Independent MIL with dementia refuses help. What is our best option?

Hello all-

First, thank you all for the letters and comments in this section. I have read through many of them and found comfort knowing that I am not alone. I have been sad to hear that many of you have much greater burdens than I do.

My MIL (mid-80s) has dementia. As many with dementia, she has anosognosia. She is a very bright woman who graduated from an excellent college at 19 and has been successful with her life. She was widowed young, and has always taken great pride in how she has lived independently, having a career, learning to invest and doing well with money. She has a house on Long Island and an apartment in New York City, where she usually lives for the conveniences (she eats out every meal). In the past year or so, she has become quite frail, and walks very slowly. She is doing little besides playing solitaire and watching TV (when she can get it - she often messes up the remote settings).

She has terrible hygiene problems. She has had one shower in nine months (when she visited us via plane, wheel-chaired back and forth from gate); unfortunately I didn’t get her to the salon to get her hair washed. She is fearful of the bathtub-shower at her apartment, but thinks she uses the stall shower at her house every couple of weeks. She doesn’t recall that she no longer really goes to her house (she considers going there all the time). Her body odor is very bad. Her teeth look terrible. She doesn’t change her clothes often if at all. She is ignoring her mail. (Her daughter was helping her with the bills until she became convinced that her daughter was after her money. At the time her daughter stepped in, she hadn’t paid property taxes or several months of rent.) She doesn’t seem to be taking her blood pressure medication. (When she visited me I got her to a clinic, and her blood pressure was very high.)

It is very difficult to get her to go to the doctor, and she frequently cancels appointments. We tried to get her an aide and it did not go well. (She forgot who the aide was when she went out of a bit leaving the aide to wait for her, and for weeks after was worried someone was following her. There is a long story here of how we tried to get the aide in as an assistant to someone else as she would never have accepted her. ) A housekeeper we tried was told not to come back as my MIL thought she might be stealing or getting into her things.

So, finally, my question. Is it better to just leave her alone? My husband is worried that it may kill her to attempt to take guardianship (which I am quite sure we could get). He thinks if we leave her alone, and she gets herself in enough trouble, that she may have some recognition of needing help. If she dies, that it will have been on her own terms. My SIL thinks maybe we should come out and all confront her as a family – telling her she has to accept help (maybe given by a care manager) or we are starting legal proceedings. I am leaning towards wanting to going directly into getting a guardianship and putting her in assisted living, where there is a chance she could thrive with companionship and a greater range of activities.

One last thing, she is frequently very anxious. This is one thing that motivated her to come see us – she was fearful of being followed and that her daughter had nefarious plans for her. At that point she was sometimes talking to us eight times a day. When she visited us, after exclaiming how happy she was to see us and taking a brief shower, she immediately decided she wanted to fly back to her apartment (she ended up staying two nights rather than the week she originally planned). She was confused about where she was and who lived here. Sometimes it wasn’t clear she was recognizing us (she would ask her son where her son was, for example). It totally discombobulated her. The same thing occurred when she visited her daughter’s very familiar home just for a day. When she returned to her apartment, she had to call us every morning to ask where she was and where we were for over a week. She sometimes becomes anxious for her safety.

Now, every time she talks to us we tell her we’d like her to move into assisted living. After she canceled several doctor's appointments, I also told her unless she sees a doctor we're considering legal proceedings (I am worried about the BP). She is calling less frequently and discloses less to us when she does call. Apparently she has started calling her grandchildren more – they are not quite sure what to do with her and her very repetitive questions and conversations.

Sorry this has gotten so long. I appreciate any input.