Situation with my MIL deteriorating - what criteria will give the "she can't live by herself anymore" call?
Stuck in tub unable to get out twice in the past two years.
Found on ground in back yard, unable to get up two weeks ago and ten days later found on floor in house, unsuccessful at getting herself up even with help of furniture. She does not know how she ended up on floor.
Three days ago, I found a freezer meal in her microwave and handed it to her. She put it back in to rewarm. It was still there yesterday, two days later. Indicates microwave has not been used for three days.
WILL NOT EVEN CONSIDER any arrangement other than live in her house, would not allow home health care to do anything.
WILL NOT CONSIDER any changes to make living in her house easier (bath chair or walk-in tub, call button, multiple phone handsets, etc.).
We tried to get her to do Respite Care while we were on vacation and she adamantly refused “I’m not leaving my house! I can take care of myself.” Even when given some emergency scenarios and asked what she would do, her response was a vague, “I will think of something.”
In her day, MIL came across to most people as a very sweet and well-mannered lady. In reality, everything has always had to be done HER WAY and she plows through any obstacles and will not take “no” for an answer. This probably made her a great nurse, but makes dealing with her a battle we can’t win if we oppose her. Now that she has no rational ability, she "stubborns" her way through anything.
Our estate-planning attorney's assessment is that she is the type of personality who will not do well in an assisted living situation or with 24/7 live-in help, as she will fight everything. His recommendation is to put as many “safety bumpers” in place as she will allow and let “the system” determine when she can no longer live alone in her house and move her at that time (he also pointed out that doing it that way secures at least some Medicare funding). If she has a “catastrophic” event that puts her in that position or reaches the point that she is no longer cognizant of her surroundings that decision and transition will be more straightforward. Our concern is a situation where she is still somewhat cognizant but degrades to that point without a precipitating event. In that case, someone could determine that she can no longer live alone at home but she will strongly disagree, even to the point of refusing (perhaps violently) to leave her home. In such a situation, how do we enforce such a determination (do we call the police and have her forcibly taken to a care facility?)?
What criteria would put her into a “unable to live at home” situation?
Who makes that determination?
How is it implemented and enforced when she has it in her head that we will fix things? Or that she doesn’t need help? She will physically fight and/or resist any effort to move her.
You can call your local Agency of Aging . A social worker will be sent out to do a needs assessment . The social worker that interviewed my mother determined she was not safe home alone and needed 24/7 supervision . I had an assisted living all picked out already . The social worker was due to come back with someone else to remove my mother from her home.
However , another family member gave my mother a heads up before that and my mother ended up with chest pains and went to the ER . I think my mother claimed chest pains to avoid the social worker . She had no evidence of heart problem . I told the hospital social worker what was going on and they had her assessment done by a doctor which confirmed dementia . My mother went to assisted living from the hospital after a few days .
If your MIL ends up in the hospital ask to speak to the social worker about unsafe for MIL to live alone and get her assessed at the hospital .
SW, OT & Dr all recommended supported accom. Refused. Not legally able to force & head that direction at this stage - until a crises forces change of health significantly or guardianship is applied for, neuro-pschy testing reveals a guardian is required & then granted.
The bus still drives on..
Adding many 'safety bumpers' too! Has keep stable for much longer that anticipated (although very precarious & NOT sustainable).
Still in the *awaiting a fall* club.
Stop the "propping up" that makes it appear that she is independent.
Allow natural consequences to occur. She will end up in the hospital and the discharge team will evaluate her safety to live alone at home.
Make sure that the discharge planners know that family will not be providing home support.
Do not listen to any promises of "home health". It won't happen unless YOU arrange it.
This is not a punishment, it is the process necessary to get her the care she needs, unless you are able to provide it.
Have her evaluated for a UTI, which presents as behavior/mood/stubborness in the elderly.
If they release her again do not help her in any way. If she wants to stay in her home she will have to fend for herself. You cannot reason with an unreasonable person.
Time to play hardball with her, talking to her will do nothing, she has to fall to her knees before she will realize that she is incapable of caring for herself.
Good Luck!
I would explain to her that she needs to take precautions so she does not fall. Use a walker. Maybe put a commode over her toilet so she has arms to help her push up. At 95 what usually goes are the legs. May want to say if she breaks her hip, that means an operation and Rehab. And if you don't feel u can care for her, an Assisted living. Better to take precautions. I may get an order from her doctor to have in home therapy come in and evaluate her.
If nothing works, then u wait for something to happen where she winds up in the Hospital. There you get her evaluated for 24/7 care. If needed have the doctor tell her "time for Assisted Living". If she goes to rehab, they can also evaluate her. Stick by your guns and tell her you will not be caring for her. Time for AL.
She's a proven danger to herself.
She doesn't remember how to cook food.
She is a proven fall risk (increasing with each passing week).
All conditions have been met. Now is when she is no longer able to live at home, especially if you guys are done orbiting around her.
Is your husband her PoA? If so, he needs to read the PoA document to see what triggers his authority to make decisions in her best interest (and doesn't matter if she agrees or cooperates). Sounds like she may need MC and not AL. If she can afford it, then pick an acceptable facility. Then work with the admins to create a "therapeutic fib" to get her there: tell her her home has an infestation and has to be fumigated so she needs to go to a temporary place; she has a gas leak; whatever works. Or, she goes the ER direct to facility route.
If no one is her PoA then call APS to report her as a vulnerable adult. Eventually they will acquire guardianship over her and will transition her to a facility. If she falls before that, call 911 and work with the hospital social workers as an "unsafe discharge" so that they will get her directly into a facility. I wish you all the best.
Our MIL's seem to be the same person.
She's in her home, being propped up by her 3 kids, 2 nurses, 2 cnas and an entire Hospice team. And by having all these people (in the background, 10 adult grandchildren and 3 in law kids) she considers herself to be 'independent'.
Truth is, she'd fall completely to pieces in 24 hrs if one piece of this puzzle 'left'. It's taking a village to keep up the illusion of independence.
We're 7 months into Hospice that told us she had maybe 3-4 weeks left. It's depressing and anxiety inducing at the same time. Whatever she wants, she gets. She pitches fits and screams at her kids and causes them such emotional pain, even in their 70's. (she's 93).
The time to move her to AL was 7 months ago when she had a fall and was 'out of it' for about a month. She improved, to a degree, is still actively dying, but oh, so slowly and taking us all down with her.
This is all being driven by the daughter. The 2 sons (one is my DH) would have her in a NH in a hot minute if they didn't want to support YS in her choice to keep mom 'home'.
I wish I could tell you that you can simply move mom to a better place for her. Unless she is declared incompetent or a danger to herself or others, you can't do much.
If she falls and is injured, she will have to be hospitalized and that is the (seemingly) most common way people get their aging LO's into care. That's where we are now. Just waiting for the fall, or the stroke.
A person who becomes violent and uncooperative, that's kind of in your favor. It just makes the case for placement easier to make.
I'm SO SORRY you're going through this. It's awful. By the time my MIL departs this earth, there will not be one person left to mourn her. She's offended and hurt everyone in her pathway. Because everything is about HER and only HER. She's driven away any and all family & the few friends she had left.
WHEN should the kids have placed her?? Last year. They just...couldn't...and they (and the rest of us) are paying an enormous price for that lack of courage.
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