Hi - I haven't posted in a while. Last Tuesday I took my mother to a dr. appt, and noticed that every pot in the kitchen was black. She was telling me she had to move out, and she had decided to move to an assisted living in Falmouth, in spite of my offering to take her in temporarily so she could look around at places near me and my sister. I live about 100 miles from Falmouth.
My mother was manic - talking non-stop and not letting me get a word in, or yelling at me if I tried to interrupt her. She scolded me loudly in the doctor's office because I was shocked when she referred to her neighbor as her fiance. We decided to drive over the the AL that we had visited last year, which she had been talking to. They were able to take her in the next day, which was the only option at that point - I was not going to leave her at home, and she refused to come to my place.

She's 80, lost her second husband in April. She had been getting crazier and crazier. I signed a release for her to be evaluated by a psychiatrist.
I got her setup with temporary furniture and all her stuff, but had to leave to go home. Calls the next day to her and staff - she's doing great. Whe would see the psychiatrist next week.
The next day I call, and they have have sent her to the psychiatrist, who has determined that she is bipolar and prescribed depakote.
When we signed the papers, she was assured that she could transfer to one of their other places near my sister, which my mother agreed to do. We found that they had space, and were planning to move her tomorrow, so I did not arrange for moving her own furniture, transferring her phone etc.
Now the second place won't take her without hearing the report of the psychiatrist, and the psychiatrist was too busy to fax his report.
My sister is hearing that they will probably want her to have an inpatient stay of 10 days.

This is really bothering me - they did not call me when there were issues. The doctor does not have a complete medical history - she has a couple of issues that can cause manic behavior that he did not rule out.
From what I can see on the web, her behavior is hypomania - she does not have any major depressive components. She's resorted to yelling and being rude to get her way when she is upset, and I think that's the major problem. Her husband suffered with this behavior, but put up with it -he was a dear, may he rest in peace!!
I'm hoping we can convince the new place that since my sister and I will be available to see my mother every day while she adjusts, and that the medication is already helping her (it took them more than a day to get the scrip filled and get her started..., but we are told by the second AL, that they were going to get her admitted if the pscyh. wasn't doing his rounds that day).
We really want to get her moved up here asap, since her "fiancee" has been borrowing hundreds of dollars from her.
Any advice? It would kill my mother's pride to be admitted to a psych unit - is it really necessary?
In retrospect, I should have stayed in Falmouth near her for a few more days to help her out - she does have cognitive issues, and distractable (thence the burnt pots) and very bad organizational skills. Her memory is not that bad, and she does not get lost.

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My aunt thought we should have a second opinion before doing the in-patient eval - she's an RN, and knows my mother very well.

Oh, horsefeathers!! I don't understand her reluctance, given your mom's behavioral changes even before her UTI... This is not an invasive, surgical procedure and doesn't involve electro-shock therapy or bleeding with leeches!! They are not locking her away forever - only for a short period of time to evaluate her behavior!! If you do not wish for the docs to start her on any meds until they discuss their findings with you, you can certainly do so. This sounds more like the older generation's prohibition against admitting any kind of "mental defect" (which dementia is NOT - it is a neurological condition). Lots of folks, particularly elderly ones, resist psycholgical help or evaluation because somehow they think it may brand them as "crazy", a taboo condition to their generation and one that they keep hidden and behave as if it were something about which to be ashamed!

DENIAL is one's worst enemy in nearly all walks of life and this tendency is NOT limited to mere mortals without advanced education, credentials or letters before or after their names. Perhaps auntie might not want to accept that her sister is having neurological difficulties because she might feel that could be foreboding for her as a genetic relative...

One thing is for sure: One can't treat what one refuses to learn about! To choose to remain ignorant of a physical condition of any sort is NOT best medical practice nor is it a wise adult decision.

Joan, your aunt is a RN, so her opinion is to be respected. Is this your Mom's sister? How old is she.? For "Modern" medical science, geriatric specialty is NEW. (Granted, taking care of "Pops" in his senility is "old guard" stuff, but it ain't modern medical science.)

If she is retired for several years, does she keep up with her profession. Definetely bring her in, hear her out, second opinions are usually a good thing, but YOU are seeing the presentation of symptoms that call for this evaluation. If you don't find the validity in the diagnosis and the recommended treatment, OK, second opinion time.

Usually, a second opinion would be called for after you are dissatisfied with a first opinion. Is that truely the case, here? Do you think this is out of line for your Mother's best interest?

Good luck, and breathe.

Hi again,
Just heard that we can move mom to Andover. I am so releived. My aunt thought we should have a second opinion before doing the in-patient eval - she's an RN, and knows my mother very well. Wish me luck and patience.
Joan

Hi,
I do have the DPOA and am in the process of getting control of the finances. My mother is a very strong-willed person, and I do want to respect her wishes as much as possible, but she told the nurse about loaning her boyfriend $500 (which I verified with the bank). But we don't want to confront her. She has changed her mind about assisted living many times in the last year...
Joan

Hi All,
Thanks for the helpful thoughts. This is so upsetting and stressful. Neither AL has called me back today to move forward. At least the nurses are saying my mom is fine since Friday. My sister was down there Saturday with her family. I have a bad cold, otherwise I would probably go down there today to help take care of some things for her.
She did decide to move to AL and decided on the place. So this was a willing decision on her part. But now she feels she is being held prisoner, that nurses can just walk in any time with their own key (they do knock first), and she is disagreeing with them on the meds she feels she needs. Her pcp has not called me back regarding those questions.
She has a UTI, and it seems that she was originally put on Cipro which can affect the thyroid meds.
So right now I'm worried that she is going to get fed up and leave, or discover that my sister took her checks and get mad and decide not to move to Andover.
I have been reading that AD can present with hypomania.
I plan to schedule her with a neurologist up here if we can get her in, rather than wait around for these folks to do something.
As far as reading what I signed, I did not read anything - since she was not going to listen to anything I said that day, I just wanted to get her into a safer environment even if it was not the ideal, especially when she immediately expressed interest in moving to the Andover place.
Will keep you posted.
Thanks so much everyone!!!!!

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It would kill my mother's pride to be admitted to a psych unit - is it really necessary?

Absolutely!! A comprehensive geriatric psych workup generally takes about 10-14 days and is BEST done in-patient where the staff can test and observe her behavior 24/7. Getting a GOOD diagnosis early in the game is extremely important!! Do you or your sister have a DPOA? If not, your mom needs to designate one of you as her attorney in fact for business AND medical decisions (DPOA). A simple POA will not do. Since her judgment is clearly heading south, it's important that one of you take over her finances so that she cannot be victimized!!!

To save her pride, you MIGHT tell her that the testing is for EVERYTHING - not just psychological stuff, but neurological, etc. If you think they are uninformed about any of her behaviors or conditions, PLEASE fax the doctor your knowledge and observations. VERY important!! They will give her a complete going over and present her and you with their combined diagnosis (many specialists will examine and test her) and recommend a treatment plan. Any meds should be started while she is in-patient so that if she has an adverse reaction, the staff THERE can change her dosage, change the meds, etc. This is not something that one wants to do in a home environment, particularly if she is not monitored by a caregiver.

I feel for you, dear - my mom's decline began almost the same way - the bi-polaresque symptoms (which depakote did help to diminish), etc. The non-stop talking (pressure speech) can be maddening!!

Good luck!! Please update us when you have time!

It's not uncommon for dementia patients to have spells of agitation like you have described. We've joked about our LO's "manic phases" but there has been no diagnosis of bipolar. In fact, we were advised that these highs and lows are typical of dementia. Medication has helped, especially an antidepressant, but so has getting her situated where she is receiving more social stimulation in a controlled environment.

Was this psychiatrist a geriatric specialist? I think that's where I would start.

Joan, Good to see you back, but I am sorry about the reasons. A quick question for curiousity's sake. It seems that your Mother was the one who said she had to move (right?, no other party told her she has to move?), and she had picked out a place herself? If I understood that correctly, somewhere in there is still sanity and self awareness.

Rather than just a psych evaluation, a full geriatric evaluation may be in order. That may actually be what is lined up, 10 days in-patient sounds about right.

This sends all the plans careening like balls on a pool table, where to go, what's next, and you have hugs and support through all this here. Vent, scream, but BREATHE.

While some ALs are set up to handle dementia, not many will handle psychiatric disorders unless the elder is responding well to an appropriate therapy.

I am very concerned that you are being left out of the loop for any of this. There are possibilities of infection (UTI), depression, all sorts of things. Signing papers under stress and in a hurry always freaks me out. So many if, ands, and buts, and lots of BUTTS. Maybe what you signed allows them to treat her without consulting you. It is very sad to say, but so many elders have no loved ones to be an advocate for them, that ALs and NHs almost have to have this in the paper work.

With the Agency I use to provide Mom's home care 2x a week, protocol is negotiable, but I am forever surprised at things that don't suit ME, after the fact. You will see many of us ranting about such issues in the anger wall, well, all over the place. Who among us has the money (or the time under duress) to hire a lawyer to read every piece of DAM paper requiring a signature and listen to the explaination of every loophole they write in to cover themselves?

They may be following the correct course for your Mom, but the problem here is being left out of the information and decisions. 100 miles is a long way to go to face them down daily. I hope she and all will agree that she can be closer to her daughters. You sound like a good advocate. It is a struggle all the way through.