How to know what's best?

Follow
Share

At this point, care for my grandmother has been narrowed down to 3 options, one that we've mostly ruled out, and the other two my mother and I don't see eye to eye. 1. Memory Care AL in her home town in Virginia (where all the family lives but none will commit to visiting regularly) 2. Memory Care AL where my mother and I live in California (where we could visit any time day or night and would definitely) 3. In-Home care and shifts between the two of us while my grandmother lives in our home (my mother's home). My mother and I are at odds on deciding between options 2 and 3 (I like 2, she wants 3). I've posted before about my grandmother, but short version is that she has dementia (most likely Alzheimer's) maybe stage 4-5, she's a high fall risk because she shuffles, gets tired, but also has moods where she refuses to use her walker. She has high anxiety and some depression that was never treated and now is, of course, much worse. She needs 24/hr watch and standby assistance, and I'd say she has wild delusional episodes 5/7 days a week. She tends to be very mean to my mom. Meds have helped some, but having never taken a medication in her life, most of the side effects turn out worse than the behaviors. My mother is convinced that in a home, my grandmother will decline a lot faster, will be scared every night because she doesn't see her family, and won't get the specialized attention that we can give her. Also, my aunt died last week and my mother thinks its too traumatic to move my grandma out of our house. I think that we don't have the skills and patience, my mother has health issues with her lungs and works full time, and I cannot maintain being primary caregiver any longer. (I'm only 29 and trying to start my life) I also feel as if we could all maintain better relationships if grandma goes to a memory care place, and that she will have the structure and activities and socialization that she needs. I know that no one can say what to do, but opinions??

This question has been closed for answers. Ask a New Question.
26

Answers

Show:
What are Grandmas resources like? Does she have the funds for memory care?

I don't nderstand how caregiving at home would work? Does your mother expect to bring in two shifts of caregivers and then do the night shift herself? That might work short term if grandma's sleep issues are under control with medication. But that doesn't sound like it's the case. If medications are giving her side effects, then she needs different medication. Are these being managed by a geriatric psychiatrist? If not, they should be.

Has any thought been given to an inpatient evaluation for her behavioral and psychiatric issues? Sometimes these medication adjustments are better done inpatient.

I have no idea why people think that elders will decline when they get professional care. It certainly depends upon the facility, but in the 5 years that my mom was in IL and then a NH, the only decline we saw was attributable to the progress of her dementia, not from being in a professionally run caregiving environment. They were much quicker to notice small changes that signalled that she was developing pneumonia, for example.

Option 2 sounds best to me. Especially since your mom is going to be doing this on her own. You need to get launched into your career, right? Don't get sidetracked into unpaid caregiving for 10 years. That's just not a sensible thing to do. Unless you are already a CNA and this would be a compensated, 8 he day, 5 shift a week gig with vacations, etc.
Helpful Answer (10)
Report

Things have moved on, Ema.

I think your instincts are correct.

I'd suggest you and your mother make a shortlist of facilities - say three to five - and physically go and visit them. Your mother seems to be anxious about two things: 1. natural guilt over "being the kind of daughter who won't even take care of her own mother, tut-tut, what kind of person is she..."; and 2. your grandmother being stuck in a chair, medicated out of her mind and left to rot.

The key thing is that your grandmother, in the right facility, will receive care and support that are far *superior* to anything her daughter and granddaughter can offer. Specialised attention... well, quite. While it's true that familiarity, of faces and environment, is important in dementia, the fact is your grandmother is not doing well at your home. The specialised attention she needs now is of the professional sort, from people who have the training and experience to provide it.

Quality of care can be a bit of a lottery, but in the right place your grandmother will thrive. Have you seen any facilities you like the look of?
Helpful Answer (10)
Report

Ema, almost all dementia patients eventually require facility care in the later stages. If they are able to stay home, it's  because a lot of help was brought in. That's VERY expensive.

It's going to be easier for GMA to adjust if she's moved to memory care now and not in the later stages.

"She was discharged from the hospital unable to walk"????
Was she sent to rehab? Or was that an opportunity that was turned down by grandma?

If grandma is delusional she's going to need stronger meds than Ativan. She may need an antipsychotic, which is going to scare the heck out of you all but it works for a lot of people.

No one suggested an in house psychiatric workup during that last hospital episode? Did she have a UTI?

If she's over the income limit for Medicaid, you have a lawyer do a Miller Trust to deal with the overage. What are the plans for the house in Va?
Helpful Answer (8)
Report

Ema - you say your grandma is very mean to your mom. This is only going to get worse. I've found, between me and my BFF who also cares for her mom (and a lot of the stories here on AC), that there is a honeymoon period where everything seems to go great, or at least seems manageable, and you think you can pull it off. But after a time, that kind of stress and abuse really wears you down. I am living it - and I'm not even working right now, since I've been "fortunate" enough to have injured myself and am off on disability. I'm sticking with it right now because my mom has been diagnosed as having less than 6 months to live. But even then, I'm not sure I can manage much longer.

I'm 49 and I feel like my mother has stolen my life from me. (As awful as it sounds, I feel like I'm in limbo waiting for her to die.)  How do you think you are going to feel at 29, and just starting? 

My instinct is to tell you to go get your own place, even a little studio apartment somewhere, and then see how your mom feels about caregiving. Because she's going to have to get used to you leaving home sooner or later - probably sooner, if you have the goal of starting a family. I know that you want to support your mom, but if she wants to do this largely out of guilt, then showing her how hard it's really going to be might end up being the only way to convince her grandma needs to be in a care facility. You have a right to your own life....and so does your mom, for that matter.
Helpful Answer (8)
Report

I don't think #3 is actually an option. It requires that you be a primary caregiver, and that does not work for you. I would say that puts it off the table.

Have you consulted an attorney specializing in Elder Law to explore legitimate options?
Helpful Answer (7)
Report

Option #2. Taking care of someone with dementia is the most
stressful task anyone can take on. I did it. He could walk, feed himself and he was continent, but he was out of his mind and
there was nothing I could do to help him. I had him in 2 physciatrict facilities and neither one helped me at all. The first one took him off his antidepressant and anxiety med and put him on resperdiol. All this did was make him drool continually. I brought him back home and 3 months later I had to put him
In another facility because of his constant repetitive actions for
Hours at a time. I honestly didn’t know he had enough strength
to do the same thing over and over for that long. I have the upmost admiration for people who can give up years of their live to take care of their parents, but I was broken after 15 mos of it.
I really don’t know if I will ever recover fully from it. I was 59 when
I did it. You are way to young to put your life on hold. This is your
time to start living. At 29 you really can’t appreciate how precious
one day is! I’m 60 now and let me tell you everyday you lose not
Living life to the fullest is a day you will never get back! Good luck to you.
Helpful Answer (7)
Report

Definitely option #2. Not only is that course of action pragmatic but will be beneficial to grandma, memory care is very beneficial. Routine is so important in the environment of dementia. Your mom ought to be getting ready to retire and save what good health she still has left. You need to have your own life! Your mom feels guilty and why is the question! She’s done all she can do for grandma. She’s going to drop in the ‘traces’ like Scarlett O’Hara’s poor exhausted mule!!!
Helpful Answer (6)
Report

I wonder if it's possible that mother feels guilty partly because grandma's primary caregiver was aunt, and partly because aunt passed away so recently, and it's all bound up together leaving mother with a sense of obligation to keep the show on the road. Very hard to help her untangle what she's going through and see clearly what the best way forward for everyone is.

Ema don't make any assumptions about money - talk to people who can give you definitive answers and constructive advice. Do you mean that your grandmother's occupational/widow's pension makes her ineligible for Medicaid? - I'm not sure you can "surrender" the rights to a pension in order to apply for Medicaid anyway. Are you getting professional input?

It's never quite right to think that you, as family members, "have no choice but..." If God forbid you and your mother didn't exist, your grandmother would still need care and still have the assets and income she has, and a way would have to be found.

There hasn't been any ill-advised spending going on, has there? I know your aunt was very ill - was her illness also very costly?

Whatever the situation, your grandmother needs care, your mother isn't strong enough (for very good reasons) to provide it, and you have a right to your life too. There will be a solution, keep looking.
Helpful Answer (6)
Report

Option #2
Helpful Answer (5)
Report

I also vote for option 2.
Helpful Answer (5)
Report

See All Answers
This question has been closed for answers. Ask a New Question.
Related
Questions