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My MIL is almost 97 and was "stable" despite congestive heart failure until a recent hospitalization for a UTI. Once she was home and finished with the antibiotics, she was rushed back to the hospital to the ICU with very low potassium and a c. diff. infection. She almost went septic, but somehow pulled through and has started 90 days of a Medicare covered nursing home stay. My husband is finishing the process of applying for Medicaid, because years of 24/7 home health care have depleted all of her money and the reverse mortgage funds are also almost gone. There is no more money for her to go back home to receive care there. She is mentally alert but, in addition to CHF she is almost blind from MD, profoundly deaf (doesn't want to wear her hearing aids), and cannot walk due to knee and hip joint deterioration. Despite knowing her physical limitations and financial trouble she thinks that she'll only be in the NH for one week and then will go home to "care for myself if there is no money for an aide." If we try to talk to her about the reality of her circumstances she gets very upset, which is understandable, and says she wants to die. That is something she's been saying a lot lately, anyway. Does anyone have a suggestion about how to break the news to her that she'll need to remain in the nursing home permanently without sending her into a deep depression?

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Why don't you start off with "You just need to stay here for a couple months, so they can make sure you stay healthy." Then just keep increasing the time. Telling elderly it's only for a little while, rather than forever is a lot easier, and it doesn't overwhelm them as much.
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I agree that it's probably best to say it's for a few months, at first.

I think I'd throw in something along the line of - "you're still medically very fragile and your doctor doesn't want another situation where you go home only to return to the hospital a day or two later - like this last time. It's important that your strength get built up and we know for sure that the c-diff is under control. Returning you home too soon could be very dangerous for you. We love you very much and don't want anything to happen to you."

Good luck to you - it's a tough situation to be in.
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Even with dementia my mom cried in the moment when she understood she was in a facility forever so now I do my best to avoid even answering where she is when she asks - why cause her more unnecessary pain

Honesty is not always in the best interest of an elderly person and having hope is pretty essential
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Giving hope is often better than being honest.
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Thanks to all of you for your suggestions. My husband will be the one to try to answer her requests since he visits her while I'm at work. I suppose that just the way we're better off not arguing with her when she has periods of hallucinations (not sure what triggers them) we're also better off not telling the full truth about going home but trying the approaches that you have all suggested.
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The words 'safety' and 'attentive care' worked for us.. tough situation. Honesty is always best but do realize not always when it comes to the elderly. A nicer 'version' of the truth should work. Good luck. :-)
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Say that 'we' are listening to the doctors on this one Mom, until then, 'we' will take it one day, one week at a time. We will be here to help you get better. Now, what do you want for a special treat tomorrow?
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Sometimes the most truly righteous thing to do is to tell little lies such as outlined by several in the foregoing comments...

After caring for my wife at home for nearly 24/7 for two years my heart gave out. She had experienced a massive stroke. After two months in the nursing home I realized I could no resume giving her care on my own due to my health...I told her that the doctor said I would die if I continued to take care of her at home (In fact, that was a lie.) She rebelled vehemently, but after a day or so she accepted it graciously. ...She has no dementia and is very sensible and loving. by nature. That was in 2007. From that point forward, we spent north of a half million dollars on nursing home fees and she finally qualified for Medicaid....I visit her twice daily to assist her with eating and I hire a lady every day of the month to visit and assist her for the supper meal. She is very happy...

You may want to soften the language of saying " few months" to a "few weeks" but I see the "gradual" approach as being sensible.)

Grace +peace,

Bob
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Good advice here as always. I found with my mom that I had to just take each day as it came. I never talked days, weeks or months; it was always by the day (singular). When mom ended up in the ER for the first time, (which there have been many since) the doctor said she was no longer able to live alone and they would not release her to go home alone. So I had her move in with me because it was the best choice and none of the other siblings were willing.
Her routine was kept intact during the day which was going to the restaurant and doing what she could do of course, over time with dementia that ended. But there was enough time in the interim to ease her out of her routine at the restaurant. To where eventually she could not go to the restaurant anymore and I had to bring in outside help.
I would pick her up at night to take her home. I would answer her question of why I was picking her up with saying I don't like to stay alone and would really like her to stay with me if that was ok. And she almost always said ok. On the other days when she didn't say yes, I waited for 10 to 15 minutes and asked her if she was ready to go and she would agree to stay. Eventually, she stopped asking and was more than willing to go home with me.
I would imagine in your case with it being a nursing home that the advice above about saying the doctor just wants to have you stay another day to make sure you are ok, would be the best way to go. Perhaps, change up the way you say it from time to time and over time she will probably stop asking. Some people ask every day for years and others don't, so it's hard to say in your case.
My best advice is to take every moment of every day and live in that moment. Get creative with your responses. Never say never.
Good luck and take care of yourself.
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I would lean very heavily indeed on delaying tactics. For example: "let's see how we get on"; "we're doing our best"; "the doctor says we'll review at the end of this week/next week/the month" [or however long you can get away with]; "your blood tests still aren't right, I'm afraid. You need to get a bit better yet."

I can't imagine circumstances which would make it ethically or practically essential for you to spell it out to your MIL in terms that she will never go home. Expressions of time such as "for now" and "until you're stronger" are so usefully extendable and ambiguous. But are there reasons for needing clarity that I haven't thought of? Do you need her consent to a house sale or something?
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Just from your description it sounds like she wants to die at home which is her right as a patient as long as she is of sound mind. I don't blame her, I would also want to die in the comfort of my home in my own bed surrounded by things I like and people I love. I say if she is of sound mind and competent to make that decision, I say put her back in her home and let her live out the rest of her days and let the family take care of her for what few days she has left. After all, she made it this far to 97 so she's entitled to have this particular say. If she doesn't like the nursing home and she's wanting to go back home and she keeps persisting, then for her sake, take her home and let her live the rest of her days where she feels most comfortable. You could ask her if she would allow hospice to come in and help care for her if she's serious about wanting to die but let her die at home if she's serious
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My mother's doctor told me when that time came HE should be the one to tell her because people expect to hear things they don't want to hear from their doctor. He said that way her displeasure would be with him and not me. 
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If it bothers caregivers that they have to "lie" to get their charges to stay in a nursing home or otherwise outside their own home, they should remember that it's not completely a lie--if their spouses or parents "miraculously" regained strength, cognitive abilities or whatever, then the possibility of being back at home could be entertained. Thus, saying "until you get stronger" is okay even though one knows the likelihood of this is essentially nil. Therefore, we have all been given "permission" to answer like politicians!
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I know when my grandmother was dying, she was not in her comfy, lovely home. She was in one of the nastiest NHs I have ever seen. But she knew she was dying (94 yo) and she was gracious and sweet. I don't think she was much aware of her surroundings--she never even knew she had a roommate. I visited her there quite a few times. Mother was wracked with guilt about her own mother dying in such a yucky place..Mother had cared her for a couple of weeks at home and simply couldn't handle it. I think it was her dr who sent her to the NH--not Mother.
All grandma cared about was that she had a visitor or two per day and that she knew all of her family were fine. She calmly planned her funeral and was able to tell us how to divide up some of her jewelry and such. She was between this world and the next for a couple of days, seeing her husband (who had died 35 years previously) and when we all told her she should go with him when he came to visit, she was at peace and passed a couple days later.
Having her beloved dr tell her it was time was the tipping point. Hearing it from her daughter or son was pointless.
At 97, with so many health issues, you can fib a little to your mom and likely she isn't really aware of the passage of time. Visit her often and be loving. There's nothing more you can really do at this point. Make sure she has good care, and let her know you love her. People need to hear that.
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"The doctor recommends"
Having it come from a 'professional' is usually easier to hear for
a patient.
And it can be ''' It's best for right now'''

The conversation could go something like:
'Stay a few months to get really strong before you go home so you
don't end up right back here'
Ask the doctor, nurse or agency on aging for good ways to have this conversation without devastating the patient.
Sometimes having a 'problem solving' conversation with them - helps
THEM to decide that assisted living or nursing care is the right option for them, even if they need to believe that it is only a temporary solution until they can 'return to normal', or 'return home'.
It is hard to feel powerless, and worse when you watch all of your independence slipping away, and the worst when you feel there is no hope for improvement in the future. It can look like a bleak future - until the
'new normal' is found to be not so bad.
Help the 'new '''temporary''' normal' be a good experience, so that it can help with a positive outlook and there by cooperation with the whole process.
What makes the patient happy, visits, snacks, hobbies, games, music, tv.
If they are on a ground level and have a window - can they have a bird feeder outside? Can you bring in music or cds of nature sounds that they enjoy? and of course any favorite items like a blanket, quilt, photos, photo album, keepsakes.
It's never easy, and it is hard to truly imagine what the patient feels like and the impact it has on them.
One person said " I feel as hopeless as if I was in a bad car accident and was told I could never go home and my life would never be the same. I can't bathroom by myself, I can't choose my meals or snacks or when I have them, I can't shower any time I want, sometimes I'm not even allowed to pick out the clothes I am going to wear that day" - she said 2 year olds have more freedom and options than she did. She told me one night she couldn't sleep and she just wanted to go in her kitchen and make a cup of tea and some cinnamon toast - not an option since she didn't live in her home anymore. Something that she used to enjoy that was so simple and basic, is now an unobtainable 'luxury'.
That really put it in perspective.
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I know I will be having this situation soon enough for my Mom; she has Alzheimers, my Dad just passed away, and she can barely get around since she has rheumatoid arthritis , lupus, gout and osteoarthritis thruout her whole body...my heart aches for her and she is the sweetest person EVER...but in my heart I know in time with all of her medical issues that a NH or ALF will be best for her only to make her the most comfortablest round the clock !!! I have been doing it but is getting hard for me; I've done it for 5 yrs and the last 6 months almost round the clock....I have my own family and issues there that need my attention and sooner or later I will have to make the decision but I keep putting it off...I haven't told her anything yet but every so often I mention 'how much better a medical person can make her feel'...she agrees but I know she doesn't know the REAL reason why I say that....she is in moderate to severe stage for last 5 yrs and just recently she progressed dramatically right before Dad passed away about 7 months ago...it's getting to be time and I really don't want to but I think I'm going to have to , for both our sakes...I wanted her to be at home where she is most comfortable with watching her birds, and the familiarity of where her and Dad lived together...this is tough but it is Life...this is a bummer
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In some cases, patients don't want to hear bad news. In the case of my foster dad, there must've been some kind of talk the doctor must've initiated because one time I noticed he wasn't feeling his prescriptions which for him was unusual. When I asked, he said he didn't have a doctor anymore so I wonder if she may have initiated having that talk with him and he got mad and walked out. Another possibility would be that maybe he was combative to the point that each time she brought it up, she finally decided to drop him as a patient. Sometime before this, he told me one day that his doctor really wasn't a doctor, so I don't know what happened there other than someone pretending to be a doctor somehow got their foot in the door and eventually got into private practice. It's amazing what we hear these days when we thought we've heard it all then something new comes along
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If she is deaf it's going to be hard to explain things. I would do what is suggested. Just tell her that the doctor needs her to stay for a while longer. That he is not allowed to release her to home if no one there to help her. No matter what u say she is going to get upset. Don't be surprised if she stops eating and gets depressed. My MIL willed herself to die and did at 91. She didn't want to go to a NH and would have been an awful patient. She was a passive aggressive person and tried to get things done her way. When she couldn't she just let go.
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Thank you, again for all of the helpful and caring responses. To clarify a point: it's not just a matter of her going home safely with a 24/7 aide even if that became possible. Instead, it's a matter of not having a home to go to some day soon because the cost of her home care to date has used up all of her money, including the value of her house. There is almost nothing left in the reverse mortgage that has been paying the $6,00.00+ monthly home care costs. Even if she had not been recently hospitalized she would eventually have had to move to a NH on Medicaid. We'll have to try your various suggestions to "soften" the truth as much as possible. There is another option some day: if she becomes eligible for hospice there is a hospice care residential facility that I've heard is more "home-like" than a NH. For now it's one day at a time....
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