Mental Decline & Dependency/Coping With Aging Loved Ones

@JPB,

Thanks guys, that was all helpful.

I think that gives me a starting point anyway. All I'm certain of really is that this is a conversation we need to have, and some things need to be established now rather than waiting for a crisis situation. (If there is never a crisis situation, great, but unlike my mom I don't want to operate on that assumption.)

Re: spousal benefits, does it matter that my dad has remarried?

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@sozobe,

You and your mom might benefit from some estate planning assistance. I can't recommend anyone, but maybe your mom's current employer has someone. Or if your mom has a 401k, the investment firm might have someone who gives retirement advice.

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So my aunt "got promoted" to care level III in the (mandatory) 'long term care insurance' after examinition by the medical service of the insunce companies. (The definition of that is: "a need for assistance is required for at least 300 min per day with basic care needs of at least 240 min per day".)

This insurance pays now (roughly) $2,000/month, which leaves her to pay $2,600. (And additionally the difference from July until October, since I made the application already at the end of July.) She still has some money for a couple of months ...

On Thursday, the will be a hearing (in the home, the judge is visiting her) to get the "approval of the custodianship court with regard to accommodation": since aunt is very unruly and aggressive (the latter only sometimes), she needs her bed altered. At least that ...

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@Walter Hinteler,

Just hours before the judge will look at my aunt, her psychiatrist visited her .... and decided that she should have to stay some time in a psychiatric hospital to fix the medication ...

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@Walter Hinteler,

My aunt is now nearly three weeks in the closed ward of a psychiatric hospital's geriatric department. (Situated in a large park, btw, pictures here)

A local judge decided that she's so ill, she wouldn't and couldn't leave the ward. So she's legally staying there because I said so as here legal guardian.

The first two weeks were rather "smooth" (meaning, when you looked at her illness, why she's there and where she is).
Lasr Monday, the head psychiatric of that department told me, she could be released in three, four weeks ... because she lives in the safety of a home. (He said, they didn't have a Fountain of Youth and couldn't restore what might have gone wrong in 89 years ....)

But the last couple of days, the situation worsened: she usually didn't drink enough and ate only (a bit of) what she liked (anything sweet, puréed).
Now she refuses to eat and drink at all ... (When I'd been there today, it took the nurse 30 minutes to give her two [2, sic!] nips of tea!!!)

I was asked, if she'd made any decision how she would live in old ages.
I translated that into how it was meant and told them that I had signed already a paper regarding the end-of-life care (knowing her biography) and that I therefore object force-feeding.

I have some hope, but not that much ....

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@Walter Hinteler,

Walter Hinteler wrote:

My aunt is now nearly three weeks in the closed ward of a psychiatric hospital's geriatric department. (Situated in a large park, btw, pictures here)

A local judge decided that she's so ill, she wouldn't and couldn't leave the ward. So she's legally staying there because I said so as here legal guardian.

The first two weeks were rather "smooth" (meaning, when you looked at her illness, why she's there and where she is).
Lasr Monday, the head psychiatric of that department told me, she could be released in three, four weeks ... because she lives in the safety of a home. (He said, they didn't have a Fountain of Youth and couldn't restore what might have gone wrong in 89 years ....)

But the last couple of days, the situation worsened: she usually didn't drink enough and ate only (a bit of) what she liked (anything sweet, puréed).
Now she refuses to eat and drink at all ... (When I'd been there today, it took the nurse 30 minutes to give her two [2, sic!] nips of tea!!!)

I was asked, if she'd made any decision how she would live in old ages.
I translated that into how it was meant and told them that I had signed already a paper regarding the end-of-life care (knowing her biography) and that I therefore object force-feeding.

I have some hope, but not that much ....

Since you have previously told me of your Catholic upbringing, perhaps, the concern about a sin of omission should come to mind? Just my opinion, as one that values life, whether it is the life we can enjoy, or the life that is on the low end of enjoyment.

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@Foofie,

Thanks for your kind and helpful advice.

However, if you would have followed my posts not only the last few years but earlier as well, you could have noticed that this had been discussed:
- more than 30 years ago with my father (then head physician of a Catholic geriatric hospital) and the nuns in that hospital,
- with the nuns, the Franciscan priest and other staff in my late mother's and my aunt's seniors home,
- etc etc

But I really appreciate that you found me here on this thread and helped to deal with the situation.

Drai zich!

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@Walter Hinteler,

Walter, if you haven't already done so, and you might want to do so again, make a copy of her end-of-life paperwork and personally deliver it to the facility's administrator. Let them know that you fully expect the staff to be informed and your family's wishes to be complied with.

In the meantime, do you have anything in your country like a hospice? If so, you may want to make some calls so you can find a place for your aunt where she will live out her last remaining days in relative comfort and care.

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@Butrflynet,

She doesn't have any end-of-life paperworks by her own - I signed them as her legal guardian some years ago.

There's no need for sending her to a hospice - such is done "ambulant" by a hospice group in the home. (Mother got it before she died more than two years, too.)
And it will be done in the hospital, too, if needed. (Actually, the situation here is a lot better than in the USA - I've talked about this with the nurse and the social worker of the hospice who visited Bob.)

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@Walter Hinteler,

I'll wait a couple of days to watch what progress my aunt is doing re new medication in the hospital. Then (or earlier), I'll get her back in the home.

There, she might 'recover' just because it is a known surrounding with known people etc.
Or the palliative care will start there (which can be done anytime there).

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@Walter Hinteler,

Hoping for the best outcome for your aunt, Walter.

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@Swimpy,

Thanks, Swimpy!

The trouble - my trouble, her trouble, the hospital's trouble .... name it - is that she's actually cognitively quite okay considering her age.
Today, she didn't want to drink again. And again, she didn't speak. After some time, however, she answered the nurse's question: "I don't want to drink, because I get the infusion."
She didn't want to talk to me, too. Only when I left, she said "Stay, Walter." ... ... ...

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@Walter Hinteler,

Aw, Walter.

((((hugs))))

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@ossobuco,

So my aunt will be transported from the hospital back to the home on Thursday.

They've changed her medication - but said, they can't do it more.
And actually, besides that ... nothing has changed.

She doesn't get more than 1,000 calories per day, mainly via infusions. (If she just would eat/drink, it wouldn't be more than 250 ... on average.)

In the home, she'll be visited by members of the local hospice group and get palliative medication by her doctors as well as palliative care by ward's staff.

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@Walter Hinteler,

At first, the ward's staff was quite happy that my aunt seemed to be pleased to be "back home" again. Two days later, they said, she behaved "a bit strange". Now, four days after she came back ... it's worse.

I suggested that we'll wait and watch what happens this week. And have a brainstorming next week with the doctors about how to proceed ...

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@Walter Hinteler,

Sounds right re process..

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@Walter Hinteler,

Our sympathies, Walter.

I admire the German care system, too. Of course, there's only so much they can do.

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For folks who are caring or have cared for aging relatives/loved ones with dementia. Are you familiar with "Sundowners Syndrome"? This describes to a T the symptoms my father exhibited in the early-mid stages of his dementia. He was good-ok until about 4:00pm when he'd exhibit much more severe outbursts and confusion. My mother referred to it as his "colic hour" which, unfortunately lasted all evening. I'd never heard of this as a general manifestation before. I wonder how common it is?

Quote:

Sundowner’s Syndrome is the name given to an ailment that causes symptoms of confusion after “sundown.” These symptoms appear in people who suffer from Alzheimer’s Disease or other forms of dementia. Not all patients who suffer from dementia or Alzheimer’s exhibit Sundowner’s symptoms, however. Conversely, some people exhibit symptoms of dementia all day which grow worse in the late afternoon and evening, while others may exhibit no symptoms at all until the sun goes down.

Sundowner’s Syndrome largely remains a mystery to medical science, although there are several theories about why these symptoms begin at night. More and more studies are being conducted to try to determine the exact cause.

In the meantime, some doctors believe it’s an accumulation of all of the sensory stimulation from the day which begins to overwhelm and cause stress. Some speculate that Sundowner’s Syndrome is caused by hormonal imbalances that occur at night. Still others believe that the onset of symptoms at night is due to simple fatigue, while some believe it has to do with the anxiety caused by the inability to see as well in the dark.

The theory that the symptoms have something to do with darkness has been supported by studies where the symptoms subside within an hour of the return of daylight. There is some evidence that nursing facility patients show an increase in Sundowner’s symptoms during winter, which may suggest a correlation with Seasonal Affective Disorder (SAD). SAD is believed to cause depression in the winter due to the shorter periods of sunlight, and it affects people of all ages.
More

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@JPB,

I think it's one of the symptoms which can occur with dementia. When I remember how some of the residents at my aunt's ward behave in the late afternoon - they might have it.

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@Walter Hinteler,

My mother used to give my father a protein-rich snack in the late afternoon (peanut butter sandwich or cheese with crackers) which she said seemed to help.

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Mental Decline & Dependency/Coping With Aging Loved Ones

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