Where to start and making the right decisions with so many unknowns?

"1. This may again be my denial, but this was such a sudden onset that I have a strong belief medication plays some role in this. Mom is otherwise independent and would prefer independent living of some sort. With her current state I don't know if that is the right decision, but if medication changes improve her condition then I feel certain it is. Should I consider independent with in-home services when she gets here?"

My suggestion would be to just TEMPORARILY move her in with you until you get a handle on what's going on. Then you can assess whether or not independent living with help will work. Right now, it's a guessing game.

"2. With the volume of work to do in moving her, it will be end of Sept before she gets here. Do I keep her current doc appointments in August and continue to try and evaluate the meds impact?"

Just pick her up and move her with a suitcase for a vacation. Temporarily. She is probably not safe alone. In the meantime, make an appointment with a geriatric specialist in your hometown.

"3. The level of healthcare and available physicians where she is at are terrible. I have almost too many choices in my area. Has anyone done any type of interviews with geriatricians prior to engaging their care for a parent? If so, how have you gone about that and are the docs receptive to it?"

I've always used personal recommendations to find doctors. A geriatric specialist search would be no different. Call social services at a respected hospital in your area and ask for a couple of recommendations. Research them online.

"4. She has BCBS Medicare supplemental - I pay for this for my mother in law and know that it is called BCBS Texas. Will we have to purchase a new plan since she is moving to a different state?"

If she's on vacation? No. When you make it permanent (which I'd advise to do shortly), you'll undoubtedly have to change it over. That just pretty much takes a phone call.

5. Will a good geriatric doctor work with a cardiologist or neurologist to figure out what is going on, or is there another type of doctor/practice I should be searching for?"

The geriatric doctor should be doing a pretty thorough evaluation and health history. I'd tend to follow his recommendations for other referrals provided they passed my common sense test.

You're faced with a dilemma made up of many pieces. One piece at a time. Get mom safe. Then just keep doing the next right thing.

When you get her in your home, you'll KNOW she's taking her medication correctly because you'll oversee it. Frankly? That could be part of the problem.

Thank you all so much for the great insights and information! Vegaslady, thank you for letting me know about the OTC kits. She had had a full physical about 3 weeks before this happened inluding urinalysis, but she is very prone to them and that was one thing I really wanted her to get done at a doc appointment.

She is currently about 750 miles away, so it has been a challenge. She has a handyman/maintenance person who is also a friend of both of ours checking in most every day, and he keeps me updated. The conversation about having a caregiver come in is actually what prompted her decision to move to Texas with me - she doesn't want strangers in her house.

FreqFlyer and Garden Artist - thank you for the great info on the prescription manufacturer source concerns. I have never heard that but did some reading this morning that was very informative. THANK YOU!

Everishlass, as to POA - from the time I was 18 we had an annual family meeting going over all our documents (wills, POA, advance directives, living wills, etc) which at first was traumatizing but I am so thankful for now. And as to your comment "I'm glad you're here. You will receive many thoughtful and helpful suggestions. You're not alone in this." I am glad I am here too, and have already received many thoughtful and helpful suggestions thanks to you all. So I wish you all the best of luck with your day as caregivers today and sincerely appreciate your support.

Regarding prescribed medications, sometimes the fillers used in the pills to make them larger so one can handle them easier and fillers to bind the pill so it doesn't fall a part vary from manufacture to manufacture as to what they use. I am hypersensitive to such fillers and have had good luck using pills manufactured by a certain company. It was all trial and error finding one that worked for me. I was surprised last year to learn my Mom uses the same one, too.

I also take metoprolol, and just recently had to changed manufacturer... now I noticed my brain isn't running on all 8 cylinders. Now I need to look into this. Glad you brought up the situation.

As for a geriatricians, find one that includes you on all discussions. My parents geriatrician will speak to them and to me, plus she takes into consideration Caregivers and tries to make sure testing is done while we are at the appointment, thus not rescheduling testing for another day. The Internet is helpful in getting information on doctors... you can see their resumes and sometimes a photo. I picked my Oncologist this way, and she is one of the best :)

1. About the metoprolol: I'm not challenging the possibility that it caused the reactions about which you wrote, but would suggest that you consider the source, i.e., whether it's manufactured in the US or in an emerging market.

After learning about and doing some research on the dangerous side effects of some offshore manufactured meds, I decided to buy only US manufactured meds for my father (I take no meds at all).

So I switched pharmacies after I found one that shared my concern and wasn't hesitant to be frank about the manufacturing source. I switched from a pharmacy that told me "all medications have to be manufactured in the US", researched that pharmacy's Toprol source and found it to be manufactured in India by an Indian owned company.

Some of these offshore meds have caused side effects; I've also read that some physicians have observed these side effects as well. After the meds were changed to a different source, the side effects stopped.

So you might want to check the source of the metoprolol that your mother and your friend's sister used.

When you write that your mother "went from completely fine to delusional and paranoid overnight", I couldn't help wondering if she had just had a script refilled with Toprol that was sourced outside of the US, and the change started with taking that new dose of medication.

Granted that some of the ingredients in medications can be manufactured outside the US, and it's hard to trace where that may be, but at least if the end manufacturer is American, I have a higher level of confidence in the quality.

I would try a different source of metoprolol first, but be concerned if the cardiologist wants to substitute Amiodarone (another A-fib medicine). My father and I were advised by his neurologist (after diagnosing peripheral neuropathy) that Amiodarone can cause PN as well as loss of hearing, taste and smell, which my father did suffer.

Stick with the Toprol, but find an American source. I think Dad's is manufactured by Watkins in California but I'll check for sure.

There's also a possibility if she just started the Toprol that it's interacting with some other med.

If I attempt to answer the rest of your questions, this post will be too long to read (it already is!). So I will suggest that you try to work out the medication issue first, with different facility placement options depending on whether your mother does have some element of confusion and dementia, or if she just needs assistance at an AL level, if the meds were the cause. (If you know how to make a decision tree, this would be a good tool.)

2. I would however, begin to identify doctors in your area. They'll be treating physicians shortly, so this is a chance to get a jump start on selecting a them. She won't be seeing the Texas doctors any more so I'd just leave them behind. And FWIW, I found that some of the Texas doctors in the Winter Texan area where my parents stayed were absolutely terrible.

3. I've called some doctors beforehand to try to identify ones that would meet our needs, but it isn't easy to determine that without actually learning how they handle various issues.

Referrals have worked well for us in the past. You might contact your own doctors and see who they'll recommend.

Some hospital physician referral services include information on the doctors' education, and special interests, such as an inclination toward integrating alternative healing with traditional western medicine.

Other referral services don't offer any information about the physicians and their preferences, so that makes it really hard.

Some have resented being "quizzed"; they were written off immediately. Others were too adamant about believing that drugs should be the first choice to solve problems; we did work with them for a few visits but eventually dropped them if they wouldn't consider nutrition and alternate healing as well.

One thing I've noticed, which may only be anecdotal, is that the more progressive doctors don't have boring waiting rooms with just a bunch of old magazines. Some have large screen TVs with information on their specific specialty - i.e., Dad's podiatrist's tv programs explain care for feet, dangers of high heeled shoes, etc.

Their office is beautiful, decorated with water color and oil paintings by the managing physician's mother, who is an artist.

Visiting potential physician candidate offices is an option, to get an idea how they present their services to patients.

I would also inquire whether they have intake forms online. I download the forms, print them and take them prepared to the office - no sitting for half an hour trying to write on one's knees while checking old records to complete the forms. It irks me a bit when I'm told to come early to fill out forms, when the forms could be on their website for pre-visit completion.

4. I would call BCBS - they're the best source.

5. Absolutely yes! And he/she will offer to provide a letter update after each visit.

Medications affect different people in different ways. Absolutely keep her Dr.'s appointment. You didn't say how far from you your mom lives but try to keep an eye on her until you can figure out what caused a change in her mental status.

If possible, hire a caregiving agency and get some caregivers in there a few days a week, maybe for 4 hours at a time (or whatever you think is appropriate). It might help put your mind at ease and if you're concerned about your ability to see the situation objectively a caregiver's assessment might help you understand better what's going on with your mom. This could have been a sudden onset in her mental status or maybe she's been suffering with it for a while and you didn't see it. She could have successfully hidden it for a while as well. A caregiver can be your eyes and ears when you're not there and it might give you additional information for the Dr. In addition, with the decline in her mental status regardless the cause your mom needs supervision.

If you haven't already get Power of Attorney. If worse comes to worse you mom may become unable to give you POA. Get it while you can.

I'm glad you're here. You will receive many thoughtful and helpful suggestions. You're not alone in this.

Before changing everything go to the drugstore and get a our for testing her urine for an infection. If she does, get that treated immediately.