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I have an elderly friend (I’ve known her since I was 12 and she became a family friend) who has always been very self-sufficient and independent but because of age and a stroke early this year, she is experiencing some cognitive problems (she also refuses to get help/diagnosis for this) and has been forgetting to take her meds— sometimes refusing to do so. It caused a lot of distress, and arguments between us—I became her IHSS provider to help her a couple years ago—but now she refuses to let me help with several things, gets irritated and angry when I try to remind her about taking her meds etc. I bought her an automatic pill dispenser that she used for a bit but after coming along so far in her recovery she refuses to use it. She also refused to let me keep using Alexa to remind her to take her meds when I’m not there, as she lives alone— and threatened to cut me out of her life if I tried, and I just. I don’t know what to DO. She doesn’t trust me, doesn’t want my help anymore with the important things, she yells at me and I could feel myself becoming more and more overwhelmed/short with her. I’ve quit being her IHSS provider and encouraged her to find someone else who 1) could be with her more hours than I could (I have a full time job and am going back to school soon) and 2) I think our relationship is making it difficult for her to see me as someone who can help her (in her eyes it’s a little kid trying to tell her what to do—I’m 28). I didn’t want to keep fighting with her I need her to trust me and call me when she needs help, I need her to not shut me out. It became something unsustainable as it was. she doesn’t have kids and her siblings are far away and unavailable, I still see her a couple times a week to check in and help her get food and make appointments and take her to them etc. nothing's changed she doesn’t take her meds—she’s on three blood pressure meds, heart meds and blood thinners. If I do much as bring it up she gets mad and essentially stops talking to me until I leave. She had a stroke, this is important! I don’t know what to DO. Her nurses and social worker know about this too, but because she’s still capable of making her own decisions they say there’s nothing they can do? She’s poor, has no kids no real family and she won’t let me help in the ways I need to? Any advice on this is hugely appreciated, I’m worried and sad and frustrated and every single option feels like a bad one.

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She is not your "friend" in this circumstance, but your "client" and you are being paid for her care. It is crucial that the fact she is not currently taking her medication is known to those who are her MDs and who are those who are directing her care.
She is progressing in her dementia and there is utterly nothing you can do to change that. This is reportable to those managing her care. You are responsible to someone in her care, so whomever that person is needs to understand that her medications are now sometimes not taken. She may require placement. You are doing your best, but currently this just isn't working. I wish you the best. Do know that some medications (my levothyroxine and my atenolol for instance are two) are virtually tasteless and can be crushed and put in food she loves, milkshake or something, but many shouldn't be crushed, or taste awful, so that is just a thought.
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sometimes we care to the detriment of the other person. You have tried to make good assistance to remember her pill taking. How many times can she say no?
sometimes the consequences have to happen and then the help they really need can be put into place.
Let the nurses and social worker take over for a month and see if they realize she needs more care .
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I think James gave you the best advice. But out and call APS (adult protective services). This may likely get her placed in a "home" that may or may not be a good fit for her. It's not YOUR problem, she's the problem this is giving her an answer to what's going to happen. You don't want to get caught up in being a caregiver for someone who doesn't want it. Being a caregiver is difficult, don't put yourself there.
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I think James gave you the best advice. But out and call APS (adult protective services). This may likely get her placed in a "home" that may or may not be a good fit for her. It's not YOUR problem, she's the problem this is giving her an answer to what's going to happen. You don't want to get caught up in being a caregiver for someone who doesn't want it. Being a caregiver is difficult, don't put yourself there.
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I agree. Step back and call Adult Protective Services and let them know what is going on. Let them take it from there.
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I agree with all the advice here...since she is not a relative, you need to step back for a a little bit and call agencies that can help her better...like some elderly/ disabled agencies in your state. You're not going to leave her, but you are going to escalate the request for help to the authorities. This is really bigger than you, you cannot do this all by yourself. Document your plea for help...in letters, to managers, even take video and make notes, if you're so inclined. On the side, please search for the closest relative of this friend of yours, and make sure that there is no one who can take care of her. Only when you have exhausted the search can you step in as her caregiver, if that's who you want to be for her and she will allow you. This position brings a load of responsibilities on you, and you have to be ready to shoulder them, and you have legal backing to do so. But right now, I would bring her care to the authorities...just keep bugging them about her, until they pay attention. You can help her best if you do this first.

If she does trust you with her care, one suggestion that might help is talk to her doctor and see of you can limit the amount of medications she is taking...perhaps one tablet can do the purpose of two ailments...if you explain to the doctor her aversion to taking tablets, they might be able to work with you. They SHOULD be aware of this kind of temperament in old people, and they can find a happy medium to maintain the health of the patient without stressing them too much. If she absolutely will not take medication, maybe the one or two tablets that are absolutely important can be mixed in her food, ground up in pudding or applesauce. These workarounds I have used on my mother who has dementia and I have advised her aides/nurses in the nursing facility to do the same, and it has spared us a lot of grief. I commend you on your dedication and I wish you success in helping your friend.
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Grandma1954 Dec 2022
GB2012 can talk to her friends doctor BUT unless GB2012 is on forms indicating that there can be communication (HIPAA forms) the doctor can not share any information.
IF her friend has been diagnosed as not having capacity then medications can be covertly given. If she has not been diagnosed incompetent then her friend is within her rights to refuse medication. And to grind meds up and give them to her is not legal.
If her friend has been diagnosed as being incompetent then she should not be living alone.
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GB2012: I'm so sorry that your elderly friend has cognitive issues due to the stroke that she suffered. Apparently all rationale is non existent as it pertains to her health. Hugs and prayers sent.
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This is a tough choice for you to make.
You can be a friend.
You can be a "caregiver" of sorts.
You can't be both to this person. She won't accept it or allow it.
You can be there for her as a friend but you need to accept that at some point the choices she is making may shorten or end her life.
If she has family you can relay concerns. If she has a POA you can relay concerns. You can relay concerns to her doctor. But you can not expect family, POA or her doctor to comment about your comments or concerns.
Decide what you want to be, friend or caregiver and make peace with that role.
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Step away from this.

You may want to consider following;
If there are any biological relatives for her, notify them re her needs and, that you are no longer available.

If there are none, or if they refuse to step in, call APS, Adult Protective Services and notify them re the patient status. This can be done anonymously if you prefer.

If she is cognitively able to understand you, tell her that her safety is compromised and you must for her best interests step away and, contact the above.
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I would not be able to help in this situation I would remove myself as quickly as possible.
You had no idea what you were getting yourself into. There might a reason unknown to you why no family is around.
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Call Adult Protective Service. If she will not take her meds, it’s potentially life threatening.

Sadly, the only thing they can eventually do is have her placed in a facility. And the only thing you can do is visit her. At least she will be getting hers meds and will be looked after.

Please don’t hesitate doing this. Speak with her social worker and her nurses…there’s no way they are letting her not take her meds. Can she grocery shop? Pay her bills? Drive? How are these things getting done? If it’s you, tell the social worker you will stop and to get her placed.
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Please call Adult Protective Services and request a welfare check so that her home and lifestyle can be evaluated for placement through Medicaid (if she isn't already using that option). Stop trying to be her caretaker so that they can see what will happen to her without constant care and medications. Let go and see if the Adult Protective Services will do what they get paid to do. It sounds like her nurses and social worker have taken a pass and just washed their hands of seeking 24/7 care; while she might be able to vocalize her decisions, are the really healthy decisions?

All you can do is call in the authorities and show them videos of her dealing her medications. Everyone uses their phones to document dangerous situations nowadays.
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Isthisrealyreal Dec 2022
Connie, people of ALL ages and ability make really unhealthy and dangerous choices every day. This isn't reason enough to take someone's autonomy.
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You speak so very well and express the situation beautifully.
I understand. There comes a time when we realize we've done all we can - and that we need to let go. You need to let go.

Yes, it is difficult. However, it appears to me that this woman:
1) is depressed and needs MD assessment for medication to deal with depression;
2) is cognitively compromised, perhaps due to stroke, perhaps not. Clearly she is either choosing not to do what she needs or cannot. She needs a MD assessment and it appears only she can arrange for this, which she won't.
3) Her needs / issues / health concerns are a combination of the above and/or more / different.

You are so right. A person will not listen to a friend, relative, neighbor, etc., as they might listen to a professional - be it MD, social worker, etc. Perhaps the only - and perhaps last resort - strategy you can do is report her to county senior services or some outside agency that can knock on her door to see what is going on - and see if she will accept the help she needs. Clearly, she likely would 'slam the door in their face' - and you will know you've done all you can.

Without POA status, many elders or older people health compromised, be it physical, mental, cognitive, psychological will make decisions not in their best interest - and there is little to nothing we can do. It is important to realize when the time comes to know when to stop, step back, and feel both sad and also self-acknowledge all that you have done and tried to do. You must take care of yourself.

KNOW THAT YOU did a huge service to this woman.
It is now up to her.
Letting go is one of the hardest things to do.
It says a lot about YOU coming to us here for support.
You will get it. Take it to heart.

Gena / Touch Matters
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NeedHelpWithMom Dec 2022
I totally agree with you that letting go can be extremely difficult for many people.

People feel that they are strong for ‘holding on’ but sometimes it takes more strength to ‘let go’ and very often ‘letting go’ is what is most needed.

By holding on people are hoping to be able to control the situation. It generally doesn’t work out very well.

I also feel that it is best to allow an objective professional, (MD or social worker) attempt to persuade them to move forward in the proper direction.
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Report her situation to the local agency for the aged. She needs help that no non-family member can assist with.
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give up the pill fight. GIVE IT UP.

Just be the friend who checks daily to see that she’s still alive. There will likely come a day when she gets p.o’d that “you are all up in her business checking on her every day!”

Do not nag about the meds. Do not even mention it.
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Maybe she don’t want to live anymore. I know cognitive wise she has problems but her will to live is gone and the meds represent prolonged life. My mom passed on 11/26/2022 and she stopped eating and she was in a NH facility. Me and my brother couldn’t do anything about it as she had completing lost her will to live. I don’t blame her and I’m not mad at her. It’s her life to live or not and there was no quality of life left for her. It’s their journey and know this…the medical world is about $$$ and that’s it…it’s crazy the things they suggested for my mom for prolonged life.
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There is only so much you can do. My father throws all his medication out every time I fill it. I gave up trying. He should be on blood pressure medication and a few others. Him not taking it could very well lead to some bad health outcomes, but as he has Alzheimer’s (and had a stroke last year) and is also adamant that he never goes into care, what purpose is fighting with him to take medications that only prolonging the inevitable? This sounds harsh I know, but if he wants to stay in his home (he lives alone) and refuses care, then he is going to get his wish and whatever the consequences are of that. At some point there will most likely be an event that triggers placement. Same with your friend. Live your life. You are too young to let this derail you.
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Without local relatives, it's a tough situation for your friend. You are only a friend and have to stop offering help that may harm both of you. She has to be left alone to folly by herself. When disaster happens at her home, APS steps in and The State places her into a care facility. She will not be sent back home alone.
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As I read your post again and your responses to the posts, I see that your friend is struggling to accept and cope with her situation.

She was once independent and now isn’t. That is tough for her. I also read in a response that she would rather die than go into a home. I doubt if you can change her mind.

Some people truly would rather die than enter a home. They have specific reasons as to why they feel this way.

I have a friend whose mother consistently tells her she doesn’t want to go into a home. Her reason behind it is fear.

Fear of the unknown is natural, but my friend’s mom’s anxiety is through the roof. She refuses meds.

No matter how much my friend would like to help her mom, she realizes that it’s beyond her control.

Sometimes there is nothing else that you can do.

If there are deep seated emotional issues, along with decline, it is going to be an uphill battle that may never be overcome.
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GB, like many folks here, you are "awaiting the crisis" that will put her in the hospital. At that point, the hospital with have enough evidence of "self neglect" and "lack of insight" to say that she can't go home. They will find her a facility.

You can't help folks like this.
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GB, you are new on the site, and you have given us very little information about yourself and your friend. Your problems in ‘making’ your friend be sensible are shared by many carers (especially daughters!), and so are the increasing problems with ‘irritated, angry, no trust, threats about ‘cut out of life’ etc. Sixty year old ex-nurse daughters with POAs can’t solve this, and you have a lot less chance yourself.

You “don’t know what to DO”. “Every single option feels like a bad one”. In fact you have almost no real options, and the situation is likely to get worse. She will eventually have a crisis, with sudden death or compulsory care (neither or which are necessarily bad). You have no rights to intervene, in fact less than “her nurses and social worker”. Leave it up to them. You have DONE what you can. You can’t always succeed, no matter how crazy it seems, or how bad things are. Accept it, and if you want to stay in touch, make it a friendly social visit.
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When dementia sets in, due to a stroke or for other reasons, logic flies out the window. That includes the logic required to take pills that are needed to keep the person alive & somewhat healthy. You can't force this woman to take her meds, nor should you try. Arguing with a dementia patient is an exercise in futility, as well, and should not happen. Expecting your friend to call you when she needs you, or to trust you, may not happen anymore either because again, once dementia sets in, so does paranoia and general distrust of everybody including loved ones.

In the long run, extending her life may not be the wise idea you think it is. Living with dementia and all the headaches & heartaches associated with brain dysfunction is not something most people want to do. If she decides to stop taking her meds, so be it. She will let the chips fall where they may and it's up to her siblings to intervene to save her life if they so desire, 'unavailable' though they may be. There is only so much you can do as a family friend. If you feel she's in danger as a vulnerable adult living alone, call APS to do a wellness check on her. If they feel she should not be living alone, THEY will see to it that she's placed in a Skilled Nursing Facility for her own safety.

Wishing you the best of luck detaching from this situation with love, realizing there's nothing you can do for a person who does not want your help. As long as she's still considered competent, there's nothing ANYONE can do to save her from herself. It's her right to live as she sees fit, and to die the same way, if it's in the cards for her to.
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GB2012 Dec 2022
I think that’s been the hardest thing to come to terms with for me and my family, the fact that we can’t and shouldn’t force her to do these things even though it’s for her own safety and well-being. She’s told me she would rather die than end up in a home practically since I met her. I can empathize with that, but it’s hard to reconcile that with the reality of her as she is right now. As for APS, they’ve been by to see her a few times now. She was a VERY good nurse and conference speaker for hospitals when she was young so she knows what to say to them to keep up appearances when they talk to her I think. I may need to call again. At this point I think what she wants most and maybe needs most is a friend, since nothing else I do or did is actually helping. It’s hard. Everything you’ve said is hard but necessary to understand i think. Thank you.
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GB2012,

The bottom line is, as much as you would like to see your family friend listen to reason, you can’t force her to see things from your perspective.

You have offered your help. She has shown you that she isn’t interested in following your advice. So eliminate the sentence, “I don’t know what to do.”

There isn’t anything left for you to do except to step aside and allow her to take over the reins. Perhaps her care team will be able to persuade her.

It’s disappointing and even unsettling to us when we have someone’s best interests at heart and they refuse our help.

You can remain being her friend if you wish. Leave it at that though because anything more will cause nothing but frustration for each of you.
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TouchMatters Dec 2022
So well said.
Gena / Touch Matters
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You sound very sweet but you're giving more of yourself than is required or useful. Look into concepts like codependence and boundaries. Unfortunately we can make ourselves crazy with worry but none of us can force a competent adult to make the decisions we want them to.
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GB, her nurses and SW know this important information. Speak to them about what might be done.
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GB2012 Dec 2022
I’ll call them again. They already know about it since the physical therapist and myself have both let them know.
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She’s very manipulative. You seem to be at the end of your rope, so why keep on? Yes, you want to save her life and all that good stuff, but it’s beyond your ability to help now. Let her cut you out of her life and she will have consequences that could help her, like social workers, medical care and other folks to deal with her problems. She is sick. You are enabling her to keep on this way. Very sorry, but you need to get out of this bind and take care of yourself.
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First off you have my deepest respect in taking care of your family friend, that is very good of you to do so.
 
My mother that has Vascular Dementia started not trusting pills around year 4. It caused arguments every night and was very stressful for both of us. It's not her fault her ability to make rational decisions is not very good and she may have developed trust issues or is not fully understanding the overall importance of what you are trying to ask (she sees it as make) her do and the impact on her health. Since she's not understanding she may see it as a threat and just refuse.
 
Don't get frustrated or pushy with her as it will make it worse in the short-term and future. You can try and get very very very patient and spot those certain times and moods they are willing to take medications. Her doctor also told me to grind up the meds and put a little in her morning coffee or evening desert. The later stages are where are now as she will spit pills out if you give them to her at the wrong time.
 
You are very right that these meds are very important, and good luck believe me I know how hard the meds game really is.
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If this woman does not understand that this medication will help her keep from having another stroke, then she needs a full physical with some cognitive questioning. Has she been told that without the meds the next stroke can cause so much damage that she will be placed in a NH. Or, the next stroke can kill her.

Sorry, as long as everyone feels she is competent, then she can make her own decisions, good or bad. Drop the telling her all the time.
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GB, welcome!

Some folks CAN'T be helped. They have capacity to make decisions for themselves and insist on making BAD decisions. You can't stop that.

Visit as a friend. Don't nag.
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Isthisrealyreal Dec 2022
This!
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