Mother in rehab is refusing food, meds and rehab. Any suggestions?

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She developed disorientation and worsening depression and felt she was being abandoned. I thought her depression meds were inadequate (I'm a clinical social worker) but the psychiatrist saw her on a good day and did nothing to her medication. Two weeks later when she felt she had been "tricked" into rehab he opted to change her meds. She is now refusing medication, rehab and most nourishment. Help. There are 5 of us and we don't know what to do?

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Anna; the fact that YOU don't know what to do simply means that you're a daughter first. Sometimes I was able to put on my "clinical" hat with mom and analyze, but not always, so stop beating yourself up on that count, please.

As CM asks, what put your mom in rehab. My mom was doing "fine" in Independent Living and then had a stroke. After a week of acute rehab (the got her up walking and talking again) we moved her to a lovely subacute rehab that had a really nice Assisted Living place on the same campus. Seamless transition, right? We were patting ourselves on the back for being SUCH good planners when Mom went bonkers.

There were people having sex in her bathroom. Dead bodies were being transported up and down the hallways at night. She told us she had to pay for everything that was being done for her. She announced to me, with her nurse sitting right there, having just doled out the afternoon meds "you DO realize, don't you, that I have to manage my own meds here, don't you?". When I said falteringly, "Um, Mom, didn't Nurse Nancy here just give you your meds?" My mom cocked her eyebrow at me with one of her "significant" looks and pointed her arthritic index finger and the water pitcher by her bed.

I couldn't argue with her because there was nothing rational to argue with. I followed Nurse Nancy out of the room like a beaten puppy and said "what....what...what's the matter?"

Nurse Nancy gently explained that although it MIGHT be "just" disorientation from being in a new place, it might also be Vascular Dementia brought on by the stroke. The geriatric psychiatrist confirmed that a few days later.

The next 4 years were like Mr. Toad's Wild Ride. Keep the geriatric psychiatrist involved.
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This probably won't help your situation, but when I broke my hip or it broke about 2 weeks later I fell again and hurt my right hip which had benn replaced 10 years prior. The hip was very painful and I was not able to bear weight on that side. X-ray did not show anything but the surgeon said i was in too much pain for a bruise so there was probably a fracture but as it was not displaced it did not need treatment. Six weeks later at a routine check the X-ray showed remodeling on the bone so the PA told me that was a good sign of there being an actual fracture. Both hips being fractured at the same time requires a great deal of rehab and hard work which can be very depressing as progress is so slow.
The choice is to work hard or give up and take to your bed. I promise it is very hard not to just sit back and accept whatever happens. Nagging or bullying does not help progress. A person needs to accept their current condition, keep doing what they can, appreciate those who are helping them and set some realistic goals which will probably be very different from your previous lifestyle.
Downsizing does not mean giving up everything it can just mean changing the focus of your life. For example if you enjoyed building furniture but can no longer safely manage the big tools change to making dolls house furniture. Having cognitive decline changes everything so it is fruitless to expect someone with cognative decline to realize the importance of trying to do what is required.
Constant encouragement, praise and sensible rewards and most important of all recognisising what your loved one can no longer manage rather than simply does not want to do. Some things may have to be enforced like finding a safe living situation and taking over finances. Don't make it a big deal. Arrange for certain mail such as bills go to a post office box . Sort things out then sit down with Mom show her the bills then present the checks for her to sign as long as she is able. present it as a time saver as there is some kind of reward waiting. '"We'll take this to the post office as I don't trust that someone won't steal them from your mailbox. After that we will go and get ice cream", or whatever would tempt her.
There is no right way of handling these situations, a lot depends on the emotions of the participants. A lot of thinking on your feet and making quick decisions is required.
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I'm sorry to hear it, Anna, and wish I had some advice. If you figure out what to do, please post about it. I could use the information. My mil is in rehab refusing to cooperate with the exercises, trying to hide her pills rather than swallow them, and demanding to go home even though she can't even stand up without assistance. The more I read of other people's stories the more it seems like we're all trapped in some awful game where are choices are very limited and none of our options are good.
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(((((Anna)))) I'll share my story in case it helps. Mother has Borderline Personality Disorder and accompanying narcissism, so she as always been difficult to get along with. She started showing signs of dementia in her late 90s, and became more and more paranoid over the next few years. Then she started making poor decisions, and having delusions. She had always refused any medication for her BPD. I think an antidepressant would have helped as all a lot. At one point an antipsychotic was prescribed but she would not take it. I was getting phone calls and emails from her that were more and more bizarre and abusive. She made accusations to the staff of the ALF. Finally she became suicidal, and was placed in a geri psych hospital. At first, she refused all meds. They asked my permission (which I gave them,) to put the meds in her food, but she figured it out and refused those foods. So she stayed there for about 9 months. During that time they did a thorough evaluation and concluded she had vascular dementia, as well as the BPD. Her delusions became worse, and finally, after a particularly bad episode, she agreed to be given risperdal, by injection, We figured, as she was not compliant with meds,  that the injected form was a better bet once she was moved to another facility. It worked very well for her, and she was moved to an ALF for people with mental illnesses until last October, when we moved her to an NH. While in the ALF she was put in an antidepressant also. The gentle persistence of the staff at the geri psych hospital was invaluable. Mother went on a couple of hunger strikes, but they did not last long. If she had not been admitted to hospital, I don't know what we would have done.
I hope you can get your mother treated.
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So, heart disease of varying kinds sometimes leads to Vascular Dementia.

Has anyone investigated why she can't walk? Sometimes, the elder falls because of a break, or an event, not the other way around.  Make sure they'e checked for stroke, broken pelvis, broken hip.

My mom was "refusing" rehab at one point. The alert PT realized she wasn't bearing weight on one side. Her hip was broken, but it didn't show up in the first xray taken.
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Thank you.
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Does your mother already have advanced directives so that you and your siblings know *her* wishes for end of life?
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If someone was trying to make me practise using my rollator and I'd fractured my pelvis I think I'd be pretty rageful too. Please ask somebody to examine the range of movement in her legs and hips properly, and check that she has not "pinged" something. Classic sites include neck of femur and symphysis pubis but her PT will probably want to have a good look all round if you mention it.

You then want to research chronic heart disease leading to vascular dementia. Your poor mother, she probably does indeed feel completely wretched, knackered and fed up. Don't despair, it may yet be you'll find there are things going on that somebody can do something about which will help; but for now, failing that, just hugs all round. This is very hard on all of you.
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Anna, we are all there with you! My mom refuses PT, OT & speech most times then complains to me that they don’t do anything with her there. She has no memory and thinks everyone is lying about trying to get her to do things! She demands to go home and recently I have been told she doesn’t want her meds and won’t let the nurses give her insulin. She needs assistance with all ADLs and calls me up frantic why she can’t reach her brother (dead since 2005). The sad part is when i remind her he’s passed she realizes her brain is failing her and it makes her sad and mad and all those emotions that go with that. I wish there was a easy answer as what to do, but do what you can. Encourage her! But in the end you have to make sure she is safe and cared for.
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Physician, heal thyself...

Sorry, Anna, it's just that if *you* don't know what to do - ?!

What put your mother into rehab?
How old is she?
What are her circumstances - living alone, recently widowed, anything like that? Was she doing fine until recently?
Any underlying chronic conditions?
What medical investigations have been done?
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