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My mother in law has congestive heart failure. She is nearing end stages but still doing very well and is not ready for hospice. In the last several months her behaviour has started changing and she is starting to act in ways that my husband and I would never have expected from her. She does have quite a few health problems along with her chef but most can be controlled by medicine and diet; however, recently she seems to refuse to do things that she herself has mentioned how well it works. When she gets better she suddenly claims that what we are doing doesn't work. For example, she has a distal hernia and she knows that she cannot lie down within two hours of eating yet she still lies down, causes herself a lot of discomfort and then continually calls throughout the night complaining about her stomach hurting. She lives in her own house which is only 15 feet from our back door so we are constantly up and down all night when she has a bad night. Last time she came home from the hospital (for chef related issues) she could barely walk and get around. I spent all day, every day at her peacekeeping her with feeding, dressing, taking care of her dogs, etc. I don't mind doing those things for her but she wouldn't make an effort to try and get her strength back. She claimed that she was doing her physical therapy exercises when I know that she is not. When confronted about it she gets defensive, claims she is doing her exercises. Sometimes instead of lying about it she claims that she can't get up and do anything because she gets dizzy and will fall, even though she can walk to the bathroom without getting dizzy. I don't mind helping her with things that she truly needs help with but she is capable of doing her physical therapy exercises and just won't do them. A few days ago we were actually having some good days. She was walking g to the mailbox (which is a good distance). We had gone shopping that afternoon (although she was in her wheelchair) but getting out was a sign that things were looking up. She had lost about 12 pounds in water weight over a few days and claimed herself that she was feeling much better. Suddenly that night, her stomach was hurting her. I gave her what medicines we have for it and told her that she shouldn't lie down so soon after eating but she insisted that she had to in order to make her stomach feel better even though she knows that it makes it worse. I checked on her a few more times that evening and she wasn't feeling better but there was no more meds that she could take and I told her that she would just have to wait it out. We went to bed and after going to sleep, she woke my husband and I up claiming that she had fallen in the floor. We ran over there terrified that she was hurt. When we got there it was apparent that she had not really fallen but had put her self on the floor claiming she had fallen. She was begging us to "help" her. We tried to get her up and eventually we did and we set her in her walker in order to get her over to her chair. I was holding her from falling over while my husband was getting ready to move her and she was pulling g against me so hard that it was difficult to keep her from flying forward because of how much she was pulling against me, the whole time trying to pretend that she was passed out. She was then telling us that she had been begging for help for days and we refused, and insisted that we call an ambulance which we did. I checked her boyfriend and it was very low. I also found a bag of prescription pills that I had never seen, that she has had for a while. She says that she didn't take any but I think that she did in order to lower her blood pressure so she would be admitted to the hospital. I take her to all of her appointments, take care of all her medications. I handle all of her care. What scares me is that she is faking symptoms and I will not believe her when something really is wrong. I have confronted her about it and she just denies it. She is going to be home from the hospital in a few days and I have to somehow make her understand that she cannot fake and pretend and that she has to quit doing things on purpose knowing that it will cause her pain or discomfort. She has never been like this, only recently has started this behavior. How can I convince her that this cannot continue for her safety and my sanity?

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Maybe the happy medium would be in-home nursing/companions for M-I-L. Maybe a.m. & afternoons......maybe around the clock? You and hubby would still have primary involvement, but yoy would also much freer to focus on your own home life, your marriage and your overall sanity. I hope you find a workable solution. And you will have to find it; it won't find you. (Take note of "workable," too. Once an elderly parent's needs spiral out of control, there are no perfect solutions. Just workable solutions.)
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I guess the reason I don't like the nursing home idea is because I think I would feel guilty be starting to see that is not a good reason to rule it out. My husband has mentioned it a few times and I have (up until now) told him I don't want to consider it. Pamstegma, I am hoping that she will see that it is not going to work so your experiences give me some hope.
I became the care giver I guess because I was willing to. She has two sons and one daughter. The daughter and my husband have always been more thn willing to carry their share of the weight. The other son's wife does not approve of her husband havi g a relationship with her (long story). 3 years ago MIL lost her hsuband of 61 years to cancer. She continued to live alone until Jan of 2016 and after a stay in the hospital her health had declined too much to live on her own. The daughter was not in a situation to accommodate her moving in with them. We have a lot of property and were better situated to take it on. We built her her own place so she would feel some sort of independence but still be close. I know she has had a lot of changes over the last year and it would be difficult for anyone so I try to be understanding but I think y'all are right in saying that it is time for tough love. Thank you all. I feel like I have a entirely new view on this situatio.
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Texas, the thing is, you can see that there might be reasons that MIL is doing these things, but since her reasoning skills may no longer be those of a competent adult, you won't be able to re ason with her reasoning. Find out out what her cognitive impairments are. Watch some Teepa Snow videos about handling dementia.
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Good Lord, Texas! I have a list a mile long of the ploys my mom used to get me to come over - and I was visiting her two - three times a week as it was! I have a tie for my favorite ploy - one being when my dad was still alive and they were living in Independent Living. My father was under hospice care. My mom called me and in a hysterical and vague manner told me my dad wasn't doing well and I had to get over there RIGHT NOW!!! I adored my dad and would deny him nothing so at about 10pm I left my hubby and son and drove like a bat out of h*ll to get to my dad. Imagine my surprise to find my dad sleeping comfortably. Seems mom decided she wanted to take a late night bath and since 16 hours worth of daily paid caregivers had left for the day, mom wanted me to sit with my dad. The other - mom called me from her nursing home - this was last Christmas- about three days prior and I had told mom I was going shopping that day. So she calls and says she had a diarrhea blow-out and "it" was everywhere. Seems I needed to go over and clean it up. I asked mom if she had pushed her button for someone from the NH to come help her. Nope. As calm as I could manage I told her to push the frickin' button and told her I was leaving to go shopping. I then called the nh and asked them to go check on my mom. To be honest - I doubt the whole diarrhea thing Even happened. But it didn't matter - my day had been ruined. Texas - I know what you're going through and I feel for you.
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JessieBelle, I'm having similar problems with my father. He does have serious health problems. But he also tends (in my opinion) to exaggerate various symptoms so that I'll take him to the doctor or the ER.
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Texas, you are not ruining the good relationship that you & MIL always had. Your MIL's changes -- be they deliberate or beyond her control -- are the catalyst. And you are strangling on your superhero cape.

Please think twice about "nursing home is not an option." This is your stance, I noticed. Is your husband in full agreement? Hubby will lose his mother, no matter what. That's the circle of life. Also losing his wife -- to a rabbit hole of servitude and gaslighting and going nuts trying to be the bigger person -- is optional.

You love MIL and you surely mean well. But you are not a cardiologist. Or a PT/OT practicioner. Or a geriatric behavior specialist.

And why do you have to tell MIL that she needs to stop faking and stop self-sabotaging, yada yada? Perhaps that message would sink in if it came from her son. Peppered with "we" -- meaning you and him.

Something more than MIL's issues are at play here. Can you give us some insight into how you became the family angel?
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Insist on dementia testing while she is still in the hospital and ask if they did any toxicology to detect drugs in her system. You cannot convince her to change her ways, but yes, you can limit access to medications and salty foods.
I'm willing to bet she has had somatoform disorder (fake illness) since she was a kid. My MIL was the same way, would feign illness if we decided to vacation.
You have to refuse to respond, call 911 and let them cart her away. Once she is sitting alone in the ER, she will realize faking didn't work. This discourages repeat performances, since there is no audience to play to. Been there. Done that. Went on vacation anyway; mom recovered fully.
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TexasGirl, I had to do tough love with my mother. She is a hypochondriac. It was so bad for 2 or 3 years that we were at the doctors' offices several times a week for something. I didn't feel anything was wrong because she cried Wolf so often. I always felt stupid when the doctors would say nothing was wrong. I'm sure Medicare would love to have back the money wasted on doctor appointments, MRI's, blood work, and specialists.

Much of her problem had to do with handling her own medication. She was taking Metformin a few years ago for her diabetes. In the nighttime when her sugar was too high, she would take more. It made her gassy and sick feeling. This went on for a while until one day I counted her pills. Goodness, she had been taking a lot of Metformin. So I looked up what too much could cause. You probably guessed -- gas and nausea. The MRI had also shown a lot of gas. My mother had been creating her own problem, though she was sure it must be cancer or something fatal.

I managed to get all her pills away from her after she overdosed on an Alzheimer's drug. That was terrible, but a blessing in disguise.

She still turns every spot into cancer and every discomfort into impending death. But she stopped asking to go to the doctor and hospital. Two things helped -- her favorite doctor retired and I started taking her to Urgent Care instead of making appointments or going to the ER. She still gets care, but it's not as personal and fulfilling anymore. I still worry when she cries Wolf, but I follow my best instincts about if something is really wrong. Physically she is as strong as an ox with a bad back. Her vitals tell me the things I can believe. Sometimes I do have to remind her that nothing is going to make her 40 again. I wish we could reverse the maladies of age, but no one has found the fountain of youth yet.
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I think her reason for wanting to be "sick" is for attention but specifically from her daughter. Her daughter talks to her everyday for at least an hour and visits when possible. She lives nearly 800 miles away so it is not easy to find time away from work to visit, not to mention the expense. I think that my MIL is convinced that if she is sick enough that her daughter will drop everything and come visit. So we think that this is her main motivation. Her daughter has made it clear that it is simply not possible for her to visit as often as my MIL wants but that doesn't seem register. I am terrified that the "plots" to get her down her to visit are going to increase in severity and that she may go too far or I will think that it is just another ploy and not take it seriously. I think that my MIL knows that I cannot, in good conscience, ignore any symptoms that she has. Maybe that is what has caused some of the problems that we are experiencing now. Because of her many conditions we take everything very seriously and maybe she has started taking advantage of that. It is so hard to know what to do. Just this morning she is asking me to bring her things that she rarely uses and I know it is just to get me there to spend the day with her. I don't like her being in the hospital and even though in the past I stay with her day and night while she is in the hospital it is not possible for me to do this time so she is finding manipulative ways to get me there. Little manipulations like that I can handle and just let them roll off my back but the more serious plots really scare me. All of your answers have brought me more insight to the situation. This is all very new to me. I have never dealt with anything like this. I knew that taking this on was going to be difficult but never once thought about not doing it. I see now that confronting her will not help, but before she comes home from the hospital, I am going to have to remove all of the salty foods from her pantry (canned chili, tamales, vienna sausages, full sodium broths, etc). And I am going to have to remove her medications and only give her what she is supposed to take. Just by doing those things I feel that in a way I am confronting her and don't know what to say. I cannot tell her that we don't trust her but she will feel that no matter what I say. In a way she cannot be trusted. With all of this I am also worried that I am ruining the relationship that we have always had. We have always had a special bond and I can feel that dwindling away which is also hard to deal with. Somehow we have to get her to understand that this behaviour is not going to get her daughter to visit, that it not possible because despite daughter telling her that, MIL still thinks it is going to happen. I feel like we are going down a similar road that Rainmom did with her mother. I have told my husband that a nursing home is not an option for several reasons but mainly because I want her here with us, but I want the sweet woman I have known, not this new version of late.
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My mother, on the other hand, was being purposely difficult. However, there are differences in the individual situations that are likely significant. My mom had always been a bit of a hypochondriac- for reasons I believe that went back to her own childhood. As mom aged her need to see a doctor increased to the point I referred to it as her hobby. As mom entered her mid 80's and after my dad passed there was a shift in this situation that was due to dementia. I knew mom wasn't thinking through the consequences of her new behaviors as they related to her faking symptoms of poor health but I didn't understand why - and why mom could not see reason when I explained the consequences to her. Once in the ER after a fall, mom started to pretend she didn't know me - after I returned from the restroom - having been sitting with her for a few hours and she had been fine. The ER doc became so mystified at the sudden change that he was ready to admit mom and start a whole new regime of tests. Finally- my mom started to laugh and fessed up - she was "just having a little fun". A few months later mom began to "fall" at the nh where she had just moved to. After mom had told my brother the head admin guy had molested her and everyone was stealing from her - when that didn't work mom moved on to the falling. Seems mom thought we would think her unsafe living there and I would bring her home to live with me. All that happened was the NHL implemented "the fall plan" which had a big impact on my moms life at the home - a lot less freedom. I could list a dozen more examples but you get the point. I tried to reason with my mother until I was blue in the face - but I could never get her to see how she was making her life more difficult and more unhappy with her games and plots. And I doubt you will have any more luck with your MIL. I know now - you can't reason with dementia. My only suggestion besides supporting BarbBrooklyns suggestion to have MIL see a geriatric psychiatrist- is to try to figure out what her end game is - what's motivating her to do this? Personally, I suspect your MIL is afraid to be alone - especially at night. If you can figure out what her goal is - even if it makes no sense - you might be able to hit this situation with a bit of a plan.
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CHF is a major cause of vascular dementia. If this is what has developed ( and an appointment with a neurologist or geriatric psychiatrist is a good idea), it may no longer be safe for her to live even 15 feet from your back door, alone.

With my mom, her chf caused Mild Cognitive Impairment, which affected her ability to manage her finances and to drive. She also became overwhelmed with anxiety about EVERYTHING. My brother referred to this as "something mom is doing to herself". Nope. Anxiety is a very real medical condition which can be caused by changes in the brain, such as the changes that happen with the kind of brain damage that chf can cause.

It may also be that MIL has had a small, unrecognized stroke that has changed her ability to think, reason and communicate. In thinking about MIL's trying to fling herself in the wrong direction, it reminds me a great deal of my mom's post stroke inability to do " motor planning" ie, how to cooperate with being moved and her poor ability to use gesture to communicate ( she points at her open mouth when she wants a neck rub).

Depending on how severe her chf is, you might want to forgo an extensive neuro workup. But I don't for a minute assume she's being purposefully difficult.
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Doing things known to make you uncomfortable, faking symptoms, claiming to have done things that you did not do ... these are irrational behaviors, aren't they?

If these are relatively new symptoms (if MIL hasn't been an attention-seeker all her life) then I suspect that some cognitive or neurological impairment could be the cause. Maybe in addition to CHF she has developed some disorder, or is in early stages of dementia. Clearly she is not "in her right mind," as we say.

My husband had CHF but did not reach the late stage before he died of dementia. Curious, I've just looked at articles about the condition. Did you know that late stage symptoms could include "confusion and trouble thinking"?

I don't think confronting the sick woman and trying to get her to behave rationally is going to change anything. This is beyond her control. Instead I'd concentrate on ways to minimize the disruption to your lives while comforting and reassuring her. Maybe a companion or aide for part of the day, or in the evening would help her be more calm and less agitated.

She has a fatal condition in the late stage. She is losing control of her thinking. She must be very frightened. Poor woman! I hope you can find ways to bring her some peace. That is what I would want if I were in her situation.
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Another possibility I just thought about is she could have taken medication, then been surprised by the affect. The answer there would be to get the medication away from her that has not been prescribed by her primary healthcare team.
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If she is deliberately doing things to harm herself in order to get medical attention, you need to let professionals handle it. There is a disorder called Munchausen disorder in which a person will do things to mimic symptoms in order to get medical attention. It is fortunately a rare condition that is usually found for people who have a good medical background, e.g. a nurse. She may not have the full disorder, but may be calling out for attention. It sounds like she may have gone beyond hypochondria if she is taking things to mimic symptoms. If you think that is the case, let the professionals know the next time it happens so they can figure out what they need to do to get her to stop.

From what you describe, she isn't seriously affected. People with the full disorder will visit many doctors and have very thick medical files with each. It may just be attention seeking behavior that will end quickly if she thinks someone knows. Good luck!
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