Prior to these falls, she has advanced rheumatoid arthritis in her knees which gives her a bad gait, has balance problem and is type 2 diabetic. In April she fell & had hip surgery. After that, we transfered to a skilled nursing facility. Each day she complained about the facility and insisted on going home. She was discharged (reluctantly but we had equipment ready).

I live with her & my sisters hired a 24/7 caregiver for safety and help. She would not accept being helped & it lasted 5 days. The Medicare benefits provided at home PT and weekly nurse checkups, but she refused them. Used mainly a cane instead of walker and I couldn't stop her from walking outdoors on grass and slippery cement alone & w/o a call button or cellphone. Six months later, after using the toilet (it's made for disabled w/bars) by herself, she lost balance, fell and broke the neck of her other leg & had hip replacement surgery.

Placed her in highly rated & recommended skilled nursing facility for post-acute rehabilitation. It's been less than a week and I'm seeing the same attitude of complaining about procedures (like trying to have me remove the leg restraints for stabilization of bones), writing daily to-do lists for me of items she wants with her (like a checkbook!), yet asking us to hand feed her meals and then barely eating. Wants one of us 4 girls to visit at least every other day. I live in the family home close to the facility and after 1 week feel exasperated and even mad for her refusing to comply with at home therapy and the hired caregivers assistance.

I dread her coming home now, after the earlier experience. The nurses there agree she is quite difficult and put her close by their station to respond quickly but I feel overwhelmed from seeing her put herself in unsafe situations. Is there another perspective for me besides being worried for her return and the anger?

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I understand the difficult, uncooperative, and unreasonable parent. My dad was often difficult and uncooperative but usually fairly reasonable until dementia came into play. With dementia he would get an idea into his head and often no amount of discussion would change his mind. Some of them didn't have any real impacts. Keeping all the interior doors closed to "help" the heating/cooling system worked the blower motor a lot more than leaving doors open and allowing easier air circulation but it didn't hurt anything. But when the man that left his keys in the car so he could find them wanted to put a keyed lock on the master bedroom door to keep my mother out (she cleans in there every day, way too much), that couldn't be allowed since it compromised his and my mother's safety.

To some extent, you have been enabling some of your mother's unsafe behaviors. Your mother might have wanted out of SNC but someone else drove the car that took her home. Mom might have wanted to use a cane instead of her walker, but someone else made that cane available.

I'm going to encourage you and your sisters to be the difficult daughter, the mean daughter that acts in what you and the medical professionals believe is Mom's best interest. Tell her no one is taking her home until she completes the rehab/treatment program the doctor has prescribed. If she has only been cleared for a walker when she comes home, then put the cane in the garage or the trunk of the car until she has been cleared to use only a cane. You're going to hear about and probably called all kinds of names but is that really more stressful than the constant worry about another bad fall?

Before she comes home I really encourage you to arrange an evaluation by a geriatric psychiatrist. Her unreasonable behavior could very well be vascular dementia like my father had. There are some medications that can help calm Mom's anxiety and let her return to a more normal level of disagreeable. With just a little more cooperation, her fall risk would be greatly reduced whether at home or in SNC.
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senoravee Sep 2018
I agree with being an enabler to her first hip fracture and its aftermath. I've been going over all the situations and safety rules that were not strictly adhered to that were in her daughters control. The geriatric psychiatrist is an good idea and one I had not considered. Thank you for the advice.
Leave her in the NH. Tell them you can no longer care for her. They will make her stay in a wheelchair because she is a Fall risk. If no money apply for Medicaid.
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I agree with BarbBrooklyn. When a senior seems oblivious to reasonable measures of health care, resistant to medical advice and treatment, and demonstrates inappropriate anger, it may indicate mental decline. Even if she's been difficult earlier in life, I'd have her evaluated, if possible, so you can at least take control of the situation.

I experienced something similar with my LO when she sustained a fracture. Resistant to care, refused therapy, unreasonable demands that she didn't see as odd at all, etc. I was suspicious, but, didn't know why she had become so selfish and moody. Even her healthcare providers said she as spoiled and lazy, BUT, they were wrong. We all were. She had dementia and soon it become very apparent.

If that is what your mom has, she isn't mentally capable of protecting herself or making sound judgment calls. The same things will continue to happen, as long as she is left on her own.
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senoravee Sep 2018
Thank you for sharing your own experience and I have discussed it with my sister who is the actual decision maker but has to have continuous communication with me and does. We agreed that it cannot continue this way and her current mentality shows a decline that must be checked out. This change of reason and resistance began to show about 3 years ago and has really escalated the past 9 months. But even though I reside with her, sometimes seeing a person every day, you don't see the objective perspective of noticeable change. Thanks for you reply.
Although your profile says your mother lives in a nursing home, I take it she (expects to/will) come home again? And then there will be the expense of hiring caregivers that she won't accept again? (By the way, who paid for these caregivers the last time? I hope it was your mother.)

I'm glad your sisters all help, but it's YOU that it's going to be most affected, when/if she comes home again. Since she fell at the house (refused help), this is proof that the house is an unsafe living environment. She needs to be in a facility fulltime. And do you work? If so, if she refuses caregivers, what is going to ensure her safety while you are away from the house? (And if you are home, do YOU want to be her caregiver???)

What's her financial status? Can she afford a facility? What would it take for her to qualify for Medicaid?
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shad250 Sep 2018
There is not guarantee any facility would put up with her behavior and in fact they could decline to take her in as a resident and/or be mean to her if she was a resident there.
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Has your mom always been difficult and demanding, or is this new behavior?

Has she been evaluated for dementia? Think loss of logical reasoning skills and safety awareness. Those are part of executive functioning, something that is lacking in those with dementia, sometimes.

You can only control YOUR behavior. I would not show up, and would hand feed her if she's capable of doing it herself.

Is there a geriatric psychiatrist at the facility who could see her?
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senoravee Sep 2018
She's always been rather difficult but in a way of being extra picky about cleaning and maintaining full control of her home and handling finances. She has always been a person who worries in excess about everyone's lives and it was a given that us girls always kept regular contact with her. That was basically the extent of demand in our lives. This behavior I wrote of is like an exaggerated version now of being too difficult and picky about her home and finances that is impossible to perform for any of us, most of all me. I agree that she has declined in logic and concern for her own safety which began in late 2015. I was living with her at that time and noticed small changes then. I also feel that each of her daughters contributed to her poor decisions that could have prevented the second fall and fracture by being firmer and not being intimidating by her demands and anger. She's always been tempermental when mad but now she gets upset real easily and is unable to calm down or talk it out until sometimes 2-3 days later, in my experience. I thank you for your advice about a geriatric psychiatric evaluation, will talk w/sisters about it. After posting my question, I realized that only I control my behavior and have begun taking steps to keep the extent of control to my own self. I don't visit her at the SNF daily anymore or fill out her menu and feed her which was not necessary. Now I let the facility take care of her daily needs which they are doing an excellent job of. She had a to-bring-me list the other day which normally was done pronto, but it was done when I had the time and left with the staff. I told my sisters that frequent visiting is a distraction for her and impedes her recovery process. I don't think a geriatric psychiatrist has been asked about by us at the facility, so I will find out. Thank you for your help.
My mother is similar in temperament. I am preparing myself emotionally to keep her in a 24 hr care center if she breaks something. I work, have a family and no other relatives in town. My mother refuses to allow anyone else to care for her, demanding I take care of her. I will not allow her to drag me down to the core-that is like the tail chasing the dog. To allow a brain that no longer functions adequately to call all of the shots even if it is a mother I love, is not healthy. That would mean I have to sacrifice my family, my children for a dying brain that will never recover. I do not have the skills to give her the proper care as she progresses deeper into the world of dementia and Alzheimers. She deserves much better than I am qualified to provide for her. She deserves qualified, skilled nurses and doctors. Now...when that time comes, I pray I have the strength to place her into a qualified facility. This could be a very challenging decision in the future.
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jacobsonbob Sep 2018
It's apparent you understand the proper priorities and have summarized the situation about as well as can possibly be done. Hopedly this mental preparation will serve you well if/when the time comes for suitable placement for your mother.
Difficult or not, attitude or not your Mom NEEDS 24/7 supervision that is a hard and fast condition at this point.
She can get 24/4 supervision in one of 2 places.
In a facility where there is staff 24/7
At home where you will have to have someone that can be there if needed 24/7. That can be done by family or paid caregivers or both.

This is the conversation you have with Mom.
"Mom if you want to come home you have no option but we must have someone here to help you at ALL times. If you will not accept that you can not come home and we will find a place for you. There can be NO discussion about this other than will you or will you not accept help in the house?"
When I was caring for my Husband I said I would keep him at home as long as it was safe. Safe for me and safe for him. That was the only thing that would have made me decide to place him. At this point it is not safe for your Mom at home without supervision.

I also wonder about some dementia of some type. The big problem with surgery and dementia is the recovery from the anesthesia is long, much longer than you would think. Sometimes months before the effects are gone. And there may still be a mental decline afterwards.
If your Mom is resistant to all types of help, resistant to the physical therapy there is a good possibility that even with a surgical repair on this she may not walk.
You might want to look into Palliative Care as an option. Palliative care will help manage pain as well as trying to maintain a quality of life.
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jacobsonbob Sep 2018
If it takes months to overcome the prolonged effects of the anesthesia, the patient is now that much older so the normal deterioration due to the dementia itself has also been ongoing.
At this point you honestly just need to have the help wether she wants it or not. Do not give in to the tantrums, she will get used to the help, just forewarn the help that she will be uncooperative. I can’t tell you how many times dad told me to go home after I moved in to help him, today 4 years later he appreciates me even if he doesn’t know I’m his daughter. It will get better.
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It sounds like she is content in her way to live her life the way she wants, others be damned, (excuse my french). She is going to continue to try to do things she could do when she was younger, not realizing that those days are all but gone.
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Sometimes it all is harder on the family then the patient. Your mother is facing a lot of issues at the moment. One of them unfortunately is realizing how vulnerable we as humans are. She's really not angry at you it's the situation. Try and find a kind hearted caregiver. There are some out there. You will need to try several to find the right fit. Mom has been so poked by so many Doctors & Nurses in many ways she just wants to be left alone. Of course the therapy is really needed to get it working correctly. It might be a slow approach for the 1st week so she has some down time. Build the sessions up as days go by. When you go to visit "VISIT" with her. Let the caregiver handle the therapy. I think you will find she will soften her ways. Another idea is to set a long term goal. The Holidays are not that far off. Plan a trip of celebration, something to inspire her to work hard. It's up to her. When the time comes for the trip go, enjoy yourselves you've earned it. Or stay home and enjoy your family. If Mom can't go it will be her fault no one else's and will be a real wake up call to her. She must do the exercises.
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