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She will not admit that anything is amiss. Sometimes her clothing smells of mildew, too. When she visited us recently, she would pee all over the toilet seat. She insists that she is just fine, she lives in a huge house that she refuses to leave, and she still drives. She also refuses to get a medical alert device. What should I do? Write a letter to her doctor?

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OkieGranny. I'm kind of in the same place. My mom is 79. Drove today. Only drives once a month. A year ago drive to her job every day. She loved to work. She is with it in some areas. Totally not in others. Takes aricept. Bathes / dresses/ takes meds as prescribed but failed the memory test. Guess we are in the grey area
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Do you have the financial and medical POAs set up? That would be an important thing to get done right now. Other than that, you can talk to her about going to assisted living. As long as she is not deemed incompetent, though, you can't force her to do it. You'll just have to wait for something to happen or for her to be willing to do it.

Would she allow a maid to come into her home to help keep it clean? Even a warm house shouldn't be mildewed. It sounds like she isn't keeping it clean enough. It is hard to figure out what to do. As long as they're legally competent, we can't force anything onto them. We just have to wait for an opening.
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Do you live in the same town or nearby? Start by writing her doctor or offering to go to an appointment with her, but getting things in place - POA, etc. is also extremely important. Does she have a diagnosis that involves memory loss? Can you try to coordinate a "benefits check" with the county? It will get someone in her house & perhaps if safety recommendations come from them it will help? (The toilet thing - I got my mom a "frame" that gives her handrails to grab onto with sitting down/getting up - because she was wrestling with the toilet everytime she sat down to go. These are the types of things she needs to be evaluated for - for her safety...You might need to play hard-ball - if she wants to stay in her home, she has to be safe and follow recommendations.) Contact Senior Services with the county to discuss/see if you can't come up with a game plan? If the house smells musty - could there be a water/plumbing issue that's gone unchecked? Sitting/breathing in that environment is a health risk, so someone needs to get into that house and check things out. Sometimes advice coming from a third party will be heeded more than family members.
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As we age the body does what it needs to do to keep the core warm. This means that extremities like fingers, hands, toes, feet get cold. This may be why the heat is up. Or if it is summer she keeps the AC off.  (Or it could be she is "saving money" not running the AC.  Was the house cold in the winter?)
Get a dehumidifier that will remove moisture from the air so that mildew, mold will not continue.
If you see any you must have it removed or you can do it if it is not an overwhelming problem.
The presence of mold can cause medical problems so use that method to talk to her about this.
LIKE...
We need to take care of this now before it gets worse, if the problem continues you will not be able to live her because it will be dangerous for you health.

This is your MIL..it might be best if some of this comes from her Son if he is able.
The note you want to write to her Doctor might also bear more weight if it came from her Son but if he can not a letter from you might give him a bit of insight.
Does she have someone that is designated POA for Health and Financial?
If not and she will not do that you will have 2 courses of action.
Do nothing until a "catastrophic" event forces action.
or
See a lawyer, go to court, declare her incompetent and assume Guardianship.
Neither is a great way to enter into this "care-giving" role
At that point you must decide will she live with you or go into Assisted Living.

That is a whole 'nuther discussion.
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If she won't run an air conditioner to lower the humidity then a dehumidifier in the basement is an option, they can be rigged up with a hose running to the drain so it doesn't have to be emptied. I would also get her a raised toilet set and grab bars by the toilet and in the bath, actually it would probably be a good idea to go through the whole house with an eye to improving accessibility, insist it is necessary if she wants to remain in her home. I like the idea of a cleaning service too, many will come in bi weekly or even monthly if she won't agree to someone every week. It also gets he used to having someone come into the home so she may be more amenable when the time comes for outside caregivers.
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When I noticed a smell of mildew in our home, I also noticed water along the wall in our garage. I called a plumber, and he discovered a leak under the house. It might not be a bad idea to have someone check your MIL's home. I agree with having someone come in and "help" her clean. Urine around the toilet is also a health hazard. A little honesty might be called for here. But, not from you. It should come from her children. When it came to the point that my FIL had to go to a facility for his own safety, his children had an "intervention" with my MIL and we, as the spouses, weren't even there.
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Older people do not have the greatest circulation--they generally keep their homes set at a temperature that is considerably higher--also they don't move around as much. It's 103 degrees here, my mother's home is about 80-85 and she's fine. Also probably wearing a sweater.
This, combined with the 3 aerosol deodorizers that go off "automatically" and several open jars of "room freshener" PLUS 2 cockatiels in a cage that hasn't been cleaned in 6 months, wet depends in the trash at all times--make for a pungent visit. Mother may also not do the laundry correctly and there may also be the smell of mildew. She had a pipe leaking for months before she noticed it (somebody else noticed it, actually). Mildew needs constant moisture.

A good cleaning never hurt anyone--and the mildew can actually ruin structures, so you need to address that.

I would LOVE for mother to allow ANYONE to clean for her. Most of her apt is so hoarded you just cannot GET to the places to clean. She recently refused ANY type of in home care, so she is doing for herself. She says her 17 yo granddaughter gets paid to clean, but she cleans like a 17 yo--badly.

A service that will do top to bottom twice a month would be best. Find the source of the mildew smell and remediate that and you should be OK.

As this is your MIL, the suggestions should come from somebody who is NOT an in law. Unless you have a fabulous relationship with her. Good luck.
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Ah Denial,
My personal favorite! Followed by outright ignoring any suggestions you try to make things better. I'm fine! I don't need (fill in the blanks) What smell? Nothing is wrong! I did not! Arrrrrggghhh. The never ending battle of wills when you try to help them out. Even letters from doctors can be ignored unless you have been named as the one "legally responsible" for her health, well being. My Mom is stubborn, always has been but she has become WORSE! I just don't have the energy to argue on every score anymore. Wish I had a magic answer for you but everyday I am the crocodile's dentist.
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Um, you are sure that the odour you've noticed is mildew, are you?

Have you noticed any problems with the fabric of the house apart from the odour?
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I agree about a humidifier. But I have found out that as homes age the cellars are no longer water resistant. Because of this they get that "smell" that gets into the house. If she has a cellar check this out. If possible, put a humidifier in the cellar. The distilled water you get from it is great for steam irons.
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If you smell mildew then something else is wrong, it's not the heat.
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https://www.bobvila.com/articles/how-to-get-rid-of-mildew-smell/#.WWAJxqTD-f0
From This Old House.
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Oh, of course heat kills mildew, but a source of continual dampness + heat creates the perfect storm in some areas..like under the sink, under a bathtub, behind a washer.

Could just be mom isn't completely drying her clothing or she's letting it sit too long in the washer before drying it. My daughter lived in Houston and if you left wet laundry for more than a few hours, it would begin to mildew. The smell cannot be removed w/o a re-wash. I notice Mother is getting "sloppy" with her laundry (the ONE task she still can do) and forgets to put vinegar in her final rinse. All her clothes smell strongly of urine. So she sprays on more cologne.

And there is that "old person smell" which thankfully, neither of my lovely grandmothers got--but it's a combination of fusty old furniture, urine, dirty dishes, an unclean kitchen. personal hygiene slipping and unopened windows.
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Buy her some sweaters and turn down the thermostat.
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I appreciate everyone's replies. First, what does POA mean? As for my MIL, she absolutely refuses to think anything is wrong in her world. We pointed out some of the mildew on her wallpaper, and she said it was just dirt and wiped it off. If anyone were to talk to her, they would think she is mentally competent, so I can't see being able to force her to do anything. She refuses to get a medical alert device or move out of her huge house. She is very thin and cold all the time, so she puts the heat on in her house in the summer in the mornings. I guess writing to her doctor is our best first option.
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POA stands for Power of Attorney.  And of course your loved one thinks she's right about everything! Most, bordering on all, elders do! Sorry, but welcome to the club.  I recall a heated issue my mother started about a bed linen! After hours I just said "whatever mom...if you even want to wear the bed sheet as a shirt go ahead." UGH! And actressing comes into play when the elder wants to trick someone into thinking she's perfectly fine! Could be deemed an oscar-winning performance!
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Thanks, Llamalover47. It's such a difficult situation. My MIL also lies like mad. She lies even when she doesn't need to lie. We live 3 hours away, so we can't check on her all the time. I hope I can find out who her doctor is so we can write a letter letting him know what all has been happening.
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Sounds like someone needs to jump in there, but POA and DPOA (Durable Power of Attorney) must be drawn up by an ElderLaw Attorney and hopefully she is OK with that. You need to appeal to her that if anything happens to her, someone needs LEGAL permission to step in and help her out medically, financially, etc.
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Just a note, OkieGranny, that our elders lose their sense of smell, taste and they also lose their hearing to some degree.. If Dementia and/or/a special personality is involved also, things can get quite complicated. My Mom is one of the sweetest ladies I know, but her memory is about 1 second, which is frustrating, but it must be that way for her too!! When she was so worried about Dad, when he was still alive, it was MUCH worse for her!! As her fears go away, so do some of the some of the problems, just a little!!
The other posters have all given such great advice so that you can help out with your MIL as she ages, which is scary in and of itself!! God Bless You!!
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Thanks, Vicky and Rainey. There is no way my MIL will allow us to take over anything. She thinks everything is fine. As for the mildew, it is even on the wallpaper, and she won't admit it. I have been in contact with one of her neighbors who also has concerns. This is going to get even more difficult, I'm afraid.
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OkieGranny: Sure thing, no problem. Yes, elders do lose their olfactory sense. Something should be done about the mildew because it's unhealthy, but it could be deemed quite invasive and costly if walls have to be ripped out.
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Just curious..would a Dr. actually take the time to read a letter from you about one of His/her patients?? I have a MyChart through which I can contact my own Dr. about my medical issues, but only I can access it and use it. If, say, one of my kids expressed a concern, I am sure she would ignore it. Same with hubby's dr.

I have 2 kids who ARE Drs. and I asked them if they would "validate" a letter written by a patient's family, and all I got was puzzled looks and the response "Uh, HIIPAA kind of locks us down on that". So, TALKING to the Dr. might get you somewhere, but a letter? Probably not. Also you have to be on the patient's chart as someone to whom they CAN speak. If you don't have that authorization, you're kind of stuck.
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Midkid, from my understanding your HIIPAA protocols apply to the doctor sharing information with anyone but the patient and those who the patient has given consent to, it shouldn't preclude the doctor from reading/listening to any concerns expressed by the family.
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I really appreciate all the replies. I talked to my MIL's neighbor this evening and they have been concerned about her, too. They said one time her house alarm was going off and she couldn't hear it. That means she wouldn't hear a smoke alarm, either. We know (or are pretty sure) she purchased new hearing aids last year, but either they don't work or she doesn't wear them or turn them on.

I don't know if a letter to the doctor will do any good or not, but at least we can try. I know she isn't telling her doctor about all this stuff. She always pretends everything is just fine. Thanks for all the support.
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Mildew smells can also be mold smells--some molds are actually very toxic. If she has damp wallpaper, it's not unlikely that it's mold you're seeing. Esp if the room is warm. You can do mold checks using kits found at hardware stores. They're simple to use, then you mail the sample to the lab. My DH was obsessed with that he KNEW was stachybottrus (sp!) and it's possible lethal. I did mold checks all over the house and they all came back as "normal" molds found in plants and house dust. Sneezing stopped and life went on. HOWEVER, if they are actual dangerous molds, you are "told" to remediate such things....wallpaper comes down, KILZ or some such mold reducing paint is applied--actually, is some instances, Disaster Cleanup has to be called. It's a real pain, but mold is nothing to ignore.

I too have a problem with a hubby who is nearly deaf. He cannot hear the phone and it's within 18" of his head. Luckily, I'm rarely gone when he is, but he also doesn't hear the smoke alarm nor the CO2 alarm. Lucky for him I hear perfectly!

As far as the letters to the drs that I mentioned, my kids were pretty adamant that they wouldn't even give them a second glance. They would, however, listen to family concerns if the family is in the room. HIPPAA has them running scared, for sure.

MY SIL told me that he KNOWS his patients lie to him ,all the time. I asked him if that was super annoying, as he may have test results, etc,. that tell him what the "truth" is and he said "Oh, you get used to it. Probably 80% of my geriatric patients are completely non-compliant. It's their lives, all I can do is dx and prescribe". Seemed pretty ok with it, as this evidently is the norm. The days of "The Dr is next to God" are over.
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Well, Midkid, I'm kind of getting to the point where I don't know how much we can do to remedy her situation if she is adamantly opposed to change. So far, the mildew/mold hasn't seemed to affect her, but our daughter can't be in the house without her allergies acting up. Every time we do try to say something to my MIL about any problem with her house or her health, she pooh-poohs it. At least her neighbor is keeping an eye on the house, checking to see if there are signs she is up and about. She always opens the drapes in the front of her house every morning.

I know doctors can't tell us anything, but it will make us feel better to send the letter. I'm sure doctors are used to being lied to all the time.
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