Mom refuses to go into long term care. She is rehabbing from hip surgery, rehab has plateaued and she is still a two person assist. Advice?

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Mom refuses to go into long term care. She is rehabbing from hip surgery, rehab has plateaued and she is still a two person assist. Advice?

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I really empathize with your dilemma. I really beat myself up when I had to put my mom first in assisted living, and then because she fell and wore a cast, I placed her in a nursing home. At the very minimum allow yourself the reality that you can and probably will visit her daily or almost daily.
She will be safe.
Unfortunately what she “wants” is not a reality. She’s scared and trying to retain some control but just do what you know is right. If she is verbally abusive to the staff it won’t be the first time they’ve seen that. And though it’s impossible to imagine right now she might actually like it once she sees that she is safe and you’re visiting and it’s not as scary as she pictures it.
One random tip: I visited my mom daily until her death ( she was there about 3 yrs) but always switched up the times. That way the staff never knew when I would show up.

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It's great that you were able to visit every day. But while I believe family should visit as often as possible, no one should feel obligated to visit every day. For most, that would still limit their own lives tremendously. I like your idea of changing your visiting times in order to get a true picture of the care your loved one is receiving.

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I am exhausted reading about your situation. No wonder you are at the end of your rope. Most people would never have been able to do all that you and your wife have done and are doing for your aging parents. Your mother needs full time care and supervision. It is not her decision anymore since she cannot take care of herself. Walking away from her protests and accusations might be your best strategy. Engaging in argumentative conversation further reinforces her terrible behavior. You need to preserve your own sanity or you won't be able to function as POA anyway.

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Ok..your mom is 102. She has had one hell of a long life. She is no longer capable of making her own decisions and you have POA for a reason. Do not let her tantrums rule your decisions. There are a percentage of elders who will NOT go cheerfully to the next level of care...my dad being one of them. I'm sorry it didn't fit with his life plan but then I'm not the one who broke a femur around the prosthetic hip and had to have it nailed and cabled back together and then refused to learn to walk again. So from AL to LTC he went. Lately as his dementia progressed after yet another fall and break, he became angry, agitated and even striking and hurting people. We have a new doctor who is trying Tegratol for this behavior and we are hoping it will help. So all this to say, do what's in her best interests and yours and get her admitted to LTC regardless of her refusal. And then get a doctor to assess her behavior before moving her.
The mean and hurtful things are difficult to take, as again I've heard the same from my dad. They will blame us till the sun no longer shines. I read about something on here called "going gray rock". I wished I'd known that back then. But google it and read up on it and use that technique with your mom. As for you wife trying to reason with her...good luck. Don't even go there, she doesn't want to hear it. It only makes them angrier. And never argue.
I'm sorry your life is so all consumed by this as I know it is very very hard. Hang in there.

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Jim, please Google "Narcissistic Personalty Disorder" and see if you find yourself reading a description of your mom.

Knowing what something is called is the beginning of understanding how to deal with it.

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As stated, make sure facility knows she does not have a support system in place and can not return home at this time. TELL mom that until she is able to function she is not going to go home, that she needs to do her therapy and get better. If SHE choses not to do it, she won't be going home because it's not safe to do so. Could she be having a reaction to the anesthesia from surgery? Has she always been this angry and confrontational? She may need a mental assessment and some kind of a medical treatment. Im sure she's also scared, angry about her situation, unsure of her future, which maybe the reason she's acting the way she is, lashing out at everyone. Stick to your guns, you have your hands full. Does she do this because it has worked in the past to get her way? Wearing you down until you give in because it's easier? Here it was pouting and crocodile tears, wailing what kind of family do I have when sil complained about her brother, he wasn't backing down, told her this may work on SILs but not here, funny how pouting temper tantrum started instead of poor me. Told her that wasn't working either that she needed to let them work it out and I agreed with husband. Final answer was fine. Pick and choose your battles but don't be bullied by her. Good luck, not an easy situation you have going on.

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"I am ready to resign as her power of attorney and have the court appoint a guardian." You have done your best and wanting to resign while understandable for your self preservation at this point is not going to get you the relief you seek.

Do not accept discharge to home. Do not piecemeal together help for her at home. If she's competent, which I doubt, she won't appreciate your efforts. And if she's not competent, which seems to be the case, she won't appreciate your efforts. You can still help her as her POA by stepping back from the day-to-day, working with the healthcare team to find longterm care, selling her house, and using the money to pay for her care.

No one ought to be abused by those for whom we are caring and it should not be tolerated.

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Jim, I've also read through some of your previous posts. I am exhausted reading about your life. I want you and your wife to be able to have a real LIFE! What you have now seems to be a death sentence.

Having your late-stage dementia MIL in your house is bad enough! And now your mother is demanding that you take care of her? NO WAY. Refuse to play any part in her return to her home (is she still legally mentally competent?). Make sure the discharge planning folks know that there is no help available for her there, and that she needs placement. NOW.

I wish you could also place your MIL somewhere. How old is she, and how much longer do you think she will live? Does your wife have to do a lot of physical caregiving for her mother?

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Thank you for your answer. My wife and I have been primary caregivers for both sets of parents. My mother has always been difficult and is used to getting her way. It has been about six weeks since her hip surgery and she has not always been receptive to the rehab process if it doesn’t fit when she feels like doing it. My dad took ill four years ago with cancer. I would visit him each day and took him to most appointments. During the summer months when I was at my busiest with work my sister covered. My dad passed two years ago. My work load was lighter during the winter months and it gave me time to visit my mother each day. I would have the conversation about getting help in the house for her and each time she refused. She fell for the first time last November ending with a large gash on her head,concussion,and small brain bleed. The second fall resulted in the broken hip. She will accept no responsibility for her decisions. I have stayed away the last couple of days. My wife stopped in to see her yesterday and she talked with her a bit. My wife explained to mom that she is putting enormous pressure on me. My mother said hogwash. The next words were I am going home tomorrow. On my wife’s side her mother is 98 with late stage dementia. She lives with us and has done so for over ten years. Weekdays my mother in law goes to an adult day care from nine to one and we have aides that watch her until we get home around four. My wife from that point takes care of her. We go through the sun downing each day with all the associated things that go with it. My wife knows we are nearing the point when her mom will have to go to a facility. She is becoming more difficult to deal with by the day. Typically when sundowning anger is her driver. She will also grab anything in reach and put in her pockets or pants. Eating ,we have to watch her like a hawk as she just shovels food in her mouth. I know she has no idea that she does this and we divert her attention all the time to slow her down. We don’t have much of a life because both of us are so busy tending to parents. We also took care of my wife’s dad when he was ill. He had a stroke and was paralyzed from the chest down. I would watch him days and my wife at night. We had him with us several years. All of the things you have suggested make a lot of sense. I am new to this process of care, long term care,etc. My mother has stated she will fight us and them wherever we place her unless at home. She also said no help at home should she go there which won’t happen. The social worker said they are doing cognitive function tests on her now,but no answer on it yet. That they will be forced to medicate her is not a question anymore. I am scheduled to speak on Monday with her attorney so that we are on the same page and then move forward with the social worker. Thank you for taking time to respond.

(12)

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Very sorry, but at this point it is not up to Mom. She clearly isn't in control. At some point they seem to descend back into the world of regression to the point that they become 2 years old. Would we allow a two year old to make decisions? Sadly enough I guess, these days we seem to.
You have received good advice. She does need placement now. DO NOT make the GRAVE mistake of taking her into your home. You will not easily have her removed from that situation and it will be a nightmare.
Now you tell her quite simply that she will have to accept placement. If she is combative the placement will not be as pleasant as it would be otherwise as she would require memory care and medication, which she may require in ANY case. You tell her that this is not up for argument.
I cannot believe the numbers of people who live their lives by guilt. Are we flawed and inadequate human beings? Yes. We are. Are we Saints, doormats, slaves? No, we are not. Yet over and over again I see people martyring themselves out of guilt to people undeserving of the care. Even if DESERVING of it, there is a limit to what humans beings can endure. So not up for argument. Admit to the being flawed. Tell her that yes, you are an inadequate son, and as such very close to giving her guardianship up to the state who will not have much time to listen to her abusive critique. Nor care overmuch. States feel no guilt. Psychopaths and narcissists don't either. Only good and decent people feel guilt. Welcome to the club of the enormously flawed human beings.

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Thank you. I know that my mom is not capable of making this decision. She won’t make it easy at all. While I wish that she not have to be medicated I know that will be our only choice. They do end like two year olds and I am aware of it, but when you see someone every day and they badger away at what they want for hours on end it gets to you. My fault for probably spending too many hours with her. I have found recently after receiving counsel from a cousin when they start in hounding you tell them to stop. If they don’t,get up and leave. I did tell my mom I was considering resigning as POA . She didn’t even blink,just kept right on about going back to her house.

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She is not going back to her house, no matter how much she screams. She cannot. I can see the anxiety in your post but try to take a deep breath and work with staff to find placement for her. Under no circumstances should you try to make some arrangement to get her home with help. She cannot live alone. She needs 3 shifts of caregivers a day; no one can take that abuse for more than 8 hours. She needs to be seen by psychiatrist and put on some meds to calm down a bit. She is probably frantic and understands her only hope (at least in her mind) is to control you with her fury to get what she wants. But she cannot have what she wants and sorry, at 102, she has lived a long life. No need for her to take yours too. Just remain firm with staff and say no, she has to be placed. There will be no reasoning with her so really don't bother trying. Hopefully you can find a place to agree to take her; but remember no one really wants to go into a facility, no matter how nice. And she will not be the first one they have had to deal with who has a bad attitude. Try to make it as easy on yourself as possible. You still have her house and all her other stuff to deal with.

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Thanks for your thoughts. All the answers I have read make sense. Sitting back and realizing they do is the first step. I understand most facilities have experience with unruly people who don’t want to be there. I understand nobody wants to really be there. We have to deal with the realities at hand. Taking a few days away has at least allowed me to calm down. My wife thinks I should go visit today. I disagree in that the minute I walk in my mother will start in again. There goes my BP. I will keep the visit short and then see what the new week presents.

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Dear Jim,
I have been following your questions about your life. You and your wife have your hands full. I second telling the Social Worker at Mom's rehab that there is no home set up for a wheelchair to get around. Tell them you are already careing for a MIL. You must say you cannot take your Mother home. It takes a village to care for a 2 person assist. I also think some "calm down" meds may have to be started. Your Mom is terrified you say of being alone. So was my Mom after my Dad died. If she didn't want to be alone in the NH bathroom...well life at home would be the same way. We all do this as long as we can for our parents. But there has to be a point where you can tell the SW that you simply cannot do this anymore. You have no extra help, home is not set up for her, your already caregivers for MIL, and she is not a safe discharge to home because there is NO 24/7 help there at all. It is horribly hard to do I know. I finally after 71/2 years put my Mama in Memory Care. She has had a Geriatric Phych. Evaluation, new low dose meds and is settling in. This is hard but you must say to rehab you can't being her home it is just too much for you. You have lost Dad too and you sound like me 6 months ago. At the end of the rope. Please the a knot on the end of your rope and hang on.

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Thanks. When we met two weeks ago with the care team I did in fact tell them I am at the end of my rope. I explained to them that I have been with my parents every day for four years excluding my busy periods of work when my sister stepped in to help. I made the team aware that neither home is set up for a wheelchair and that mom doesn’t have the money for that kind of care. I spent most of a day last week talking with in home providers and determining costs. All said if the home isn’t set up correctly it’s a moot point. Anyway at north of two hundred thousand dollars a year for care it was out of the question anyway. I am sorry for your loss too. It isn’t easy.

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Have you met with social worker or other staff where she is now to discuss what happens when she is discharged? Your profile says you’re caring for someone with dementia, is this her? If she has dementia, is prone to becoming violent, and can’t stand or care for herself, and doesn’t allow help, it’s time for a plan for her care whether she agrees or not. My dad is living alone, physically very frail, but is of sound mind, so I’m forced to wait on an event that changes the picture. Looks like you have enough to change your mom’s, meet with the staff and emphasize that she has no place safe to go and won’t allow help

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We have met with her care team to discuss her discharge. I wanted to transition my mom to their long term care facility. They had an opening which is rare and they said they would move my mom. As you have read it didn’t go well and they stopped mid move and put her back in a rehab room. Where she is at is one of the nicest facilities in our area. Striking staff is a serious thing with them as stated in their handbook. That is strike one. The room has now been taken, strike two. They have a long waiting list to get in here so my guess is we will have to find another place. I know she cannot go home or come to my home. We also care for my mother in law . It is she who has dementia. We will get it sorted out. Thank you.

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Mom refuses to go into long term care. She is rehabbing from hip surgery, rehab has plateaued and she is still a two person assist. Advice?

41 Answers

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