How can I get Mom to calm down and work to get out of rehab?

This thread is 3 years old.

She's probably being combative because she probably thinks she's never going to see home again and I don't blame her. No one wants to be ripped out of their home and if she wants to go home and someone is willing to help with whatever she's getting at the facility, then see if you can arrange that because it will probably be cheaper to do for her at home what they are doing at the facility. There's only one condition though, she must do whatever it is the facility wants her to do. I would first find out if she's being cooperative at the timer of her therapy if so, then you may want to consider whether or not it would really be safe for her to come home. If so, you may be able to bring her home and carry on with her therapy at home. You can even have a visiting therapist come to her home to help with her therapy. If you do get to bring her home, warn her that the moment she becomes non-compliant she's going right back to the facility and enforce that boundary. What I would do is give her warning's along the way and make her choose between her therapy or being forced back into the facility. If she won't heed to any of the warnings, then it's back to a facility

la55cagirl, thanks for your words. It is true that my mom would not want me to dwell, but it's very hard not to. Also, it's true that the nursing staff is trained, but in my many hours there, I witnessed such poor care - for my mom and others - that I feel I could write a book about it! They do their best, and some are truly great at what they do, but so many are not. The system is very broken and needs many, many improvements.

Chicago - will never do this to my kids. For one thing, I'm not all that fond of having them giving me a bath/shower. Thank you very much. If I'm going to lose any dignity, it's going to be a stranger who's seen it all .... I believe as people start seeing what the increase in aging has done to those 'younger' than them, i.e., those who used to be seen as 'older', they, too, will begin to think about this long before what remains of our WWII parents.

Read Coping With Your Difficult Older Parent.

It sounds like your mom is exactly where she needs to be. It may be time to realize that she can never go home. My mother is 95 and in a great nursing home. My MIL is 92 and is an equally great assisted living.

No more worrying if they have fallen, been taken advantage of, getting bathed, dressed, fed, etc. They are both safe and that is the main thing.

If you are your mother's caretaker, think about what will happen to her, if she survives you. That is exactly what happened in our family. We feel that mother's neediness resulted in my sister's premature death, at age 69.

My MIL sold everything and went to AL, after a stroke. It made everything as easy as possible on her "kids" ages 61, 65, 68 and 70. :)

I agree with debsent. You have to hit that middle ground, even if it may seem uncomfortable to step back a bit. It is like taking a child to the first day of kindergarten. You want to hover, the child is clingy, and you hate to leave. But you just steel yourself and walk out, knowing the child is in good hands during that time. My mom was getting ready for bed at 5:30 so I could get her situated before the overnight helper came. She would rather that and me be involved than trust the caregiver! Again, just like children you are not helping by enabling. Be involved, but do your best to let go of some of the strings. You will both be better off.

I think the idea of not visiting quite so often is one that should still be considered. This was suggested to me by the rehab social worker, who explained to me that my Mom was very dependent on me. Visiting and staying all day just made my Mom want me to care for her more and she used my visits there as an excuse for not doing her pt. Everyone is different, so you have to find what works. I found that sometimes going to her pt sessions helped. Problem is, you also have a life, especially if you work or have young children. The idea is to NOT abandon your loved one, but to get them to do basic self-care if they are able. Rehab is NOT the same as an ALF.

Hilary65, Thank you for sharing so deeply. I too, have guilt, even though I was there. I wasn't as calm as I would have like to have been and I feel I didn't do enough to relieve my father's suffering by requesting more medication. I live with images in my mind, as I think you do, that are hard to shake. Telling our story, writing about it and persevering through the guilt and pain of it, is the only thing I can think of to do at this point. And remembering all we DID do for our parents to help their quality of life in their last years and months. We both tried our best and I keep thinking that my Dad would want me to be happy and not dwell too much on the pain. I am not there yet, but I am striving to be. A friend of mine who had similar experience with her parent in a facility said something to me that gave more perspective: the people in the facilities (SNF, hospital, ALetc) are the professionals. It is their job to guide and help us help our loved ones. They are paid and supposedly trained for this. We are part of a dysfunctional system, in my opinion. Yes, as individuals we may have been ineffective in some ways. But we don' t live in a vacuum. We could only do what we were capable of in that moment within that larger system. It doesn't assuage the guilt or sadness for me yet, but I try to distract my mind with this thought when things start to feel really bad. You were a good daughter and a blessing to your Mom. I wish you the best.

Give her a goal. Mom when you can do XXX by yourself then we can talk about coming home. I did that with my mother and after a couple of reminders she stopped asking and started sharing her progress on the goal. Praise her for any small progress.

Told you let her go you full

MP, how is your mom doing?

My aunt broke her hip and was transferred to a lovely NH rehab next day after surgery. Most people stay in the hospital 3 days after surgery, but she had already spent 3 days in the hospital beforehand. (Medicare 3 day hospital stay rule). She was 91 at the time. She lived alone and didn't like to be around people. So the first fee days she ate in her room. Then after she started eating in the dining room, she enjoyed it and made friends. She didn't even want to come home til after Christmas. She wanted to be there for Christmas not just with me at her place because there were more people around. So she'll get used to it.

I loved my mom more than anything in the world, so the idea of not visiting "too often" because a parent is agitated is unfathomable to me. But I know everyone's situation is different.

la55cagirl, thanks for the comment and question. I am having an extremely difficult time dealing with the death of my mom -- especially because I wasn't there. I am very depressed and having a hard time dealing with life. I had been with her at the SNF every day for over a month. Luckily we found a SNF only a mile from our home, and I was not working, so I went for lunch and dinner every day and we had four weeks to talk and be together, and although she really worked hard in PT, she was losing weight rapidly and the Ativan and Morphine made her worse, but she also had many signs that her body was shutting down. The last few days were extremely tough on her. She could not get comfortable and we wanted to bring her home on hospice, but because she still had over 50 days left on SNF, and needed constant care, my husband and the hospice worker recommended keeping her at SNF. Because she was vomiting (due to the morphine, or just to her body shutting down - not sure), the hospice worker also recommended changing her from morphine in a 1ml dose to a sublingual .5 ml dose of 10mg, ever hour as needed, and a Fentanyl patch (both can cause respiratory failure, which is what she died of). After 2 10mg. doses of Morphine over 2 hours, she was still uncomfortable and moaning, so I told the med nurse to give her the morphine every hour -- she really couldn't request it herself. I was so exhausted, after an incredibly physically and emotionally painful day, so I left at 10:30pm, and made the mistake of not requesting a student or someone to stay with her. I know the nurses observed her, but no one was sitting with her, or closely monitoring her. The ONLY thing I can think of to relieve my guilt for not staying with her is that she really was close to end of life. Her liver was shutting down and she was miserable - and she was DNR, at her request. If I had stayed, I would have stopped the morphine and she would have continued to suffer for another few days, or weeks. I know my mom wanted the pain to end and she was not going to get better, but one more day would have allowed us to say goodbye, and that is just something I will have to live with.

Just let her go you don't need to be a guardian anymore

My mom went through the same agitation problems while in rehab. I think one of the best pieces of advice is not to visit too often. It is difficult, but gives you a break. Mom has hemocromatosis, which is iron overload, but it causes anemia. I constantly have to educate healthcare professionals about not giving her iron pills, because it could be dangerous. I find that caregivers must be aggressive about medications. Don't be afraid to speak up. My mom's anxiety is due to fear of actually having to do for herself, which she can do. So I try to pick the issues. She is in independent living and has to do some things for herself. If its not really important, I accommodate her. Otherwise , I push. Try to save your energy by getting the staff to help you. If I say something, I am a b*tch and a dope. If the staff says it, they get more cooperation.

My mom did that. She was in hosp for 3 months and never cooperated. They then moved her to nursing rehab outside of the hosp. Mo
Was uncooperative there as well. And Medicare won't pay if you don't make progress. Fast forward a year. Mom is now 100% confined to a wheelchair as she lost all her leg muscles. Now she cries cus she is stuck in a chair and she is in a residential care home, waiting 6 years for me to retire. She thinks I will bring her home then to live w me. What she doesn't know is Im not.

You might try Valerian root as well. It is a mild sedative. I give it to my mother at night to help her sleep. Also L-Trypthaphane (sp?) helps to produce seratonin which is a natural calming agent.

Morphine almost killed my mother a few years ago when she has a dislocated shoulder. It's a shame that we have to be watch dogs and forbid medications be given, but that is what I've been doing for over 5 years now.

Hilary65,
I am so very sorry for your loss of your mother due to the OD and morphine. Sounds like we have both learned the very hard way- us both having lost our parents due to medication mistakes - that advocating for the elderly, especially when they are in a Skilled Nursing or Therapy Rehab situation, is vital. As you pointed out, they medical system does not always excel in communication among them selves and horrible mistakes happen often. And , the rehab PTs are often young and not empathetic to the elderly. How ironic and sad I find this to be. I wonder how you have found to deal with not being there when the incident with your Mother happened? I am very hard on myself because I was not there with my Father when the mistake with the Ativan occurred.

My mother was given Levoquin and it made her crazy. The UTIs also made her crazy and angry. Any antibiotic seems to agitate my mother. Give her cranberry juice, the real kind Knudson makes one. It must be mixed with water because it's bitter and strong. I mix one "Sweet & Low" in a glass of mostly water and about 1/4 cranberry juice. It seems to do the trick. Some people also recommend D-Mannos for prevention of UTIs. The UTI is like some devil has taken over my mother and she completely changes personality, so give it a week while the infection clears up and remember to keep her hydrated and drinking cranberry juice.

la55cagirl, excellent answer.

"Dad had a panic attack, they gave him Ativan and he had a bad reaction to it. They called me, I flew out and 48 hours later he was dead. I don't blame Skilled Nursing/Rehab but I will tell you there is a particular culture and attitude to the people who work on these nursing units that is vastly different from the Cardiac or other floors. Even the Social Worker agreed with me on this. My fatal mistake was not being there and not having got a replacement for the caregiver who didn't show. Listen to your Mom's complaints closely and make SURE an advocate is there for her while she is in that unit."

My sweet mom also had a very bad reaction to Ativan. She seemed fine at first, but then had severe delusions - yelling and screaming and completely not herself - which stopped as soon as the Ativan was stopped. I looked it up and found that this reaction is fairly common. Ativan is very strong, and should only be given to certain geriatric patients, and in very small doses, to see how they react. I strongly agree that an advocate is extremely necessary to be sure that the proper meds and treatment are given at SNFs. Although some of the caregivers were wonderful and took great care of my mom, the communication between RNs, LVNs, CNAs, Therapists and Doctors is poor - pretty much across the board. And Doctors are rarely seeing patients - if at all (my mom was seen by the doctor only once in 5 weeks). It is very important to make sure that patients get the proper medication, as I know they gave her contraindicated medicines for her condition. In addition to the Ativan, they gave her too much Morphine, and she OD'd and died. Had I been there, I would have asked them to stop giving it to her, as she was not in pain, just uncomfortable.

I found this article interesting: http://www.mdanderson.org/transcripts/delirium-palliative-care.html

She has a UTI which is not pleasant and she has been out of her normal routine in institutional settings (the hospital and the rehab) during the holiday season, that's all part of the change in attitude toward you. I would continue to visit, yes she will say hurtful things but just refuse to feed into that conversation. Ask her about how she thinks she is doing with the rehab and if she is feeling a bit better in general. Tell her if they can finish the treatment for the UTI she will feel better and that the sooner she is stable on her feet from rehab or PT she can leave the rehab. Stress everyone wants this to be a temporary placement. If she senses an end to this dark tunnel she feels she is in --she will slowly come around. Leaving her alone will only make her feel abandoned and make her effort at rehab become worse. Often I had to "sell" a visit to rehab or treatment to my father. Use words like "we will get through this today" etc. Avoid you must do whatever, as it leads to lots of problems with the elderly above 85 years old.

I would observe the staff doing her PT also. Some of them are not very good at handling the elderly and really unrealistic regarding their stamina. They tend to be 20 somethings with little life experience and poor social skills. They can not relate to the elderly. If you have one who shows genuine interest in your mother , you and your mother will really be so fortunate.

Good luck.

Does your mom have dementia? Something like Alzheimers? Because my mom went through the same thing with therapy after breaking her knee in a fall. She was really hard on the staff and her family, acting out and at times actively trying to hurt me. Let the staff handle her and just be there as moral support. If she's not too bad and still can be reasoned with tell her she can't hurt others and if she does that you will have to go for awhile. A uti or any other infection really does seem to change their personalities. So that will get better. My mom did complete her therapy and we did take her home. But while she was there at the rehab facility we brought her some personal things from her bedroom to make her more comfortable. I never thought I would miss her crankiness but she is in the final stage now and can do nothing for herself. She sleeps most of the time and is slowly just fading away!

Apologize to your mother for making her upset. Often, the angry person just needs to hear that the other person is taking responsibility for her actions. Ask what you can do to make reparations or fix the situation.

Do your best to understand why your mother is angry. Was she worried because you came home past your curfew? Acknowledge and empathize with her feelings. Help your mother identify the feelings causing her anger by naming them. Use statements such as "I understand that you were worried because I didn't spend some time with you nd other stuff..good luck

I think she just isn't feeling well, alibi tale confused and frustrated at not getting her own way and being hospitalized, so she is lashing out and says hurtful things but truly doesn't mean to be hurtful to you...but just feels too darn bad to take them back.

Don't take it personally, but for your sake, just remind her you love her and wish she didn't have to go through this, but each day will get better and she'll be home befor she knows it...stay positive.

Take a break and keep conversations and visits short. Give her a few days to adjust and let the care team know you are available but you are stepping away a few days while they get mom on board.

Tell mom, you can't wait to get her home when she can walk on her own, feed and toilet herself, whatever and request care team reinforce that message everyday in rehab.

55cagirl--
I'm very sorry for this terrible experience and the loss of your father, that is so sad!
I know in my mother's case--it would have been impossible (and I think many others will agree with me) to have had someone with their loved ones "watching" them to make sure their care was the best. This is why they are in rehab facilities or AL. Because we CAN'T be there. We really tried to give mother a ton of attention and time, but it was to the point that the therapists said our constant presence was just making her less likely to be cooperative and to adjust to the rehab facility. (If she didn't like the food, she'd call one of us and have us bring her something she liked). She really had a chance to socialize and do a lot during the days,, but all she wanted to do was lie in bed and "receive" visitors. I think there is a fine line between keeping an eye on the situation and practically living in. Most people don't have enough family, friends, etc in their lives to DO a 4-6 hr stint for weeks, months...again, I am very sorry for how things went with your father. That is sad, and no one should have to deal with that. Please don't beat yourself up over not being there.

I'll go against the grain here. I strongly advise you to have someone you trust be there with your Mom as much as possible to monitor her care while in Skilled nursing/rehab. Bear with me while I tell you why.
My sweet father was recently in hospital for a fall, but he was recovering well. I live out of state and didn't fly in because I was assured by him, his caregivers and his niece who is a nurse in that hospital, that he was healing up and I didn't need to come in. At 94 my Dad's mind was sharp as a tack. But he did have chronic congestive heart trouble and got easily upset. But accounts even from Doctors said he was healing from the fall, but it was recommended to get him rehab for strenght so he could return home with caregivers of course. I agreed with the recommendation and he was moved to Rehab/SNF floor in hospital. That night he and caregiver said the nurses were not nice there. And his roommate was loud and yelling. My Dad was upset but I knew a caregiver would be there. But she got sick and didn't show. Dad had a panic attack, they gave him Ativan and he had a bad reaction to it. They called me, I flew out and 48 hours later he was dead. I don't blame Skilled Nursing/Rehab but I will tell you there is a particular culture and attitude to the people who work on these nursing units that is vastly different from the Cardiac or other floors. Even the Social Worker agreed with me on this. My fatal mistake was not being there and not having got a replacement for the caregiver who didn't show. Listen to your Mom's complaints closely and make SURE an advocate is there for her while she is in that unit.

My mom was also very emotional and prone to outbursts when she was in a rehab facility. She picked it based on its location close to me (!) and I knew it was not a great facility for her. She was resistant and angry with everyone there, and with family too. Honestly, they did try to make her "happy" but she wasn't at Club Med and people weren't jumping up to fulfill her every wish. She had a TON of visitors (her friends, mostly) but she finally got to us w/constant complaints and refusal to cooperate. We told her she could not go home in a wheelchair-she had to be able to walk (as per dr's orders, not ours) yet she continued to try to manipulate the system behind our backs. Finally wealthy older sis gave up and had her moved to a facility about 5-6 miles away. Much more posh, but almost no visitors--so she traded a place she hated for a lonely, quiet one. Eventually she quit trying to manipulate everyone and gave in to the therapy--it did take her 10 weeks instead of 4 to get ready to go home. Hard to watch a loved one turn on you--when you are really trying to do your best by them. Mom swears to this day that the 1st place was "robbing her blind" but she would forget from day to day she'd given ME her wallet, keys, watch, etc and all they could have stolen from her were housecoats and word puzzles. And it's VERY likely the UTI is making her worse. Try not to take it personally.....I know that's hard to do. I'm one of 5 sibs who care for her and she's often just horrible to me. The ones who never visit are the "good ones"..the 2 of us who take care of her--oh well. This too shall pass.