Perhaps you can put a bug in the ear of the evaluators that (1) they begin without telling her they're assessing her and (2) do more than one session so they don't catch her when she's least bad.
Interesting idea if it's allowed with someone who still has capacity. I doubt this would happen in practice with a reputable facility (at least where I live). My mom (who still lives independently) was offered some dates for her annual reassessment last May, and she "declined" them all because it "wasn't a convenient time". No surprise there. She can do that because she has to give consent to have it done in the first place.
Because we have pulled back and really are doing the minimum we can get away with, mom is struggling a lot. The "I want to die" messages have appeared a number of times recently. She is constantly bemoaning her loss of eyesight. She will never connect that loss to her decision to cancel home care services who were dispensing medication into her eye twice daily for her. She wails about her loss of vision every single time one of us sees her.
Because she is struggling more, she has agreed to have community care come assess her again. The appointment is booked for September. We shall see.
Like NW, my mom "pulls it together" for these appointments and "assessments". Suddenly she can talk and sound 10 years younger, and reasonable and witty and charming and completely coherent.
It's like she can have multiple personality disorder. Really. The difference between her functioning on the assessment, and her day to day functioning feels like 2 standard deviations. The higher functioning witty personality only comes out for an assessment. I swear it is the ONLY time it presents. Then the day after the assessment, she completely falls apart again which can include a demand to take her to emergency for some crisis she has imagined or created. This has been the pattern for all her assessments.
I have come to have little regard for those assessments. They take such a narrow snapshot in real time, and they do not include family unless my mom consents. She consented the first year. She lied through the assessment, and is not required to "prove" any of her answers.
Q: "Do you do any of your own cooking ?"
Mom: "Every day".
Q: "are you lonely?"
Mom: "never"
She hasn't actually cooked for herself in many years. If someone she knows (friends) haven't dropped meals off, she eats snack food (cookies, fruit, treats).
She tells H and I all the time how lonely she is. More importantly she ACTS lonely by saying things like "not a single person came to visit me today". (The guilt trip)
She will even tell the assessors she has no problems with her eyesight. I know the chair she uses directly in front of her TV (about 18 inches away) will be moved back into the living room with the other furniture.
When I added different information/perspectives in her very first assessment, she went nuclear, and I was "left out" of all future assessments. Right? You have to "agree" with them at all times, or "suffer" the rage. Last year she let H attend because she uses him as an interpreter to understand the questions (she can't hear/process well). So frankly, these assessments are probably ok for non-PD geriatrics, but I have found the ones used where I live to not be helpful or a true reflection of the facts (from my perspective) for my PD mom. Thus, she cagily continues to prove her "capacity".
As NW says, in the normal day to day it's impossible to tell if they're lying or confused, or just seeking attention or what the heck is really going on. All year long is like "H_ _ L on wheels" with her, and then the day of the assessment, she has an amazing day. One geriatric psychiatrist even mused out loud "he was surprised by how well she was doing". (H was there with her and couldn't believe her "performance"). Every time. Every year. So what does that suggest? "Pulling it together" feels like the understatement of the year.
Would part of the assessment be the assessors talking to the staff and looking at their notes on how your mother has behaved since she has been in assisted living?
Good Question! For NW's sake, I hope yes - because they also have a vested interest since she's in their "facility". I expect there would be weight put on the responses of professionals. Where I live, family are not included in the assessment process at all except by "invitation" of the person being assessed.
It is troublesome that the people "held responsible" for her "care in her own home" don't get an opportunity to include their observations/perspectives. My mom leaves her family out, yet demands they meet her needs to continue to live in her own home.
One would think that at some point, "lying" on these assessments isn't enough to "let her pass". On the other hand, human resources where I live are so limited, that they seem only to happy to accept her lies and not question what looks so obviously like someone struggling. She also has a "reputation" of being difficult with community care, so I can't see them being very motivated to get the "truth" on these assessments. Easier in every way to "let her pass" according to her own answers.
I'm hopeful NW, that with your mom being in an AL facility, she gets away with less "game playing" and as other people have suggested here, her assessment gets input from the facility. Ultimately the facility will do what it has to do (transfer to memory care or alter meds).
To a great extent your mother is in the care of a support system and you can mostly step to the side. With your mother being reassessed regarding her meds - though we know meds generally only moderate poor behavior - let them determine whether changed or increased drugging is a solution.
Meanwhile, you should to insulate yourself from the emotional impact of pleas begging to come back into your life.
This is so wise. Your mom will continue using guilt to have family come rescue her from the facility. The trick is to not let the "push pull" or the guilt, or your own kindness draw you back in over time. I would predict that she will "tell you things" things that will make you question the quality of the facility she is in, or some of the workers. Terrible things will get said, and already have if I remember right. It can be difficult to know what is truth and what is their imagination. And of course nobody wants their parent to be mistreated. But our mothers are masters at creating a narrative that benefits them and is designed to meet their needs. Since they have made us "their caretakers" (not something we ever "agreed to") they see it as our job to meet their needs and protect them from things they don't like, or we are failures as daughters. She is going to put a lot of pressure on you now or later, and so the advice to insulate yourself from her pleas begging to come back into your life are easier said than done in actual practice.
I hope this makes sense.
I hope you are finding ways to stay grounded through all this, and keep perspective.
