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dogperson Asked January 2018

Just looking for general advice, I think. Any suggestions?

Hi everyone. I just joined the forum and apologize in advance if I'm doing things wrong with the posting. I'm not really a caregiver at this point, but my husband and I are trying to figure out what to do for his mother. She lives in the house she's been in for 60+ years and is adamantly opposed to living anywhere else. She has been getting by with some help from my husband and his brother, but we are concerned about her safety there. Also we live two hours away, and my husband has been six hours away much of the time lately because of having to go out of town for work. One of our concerns is that she has left pans of food on the stove and then gone to sleep. My husband is considering disconnecting or removing the stove, leaving her with the microwave for heating food. She has always been a rather stubborn and cantankerous individual and seems to be becoming more so with age. This is making it difficult for her sons to help her. Her latest crisis seems to have begun with dental problems. Her remaining teeth are in very bad shape and causing her pain. She has been refusing to see a dentist because "they put their hands in my mouth." None of us know how a dentist can work on her teeth without doing that, but that is her argument. Because of the dental problems she hasn't been eating much and because she doesn't eat she hasn't been taking her medicines. (Some of them need to be taken with food.) She has diabetes and heart problems. A few weeks ago she called my husband saying she needed him to take her to the doctor right away, but wouldn't say what was wrong. By the time he made the two hour drive, she had driven herself to her heart doctor wanting him to do something about her toothache. The heart doctor refused to treat her and told her to see a dentist. A week or so later she called my husband to say she had called an ambulance to take her to the emergency room, again refusing to tell him what was wrong. As he was in route, she called to tell him the hospital would not admit her, and that he needed to come get her because they were going to throw her out. He said he was on his way and would be there as soon as possible, but that wasn't good enough for her. He asked her to let him speak to someone at the hospital to explain that he was on the way, but she refused. By the time he got there she had left. He didn't know where she had gone or with whom, and the hospital couldn't tell him, either because they didn't know or because of privacy concerns, I'm not sure which. She was mad at him for not coming soon enough and was refusing to answer her cell phone. He called various relatives and finally learned that his cousin had picked her up and taken her to his aunt's house after she called the aunt telling her that she was at the hospital about to be thrown out and her son wouldn't come. The problem again was the toothache, and the er doctor told her to see a dentist. Not long after that, my husband got her admitted to the hospital after she called to say she was very weak and couldn't even get up. She had not been eating right or taking her medicine and her blood sugar was very high. She has improved somewhat and has gone from the hospital to rehab, where she is uncooperative, unhappy, and wants to go home. When my husband refused to do as she wished, she got mad and stopped taking his calls. She called her other DIL wanting to be taken from rehab to the ER to get her toothache treated. Rehab has a van to take patients to non-emergency medical appointments, and they have arranged to get her to an appointment with an oral surgeon. It remains to be seen whether she will cooperate. If she doesn't, I don't think she can be forced. In the meantime she is on antibiotics for the infections caused by the bad teeth, and on pain-killers. This will be the third attempt to get her to a dental appointment for this problem. Previously after a few days of antibiotics and pain-killers she has decided she is better and cancelled appointments. This was before trying to get the heart doctor and the ER to treat the problem. Ok, this is horribly long. I'm sorry and thank you to anyone with the patience to read it. I'm wondering if anyone has any advice. From what I've read, she can't be forced to do anything she won't agree to, and she won't listen to her sons, her doctors, or anyone else. It looks like we have to wait until things are bad enough that she can be declared mentally incompetent and have a guardian appointed or adult protective services steps in to save her from her own bad decisions. At this point, I really don't think she's mentally incompetent, just incredibly stubborn and ornery. I am, of course, very glad to be living in a time and place where the individual's right to self-determination is protected, but it looks like we can't help my MIL until things get a whole lot worse. Looks to me like we have to wait for her to crash and burn, and hope she survives long enough to get help. Any suggestions? Thanks.

dogperson Jan 2018
This morning she called my husband from rehab wanting him to take her home so she can do laundry. She can't stand up without help, but she thinks she can go home and do laundry. It's sad. He told her no. She is already mad because other son won't take her calls.

They did have that teleconference yesterday. The recommendation is that she needs 24/7 care. We have made it clear that neither son can provide that.We have applied for Medicaid as she has no assets, and we are looking into nursing homes.

BarbBrooklyn Jan 2018
I'd say you have it about right. It's sad that the relative picked her up from the ER, because the hospital might have called APS if no one had showed up to assist her.

So, she's in rehab now? When they start talking about discharging her, her sons need to talk to the SW or other discharge planners about the fact that their mom is no longer safe (emphasize that word SAFE) living alone. And that she is non-compliant, uncooperative with helpers and that moving in with one of you is NOT an option (she will be non-compliant in your home as well).

She is no longer competent to make good choices about her health; it very much sounds like vascular dementia may have set it (the inability to plan, see consequences, make good choices).

You have an opportunity now that she is "in a bed". The facility can help with applying for Medicaid if that's needed.

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dogperson Jan 2018
Thank you both so much for your responses. Yes, she is in rehab at the moment but threatening to call a cab and go home. My husband has talked to social workers, and he and I have looked at some nursing homes in our area. Neither of us thinks we could live with her, and my brother-in-law and his wife feel the same way. Also, three of us are employed and the fourth is disabled, so there would be nobody to care for her during the day and keep her from burning down the house. I am hoping if we could get her into a nearby nursing home where we could visit regularly she could learn to live with it, but I just don't know. My husband thinks the last downward spiral was caused by the dental problems and that if she will finally cooperate to deal with those she might regain her strength and be able to go back home. I'm afraid that might be overly optimistic. Until recently she had some home health people coming in twice a week to check on her, but she told them not to come back. She won't have people coming into her house and telling her what to do.

My husband will be talking to the social worker again soon, and I will give him your advice. It's really hard to tell whether she has dementia or is just being her cantankerous self. UTI is also a strong possibility. She is incontinent and subject to those. I didn't realize until a few days ago reading on this forum that UTI could have such a strong effect on mental state.

Thank you again for responding.

Windyridge Jan 2018
Agree with Barb. This women needs to be in assisted living. Moved from rehab directly into care. Sounds like dementia with maybe UTI and other stuff.

Different locales have different procedures for dealing with mental incompetency. APS, ombudsman, social worker etc.

I would try the MOM YOURE GOING TO THE ASSISTED LIVING PLACE UNTIL YOU GET BETTER method. Staff at these places deal with this all the time and are pretty darn good at it.

This worked with my parents just recently. I didn’t have to use any legal maneuvers other than my POA. Mom doesn’t like it, she’s mad, thinks she’s just fine and should be home. Reality? She can’t even stand without assistance.

Time to get some tough love going here. If she goes home it’s just gonna be a bigger mess down the road.

cwillie Jan 2018
To start, maybe a family meeting is needed just to make sure everyone is on the same page so that a well meaning cousin doesn't "rescue" her. If everyone presents a united front that she needs to be somewhere safe - spin it as "just until all her health problems are taken care of" if that helps - then she really won't have any other option but to go along.
I hope someone has POA?

BarbBrooklyn Jan 2018
Dogperson, cantankerous would be not going to the dentist. Going to the cardiologist and expecting to have your teeth taken care of is something else entirely.

Another thought for down the road. Geriatric psychiatrists can be very helpful with agitated elders. Sometimes meds make for a world of difference. Good luck!

CTTN55 Jan 2018
Anyone else hearing a strong echo of Dorker's situation?

I would tell the rehab place that she leaves pots on the stove unattended. That is a very graphic example of an unsafe living situation!

Treeartist Jan 2018
Dogperson, as I was reading your original post I was feeling your angst. How many times have I been in similar situations! I, too, read postings on this site for months before I posted my first question. I agree with Barb, that a geriatric psychiatrist could help your mother. I have read on this site that a psychiatrist told the caregiver that most elders will keep the personality they have had all their life, it will just become more intense. So the cantankerous mother will just become more cantankerous! My personal thoughts are that a lot of difficult people have lived their life with an undiagnosed mental illness and maybe at the end of their life, when someone else becomes responsible for their medication, they could finally get some help.
My father, on the other hand, was a raging alcholic most of the time with periods of funny sweetness. We never knew what we were going to get! After losing the ability to get his own alcohol and going through a detox period, he now takes a mild antidepressant and is as gentle as a lamb.

lkdrymom Jan 2018
I agree with the others. When she is in the ER you need to tell the doctors that she lives alone and her home situation is unsafe and no one can take her in. They need to be the ones to place her in AL.

dogperson Jan 2018
Thanks everyone for the responses, the good wishes, and the welcomes. I appreciate it.

MIL is back at rehab from the oral surgeon with new antibiotics, new pain-killers, and new diet rules (liquid diet for awhile). I hope this will at least resolve her mouth issues eventually and relieve her pain. Husband is on the way home and hoping to make it before the weather gets worse. Snow is predicted for today which is why my place of employment is closed and I am home.

Hi Martinaa. Nice to meet another dog person. I also would like to die in my home surrounded by my dogs. It depresses me to realize that probably isn't realistic, but I can't focus on that now. Just have to hope some version of the Rainbow Bridge is true and we'll all be together again someday.

I do think this is the crisis that will force a change in living situation. We will add this to our list of reasons MIL can't live alone or with either of her sons.

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