Sundowning or manipulation?

If you feel she is in danger, call 911. Let them take her to the hospital for further evaluation and treatment. If you feel she is not in trouble (and never is), let her late night phone calls go to voice mail. You and your hubby can then listen to them and decide if she needs a follow-up phone call. If she is doing this frequently, she may need evaluation by a psychiatrist to best course of action (medications or placement) to help her calm down.

lavidaloca31: That is strange that your MIL has no primary care physician because she is "anti doctor." When it comes time for her annual Medicare wellness appointment, who performs it? Under no circumstances should she live with you.

Turn off your phones and remember, "NO is a complete sentence." Have some brochures for assisted living or continued care facilities sent to her.

La Vida Loca,

I’ve always had difficulty with diagnosis’ of Narcissism when it comes to older folks with dementia. 

That behavior could result from the deterioration of her brain, making her regress and become emotionally like a child who by nature would be clingy, needy and demanding if not gently redressed and taught proper comportment on the level a little one can manage. People with dementia can’t be taught. Understanding and not taking things personally is super difficult but there is no other way.

It seems that when an adult deteriorates even further to the level of an infant they are absolutely on survival mode. Everything in its world exists for them. Any and everything that can be grabbed goes into the mouth. Some toddlers' first words include, "Mine". We teach the words Share and Consideration. Your MIL has unlearned. She's lost the tools.

The problem is due to a conflict of our perception. You have a talking, big person behaving selfishly, to no fault of their own, and we call this narcissistic. It’s confounding but it’s just the me, me, me blabbing = wailing of a giant baby. I don’t think it’s a personality disorder. It’s a brain disorder. 

We don’t become intolerant of a child that behaves like this but we, me too, get our draws seriously bunched up when an adult acts this way because we think that person that raised us is being a pain and you know that they should know better, does know better, but they really don’t. They are loosing learned tools. Someone who has been traumatized may have NDP, but this is brain damage and like a baby they are fighting for survival in the only way they can.

It’s truly annoying because to look at them, their age, their size, their history plus their ability to talk and we think surely they know better and they’re making our lives h*ll.

There has got to be another description of this self centered behavior that results strictly from dementia. Yes, they act narcissistically but there are probably hundreds of behaviors that mimic and manifest similarly to other behaviors that are not due to illness, that erases the brain and shows itself in reverse aging behaviorally. Forgive me if she's always been mean and self-centered.

With that said, whether you agree or disagree, and taking into consideration the crazy making in the trenches (kind of, as she’s not in your home) relationship you have with your MIL, which is definitely upsetting and wearing, I would say that since you guys are the sane ones, take a sobering deep breath, stand up straight and think of what is in the realm of your control. Turn your phone off at night. 

And when she goes on about how her son is the reason for all her miseries, (I understand the constant digs can get to a person, although I’ve got to tell you it wouldn’t me because I know she’s nuts so who cares if she says her son killed Kennedy or ate her clothes), stop giving her your ear, don’t listen. If she has a fit, give her a sweet smile, say your visit is too upsetting for her and you don't want to do that, say we’ll be back, and leave.

You have to be on survival mode a bit yourself. You ensure that she's in a place that provides meals, that she's comfy, sheltered and clean. If that’s done put up a shield with a sweet smile and ear buds, or go.

I can see why your asking, if it’s manipulation you can ignore it, silence the phone so to speak but if it’s sundowning not only does she have no control over it but it’s something to be concerned about. By reading some of your responses below it seems she has really tied your hands (you and your husband) so given that I’m not sure it really matters as far as what you do.

For years she has been focused on one thing when it comes to her aging care, moving in with you and the two of you have been clear, at least with each other, on one thing, she is not moving in with you. Dementia doesn’t or shouldn’t change that, in fact while knowing she may not have control over her words or behavior the fact it is likely to become worse that when she did have control making her even harder to live with. The fact is she has had full control over her path by not planning an alternative to your home, by not appointing a POA or even discussing her wishes. While in reality this makes accepting things a bit harder on your husband in particular as her only child it does make the decisions about what to do easier because the only thing he really can make a decision about is wether or not to move her in and he has to make that decision with you.

He has no ability to care for or help her take care of finances or medical stuff, if there were any medical decisions or stuff to do, without POA or her ok and she isn’t giving that. If she won’t see a doctor there are no medical or medication things to be involved in. While a social services (of some sort) worker has labeled her with dementia and is likely right I think you need a doctors diagnosis to do anything legally, if you were going to go that route. She is 91 I’m not sure I would opt to go to that expense and fight knowing it really isn’t what she wants. However while yes the calls could be her attempt at getting his attention while keeping all the control I would choose to believe she is actually feeling alone maybe frightened and anxious, all of which can come with dementia so the calls will likely continue at least sporadically since DH (dear hubby) is the only one she has to call. I would offer solutions to her like going to the local senior center, moving to senior living or having someone come in a few times a week to do some light cleaning and companionship later in the day when she is more prone to feeling this way. You and DH can say you are happy to help do the research on whatever solution she chooses and if she chooses no solution, we’ll that’s her choice. I like another responders idea of calling her before she can call you, taking the upper hand and control, then I would either let her know if she calls with something other than an emergency that you don’t have time to talk now or go over the options again when she calls. If it gets to be too much simply ignore her phone calls and check in with her once or twice during the evening to make sure she’s ok, or not depending on what you choose. The fact is even if there is something wrong she hasn’t given anyone the ability to help short of calling an ambulance or the police. No guilt here, she has eliminated that possibility.

You are going to have to sit back and wait either for something major to happen that lands her in the hospital or her passing at home because that is what she has chosen, nothing you can do about it or should. No guilt. You can have as much or little contact with her through any of this as you choose, no guilt and no responsibility to take on anything should she end up in the hospital unable to be released home, she doesn’t really want to live with you since she hasn’t made that actually possible, she has chosen to let non family members make those decisions for her. In fact in this circumstance there is a case to be made for saying you should feel guilty even considering taking her in since she has made it clear by her actions it’s not what she really wants, she certainly hasn’t enabled that option. No guilt

I don't care how nasty she has been in the past...SHE HAS DEMENTIA!!!! Have a little bit of compassion. No you don't need to move her in with you, but you could help her get set up in a facility. You say this has been going on for 25 years!!!??? Now she is 90. She needs help and will never be able to do this on her own.

Please DON'T ALLOW HER TO MOVE IN OR MANIPULATE YOU! I can tell you from the dementia part it will get worse I know this from taking care of my BIL. The best thing you can do is point her in the direction of a care facility that knows what they are doing with dementia people.

The best thing you can do is if she lives alone get DHS or something like that to check on her if they deem that she isn't fit to live alone they will help her get a place.

My BIL had a stroke/heart attack that landed him in the hospital that also landed him in a nursing home for memory care. If I could write a book I would on the ends and outs of this disease and dealing with Medicaid its not fun.

Prayers that your MIL gets the help she needs.

Possible time for memory care but still requires a professional for an evaluation. This nasty individual is making it no easier without help. Why not with trusted doctors who went through years of education and practice to diagnose and treat conditions, and social workers to refer other assistance? If she refuses to folly without assistance, perhaps leave her alone until a crises happens and perhaps the State may have to force her into help. No one is alone in our world.

Perhaps focus on the current problem, not the patient's past behavior. Ask your area on aging, an eldercare lawyer, etc. to arrange to have her situation evaluated. See what someone removed emotionally and historically from the situation sees and suggests. If the person is unable to care for themself in a the opinion of an objective evaluator, there are legal steps to hospitalize and plan for them. If is determined they are able still to care for themself, you have to determine how to deal with your feelings and expectations. At this point, is she just complaining she can't sleep and is at upset about being alone? Those are natural feelings for many different kinds of people. It may be you are so afraid she will finagle her way in that you are overreacting. Decide exactly what you will or won'd do. Ask her if she'd like you to call the police or ambulance to check on her. Let her know directly that living with you is not an option, but you can have someone help her with planning other solutions. Be sure you and your husband are in clear agreement about what responses you wish to make.

Why doesn't your husband trump her. Have HIM call her at 8pm every night, to say goodnight and remember to take your 'aspirin' to help her sleep.

lavidaloca31,
Help your husband find her a nice senior community where she can make new friends. If your heart tells you that a situation is wrong, believe your heart. Having her come and live with you will be EXTREMELY difficult and put a lot of pressure on your marriage. My mom is manipulative, follow your heart and look into other options for her. Help your husband do what he can to find her a solution that helps solve the problem.
I wish you luck and send positive thoughts your way.

Help with finding her an AL community that also can offer memory care housing on premesis. Or maybe a live-in companion to move to her house.
There are options. Under no circumstances should you allow her to move in with you and your husband. If she's been trying for 25 years she really wants in. If you've been able to resist that long then I'm not scared for you getting roped into it.

MIL says she "couldn't be alone".

Her anxiety is real to her. She probable doesn't know who else to call (or has no-one else).

The kind thing would be to believe her.  If her need for company is frequent, then living others is the answer.

*It does not need to be with you*

MIL can move to staffed, appropriate group accommodation eg AL or MC. With others her own age, similar interests & activities provided.

As to MIL's thinking "She still seems to think she is going to force her way into living with us.." MIL can think what she likes. Her thoughts do not control you or your DH... Or do they?

If that's a hard No. Then it's a hard No. Right?

Or is your husband wavering?

The feeling that "my children will care for me" and the responsibility to do so comes from before SS and Medicaid. Back then if a woman became a widow, unless rich, went to live with family. NHs were horrible and no Assisted livings. My Great Grandmother was 68 when her husband passed in 1938. He owned a local newspaper and when he died my GGma had no idea how to run it at 68. My Gmother did but that ended up having to keep her, my Grandmother and her children, since she too was a Widow. My GGrandmother moved in with her daughter. My grandmother died 5 years later at age of 42. This now left my GGmother with no home or money. So she moved in with a family member. Since being Widowed, she did housecleaning. By this time, my Moms siblings were over 18 and left to fend for themselves. My mother, 9, was sent to live with family elsewhere.

Now there are options. Which should be considered before considering having a parent move in with you or visa versa. What our elderly need to realize that remaining in their home is not always an option. If it means that the children have to mow the lawn, grocery shop for them, do any physical caring, etc, then the parents/parent is no longer able to stay in the home. If selling the house means a nice AL then so be it.

What strikes me at the moment is that I see so many posts like this one where someone decides they want to live with a family member and assumes they deserve that privilege because they’re old or sick or broke or whatever. No one deserves to live with anyone else. People who are doing this “I control your lives because I didn’t plan better” need “growing-old rehab” like yesterday. It would involve Plan Better, Save Better, and Find A Facility, Not Younger Generation Slave Labor. It could include Learn To Use An Uber and Short Course On How To Sell Your House followed by Downsizing for Dummies. Okay, so it’ll never happen. But for the millionth time - NO, you do not have to take your parent into your home and destroy yourself, your family and your peace. Ever. What needs to happen is to make clear when we turn 18 that we’re not taking them in and since they’re probably between 40 and 50 at that time they have plenty of time to figure out what they’re going to do when they’re older. Then keep bugging them like they did about table manners with us. That way they’re started on the right path and we can spend our older years kicking up our heels instead of changing an older generation’s Depends.

You say nothing about Dementia in your profile. Sundowning is part of Dementia and using the first sign that some has Dementia. The person seems to be capable of covering up the Dementia during the day but late afternoon/evening they get weird.

Your MIL call saying she couldn't sleep I don't think is sundowning. Attention, maybe. 8pm is kind of early to be going to bed.

Maybe its time for MIL to consider an AL where their are other people and staff.

What does your husband think is going on? If I were in your shoes I'd start talkiing with him and suggesting that you both figure out how to get her in for a "check up" and then you secretly pass the staff a pre-written note requesting she be given a cognitive and memory exam and then tested for a UTI. She is 90 yrs old so it is very possible she is experiencing mental decline. Doing this will give you a better idea of what you're dealing with. Has anyone been to her place lately to see if there are signs of deeper problems? Like unopened mail, food rotting in fridge, meds not being taken correctly, bad hygiene, etc.?

Work with your husband to both start talking to her about downsizing and moving to a safer community where there'll lots more to do socially, since she's been calling at night feeling distressed. Don't bring up that she can't move in with you unless she brings it up. Just go about looking for other solutions and never mention moving in with you. Is she does, tell her it's not an option, not even temporarily. If you tell her any other reason she'll start bargaining to make it work. She can't argue against plain old "no". Make sure your husband is on the same page so she doesn't do an end run straight to your husband and in a weak moment he says no. It's best to practice "the script" of what to say to her.

Take her to visit some nice, reputable facilities. She may have bad memories of NHs of the past. Assure her you and hubby will help her every step of the way so she doesn't get overwhelmed by downsizing and/or moving.

Is he your MIL's PoA? If she hasn't gotten all her legal ducks in a row, make sure she does it so that there's no circus later on. Hope it goes well!

If you are ABSOLUTELY SECURE that your husband (OR you!) will not EVER (even temporarily) invite her to spend even one night under your roof (often the beginning of a SLIPPERY SLOPE), then take her up on “couldn’t be alone” and tell her you’ll be GLAD to help her find a WONDERFUL COMPANION that SHE’LL EMPLOY.

THEN- turn off your phones when you go to bed.

Will there be protests? Whining? Threats? Guilting? YES!

If SHE has chosen her companion and SHE has dementia, she CAN andSHOULD allow you and your husband the time to sleep without having responsibility for her welfare and comfort.

ALSO (IMPORTANT)- if she has been diagnosed with dementia, HER NASTY INAPPROPRIATE PAST BEHAVIOR NO LONGER COUNTS.

Victims of dementia say harsh MEANINGLESS inappropriate things, and such comments occur more frequently in some patients as the disease inevitably progresses. NOTHING SHE SAYS SHOULD BE CONSIDERED RELEVANT OR MEANINGFUL to your husband’s life or yours. Sour comments are the product of a progressively damaged brain.

May you and your husband enjoy a peaceful pleasant future. You deserve it.