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My MIL, who has rapidly advancing dementia (moderate-moderate severe), has gotten very nasty with us recently. Every morning (and through out the night) she’ll start throwing clothes we’ve folded down the stairs and accuse of things. She’s accused us of stealing from her, trying to put her in dirty clothes, saying we’re mean, has called us a variety of cuss words, says I don’t know how to keep a house and a social worker is going to come take my child because I don’t know how to keep a house (the house is spotless). She told my husband that we’re only “here for the money” and some other extremely cruel things. She wakes us up at all hour of the night to accuse us of things as well. We’ve done nothing but help her - she lives with us, we do her laundry, cook, administer her medications, take her places when feasible. We’ve accommodated her needs in our home as much as possible. She doesn’t have the right insurance to pay for a nursing home and she has some money but not enough to cover all expenses. I’m at a loss here. How can someone be so cruel? We are at our wits end and could use any advice or encouragement.

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MIL’s dementia has progressed to the point that you cannot keep caring for her. It’s time for a memory care facility.
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Yes to checking for UTI.

Are you her PoA? Is anyone?

More info would be helpful, since your ability to get her into a facility will depend on her getting a medical diagnosis of incapacity and who is actually legally able to make decisions on her behalf.
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Your MIL may be worsening and may be soon in need of placement to free your household from being captive to her behavior. As to the "why" of it, there is much information and there is much conjecture. Some dementias are notorious for irratic behavior. Some dementias are caused by small strokes in areas of the brain that cause changes. Some dementias involve loss of inhibitions and paranoia.
The thing you want to clear here is that there is a physical including a check for UTI, as this can be very problematic for seniors in so far as personality changes. Get a blood panel workup and then discuss with MD the changes in behavior and the options for care going forward.
Sorry you are experiencing this and hoping things improve or you find a way to bring peace back into your own lives, and a safe placement for MIL.
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