My 93-year-old mother has stopped using the toilet. What do I do?

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I just want to start this post off by saying thank you to everyone here. It's great to have the support of this caring community and to have this forum to share my questions in. My mom, who lives at home with my medicated schizophrenic sister, has stopped using her toilet and has taken to wearing Depends 24/7. She relieves herself in them all the time. She sits in them, urine soaked, all day. She was released from a nursing care facility last December after a 3-month stay and her behavior has gotten progressively worse since then. I cared for her for 6 years, I live 3 hours away in another state and got completely burned out, so now my other sister, who lives 4 hours away, has taken over as care-giver. My mother has a homemaker that comes in to help twice a week, but after a visit to her primary care doctor a couple of weeks ago after we thought she had a mild stroke (she was having difficulty swallowing and balancing, her doctor said she didn't have a stroke), we decided to try and get her additional in-home care had a VN Association in to evaluate her and they discovered her current state was not good. When they examined her they found bedsores and a fungus infection on her inner thighs due to sitting in the wet Depends. The VN who examined her at home was so alarmed by her lack of personal hygiene that she called Adult Protective Services and reported her as being neglected. I spoke to that VN for an extended period of time on Saturday and she told me that my mother either needs 24/7 homecare or she needs to move to assisted living. She said she’s non-compliant and lacks the ability to make her own health care decisions and therefore she determined that she’s too much of a risk to take on as a patient. My mother refuses to leave her home, she’s extremely combative -- so we’re kind of stuck right now. She’s going to her PC tomorrow with my sister and we are having a Physician’s Evaluation filled out. I'm not sure what I'm actually asking for here, but thanks for listening.

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They decided to skip the move to the geriatric acute psych hospital, as there weren't any beds available, and moved mom to a memory care facility with the intention of keeping her long term. It's a highly rated place in the same town she has lived in her entire life.

She was admitted Friday evening and so far, with the help of a couple of psych meds, she's been relatively calm according to the nurses. When my sister visits her she starts to gets worked up and confused.

For some reason, my sister shared with me, she feels compelled to verbally revise the reasons she's been in the different hospitals over the last two weeks, she keeps telling my sister that they are "just treating her for her high blood pressure" -- at this point, there doesn't seem to be much of a reason to contradict her.

The edema in her legs got really bad in the last week as she refused to take a few of her CHF meds, the pressure stockings actually had to be cut off.

I'm glad she's somewhere safe and is able to just rest. 
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Well, the psychiatrist at the hospital has issued a PHYSICIAN’S EMERGENCY CERTIFICATE to have mom moved to a geriatric acute care psych-facility. Apparently, she's refusing to take her meds and is in a very angry/combative state of mind.

My sister has been up to visit her every day, but when she is in the room with my mother it seems to work her up even more. I am staying on the sidelines working with the social worker, attorney, probate court, etc.

The PEC is active for 15 days, so the plan is to get her into a Memory Care facility when she is released from the psych hospital. Fingers crossed that she isn't going to get tossed to the curb again before our Probate Court date.

Thanks for hearing me out and thanks for all the helpful suggestions and words of support.
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Yes, it seems like someone definitely needs to help her with hygiene for sure. If someone is living with her they should be held accountable for not helping her if they agreed to take on this type of responsibility, which is commonly why younger people usually move in with older folks.

Hopefully you're not buying these diapers out of your pocket, they're very expensive and will quickly break the bank. A friend of mine's mom was provided diapers by Who I think was his aunt until she could no longer afford it since back then I think she said they were about $23 a pack. She was also up in age and paying $23 for a pack of diapers all the time was getting to her financially, so there came a time she had to quit buying them. It was discovered that my friends mom was just too lazy to go to the toilet, which is why she always got infections. This is the other reason why the relative had to quit buying the diapers, to get this lady off the couch to take herself to the bathroom. When she couldn't get the diapers no more, she started wearing sanitary pads, which was giving her constant infections. I don't know what they do now that she's in a nursing home. I never go to see her because she can't get along with anyone. They even had to separate her from her roommate because she's usually the one instigating fights so they had to put her in a private room. Therefore, I hear you about some people being extremely combative and to some degree I don't blame them because they're trying to protect themselves as they age. If you can her to a doctor or even the hospital, I would have her checked for dementia or even Alzheimer's to see if this may be a contributing factor to her combativeness because it may be an end stage that went undiagnosed until now. If she had no doctor visits for quite a while, this would be a contributing factor of why dementia and Alzheimer's often goes undiagnosed because doctors may miss it. If she's tested by a neurologist and tests normal, then it sounds to me like she's probably just trying to put a wall up and protect herself to stop anyone from taking advantage of her or taking her where she doesn't want to go. However, the bathroom issue really does need to be properly addressed since this is an immediate health hazard. What I'd do first is find out who's buying the diapers and  put a stop to it. This is what my friends mom's sister had to end up doing not only due to expenses, but because her bathroom have it was due to laziness. Though she switched to sanitary pads, she still had to get up and go to the bathroom in order to change them. She never wrapped them and you could see them when you went into the bathroom laying openly in the trash. The dirty sanitary pads were causing her infections since sanitary pads aren't meant to be worn all the time but were made for a specific purpose.
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Ruggles, my heart goes out to you and your family. Only today did I see your original post and you have been through the wringer over the last month. I am so sorry that it took so long for your mother to get a proper diagnosis and proper care.
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Ruggles, thanks for the update. I hope you can relax now and get some rest.
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Thanks so much for your helpful posts GardenArtist and Layyylah. So much to think about now that mom's in a safe place. We just heard that her blood sugar levels are through the roof and she probably has advanced vascular dementia. The short-term goal is to get her UTI under control and to try and stabilize the blood sugar levels. The long-term goal is to get her in a memory care facility. Her health seems to be deteriorating rather quickly now, but she's in a safe place, and the hospital isn't threatening to put her out which makes this whole thing a bit less stressful.
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Ruggles, somehow I didn't see this thread until now. Reading through the posts on the ordeal you and your family have endured, I have to credit you with the perseverance to see the situation through to a better solution, as well as to logically and calmly deal with a poster challenging your actions. Your responses were rational, well reasoned, and patient.

That's not to mention dealing with what I began to think after a few posts was a recalcitrant and not particularly responsible facility which sent her home when that seemed clearly to me was an inappropriate choice.

You might want to ask your attorney to order all your mother's medical records from that facility, since you raise the issue of addressing their negligence. That would be a first step, although I suspect that the records will be changed after a subpoena is issued. That shouldn't happen, but this facility doesn't sound very responsible, and it wouldn't surprise me if CYA suddenly became their driving motive.

As to filing an "official complaint", start with researching the state to determine if has oversight over the type of facility that Masonic is, if it's properly licensed, if there are other reports of noncompliance, etc.

If it accepts Medicare, Medicare used to publish results of inspections it conducts. I haven't checked recently, but you could always search the Medicare website or call it directly.

I also don't know if Medicare would take any action, but it might initiate an updated review after being notified of the problems that existed.

When I was searching for a facility over a decade ago, I first reviewed the Medicare rankings, selected potential candidates, then called them and specifically asked about the deficiencies (they loved that! Obviously I'm being facetious). I wanted to learn not only if they had addressed these issues, but also how they handled them as well as my inquiry. Some were defensive, others calmly explained.

Your attorney could probably help you on this, as to where and which issues to address in a state complaint to a licensing or oversight agency.


If you're considering a medical malpractice suit, she could also help you find a qualified and reputable medmal attorney. The first step after taking histories of the problems, issues, etc. would be to order a copy of your mother's records, not only from Masonic but from the hospital and the PCP treating her.

Med mal firms sometimes have nurses on staff to evaluate claims, or they'll send relevant data to doctors in comparable fields to determine if standards of care were breached. I.e., standard of care for a UTI or for pressure ulcers would be specific treatment. Failing to follow those standards MIGHT be grounds for a medmal claim. One aspect in consideration would also be what long lasting complications resulted from any negligence.

Be aware though that medmal attorneys, like any business, evaluate claims on a severity of injury, long lasting and/or permanent decompensation and results and similar issues. Sometimes medical issues which are resolved minimize or negate the value of a lawsuit.

However, that doesn't mean that a firm wouldn't necessary file, or at least initiate negotiations with Masonic's med mal carrier. There's still the pain and suffering aspect, and that can sometimes result in a nuisance value paid by the malpractice insurer just to close out the claim.
There's also the issue of bringing these failures to public attention, which certainly wouldn't be desired by Masonic, the PCP doctor or anyone else involved with lack of proper care.


The hospital discharge planner can offer suggestions as to other facilities, but I've found that there are often ones that are specifically chosen by hospitals, have representatives on staff, and that it's better to do my own review and analysis and choose the facility I want.

I would do the same for the home health care team. If you're satisfied with VN, go with them, but it's your right to choose an agency you want.
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My sister is a geriatrician, we discussed at one point getting APS involved because my then 88 year-old mother was refusing to listen to us. Getting APS involved just means that they can get her into a nursing facility whereas you cannot, unless she's been declared by a judge as non compos mentis, of unsound mind. It doesn't mean that you have neglected her. We saw my mom with signs of dementia and I took her for evaluations but she usually scored fairly high and she denied what the family was telling her. She refused help in the house which was also filled with clutter. We couldn't do anything, until she was threatened by her development. We used that opportunity to clean out much of the apartment. She gets pneumonia and UTIs and is also incontinent but refusing showering, baths and in-house help. We had to go to the geriatrician and beg her to put my mom in the hospital, which they did. After, they put her in rehab but she refused to go for treatment much of the time. We executed the POA because she wasn't paying her bills and we got the doctor to write a letter saying she had early dementia so that we could get her on Medicaid and deal with the SSA. It's been very difficult because even while in a nursing home, she's refusing help. So, let APS get involved if that's what you have to do. It's not a reflection on you.
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As far as reporting Masonic Acute Care, it's on record with the APS, the Probate Court is aware of their actions, and so is my mother's attorney. I will look into filing an official complaint in due time, not sure where. Perhaps there's a thread about it somewhere in one of the AgainCare forums. Not sure why they wanted my mother out of there to the point they seem to have put her in harm's way. All I know is, I wouldn't send a dog there. Also, she suffered two injuries there: a cut to her wrist and one to her leg. 
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I am SO glad she's finally in a place to take care of her and figure out what's in her best interest and make it happen. I'm sure you're relieved. Is there a way you can report the Masonic hospital for failure to care for her in an appropriate way (once all of the dust settles and you get mom safely settled somewhere)? I'd consider that.
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