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My mother has dementia and is bipolar. My husband and I are both sick and unable to care for her any longer. No other family members are willing to take her in. We have tried to get her into nursing homes but each time we try to do so, she threatens suicide. She is definitely a master manipulator.  She has been this way all her life.  She will then be sent to the psychiatric ward at our local hospital and she will literally have a standoff by locking herself inside the ambulance with the driver inside with her. She refuses to get off even when nurses come and try to talk to her. What can we do?

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Wash your hands of her.

You cannot force what she does (unless you become her guardian), but you certainly can decide what you can and will do. And you won't have her in your house any longer. You cannot care for her and the situation is not safe.

Call APS and tell them that you have been caring for your mother, but her impairments have become worse and your health is not good. You can no longer care for her in your home. You want to avoid the hard feelings of evicting her, but she must be removed.

I and I don't really mean abandon her forever. Once she is safely settled in an appropriate facility, you can establish relationships. You can be her loving daughter and son-in-law; you just can't be her caregiver.
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Don't be anywhere near the transport to psych when it happens-let them handle it.

What did happen when she locked herself in the ambulance? Were you there?
Did they just let a very ill woman walk?
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Try a gentler approach.
Mom, we know you are not happy here and don't like to be told what to do.
We can show you a few affordable apartments you might like.
(depending on her level of functioning, need for help, and finances.)
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Dear Galaxy51,

This is a very tough situation. I know your mom's condition is hard to cope with. I wonder if her meds could be making her condition worse. I have to agree with Jeanne and let the health care workers handle her. Wait till she is settled before seeing her again. I know it will be hard, but I would try and step back till she is resettled.
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A suicide threat would automatically result in your mother being placed in a mental facility for observation. Call 911 and report her threats. You haven't mention her age and whether or not she's taking antipsychotic drugs. My mother is 92, bipolar and medicated but she still has manic episodes. There is no panacea and changing these meds for geriatric patients is risky business. Calling 911 may be your best chance of getting her into a facility. Once she's there you have to refuse to resume her care. She will remain hospitalized until she can be placed.
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It sounds like someone needs to gain guardianship and next time she was taken by ambulance to the psych ward, someone just needs to leave her there until she can be put into the Alzheimer's wing of a proper facility
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I totally agree with what everyone else has said. Call APS and let them handle it. Since she will most likely have to be restrained and it won't be a pleasant scene, you and your husband need to leave when she is taken out of your home. It will be traumatic for all of you, but in the long run, it needs to be done.
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Excellent advice by everyone. I would just add to NOT listen to any of the other family members who are not willing to take her in (if they disagree that she needs a nursing home).
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When you talk to APS, tell them you'd like the state to take over her care and to be her guardian. No one can deal with her. When she threatens suicide for whatever reason, always call 911.
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And there are options besides a nursing home: eg. Assisted Living, Memory Care apartments, etc. APS is a good choice for advice and direction. I used them for my two friends, one with frontal temporal dementia, the other with short term memory problems who could not see the changes happening with his wife. Because they were still driving with revoked licenses, I called APS for advice. They sent someone to evaluate them and convinced them to give me the keys to the car and also told me their state and how ready I should be before they could not live on their own anymore and about how long that would be. I had never done this kind of care or responsibility before, so their advice was really helpful. There are anti-psychotic drugs that help a person become more compliant without doping them up. I took the wife to an geriatric psych ward at a hospital when she wouldn't let anyone clean her up after she soiled herself and they found the right drug for her that changed everything. She was much easier to work with and still alert. Best of luck on this journey. There are some good answers out there and hopefully you will find one that is just right for you and your mom.
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Drop her off at the hospital. Then leave.
For some reason when you are not there
I have a feeling she will be very nice to strangers.
The threats work for her or she would not keep doing it.
Call her on her bluff.Then give the hospital some other family members
phone number for them to call in case something goes wrong.
Who will be there to take care of you and your husband if needed?
You need to think about yourself.
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You have a few options here. If she threatens suicide today, cal 911 and get her admitted. Then when they want to cut her loose, don't pick her up, calmly state that you are not, can't and won't take her into your home, it's not safe. You can call APS for guidance and get them on board but no matter what, she needs to leave and go to a safe place where she can be cared for. Don't be afraid to tell them that you and your husband have health problems that prevent the both of you from taking care of her any longer.
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OF COURSE she doesn't want to be in a NH. They won't put up with her manipulating.

My mother used the "suicide threat" as her main means of "keeping us in line" as kids. Of course now she's 88 and says she NEVER did such a thing...(sigh)....

Time for mom to find a new home. Living with threats, manipulation and anger is miserable. Next time she does this, call 911, tell them she's a danger to her and you don't feel safe either and let the hospital and authorities handle it. You could scope out some NH's on your own, that may help you be more prepared.

Refuse to bring her home. Period. She can refuse to go to the NH, but that's realistically where she belongs.

Be prepared for some mighty fireworks from her--but you deserve a life too. And she sounds fairly toxic. Hopefully the geriatric psych drs can get her on the right meds to help with the bipolar issues--the dementia? No help there, but if she's calmer and not screaming at people--that may be all you can hope for.
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Your mother may not want to go for good reason the care is usually terrible and abusive.  Maybe visit a respected geri psych doctor can help with some proper medication. There are other options. Maybe paid caregiver in her own home. Does she have a house? Maybe she can take a second mortgage to pay or find out about your local community services or medicaid to help pay if she has no assets.  If no other options then let her be the master of her decisions of end of life not  just putting her in a nursing home end of story.  Mother has rights too if you can no longer care for her then maybe help look into options even at least maybe group home or assisted living too which may be less restrictive with a little more freedom and usually less expensive. Nursing homes are usually better left to the bitter end if no other option exists and your  loved one is non ambulatory and incontinet. Also nursing homes are very expensive and if she has an estate will be most likely subject to estate recovery after her lousy death. Meaning you and or siblings  must pay back for the lousy care from the estate.
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Rhonda, group homes mostly likely won't take her, given her history and she is most likely well past those stages. There are good nursing homes out there and the mother's money is being used for her care. If Medicaid has to be involved, Medicaid has to be involved. HOW DARE YOU suggest that Galaxy and her husband take out a second mortgage to pay for the mother's care? Home health care is expensive to the point of disgusting. Unless Galaxy signs papers saying that she will pay the balance of what isn't covered by Medicaid, Medicaid will go after the mother's estate only. After that, Medicaid can go pound sand and can't touch Galaxy's money.
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I did not say or mean second mortgage of Galaxy her mother may have to take a second mortgage from her own home if she wants. Home health is a not merely nursing care. It is called caregiver services. They help with bathing, feeding, cleaning and shopping too. My mother was able to live in her home and have service thru our community home based services and also thru medicaid for about 15 years. A trusted family member can even work with the agency and provide the care for payment if you do not want a stranger in the home. There are options instead or nursing homes for many seniors. Contact local Social Services Dept. or Division of Aging Services for a referral.
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Are you sure her only mental health problem or even main mental health problem is bipolar?
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Next time she is taken to the hospital tell the Social Worker she can't come back to your home and don't let them intimidate you. No Assisted living will take this woman and she can not live alone. If in a hospital, ask to have a 72 psych eval.
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Sounds like Galaxy is now in over her head - to continue to expect her and hubby to care for Mom in any hands-on way would be abusive to the caregivers. Next time she goes to hospital refuse to accept her back - she needs to be appropriately placed and APS may be able to help.
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Digital Banker and Suprise I'm willing to bet your guardians who prey on families who need help to care for loved ones. Galaxy If you allow a stranger to become guardian be prepared for mother's possible abuse and the draining of her bank account and estate which is more common than not. You could even lose the ability to see your mother again if the guardian decides and it happens more often then not. Please read up on guardianship abuse which is a very common these days. There are options if she can longer live with you family or herself. Please explore assisted living or less restrictive options first if she is somewhat ambulatory and can advocate for herself. She may be manipulative but if she can manipulate her way in a less restrictive environment she may be able to live in assisted living. Taking her rights away and giving them to a stranger or state should never be taken lightly.
We are all going to be old someday basic rights taken away by a guardian left to a stranger could be the most lousy death to go thru and for a family to have to deal with.
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Rhonda1, Your spelling is making your statement slightly unclear. Are you accusing Digital Banker and myself of preying on families????? Just because we are advocating for responsible detachment from an abuser? You have accused two people who were severely abused as children of abusing multiple people. ??????  Notice: I am not making a personal attack as you have to myself and Digital Banker.

I'm not usually on Digital Banker's side, but allowing the state to take over guardianship makes the state the "bad guy" in the mentally ill person's mind. The family no longer can move heaven and earth to bow down to the wishes of the aged one. The public guardian charges a fee for the headaches they go through that either the person with money pays or the person who has public assistance has paid by tax dollars.

When there is a long history of abuse to the offspring of the person, the aged one would much safer to have their children visit them in an institutional home where there is supervision than to live in a private single-family home with the chance of the offspring inadvertently abusing the aged one out of resentment. If the person is unable to make wise decisions, especially in the case of mental illness, having the state as guardian removes the opportunity for elder abuse.
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You cannot "reason" with someone suffering from mental illness much less dementia or alzheimers. Oh call APS. And if she threatens suicide call 911 immediatly in order to get her to hospital. Don't beat yourself up, this is all for her to have proper care. Very difficult to do and go through but what must be done.
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This an update to our problem with getting my mom into a nursing home. She finally gave in and went peacefully. She is actually happier there. Thank you all for your advice and concern.
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Galaxy, so glad for you that your mom is settling in! If you can, tell us how you accomplished this; we learn from each other!
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Rhonda1, did you happen to notice that the mother lives with the OP? She has no house to mortgage and for Medicaid she will have to spend down her own funds first. There will be nothing left for Medicaid to claim. And anyway, this doesn't appear to be about money. OP has health issues and cannot continue to provide high-maintenance care.

Most of us continue to do caregiving when our loved ones go into a care center. We advocate for them. We see that they are getting good care. We visit with treats and hugs. Finding an appropriate care center is not abandonment.
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Galaxy51 thanks for that happy update!

She may have on-again-off-again settling in issues, but it is very good news that she is initially happy.

We were very sad when our mother's health required skilled nursing care. To our astonishment she blossomed there, after a kind of rough settling in. She participated in nearly every activity. Our mother!! We would never have expected that. She liked the food. She liked a little flirting or at least eyeing the men. She went willingly to take her showers (!!) There was a group of women she sat and talked with. She enjoyed our frequent visits. She loved weekly bingo. The final 2+ years of her life she was content. And she got excellent medical care, and was treated with respect in spite of her dementia.
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