Expert: Mary Gordon - 9/22/2010

Question
Dear Mary;

My mother in law has been a heavy drinker for about 20 years. In the last two years. She lost the house where she was living, she lost her job and few days ago she loss her husband.
My husband and his brother had tried to stop her drinking; and was this time were she didn't drink for couple days and had alcohol withdraws causing her a seizure.
Since  I know her she always tell me the same stories over and over. I guess she forget she already told me. So that was common on her. But, in the last month she forget
- what day/month it is,
-( his husband was in hospice at home permanently ) when she got a call and somebody ask for her husband she would say he left to go some place and that she forgot to ask where he was going ( which sometimes he was just in the other room ).
-She would refer to me with the name of her other daughter in law.
-The other day she ask me what time it was, when i said the time, she said that his son must be excited counting the minutes to leave school. ( his son is 30 years and he doesn't go to school long time ago ) when I correct her and said that he wasn't at school but at work, she got upset and said to me " he better be at school or he's not going to graduate"
-she hasn't leave home for weeks, but she would tell you stories about what she did the day before when she when to the market. ( which she didn't go ).
-She wet the bed at night

They are many other examples. But my concern and question is that my husband want us to move all together. We works so that would be me being with her most of the time.
Is this the best idea? Shouldn't her be in a facility ?
She still fights to get alcohol. And btw her mom had Alzheimer.
I think I am just scared to the challenges coming or not being able to keep up with her needs.
Does she can better with cares? Is there something I can do to get her better?

Answer
Hi Monica, the first thing you need to do before you even discuss having her live with you is to get her properly assessed by a doctor with respect to her cognitive impairment. You need a referral from the family doctor to a neurologist or psychiatrist with specialties in dementia. You need to know exactly what is wrong with her. They also need to know she is still drinking.

It is very likely to be dementia caused by her alcoholism, but it may also have another cause on top of that (i.e. there may be more than one thing going on at once). She will need a full and comprehensive assessment by a real expert who can then tell you what (if anything) can be done for her, and what the future is likely to hold.
Here is some general information about alcohol induced dementia.
http://www.alzbrain.org/pdf/handouts/6001.ALCOHOL%20INDUCED%20DEMENTIA.pdf

You also need to see a lawyer about estate planning to pay for her care. Is her will up to date? Do you have valid powers of attorney for her for both personal care decisions and financial matters? Do you have release forms that permit you to talk to her doctors? Do you have a good handle on her financial situation?

You are in the US and the laws around insurance and medicaid and medicare are very, very complex and vary from place to place. You need good advice from an experienced lawyer on how to preserve her assets for her benefit. No matter how much your husband wants her to live with you, that would only be temporary, because if she has a progressive dementia, she will shortly need care and supervision 24/7. You won't be able to leave her alone for a minute. It will be relentless, it will be thankless, it will be physically and emotionally exhausting and draining, and you will either need a lot of hired help, or you will need to place her in a facility.

The government helps to pay for short-term care through Medicare, but only pays for people with very limited finances through Medicaid. In some states, nursing home costs can exceed $8,000 per month (not a typo!). That means that if she needs special care, which is very likely, if you are paying for it out of her money, it can run to almost $100,000 per year out of her own savings. If she has even modest assets of about $4,000 in the bank, she will NOT be able to receive Medicaid. There are some exceptions, but the vast majority of people are not eligible for Medicaid due to existing assets (such as bank accounts and property) and monthly income (such as pensions and Social Security benefits).

A good lawyer can help you navigate the minefield and save money - proper coordination and execution of all of these matters should be conducted with the guidance of a qualified (and specialized) elder law attorney and other financial and care management professionals.

At the moment, I don't think you and your husband have the information necessary to even consider taking her in.  You have no idea what you are facing until the doctor is able to tell you her prognosis, or what her care might involve. Once you have seen both the doctors and the lawyer, and had frank talks with them, you might want to ask to be referred to a social worker with a dementia care specialty to discuss care options and the reality of homecare when the person is also an alcoholic.

If the burden of caregiving will fall on you, and you are having doubts at all, I'd go with my gut. If this is a progressive dementia, looking after her at home will be difficult beyond your imagining. You will wear yourself into the ground and resent both her and your husband. If she continues to drink, I would think she might be very dangerous to live with (i.e. falls, fires, floods). Be strong and be honest with your husband. He is enmeshed with his mother and is not necessarily thinking clearly about the big picture of how this will impact you and your marriage.

Hope this helps. Thinking of you.

Mary Gordon