like when to take her medication for high blood pressure and cholesterol or her appointments to his office. He knows that she is vague in her responses to his questions, but he has never done a basic test to find out what she knows. When my husband and I ask her about current events or an upcoming planned event, she becomes really angry, calling us “the interrogators” at times.

I am the only one of the four children in our family to live close by. It is clear to my husband and me that she needs 24-hour care or to move into assisted living. We insisted on taking the car away when she backed across the street and into the middle of the lawn of the neighbor’s property six months ago. There were children in the yard at the time, but mercifully no one was hurt, and the neighbor requested only that she not be allowed to drive.

Mother will allow only “a family member” to drive her to shop, to doctors’ appointments, and to church. My husband works from home, but is really working.  She treats him disrespectfully and calls on him all the time to drive her, or run errands for her. This is really affecting our marriage now.

My siblings don’t understand the significance of this problem. Recently, I went through the house when my husband had taken her shopping and found rotten food in the refrigerator, trash not emptied, and dirty clothes in the washer. She has refused to have anyone come in to clean as well.

I took photos of the mess I found and sent them to my siblings. Two feel that she only needs “someone to come in and clean” and one feels that she needs “someone there” daily to prepare food, clean, and drive her to appointments.

I have had a decent relationship with my always-demanding mother, but now it has deteriorated. She treats my husband and me as if we are the enemy. She refuses to allow anyone to come in to her house  except family. . . . period.  What strategies can you suggest for management of this situation and for getting all of my siblings on board?

Best,

Barbara

 

Dr. Ford Replies:

Dear Barbara:

What you are describing is both a very painful and a very common situation these days. While there are no easy answers, there are two things I can say with confidence: Your mother’s condition is not likely to improve, and it is much better for you to confront it sooner rather than later.

The first step to take is to schedule a formal assessment of her capacities as soon as you can. Your mother’s anger and irritability are no doubt exacerbated by the fear and confusion that her diminished powers are causing her. Even though she may wish to deny or ignore what’s going on, having a diagnosis is important for everyone.

Just as children need the “security” of discipline and structure, your mother needs help in feeling safe. Since her memory and judgment are fading, she is in real danger, and hard as it is to treat our adult parents as children, that’s exactly what you must do. No matter how angry it makes her, you have already realized that you cannot allow her to make decisions for herself that affect her safety or the well-being of others.

You need to take this a step further, however. She cannot be the one who decides how she is taken care of anymore. Just as you would not allow your child to refuse to have a babysitter or never to go to school, you cannot allow your mother to decide that only a family member can care for her. Although it can be very difficult to make the transition needed to defy a parent’s explicit wishes, you must remind yourself that she no longer has the full judgment of an adult.

Nor is it ideal for a family member to be the only caretaker of an aging parent. Often a non-family member or professional can approach the situation with more energy and less baggage than a beleaguered child. Furthermore, family conflicts and personality traits that have existed in the past are not likely to get better as your mother ages: If she has been a demanding person beforehand, she will be more so, not less so, and your patience will be stressed to the limit.

Your siblings don’t really have the right to an equal vote in the matter at this point. Because you live closest and carry the heaviest burden, you and your husband should have the biggest say in what happens next. Actually, the others should come in person and make a thorough assessment of what’s going on, and, if at all possible, the family should decide as a whole on a plan of action. As your mother’s mental status is declining, it is likely that she would be safest in an assisted-living situation, and the sooner you apply for one, the better—not only because it takes time to find one, but also because the better her condition is when she applies, the more choice she will have. Ideally, the residence would be a place where all her children could share the responsibility of visiting her regularly. The sooner you insist on sharing the task of caring for her, the better for everyone.

Though your mother may be angry and fight violently against such a move, it has been my experience that if you can find a place where she will be safe and well cared for, her mood may well improve considerably. Remember, she in not in a position anymore to know what is best for herself. At the moment she is confused, isolated, and frightened. It is probably very difficult for her to imagine the future at all, let alone one that involves a new and unknown environment. This transition will require fortitude and courage from her children. She needs you and your siblings to make some hard choices in order to give her now the tough parental love that she once gave you.

Best,

Cecilia M. Ford