Parents caring for the parent support thread (Part 1)

Thanks for the support everyone. Her brother-in-law just sent me the list of her meds. 11 every day, plus 2 as needed, plus a vitamin D every week. They use the same pharmacist for everything, so hopefully that helps. They make up a bill box so she gets them at the right time. Until recently she refused to let anyone help her, and she focused mainly on her hydrocodone and lorazepam, which made her quite loopy. Since they’ve been giving them to her, she’s actually doing better.
I too am interested in how you find a geriatric pharmacologist.

Hydrocodone? And lorazepam? So, an addictive opiod and an addictive anti-anxiety med. Doesn’t sound surprising that she is having memory issues.

Others may also have suggestions for how to find these professionals. There are specialists in geriatric primary care or gerontologists likely to be sensitive to these issues. Then there are Drs with an expertise in psychopharmacology; often psychiatrists who are current in meds/side effects and interactions. Some of those Docs focus on geriatric patients. Availability may vary by region; Drs may have the expertise, but not be advertised by it. Living in a major medical hub, these ideas might not translate well elsewhere.

Possible ways to locate specialists via websites or calls:

Geriatric care centers (often at major teaching hospitals). Check website and/or call and ask who is frequently called upon to review elders meds, including psychiatric ones.

State medical board listings

Best regarded continuing care communities (AL or SNFs) in area.

Hospice has access to these Dr’s and may tell you who they use.

Any trusted medical personnel who knows the patient or has a practice that consists largely of seniors.

Psychiatric hospitals will have psychopharmacologists. Look for geriatric ones. These are usually not docs who spend most of their time on “talk” therapy.

Perhaps a local private geriatric care manager could help. They often have a social work background and can be deployed by relatives who live far away to set up viable care and coordinate it; I used one just to vet my parents move to AL. This can be a good resource all around. May be listed online or recommended by resources above.

Local councils on aging may have social workers or nurses who would know.

Apologies for long post riddled with car typos and redundancy.

Thank you for the thorough reply. You’ve provided a lot of resources to check out, although I suspect I’ll have to expand my search geographically as my parents do not live in a major medical hub.

@1214mom The initial pass may not need a gerontology pharmacologist. Of course the Hydrocodone and Lorazepam needs to be weaned. I suspect there are other medications (anti-cholinergics? sleep medications such as Ambien? Or even Tylenol PM is a problem. Muscle relaxants?) that can be identified by a neurologist as harmful to memory and not serving a purpose besides habit. Here’s a the Beer’s list of medications only to be given to an elder after careful consideration. http://www.americangeriatrics.org/files/documents/beers/2012AGSBeersCriteriaCitations.pdf

I think looking at this long list of medications gives folks a good idea why my elderly patients are weaned off many medications and typically have a short list.

I’ve taken diazepam and oxycodone at the same time, and it does make you loopy of course. The problem is tolerance for both, plus I’ve found with the diazepam (Valium), I get muscle cramps sometimes when I stop it. There can be a fear of stopping either or both. I take only one most times (severe arthritis of the neck), but occasionally I have to combine them.

Valium is also prescribed for anxiety - think about it - if you can’t really pay attention to what is going on, you can’t really be anxious, can you?

How much is taken per day is important, and how often they are taken is also important. I often laugh to myself how they weigh pets, and will change their medications based on whether a cat is 10 or 15 lbs. They don’t do that with people, at least not adults.

https://www.drugs.com/diazepam.html

https://www.drugs.com/oxycodone.html

Make sure your loved one is taking the lowest dose possible, or decreases to it. Though, if the tradeoff is being anxious to the point of combativeness, it’s really a difficult decision to make.

Anyone with elderly loved ones they care for on one or both of those should seriously consider taking them to a physiatrist:
https://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation/what-is-physiatry

It’s like a physical therapist with a MD - they treat pain, including use of painkillers, but also know a lot about painkillers as compared to regular MDs.

Thanks. They will take her meds list with them when they go to neurologist so hopefully the doc will evaluate.
On a positive note, my oldest son (22) happens to be visiting her, and has been paying her lots of attention. She will always remember that.

What counts as elder abuse? I called my mom this evening and she was very distraught. My brother was apparently verbally nasty to her (he is a belligerent alcoholic.). She said he blames her for…Brexit! Yes, our 80-something year old Eastern European immigrant mother who lives in the Midwestern United States is somehow responsible for Brexit. Also apparently he told her she can only contact her handyman and occasional driver (a super nice, hardworking and honest guy) through him! What a load of you know what! I am quite concerned about both his nastiness and this attempt at control. Help! What can I do? I live flying distance! I am contemplating contacting her estate attorney for advice. (I visited one week ago and also had an argument with my brother. Had to ask him to leave the house!) do I do I come back with my sons and husband and have a word with him? Shall I contact her friends (some are younger than her) and see if they can help somehow? I don’t want to air too much dirty laundry but I don’t want my mother upset or verbally abused!

Sorry to hear this @LBowie. There is no way to deny how treacherous these situations can be. Not knowing particulars, yet having seen somewhat similar situations play out, here are few thoughts. Belligerent alcoholics do not typically listen and even more rarely follow directives consistently. There are choices to be made and perhaps there are no easy answers. Use what you know about your brother and try to help your mother plan accordingly. I am at a loss to see how her friends can stop negative interactions with him from occurring, even if there are small ways they can help your mother.

You likely have your answer, yet it is not without trade offs. You can speak with an attorney, though attempting to legislate and monitor the behavior of someone she must depend on is likely an exercise in futility that will take a lot out of both of you. The law may be one thing; her daily quality of life another. Perhaps logistics and finances can be reassessed now that it is not realistic for her to absorb his needs.

All the best as you sort this out. Given all the challenges, putting your energies into where the greatest positive impact on your mother’s situation and yours can be achieved makes sense. There are many of us here who navigate elders and difficult siblings; you are likely to get a lot of support. Wish it was a rarer circumstance!

What her friends might be able to do, if you trust their judgment, is be eyes and ears when you aren’t there. It helps if you can figure if a Brexit accusation is a minor one time rant. And if he’s not actually interfering with her handyman relationship, was just posturing.

Behind that, though, is whether it’s a pattern she can’t handle, not in her own best interests for her to have to endure. Or just random. Does it depress longer term, stop her, eg, from socializing.

Hate to say this, but you also need to consider whether he’d do anything to take over her finances, now/soon or in a way that prevents you from later caring for her at the right level. Is he devious enough, eg, to get her to change medical POA, some control over money, or estate details. Some legal advice in her state may help. No, never easy.

Thank you @travelnut and @lookingforward What you say makes a lot of sense and is actually what is going through my mind anyway, coming to many of the same conclusions. Thank you for urging me to focus on what I can control. That’s logical advice. I can control the financial aspects somewhat. I am the representative at the probate hearing, and am in contact with her estate attorney and financial planner. I don’t actually think my brother would steal, but he might do something stupid, like figure out how to execute a trade and incur a huge tax bill for her. He takes care of her computer, so I could see him figuring out passwords or asking her for them. He is so clueless – never has had a 401k or IRA because he’s never really worked, and yet thinks he knows everything. He does not have financial power of attorney. It would be difficult for him to get it because there is already one in place (me, but I’m finding the legal document carries no weight with banks or brokerage houses who want their own), and besides, he is somewhat reclusive, often asleep, and just would not have the energy to follow through on anything remotely complicated. I guess anything is possible, though.

She has figured out her immediate problem of a ride to an appointment tomorrow (brother will do it willingly) so is no longer in as much of a panic as yesterday. She was in good spirits and I’m relieved. I am actually really pleased at how she handled it. She just called him and asked, but said if he was too busy she’d make other arrangements. I think her forthrightness took him by surprise!

@LBowie - Does your mom have on-line financial accounts to which she has the password? If you’re handling those things, I’d change those passwords. Lots of people write them down. Preventing him from accessing that material is the first step.

Is she able to sign the forms the different institutions have that will enable you to directly manage the accounts? (I’ve already had my rant on the ineffectiveness of POA documents, so I won’t go back through that.)

I’m hoping to take care of these things^ arabrab hopefully when I’m there at the end of July for the probate hearing.

Meanwhile Mom did not get to her appointment because my brother had a fight with his neighbors with violence threatened (their workmen woke him up) and was too wasted to drive anyways (incoherent with the explanation over what happened with the neighbors.) This is a new level of craziness, I am sad to say. Things have not gotten this bizarre before. Will he hit bottom?

@LBowie - can your mom learn to use a taxi service? Clearly your brother isn’t working out well for rides.

I’m also unsure why your brother told her that she couldn’t call some people directly. Clearly he wants to control her, but why is she allowing this?

She actually can and did call the handyman yesterday to give her a ride but he was out. He did get back to her and actually helped sort out the whole mess. I don’t think it’s a threat my brother can act on.

My mom is funny - she asked me if taxis still exist! She has heard so much about Uber and I use it when I come to visit. She thought taxis were done with! There are definitely taxis where she lives! And, yes, she came up with that as an option, but I think there was just too much turmoil for the appointment to happen.

Sounds terrible LBowie.
I’d suggest acting strongly sooner rather than later. The person that was "helping’ my Mom was grooming her to give him everything. We thought it was easier to have him help, but it was WRONG and a bad choice in the end. Acting sooner IMHO means fewer regrets that you didn’t act sooner. Sometimes you just have to suck it up and deal with a lot of c*** at once. At least once it is dealt with it is dealt… better than death by a thousand cuts. Similar to the small dings and accidents in the car that someone shouldn’t be driving. Better to do the fight now than have someone severely injured. And you are in a very similar spot with someone not capable of caring for your mother being the one to control her.

Has anyone sold their parents’ house using a durable power of attorney? We are in the position that my brother and I I are needing to sell our mom’s house to pay for her care and she is incapable of any participation. She has always wanted her house sold for this reason and has even offered to sign it over to us in the past in an effort to make that easier so we know her wishes. Just curious how the DPOA is received during a sale (we’re in Texas). Ours was signed almost 10 years ago and does list the right to sell property.

@LBowie- does he live with your mother? This sounds untenable over time. I may be over-speculating here, yet have seen this before: Adults who have continually depended on their parents and then see them declining become vulnerable, angry and controlling. The aging parent is vulnerable, too, as they are used to placating the weakest link, often to each of their detriments. The parent’s ability to accommodate diminishes with time, challenging established relationship patterns, something their needy adult child has no ability to handle. Without sobriety, motivation to change and active treatment, improvement in your brother’s functioning is unlikely. In the best case scenario, this would take lots of time and he would still be an “inexperienced” adult.

Your brother can not be counted on to keep her safe or use good judgment. If it were me, I would not want have him become further emboldened to be in the driver’s seat for my mother literally and metaphorically. Is it time to put significant changes on the table? Conferring with the lawyer may help determine options. If he continues to have unfettered access to her, while remaining volatile and impulsive, it will be hard to protect her. Restraining orders with ambivalent parents are quite complicated.

Just saw @esobay’s post. Agree about tackling the big picture, rather than attempting putting out fires.

@preironic- is the attorney who did the original documents still in Texas? If so, they should be able to give you any guidance necessary to complete the sale. There also may be decisions that impact taxes or nursing home payments now or in the future, making a consultation with an elder law attorney worthwhile.

Preironic–my brother and I just sold our mom’s house for that very same reason last fall. I am in PA where the house was and he is in NJ. No problems at all with the DPOA, although the title company took the original (would not take a copy) for settlement but did return it promptly. We did not even have to attend settlement, just signed all the papers ahead of time. Thank goodness our mom had set up all of those legal documents years ago, I’ve used them a lot since she had a stroke last summer and now a fall recently.

LBowie, you described being somewhat intimidated by him, yourself. Eg, not wanting to wake the belligerent bear. And how he verbally abused your father. It’s possible you only see the tip, that your mom is minimizing in what she tells you. We don’t know.

I think we all hope to delay intervention and the emotions that go with it. But the suggestion to talk to a lawyer now may help set some protections in place, should they be needed.

I was under the impression any POA, will, etc, is only good until changes are made. If the person was pressured into changes or not able to make a rational decision, that would need proving after the fact-- and could be messy. I’m not sure having today’s documents makes things iron clad.