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My mother in law lives with my husband and me. Her function has declined significantly over the past year. I injured my shoulder a couple of months ago trying to assist her with standing, so I need my husband just to take her to the bathroom. She has rheumatoid arthritis and osteoarthritis and does nothing all day but sit in her room. The only time she gets up is when we take her to the bathroom in the evening. As a result, she has pressure ulcers on her behind (both sides).


We get a lot of assistance through Medicaid, but she needs more assistance. A wound care nurse comes 3 days/week to treat the ulcers, but they are not healing. They get better, then get worse. It is an endless cycle due to her sitting all day, sleeping on her back at night and sitting in wet adult pull ups for hours. We both work full time and are gone for 11-12 hrs each weekday.


I had a conversation with her about her going to a nursing home and met with admissions a couple of weeks ago. She does not want to go and we cannot admit her without her consent. Her daughter has power of attorney, but my mother in law is still mentally competent. What can we do to protect ourselves from getting charged with neglect? We are incapable of providing the care that she really needs and I fear that our situation is heading in that direction.

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We were in the same position and out of sheer desperation my adult son called APS. We were assigned a case worker who told us that since she has a roof over her head, air conditioning and food that is available (even though she’s bedridden and can’t get it in her own), they can’t really do anything because there is an able bodied adult (my son) in the house. My son and I are in IT and work long hours, he’s just able to do it from home.

She needs 24 hour care, is mentally competent, and refuses to go into a nursing home. Her last hospital discharge was at the end of August and I finally told her ‘you can’t come home without a catheter (she already had a colostomy Thank god so that was never an issue) and you have to pay for help during the day. And finally we told her ‘you have to adjust to our schedules, if you need something and neither of us can’t get it right now, you are out of luck. That is the price you pay for refusing the type of care you need so you can ‘stay home’.

The only way APS would intervene would be if my son ‘moved out’ and we left her alone. We were seriously considering that when her last hospitalization gave us a break. That is when we came up with our current plan. I’ve accepted she cares only about what she wants and doesn’t care how it affects us. If she wants to be miserable at home, it’s her choice.
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Isthisrealyreal Nov 9, 2019
So the OP is in luck, they both work full time leaving her at home alone for hours.

Thank you for sharing your experience.

God bless you and your son. I just can't believe that we are made responsible for caring for an adult that can not care for themselves, yet they get to make decisions for our lives. Something far wrong with that.
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I see where you answered Barb about not having contacted any authority.

The Medicaid aides are mandatory reporters and it would be far far better for you to call APS and say, "She needs more help than we can give, yet refuses everything that we suggest, please help us, because frankly I think that her health is in jeopardy. "

When we do the very best we can and it is not enough because the person requires professional help, I don't think asking for help will get you in trouble. It's being turned in by someone else that sees a problem.

Call and get her the care she needs. It is hard, but so much easier than dealing with the alternative. Everyday that you wait to ask is another day that she is not receiving proper care, you get it I am sure.
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Jdferguson Nov 9, 2019
Texangal81 is in a similar predicament and APS said they can't intervene as long as an able bodied adult is there
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Your husband has to give his permission before his mother can appoint. Let the attorney know
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If she is mentally competent she can give her son POA, it is not for life unless it is a mental health POA, then they can not just be revoked.

I would tell her that you don't want to go to jail and since you have a minor child depending on you and husband your wants trump hers. Pick MIL, a nice move to a facility or a dump and run at the ER? Those are the only choices that she has left.

Who in their right mind wants to sit in a dirty diaper for hours, I think that she has some mental decline.

Maybe you can approach it from the stance of getting her wound healed up. Get her in and then you can let her figure out how to get out.

I am sorry, but young children are more important than any senior that doesn't care about anyone but themselves and that is where she is. It's her grandchild she is putting at risk of ending up in the foster care system. Says everything I need to hear.
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Jdferguson Nov 9, 2019
I had a talk with her last night, after she fell...again. I told her she it at the point where she needs more care than we can give her. She said she will do therapy, but I let her know that she won't get admitted to inpatient therapy unless she was admitted to the hospital for 2 or 3 days (according to her former dr). She knows that we cannot transport her to outpatient therapy.

This morning, she couldn't even make it to the bathroom. I told her about the potential of us getting charged with neglect and our son getting put in foster care, so she said to put her in a home.

The only issue, is that she said she wants ALF. I am not sure how much would be out of pocket, but I know that the NF will be covered.
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When you say "her insurance" will cover the cost, do you mean to say that she has long term care insurance; or that Medicaid will cover the cost?

Have you spoken to the Area Agency on Aging about how to manage this situation? To Adult Protective Services?
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Jdferguson Nov 8, 2019
We enrolled her in the long term care plan through medicaid. No I have not contacted any authority bc I do not know how to w/o implicating my husband and me.
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Have you tried an alternating pressure mattress and/or chair pad to help with the bed sores? These are available from Amazon for under $100.

How about getting some in home PT to assist MIL in rebuilding enough muscle to stand and use a walker? If MIL has a lift chair, you can raise the lift chair to its highest point and have MIL stand and sit repeatedly (with the walker in front of her for balance), then when she can handle one level lower the seat an inch and repeat until it's level. It may take several weeks to get to the point where she can stand from a level seat. MIL can also work on balance by holding to the walker and shifting her weight from one foot to the other, taking one small step forward and then backward, etc. Supporting her weight on the walker and simple exercises with stretch bands from a seated position can built strength and range of motion in her arms too.

My mother has spinal stenosis and osteoarthritis, drags one leg/foot along the floor (because of nerve damage) with a damaged knee on the other leg that will never flex properly again, yet she can slowly walk 150 ft with her walker. Several trips to the bathroom and at least one round trip to the living or dining room each day keeps her strong, able to assist in transfers, and prevents pressure sores. Mom has always been independent and worked hard on various rehabs over the years to recover as completely as possible (hip and knee joint replacements, rotor cuff repair, femur fracture at the knee, etc.), yet we have always agreed if a time comes when she can not at least assist in transfers, care for my own spinal stenosis (in the same area as mom's) will force either purchasing a lift system, more in home care (from her funds) or placement. OUR goal is to keep her at home, but she understands its a joint effort.

If MIL can regain self toileting, she would probably qualify for an adult day care which along with the 20 in home care hours would probably cover your work days completely.

I strongly encourage you to engage in home PT and push MIL to regain basic transfer assist and at least limited walker mobility. I suspect MIL has at least some depression and regaining even a little mobility may greatly help with that too. Limited mobility will also greatly reduce your venerability to any potential neglect findings. If she's unwilling to cooperate with PT, then I would call your Area Agency on Aging for help with a needs assessment and placement. An AAA SW would also document your attempt to provide MIL with appropriate care but being blocked by MIL's choices.

Since MIL is competent, make sure she has a phone within reach at all times and consider recording a conversation periodically where you discuss placement and she refuses.
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Jdferguson Nov 8, 2019
The PT can not come anymore bc she reached a plateau and medicare will not pay for more sessions. They will restructure their payment and cover maintenance visit, but that is in January. She has had physical therapy (in home, in patient and outpatient). It doesn't help bc she does not keep the work up when therapy is over or in between visits.

She complained about the mattress and the numerous pads we have purchased. She has a lift chair (that was her christmas present) and she still cannot get up w/o assistance.

She fell the last time she tried standing up on her own, so that is a no go.

Believe me, she has been provided with many resources to delay getting to this point.

The huge difference is that your mother does the work required of her to maintain her mobility. My MIL does not. When the therapist was coming, she did not follow through and do the exercises she was given.
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Drop MIL off at her daughter's house. She has POA, so let HER figure this mess out! I mean, that may sound harsh, but what's harsher? YOU getting in trouble for NEGLECT? Injuring yourself further? And all because she 'doesn't want to go' to a nursing home? Sorry, but life's unfair lots of times.

Pressure ulcers on MILs behind CAN kill her. Were you aware of that fact? She can become septic eventually, and die from those wounds since they are not healing. That alone is reason enough to get her placed.

Let her daughter handle the situation now, you've done enough. Or, have your husband quit HIS job to care for his mother 24/7. I don't see any other alternatives here.

Best of luck!
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Jdferguson Nov 8, 2019
Yes, I am fully aware of the issues caused by pressure ulcers. That is why I keep on her about getting up and moving to get the pressure off. We got an air mattress that she complained about and a coccyx cushion that she also complained about.

Her daughter was verbally abusive to her when she did live with her and she also lost a lot of weight even though she is a relatively small woman.

My husband cannot quit bc we need both income streams. So, once again not an option.

She also is in the process of revoking daughter as POA and naming my husband. As long as she is competent, having POA is no help.
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Sounds like her needs greatly exceed your ability to meet them. 20 hours a week of help is, as you well know, not cutting it.

Someone needs to spend more time with her. Her sores and sitting in a wet diaper are not good for her, obviously.

What do YOU and hubby want?

Can you talk to her doc or someone about this situation?

Bottom line is I think a nursing home needs to be considered. No one in their right mind WANTS to go to one, but when the level of care required exceeds the capabilities of the household, then it really has to be on the table as an option.
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Jdferguson Nov 8, 2019
My husband is on board with the nursing home. He said that he needs to call his great aunt to try to talk some sense in her.

I had to bring it up again today bc she fell when she was trying to get up from her wheelchair to go to her chair, about 1 foot away. The sad thing is, the paramedic know where her room is. That is how many times they have been here in the past few months.
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"since there are two caregivers in the home..."

It's a shame that YOU have to be your MIL's caregiver.

MIL probably shouldn't be left home alone for the hours that there is no one there.

What MIL wants may not be what she NEEDS. And her wants are NOT more important than your H's and your life together. Do not forfeit your future because of some old woman's selfish desires.

If your H refuses to say no to Mommy, then I'd back off the caregiving. He can wipe her and change her and do all those other things. Perhaps he's working until 9 or 10 at night so he doesn't have to?
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Jdferguson Nov 8, 2019
He keeps mentioning putting her in a home as of lately. He works those late hours bc he keeps getting dispatched and has to drive long distances.

I spoke to her PT a couple of weeks ago and she agrees that she is a NH candidate. I am meeting her at her doctor (we have to schedule rides for her bc that last few times I took her she fell) and will mention it to her doctor. The doctor obviously agrees with her qualifying for that level of care bc she fills out the paperwork for respite care for us. I would like to admit her to our go to respite care facility on a long term basis.

Medicaid also provides her with a medical alert system. She fell yesterday while with the new HHA. I have to call to request a someone stronger. Part of hopes that they decline and say she needs 2 people.
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Unfortunately, you may need to take a harsh stance here.

Can you start eviction proceedings?

You can no longer provide the care she needs and yes, you can get charged with neglect.
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Jdferguson Nov 8, 2019
I would have to check the laws regarding that. Thank you
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She was living with her daughter a few yrs back and she was being verbally abused, that was when she gave her POA. She then moved up north with her aunt (hubby's great aunt), a healthy 93 yr old but had to get surgery and that is how she came to us. Within the past yr she needs more assistance.

My should is better now, but it still hurts and that is why my husband uses the gait belt to assist her and I stabilize the walker. He holds her up while I wipe. Some days he doesn't get home from work until 9 or 10 pm. I start work at 5 am and get to bed routinely 9:30-10 pm.

We even put a bug in her ear about getting charged with neglect and that we have a 7 yr old and cannot allow that to happen, but she isn't hearing it. I told her that she is getting to the point where we cannot help anymore and all she says is that she doesn't want to go to a nursing home.

Medicaid pays for a home health aid for 20 hrs per week. Since there are 2 caregivers in the home, that is all they approved. I cannot afford to pay someone to come. I did that for a few months waiting for her to get approved for Medicaid's program and my account was overdrawn every 2 weeks.

I spoke to admissions at a nice NH locally and her insurance and SS check will cover the costs.
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cherokeegrrl54 Nov 9, 2019
I think you have the answers you need. Do what yall need to do to get her in the nursing home....you are injured and you have a 7 yr old that doesnt need all this drama. Reclaim your home and life....hugs and prayers for you.
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How did she come to live with you? I'm sorry that you injured your shoulder helping her to stand. Were you the only one helping her? Even with your injured shoulder, are you still assisting your husband to help her stand? Are you the one wiping and diapering her?

What is her financial situation? Can she afford a NH? Of course she doesn't want to go (who does?), but she cannot continue to force you and your husband to meet her needs. Who is there with her during the day? What does the POA daughter say? (If your mother-in-law lives with you, your H should have POA.)
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