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Before we moved my MIL to an independent living facility, she was so eager to go and be waited on restaurant-style for every meal. She said she never wanted to fix so much as a piece of toast again. Now that she is there, things are dramatically different. She is having a ton of back pain from arthritis/stenosis/spondylothesis and says she is in no condition to go anywhere. She’ll eat a meal if it’s brought to her room, but she doesn’t want them to deliver it because there’s a charge each time and she says the food isn’t worth it. She IS capable of walking to the dining room but she adamantly refuses to go, saying it’s too much trouble to get there and then talk to people. Even if she is down there during mealtime if we have just come from an appointment she will not eat there, but wants the meal taken to her room. She is isolating in her room and becoming depressed, and has lost 18 pounds. We got her some aides to come in, but she doesn’t want them. Yet without them she just sits around, doesn’t get dressed, and her condition worsens when she doesn’t move around. She has food in her kitchen but she won’t fix any of it, she just eats crackers and peanut butter and Coke. (Last time I went to the store for her I did not buy her the Coke.) I suggested to my husband that we not buy her crackers and PB either but he says we can’t use food as a weapon. Ideas? We are very frustrated. Is it time for assisted living?
(NB, I am doing EVERYTHING I can with the medical community to help her pain, but cannot get her in to the pain doctor for a few more weeks. I have begged them and still can’t get an appointment any sooner.)

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Gosh.. the memories!

I wish I had the crystal ball that told me, no amount of encouragement, lecturing , nagging etc was going to help my mom. She just wanted to sit in her room, in her gown , and be waited on. I told her when she stopped going down for meals it would land her in a wheelchair, it did..

go ahead and buy her the soda etc… treats are needed, along with some fruit..

maybe try going with her for a bit, but , that creates a dependency on you, would she continue to go if your not there..

I wish you luck with all of this. Just know you may not gain her cooperation and, let it go…I wish I had . All my attempts just caused me to look and feel like a nag….
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not sure how old she is or what her other issues are besides the back pain ..I didn’t see anything said by OP about mil having dementia so not sure why so many think she needs an AL. I myself have chronic back pain- all kinds of stuff going wrong back there , mostly due to a career spent as an RN in hospitals with last 20 of those in Labor and Delivery..took its toll for sure! If I myself were in an IL , at a mere 62 with all my faculties intact — I am quite sure that I would also prefer eating in my room also. Is she not of sound mind that she needs to be managed ? Different story once her pain is handled somewhat - in meantime perhaps her GP could do something ..she might not actually need the big gun pain management doc. Is she on an anti inflammatory? Also some mild exercise and stretching with good recovery routine afterwards could be beneficial especially if the IL has PT available or she could be transported or have someone come to her .. pain makes you not want to do anything much ..makes you antisocial, irritable (likely compounded with a noisy dining room if hearing aides exacerbate the clamor ). I myself would STILL prefer takeout or just about anything to eating out - however my husband does like to go out so we have been trying to do that at least occasionally. In our community we have many activities , not an over 55 but we have a clubhouse and facilities and lots of activities. I will go to beach , pool and sometimes to get together at a neighbors but not the organized stuff. DH is member of Pickleball group, goes golfing weekly with another, has gone to some minor ballgames, etc…we just have different personalities and while I enjoy being around everyone at times , I am also content at home. So I empathize with MIL. Perhaps if it is loud in dining hall they could also have a quiet corner , even maybe a table designated for folks who don’t really feel talkative that day..
let us know how she does- pain is no fun , and I think it is really not treated as it should be by medical folks as well as insurance - quality of life SHOULD matter. My pain was much better controlled for years than presently but the medication I was on has been completely demonized now (a narcotic) and though it helped me tremendously I never felt any desire to overindulge nor any “high” associated with it, now only thing I take is ibuprofen or Tylenol but can’t walk to the corner without pain. Progress huh.
good luck
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AlmostLisa: It is due time for your MIL to reside in an assisted living facility. That is unacceptable that the independent living facility cannot accommodate her need to see a pain management doctor stat. She may require medication and a visit to a specialist about possible depression.
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You sound very concerned and sometimes it is difficult to stop the hovering when you have been in that mode for a long time. Having said that 18 lbs is a lot if she didn’t need to lose weight or even then if she wasn’t trying. I would be concerned as well. But something is wrong beyond not wanting to be social.
Soft drinks are almost the worst thing a person can put into their body if they contain HFCS. I’m not sure if they all do. I would let her have it if that was on her order but HFCS or sugar in any form can make joint pain worse is my experience. The type of sugar that is in milk is not as bad if she can tolerate milk. In fact dairy is supposed to be good for some types of arthritis. Also salt can make matters worse. Dehydration is awful for pain. DH aunt likes the small bottles of water. She can’t open them but she can pick them up easily and will drink and not just sip. You might try that. There is a “new to me” protein drink called Fairlife. It is pretty tasty and with whipped cream it is a treat. For your MIL I would add ice cream. Most of us need more protein and she is getting basically none from what you describe.
I have arthritis so I feel for her. Just getting dressed sometimes is a chore when I have inflammation.
Wearing the hearing aids in a noisy room bothers my DH.
Home health is a great idea and also pt/ot. She can get to know the nurse and aides and have a nurse to talk to about her pain and help monitor her vitals.
I think I would try massage, acupuncture, aromatherapy, any and everything to make her more comfortable and let go of expectations that she join in the dining room. 18 lbs sounds serious to me. I hope her appointment is soon.
My dad had an occasion to go to a pain doctor and it was one of his prescription drugs causing the problem. Took about 30sec for the pain doctor to know what to try first.
Sometimes elders are careful not to say what is bothering them for fear someone will try and “fix it”. Aunt would say on the way to a doctor’s appointment “Was I complaining”. And no, she wasn’t. Please be sure to let us know what you find out and I would call her doctor and ask if she can increase the antidepressant.
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Have you eaten in the dining room, yourself? What's it like?
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Same thing happened with my mom. She quit eating and we weren’t aware it was so bad until she passed out in her apartment and hit her head. She ended up in the hospital. She was very depressed about being in AL once she got there. She was on board when we were making all the arrangements. She also didn’t like the food at the AL facility. It’s a difficult situation. I would definitely leave something in her apartment that she’ll eat. I hope you’re able to find a solution. I wish I could give you one. Sending hugs.
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You might also want to check on side effects of any meds she is on. I recently had an issue with my mom having to be hospitalized with Digoxin toxicity. Leading up to it was a loss of weight, loss of appetite, lethargy, etc. In looking at two of the meds she is now off of (Digoxin and Diltiazem) they both have loss of appetite, among many other, as a side effect. So it wouldn’t hurt to check side effects of any meds she’s taking just to see if it could have anything to do with your mom’s current unwillingness to eat.
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How about a Zoom meeting in her room? Dr, Phil has a "Doctor on Demand" Zoom program: https://doctorondemand.com/

Meeting with a Geriatric Psychiatrist in person or via Zoom? Depression is a sad companion to chronic pain........speaking from experience.

Visiting Angel or Care.com companion who likes to cook and will do it in her room.

Are there activities that draw her out of her room?
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Absolutely get her into assisted living.
Ask if other residents or staff can call / approach her to join / encourage her to join one other in the dining room. Say, xxx would appreciate your company (so it isn't about her; its helping another person).

Depression is huge. Have you discussed this with MD provider(s)?

Ask social worker to intervene although in ind housing, they may not.

Coordinate as many visitors / friends / church members as you can to visit. Have them bring their own meal (and hers) to eat with her.

BE AWARE to listen, reflect what you hear.
DO NOT go into 'convince' mode as this will only bring up resistence. Key is compassion and letting her know you understand how she feels.

Is alarming that she's losing weight. I bring my friend (can't walk/bedridden) in nursing home strawberries and / or watermelon. Find foods she likes - fruit - fish - anything that she might eat.

Key is dealing with isolation and the overwhelm. With pain meds, she might be in a mental / psychological place to shift a bit (even one-on-one socializing). Ease into it and avoid setups that she will resist. She is letting her anger and depression to make her decisions.

If you/family (POA) can make some decisions, do it. There comes a time when a loved one cannot make decisions in their best interest. Even if this means having her 'carted' - wheeled into the dining room. If you can, have her seated w one person, who is also an introvert.


Touch Matters - - - - try touch / massage. Hand massage. Doesn't have to be a professional. Touch will reach her as words cannot. I am a massage practitioner.
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Please get her referrals to a pain doctor and a geriatric psychiatrist. She needs to also be encouraged to eat in the dining room - maybe go with her couple of times each week.
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Some great suggestions here! My mom went into a nice independent living place a few years ago, she has since passed away, but we had very similar problems with her.

We did find that there was a lady who was very nasty to her, and the admin addressed that quickly.

We found that accompanying her to meals on occasion was very helpful to facilitate some good relationships.

We also did get her antidepressant tweaked a bit, and her primary ordered PT and OT through a home care agency. The PT worked wonders and building her strength which ultimately led to decreased pain and better mobility.

Initially I did lots of visits (daily)in order to support her in her adjustment to the place. I made friends with staff, who then were more inclined to make a greater effort to keep an eye on her.

She also slept in her clothes and washed and changed after breakfast, however she was never a morning person so we left stuff for her to munch on in the morning and she had a kuerig machine to make her own coffee. She liked that and enjoyed making me coffee when I came by to visit.

Also, since my brother lived 4 hours away, his job was to call her daily to encourage her to get to lunch, which was the big meal there. So he or my sister in law did that, and if she put up a fuss about going, they told her that they were going to call me, their joke was that I was the big gun.

After awhile, she got in the groove and even began to go to some activities! But we gave her lots of time to adjust and gave her lots of attention. It was absolutely a huge transition for her, and she could only make baby steps. Slow and steady wins the race.
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Maybe some resident or a group of residents said something mean to her? Unfortunately, people can be cruel to one another at any age and the answer is the same, keep going down to the dining room and dealing with the people or go down at another time to avoid them. My father experienced unkind behavior or simply other elders asking him why he had a bandage on his head and my dad didn’t want to admit to falling. It made him angry and he started wearing a hat to the dining room.

Sometimes my dad just refuses to go down at all because he doesn’t like being told when he can eat. They will bring him a tray and he gets mad about that too. After years of going through this with him, we just let him make his own choices. He has figured out if he doesn’t eat, he gets confused and falls more often. He doesn’t like either scenario so he will go down to eat when he wants. Sometimes he misses the dining hours and gets mad. My father is 96 with very early dementia and currently lives in AL, but exhibited these same behaviors in IL. Because he refused to eat in IL, his confusion progressed so much that his physician determined he needed AL and we are going through his lack of eating again. We keep protein drinks in his refrigerator. We open them for him and give him a straw because his grip strength is non-existent and he has a tendency to pour it down the front of his shirt without a straw. So maybe grip strength is an issue for your LO?

Also, sometimes my dad didn’t like eating in the dining room because he didn’t like all the attention a “new” person gets.

There are a lot of reasons why they won’t eat in the dining room, but at the end of the day, it’s just something they need to figure out on their own. We never stop having lessons in life.
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Not everyone likes to socialize, no matter what his or her physical condition. In Rehab situations, I have avoided the dining room myself.
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TouchMatters Oct 2022
its likely depression and inability to handle her pain in a way that supports her... to want to be more mobile.
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As difficult as it may be, perhaps honoring your MIL wishes to eat in her room , may help deescalate the current situation while, she is acclimating to the new environment; often this happens when someone actually moves into any type of facility. Remember also that physical, emotional and spiritual pain all three affect the other; so if your MIL is experiencing increased physical pain,this will affect her " emotional" and or " spiritual" pain and, therefore will greatly impact her decisions about eating etc. Be sure that she is also receiving social services and or Chaplain services as both are important to the interdisciplinary team care and, ultimately address
" pain " . She should be formally assessed for S/ S of depression.

Take care of yourselves. Get adequate support from your support team, ( clergy , your own doctors etc). So that your own anxiety and distress do not affect your own health.

As long as your MIL is safe, let her decide where she eats and any other decisions that allow her to feel in control of her life and situation. When aging and moving, one loses some elements of control and Self esteem; empowering and respecting her decisions ( where to eat etc) may help greatly......
Peace...
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TouchMatters Oct 2022
I agree and provide her healthy milkshakes, bananas, etc.
What is S/S for depression? I agree although need to be aware of side effects.
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My mom is an introvert. She didn’t like the table she was at and I asked the staff to find her a table of people who were friendly. They got her a table with delightful people who are social but moderately.
She prefers to eat in her apartment, but doesn’t because I asked her to please go to 2 meals a day. I asked her to do this for exercise (body movement) and that I felt this was a good compromise of 2 meals out and 1 meal in. The one meal in her apartment is Ensure that is in her frig and a sweet protein bar. That has worked well. She initially resisted private caregivers but when she became so stiff that showering, putting on lotion wasn’t something she could do, she agreed to let a “friend” of mine help her. That friend bonded well and is only working 1-5 or 5:30 p.m. every day so mom gets the 2 meals. If she gets up for breakfast, she can either go or have that ensure. I told mom that if she didn’t take care of herself with movement and nutrition, she would be moved to memory care because she would not be able to walk and I really didn’t want her to be bedridden (bedpans, bedsore, bed baths come with that). I also said, that if you want that, it is okay, there are people to help her but this was her choice. She chose to move around! I did ask her if she wanted to die and if I should call hospice. She said no. My mom likes to make decisions so giving her the options is empowering to her. Her caregiver is good at helping her make decision. 2 choices of clothes, 2 choices of meals, “lets get some fresh air today, I will help you go in 10 minutes.” Mom wears her clothes to bed and stays in her clothes after her shower until her next shower. So far so good but some evenings are hard for mom so patience and redirecting is required.
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Yes, it's time for Assisted Living in my opinion. If MIL is in THIS much pain, she needs more help available on site 24/7, docs that come into the facility to see residents, and an activity director who'll knock on her door daily to get her involved with the community and the other residents. My parents lived in AL and loved the dining room. After dad died, the ladies gathered around mom and kept her from isolating by insisting she join them in the dining room for 3 meals a day. In most ALs, the dining room is the social gathering place for the residents. And the Activity Director will see to it she gets dressed daily (with the help of the caregivers) and comes out of her room to join the others in daily activities. You can make that part of her care plan and goals when admitting her.

Additionally, MILs doctor needs to be contacted about her depression to see about writing a prescription for it and another for pain management. Chronic pain can easily lead to depression. Wellbutrin helped my mother a lot. A huge sign of depression to me is your MIL not getting dressed and losing weight while staying isolated in her room.

The food in my mom's AL was great and it was seasoned and spiced well, too. AL is not a nursing home where the "patients" are restricted to bland and salt free diets or fed pureed foods, etc. Mom's AL had a full menu with everything on it from Reuben sandwiches to beef stew with dumplings. The buffets they set up for holidays were mind boggling. They did allow 6 meals a month to be delivered to the room, but any more were charged at $7 per meal. That is a big deterrent for most residents to order room service.

Best of luck.
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AlmostLisa Oct 2022
She is already taking Wellbutrin, but dose may need increases.
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AlmostLisa, I see in your profile that your Mom-in-law has a hearing loss. That in itself can make someone not want to socialize.

Once my own Mom started losing her hearing, she didn't like to eat out as it was too difficult to adjust her hearing aids to reduce the clatter of a restaurant.

When my Dad, shy by nature, moved to an Independent Living facility he was assigned to sit at a table with a couple who was from his old home State and from a town he was familiar with. Dad was so happy, otherwise he would probably eat in his apartment.

I know for myself, I don't like to eat out. I just find the noise gets overwhelming and it is hard to talk to the others at the table. We do carry-out and eat at home. Plus I can wear fuzzy socks.
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AlmostLisa Oct 2022
Thank you. MIL has hearing aids but usually does not wear them.
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My dad has a lovely dining room available but says that it's too far to go for his meals. I have to agree that he's 101 years old, and uses a rollator and it's kind of a trip but I still encourage him to go just for socializtion. I also pay to have his meals delivered just to assure he'll get food every day. In actuality, he lives on cookies, pretzels, and Hershey bars. He loves ice cream and they deliver it with both lunch and dinner and he gets Boost twice a day as prescribed by the doctor. He'll go the the dining room occasionally and enjoys when he goes but he really is just no longer that interested.

Has your MIL been screened for depression? She seems to be avoiding the socialization as much as the food. And when in pain you really aren't interested in eating or talking or much of anything. My suggestion is let her eat whatever she wants. Calories are the important things right now, not healthy meals. Get her food she likes, inclulding Coke, which requires no preparation. Also, get some Boost or Ensure and have her drink it a couple of times a day. Moving to Assisted Living may not help with this since my dad's assisted living works like her current situation - meals can be delivered at an extra cost and no one 'makes' you go to the dining room if you don't want to. I even have an aide in the afternoons especially to encourage him to go to the dining room and be with him during dinner and all that ends up happening is that she brings his food up to him. I don't fault her at all because she is required to take her cues from him.
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I would recommend going and having some meals with her. Bring a special dessert that you can share with lots of people. This will get introductions started and make MIL a superstar if it's homemade and yummy.

I had to do this with my dad and it was very effective. He found out that some of the people were really nice to visit with and he could tell them any story he wanted.

We all need some help adjusting to BIG life changes, help her find the good and settle in.

I would definitely get her some type of pain control, whether massage, accupressure/puncture, PT or meds, because a good pain doctor will always treat the emotional, psychological and physical aspects of chronic pain, it can cause depression, as well as other issues. So get her seen by her doctor to treat the pain and depression and help her adjust to a very BIG life change.
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She may feel it is inconvenient to have to dress to go to the dining room. These places can have cliques reminiscent of high school, she may have encountered snarky comments about her clothes, her manners or countless other things, or seating is assigned she may have been paired with disagreeable table mates. Even if the food is generally good she may find the menu repetitive.

I wouldn't cut off the foods she likes but try to supplement her diet with some other healthier options that she doesn't need to prepare - single servings of yogurt, fruit cups, applesauce....

And finally - she sounds depressed, not just sad but clinically depressed. You/she need to talk to the doctor about that.
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Your going to have the same problem in an AL. She would be expected to go down to the dining area at least to pick up her meal. She will be charged to have it delivered. And the food may not be up to her liking. They should not be using salt for one thing. Might not be as spicy as she likes. Tgey have a lot of people tgey need to cater to. Aides in an AL can come to her room and take her to the dining room but they can't force her. Maybe she thought the not cooking was a great idea but sitting and eating with strangers is a different thing.

Sounds like depression. She is not adjusting to the change. Its hard for the elderly to adjust.
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I’ve been in a facility. The dining room is horrible. Too much noise, too many bad manners. I paid to have my meals delivered. No one will ever force me to eat in one those dining rooms. And don’t use food as a weapon. And get her Coke if she wants it. She’s not a prisoner. It’s her decision not yours.
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Cover999 Oct 2022
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