This is about my sister, what can I do?

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This is about my sister, what can I do?

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My sister has dementia. She is unaware or I should say in denial of having the disease. She lives alone but has the help of aides 2x’s a day.
My sister is quite a character and is known throughout her town. She's a people person. Talks to everyone. She lives on the corner of a very busy intersection which she crosses to go shopping or eat out. She is very lonely and is drinking quite a bit. Her Psychiatrist has called me and made me more aware of her problem. I can't stop her from drinking. I have spoken to her and explained what could happen: strokes, falling, becoming more unbalanced, and so on. What can I do? She doesn't want to move into assisted living or memory care. Can we force her to? She lives off of S.S.D.I. & Social Security.

Alcohol Abuse Alzheimer's & Dementia Anosognosia

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You go to al anon for support in understanding her drinking problem. Great information. If you can't go to a meeting you can look at it online. So many families affect by one person's drinking. It is hurtful to us because we can't stop them. Good support for you. Think many people here have covered your options for living arrangements.

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People who drink frequently don’t want to go into a facility because they will not be allowed to drink. However some don’t have that rule – my MIL was allowed a bottle in the fridge, and she gradually tapered off. I think the bottle was still there (she didn’t have dementia and she felt good offering it to visitors) until her death at 97. It might help to find out if there are any local places with a similar set-up. It’s possible that it will alter her attitude - it may be about alcohol as much as dementia. Best of luck.

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Ljr2291: Your sister's "lack of insight" does not allow her to look inward/to recognize that she suffers from dementia. But she has the wherewithal to see a psychiatrist. She is the only one who can halt her consumption of alcohol. Prayers sent.

anosognosia - definition: a sick person's unawareness that she is sick.

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It's called a sort of "folly" decision for your sister living with just 2X aids. If your unattended sister falls and suffers injury, she may not be allowed to return home without obtaining 24 hours of assisted living. Can she afford to pay for this help?

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Call the psychiatrist back and ask for his help. He called you, so has he identified a problem that would not allow her to be in her home alone when aids are not there? Ask him what he recommends and what he can do to help. What did he want you to do about her problems or did he suggest anything?

Have the aids said anything about dangers she is creating for herself? Leaving pots on the stove, flame burning, falls, etc? If she's renting, has she created any problems to where the landlord has concerns (hoarding, not cleaning, etc)?

If she is still mentally aware to the point that she knows what she is doing, there may be little you can do until the problem goes to another level. Like a fall that sends her to hosp and you could then work with social worker at hosp to release her to rehab and/or some type of facility.

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If she is competent she can do what she wants.
Drinking is not illegal.

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Nothing, that's what you can and should do about the situation with your sister. She has help, she's able to afford living on her own, she has a psychiatrist (although why s/he's speaking to you is beyond me, unless you are her medical POA), so it sound like she's doing fine. Excessive alcohol will speed up or complicate her existing dementia, but that's HER choice; living life on her terms, right? You can't 'force' her to move to Memory Care unless she's been deemed incompetent and you are her guardian.

Leave her alone, that's my suggestion. You can't save a person from herself, nor should you try, really. What good does it do? At some point, we all have to take responsibility for our own actions and for our own lives. Now that I'm getting up there in years myself, I don't want any of my children telling me how to live, what I'm doing wrong, or how things 'should be'.

Best of luck!

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Check if PACE program is in her area and make sure she gets infi if it is.

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Based on your post, it sounds like, your sister has things under control.
You've framed your post to describe your sister as needing assistance, but she has assistance. Meaning, she has every right to live her life as she wants. You only mentioned a Psychiatrist and no other M.D., involved in a Dementia diagnosis ... ??

It might be time to let your sister live her life;

Her Psychiatrist legally shouldn't be contacting you, if you're in the States, HIPAA laws normally restrict physicians from discussing medical records. WHY is that Psychiatrist contacting you, you mentioned Dementia, yet claim your sister is unaware of that diagnosis, which doesn't align with having the 2 caregivers.

Your sister is very aware of her limitations, and has those caregivers, to help with those limitations.

Let your sister live her life.

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I agree with the country mouse. You already have your sister in the system, or someone does. She has a psychiatrist. She has aids 2 times a day. It seems that for now this is apparently working, and she has the support of her community. As to the drink, it will of course take her down with a fall earlier than later, but at end of life, for some, it appears to be "an option." If SSDI and Social Security are the only support then a placement might not be great. Until it is necessary I would leave it alone. Do you have POA for health care? Seems if the psychiatrist is communicating with you, you may have. Time enough to address this when some catastrophe of some sort occurs. The option of being on lockdown isn't a pretty one.

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Excuse me, but I just have to have a little fun here. "Countrymouse" isn't actually a mouse! (And AlvaDeer--who is assume is not actually a deer, although undoubtedly dear--has made some good points, for which I clicked on the star.)

When I was quite small, my father said the car had developed a leak in the transmission, so we should take it to Mr. Wolf to have it repaired. I reacted along the lines of "Ohhh, I don't want to go there!. Then my father explained "No, I don't mean he IS a wolf; I just mean his NAME is Mr. Wolf!" I was satisfied with that explanation, and agree that we should take the car to him. A short while before I lost my father in 2014, I reminded him about this, and he remembered, adding that he knew I was afraid.

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Isn't this where we call in Adult Protective Services?
This is the job of the psychiatrist, to take action. Likely to admit her for observation and treatment, intervention for a vulnerable adult.

A person with dementia, requiring two aides (In home supportive services, a Medicaid benefit for low income) is likely on medications that do not mix with alcohol.

You can call the psychiatrist back, using his medical powers, request he take action (as if) she had no family. Or, he could contact her PCP and advise.

If she is lonely, you could visit her more, involve her more in your lives.

She may need a free attorney to help sort out her options, and get a safer place to live...(called supported housing).

These organizations provide free legal assistance for low-income individuals, including help with accessing Social Security and Medicaid benefits:
Massachusetts Legal Assistance Corporation
Community Legal Aid, Inc.
Greater Boston Legal Services
Northeast Legal Aid
MetroWest Legal Services
South Coastal Counties Legal Services, Inc.
MassLegalHelp

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I am assuming that SSDI is supplimental insurance that your State provides. If she is getting this then she does not have the income to be placed into an AL or MC, these are usually private pay. Unless, your state has Medicaid vouchers that will cover an AL or MC. So, as I see it, LTC will be sister's only option.

Do you have POA financial and Medical? If not I will guess your sister has you on paperwork with the Psychiatrist to allow him to speak to you. If not, he has violated HIPPA laws and your sister's confidentiality rights.

Really, unless she is found incompetent to handle her own affairs, not much you can do at this point. When she is declared incompetent, and if you have POA, then you have the authority to place her for her safety. Until then, you may just have to wait for something to happen.

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Ljr, anosognosia is the medical term for those who are unaware of their medical/cognitive condition. Has your sister designated a durable PoA for herself? If not and you think she is a danger to herself, your only other option is to pursue guardianship through the courts. If she never assigns a PoA and no one pursues guardianship over her, eventually someone will call APS to report her as a vulnerable adult and the county will get guardianship. Family will have no power. The county-assigned guardian will control everything, including what facility she goes to, what medical care she receives and all her finances and assets. Upon her death the county-assigned guardian will have her cremated and then send family an itemized accounting of how they used her assets to pay for her care. IF there are any funds leftover, I assume it will need to be hashed out in probate, if there isn't a will. I'm just telling you this so that you can ponder whether you want to be her legal advocate or not.

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Hi, just want to say what a wonderfully tremendous way of explaining what will happen if certain legal steps aren't taken, and soon. It's a hard decision to make - to accept all that, or let the county step in. Either way, the sister will have some regret, guilt, either way she goes. I suppose it depends on how much of her life she wants to invest in taking care of someone that don't care to do for themselves. That brings loads of resentment, and eventually, less quality of care. I just wanted to tell you that you covered all the bases, very well.

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Seeing as your sister already benefits from the input of a psychiatrist and of aides twice a day (this service must have been put in place by somebody - who was that?) I think you probably have better, more specific sources of information than we can be.

Call her psychiatrist and ask him/her to explain what steps might be taken to protect your sister if the psychiatrist agrees that your sister no longer has mental capacity (the ability to make decisions for herself). If the aides were arranged by someone in social services, you could approach that person for advice, too.

In very general terms: when an adult lacks mental capacity, decisions should be made for that person by their authorised representatives in their best interests AND as far as possible in line with their known wishes.

So, as regards your sister. If it established that she does not want to live in a facility but prefers to remain at home, in her community, the aim will be to support her living at home unless this cannot be satisfactorily achieved by any reasonable means. The "being forced" to move into assisted living or memory care would be the next step - implemented by, for example, her court-appointed guardian - but it wouldn't so much be forcing as leading and persuading.

I don't suppose your sister's psychiatrist imagined for a moment that you would be able to intervene in her drinking - if the psychiatrist can't, what chance have you got?! And, indeed, irrespective of dementia, nobody can make another person decide to stop. Where is she getting her alcohol, most of the time?

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You cannot reason or explain to dementia. You are going to have to wait for an emergency to try to do anything. It doesn't sound like she is very advanced in her dementia. It may be a long wait.

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Until, unless she is declared incompetent you can not force her to move to a safer environment.
If/when she falls and is hospitalized and or rehab during discharge you might have the opportunity to say that she is not safe to discharge to home.
If you wish to take this on you could talk to her doctors and see if they will indicate in court documents that she is incompetent. At that point you or other family member can be appointed her Guardian. If no one wants to take that responsibility then the court will appoint a Guardian.
No amount of you telling her she can not drink will make an impact. (does not make an impact on a alcoholic that does not have dementia) Any discussion you have with her about her dementia is futile, a person with dementia does not know or realize they have it. It is not denial but the fact that they can not retain information.

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This is about my sister, what can I do?

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