Mom thinks everything is fine. It’s not.

Where to start? 84 yo Mom lives at home. House looks like bomb went off inside. Food lying everywhere for days, mounds of clutter (trip hazard), and she doesn’t even know the cat poops on the stovetop. Food spoiled in fridge, doesn’t remember how to microwave things.

The problem is, when I offer to help clean up the clutter, throw out old food, or have a maid come in once a week, she refuses and says “everything’s fine.” No, it’s not. How do I convince her to accept help when she doesn’t think she needs it?!

Word of the day: Anosognosia.

Anosognosia is a word that comes from three Greek words: a (no), nosos (disease), and gnosis (knowledge). It literally means not knowing what’s wrong with you, or even if anything actually is. It’s also a VERY common sign of dementia.

There’s an old riddle about a small town with a barber who shaves every man who doesn’t shave himself. The question is whether the barber shaves himself, and the point of the riddle is that you can’t solve it from the inside.

Having anosognosia is a bit like being that barber. If Mom’s problem is that she doesn’t know she’s sick, how will she know she doesn’t know she’s sick?

Anosognosia can keep people from realizing they need help, and that’s a problem. If you try to convince Mom she’s sick, she’ll make up reasons she isn’t. It’s not because Mom’s a liar; it’s because she can’t reconcile what you’re telling her with how she feels on the inside. So here’s the news flash: you’re NEVER going to convince her she’s got a problem, which means you’re going to have to figure out another way to get her help.

Acknowledge the reality

Everybody leaves clutter now and then. Our lives get away from us and projects go undone or half-done for months, sometimes years. But combined with the food situation—spoiled food in the refrigerator and food left out on the counter for days—isn’t normal.

Look around, and ask yourself what else is “off.” Has Mom been forgetting to pay the bills? Does she give money away to strangers, or fall for phone or internet scams? Has her memory or behavior changed noticeably since the last “normal” time you remember? Check our list of other warning signs of dementia as well.

What to do:

Clean house.

The piles of stuff on the floor, the spoiled food, and the cat poop on the stove need to be dealt with immediately, for health reasons. Whether or not Mom approves, take charge of clearing out the health hazards.

Mom’s not going to like it, because she feels like nothing’s wrong. But—at least in my mom’s case—she’ll probably tolerate it.

Have Mom checked by qualified doctors.

The very next step is to have Mom checked for dementia. This is probably not something her family doc knows how to do right, so get a referral to a geriatric psychiatrist or the closest thing to it that you can find.

Find out if there are any symptoms Mom’s having that will respond to medications, and make sure she takes them. If Mom’s not capable of remembering to take her meds, that’s a sign you need to take extra steps for her care.

Talk to an elder law attorney about guardianship or POA.

If Mom does have dementia, you should take the doctor’s report to Mom’s attorney or an elder law attorney and talk about having guardianship and/or Power of Attorney paperwork written up for Mom to sign. That can be a bit dicey, because Mom needs to be sane and competent enough to sign papers when clearly the trend is away from that. That’s why it’s important to act with some urgency.

If it’s not possible to get Mom to sign papers, you may be able to talk to the attorney about having her declared mentally incompetent to care for herself.

Either way, it will start the paperwork to allow you to liquidate her assets to pay for her care.

Check into eldercare options.

Next, you’ll need to take active steps to further ensure Mom’s continued health and safety. That may range from 24×7 care, to visiting nurse “check-in” services, to having a friend or family member stay with her for a while, to moving her into one of her children’s houses, to moving Mom to a dementia care facility. If you’ve already gotten the paperwork signed, you should have access to Mom’s assets and be able to use them to take care of Mom. That’s why the steps are Doctor→Attorney→Elder care.

A lot depends on what else is wrong with Mom and how much attention it needs in order to keep things from getting out of hand when you turn your back. Broadly speaking, the better Mom is at handling SOME activities of daily living, the less things will cost and the independence she can enjoy.

Senior care facilities range from semi-independent assisted living to age-in-place options that allow folks to ease into memory care when the time comes, to residential memory care facilities that feel a lot like “home”, to more clinical, intensive, around-the-clock nursing care. It’s important to get a good assessment of Mom’s condition and find a place that will take her, because each facility has its own conditions for acceptance. Make plans BEFORE you need to move Mom, because there are often waiting lists for such facilities.

Even if Mom doesn’t have dementia, the filthy, unkempt and unsanitary conditions she’s living in are going to be a problem sooner or later, and the same urgency and same process apply. If Mom’s clearly unable to care for herself, you’ll need to express those concerns to her attorney or an eldercare attorney and ask for advice on how to deal with the situation so that you’re acting in her best interest.

But take action.

Don’t drag your feet on this.

My husband and I take walks almost every day, and a lot of the time we chat with neighbors, pet their dogs, and just try to get to know the folks we live so close to. Months ago, we were walking past a house in our neighborhood where we knew an old man lived who had lost his wife in an accident overseas. We suspect he never recovered mentally from the shock of it, and just sat around the house letting his life rot around him. Anyway, neighbors began to notice a smell and tried to check in on him. Police verified he wasn’t dead and said there wasn’t much they could do to help him. One neighbor even started mowing his grass and setting rat traps around the outside of the house. Everyone did what they could.

Then one day, as we were walking past the house, we noticed men in hazmat suits dragging out a junked refrigerator and oven, several animal cages, and piles and piles of wadded up newspapers. The smell of rats was overpowering. We asked if the man had passed on, and the cleanup crew told us he had been evicted. It may break your heart to sell Mom’s house out from underneath her to pay for her care, but I promise you there are sadder versions of the story that you’d rather not read.

Please don’t wait until it’s too late. Take care of Mom now, while you can ensure she’ll be the way she thinks she is: safe, happy, and comfortable.