I am new to this site but have been impressed by the support offered. So, I am hoping you wonderful folks can give me your perspective.
I am the sole caregiver for my mother who is almost 93. We have home healthcare coming to the house due to recent bout of pneumonia and a hospital stay. She has been given exercises and is now on a standard walker (she used a rollator for years) and in a wheelchair as needed. Mom will show off when PT or OT are here and do everything fairly well.
Afterwards, she is extremely tired. However, when I am working with her she fights me over everything. I know this is a common problem/situation and have discussed it with her healthcare team. They acknowledge the problem but told me to keep after her or "she won't get stronger." I know they are correct but it is hard to be a "drill sergeant" (Mom's words).
I try to be gentle or cajoling or even silly but it doesn't work. She is sloppy with the exercises and incautious when walking or transferring. For example, when she is walking with me around the house she will have the walker in front of her so that her arms are totally extended and she will even push it away from her. So far I have been able to catch her before she falls. However, I live in fear due to safety concerns. She can't move around without assistance but my life would be easier if she followed my directions as well. She knows and acknowledges that my corrections are how she should be walking, exercising, or transferring but she continues with her methods.
So, I am wondering when do I acknowledge that it is time to stop trying to improve her mobility and simply be available for safety. I am tired of arguing with her everyday and several times each day. Yet, it would be nice if she could achieve a little independence; such as walking to the bedroom without me needing hands on. The therapists have told her this is possible if she does her 'homework.' Other than this, we rub along well together.
Please do not catch her. This could cause serious injury to you. Then what happens to both of you?
Does your mom have any executive function problems? If not, telling her that she WILL end up in a nursing home if you get injured or she becomes immobile might stop the fighting. If she has executive function problems you can't win here and have to decide what your boundaries are for what will inevitably happen.
I would argue with her regarding doing her exercises.. I became a nag .. lost the daughter in me..
I would encourage her, but let it go ..
So I can just imagine how I would feel at 93. I would be telling people to STOP IT and let me enjoy what I have left in the life.
Mom’s cognition level varies by day. Which requires me to vary my interactions. At this point her mental lapses are being attributed to “hospital dementia.” I have been told to be patient and boy is that hard.
My brother, who was diagnosed with probable early Lewy's after a car accident went to rehab for a month. There they had him up and around and exercising and his balance was so improved by their balance exercises. But would he do them at all when he went home? Nope. And in the end I think his refusal and his claims that I was managing his life too much was just as a result of all the losses one after another, and the fear of more losses of al control. He just needed to have SOME control of SOMEthing. And he wouldn't do them at all. I gave up. He was 85. I just simply gave up.
At some point there is not more you can do without changing your relationship more and more and more each day. You can sit with her and tell her that when she cannot be on her feet anymore you cannot keep her at home with you, nor afford 24/7 caregivers in the home (if this is true) and your wishes to make her walk aren't so much being a task master to her as it is to hope you can keep her on her feet so she can stay with you. Perhaps the fear of getting bed bound will motivate her, but this is so sub- conscious that I doubt it.
I wouldn't go there anymore. Or at least I would do it once a day matter of factly getting her up and moving, or I wouldn't bother. She's 93. You are heading toward the inevitability of the loss of mobility. It is hard to accept.
That's just my advice. Others might keep going for it, keep trying. And again, at some point, no matter what you do, the inevitable is right there with you. I sure do wish you luck and welcome you to Forum.
If mom is fully aware of what she is doing, what needs to be done then she is making a choice to be a bit lax with her PT
You can hire caregivers that can come in and help you and mom. You can instruct them to help mom with her PT. So you are not the "drill sergeant" it is someone else.
You can also tell mom that if she does not continue the PT and do what she needs to do then she will be in a wheelchair full time and that might make it more difficult to manage at home and you may have to look at AL facility where she will have help 24/7 especially if she needs help transferring. (She may be 1 fall away from AL or Skilled Nursing)
It would be a good idea if you could consider the options for the future, and what is affordable for her (NOT with your money- you need it for your own old age). You can find your way around options easily on this site. Click on Care Topics on the top right of the screen, then A for Assisted Living, N for Nursing Homes, M for Medicaid etc. Once you have a clearer picture of what the future might bring, you could consider visiting the real 'possibilities', and perhaps taking M with you. Facilities often offer lunch and a tour – you can ‘sell’ it as an interesting good-value lunch excursion which you have been told about.
As well as being a good idea for the future, it gives you something concrete to talk about with M. When you can’t do x, y or z, we will have think about moving you somewhere with around the clock care. It might motivate her to try harder with exercise, at least give her something to think about. Some waiting lists are long, and it’s worth putting her on the best one or two. You aren’t forced to take a place if it comes up sooner than you need it, so it’s a good idea even if it never happens.
Best wishes, Margaret
Pneumonia is serious in the elderly. They may be "out of it" for awhile.
If she does not have dementia then have a talk with her. Let her know that if she refuses to keep up on her physical therapy and refuses to use her walker correctly and pay some care to how she gets up and transfers, that will be on her. You will not be the one who will get injured by her sloppiness, she is. Let her know that if she continues to get weaker from lack of exercise, she will become immobile and will have to get around in a wheelchair. Let her know that you will not be able to take care of her in the home if she becomes wheelchair bound and bedridden. That will mean placement in a care facility.
Once we had caregivers and do to her lack of activity, she ended up in pain and in need of PT again, and one of their jobs was to do her exercises with her. Worked great! After my first bout of trying to help her, I was DONE. I would get worked up just thinking about doing it, expecting her to whine and complain.
I never had the talk with her in depth but would tell her that having her knees done kept her out of a nursing home because if she couldn't walk that's where she would be. There was no way I was caring for a wheelchair or bedridden mother in my home.
So, I would let her know the deal. If she becomes immobile due to not doing her exercises and staying active even when discharged from PT, she will be writing herself a ticket to a nursing home.
I explained to her that I (58 years old) with my bad back would not be able to lift/turn/move her if she became bed-ridden and would need to place her in a nursing home (her greatest fear), if she didn’t continue the PT exercises to keep her body strong and be able to be mobile. She uses a rollator walker now and has not been doing her exercises. She is completely exhausted after going to a doctor appointment (and she has many), and is currently on the fast track to becoming bed-ridden. I have stopped arguing with her, I did tell her that I was not going to push her to keep up the exercises and that this would be her decision as to whether or not she ended up in a nursing home sooner rather then later. It appears that is not a huge concern for her right now. It just makes me more bitter about having given up a rewarding career that I loved to take her into my home and care for her instead of putting her in a nursing home where she can be cared for.
I feel horrible that she has made this decision, whether she realizes it or not. Do not stress yourself out with this. My relationship with my mom is not the best and hasn’t been for years. I resent having to care for her for many reasons and hopefully you can avoid feeling the way that I do.
My best suggestion is to not argue with her, but you will also need to accept that she is making the choice to do nothing and must accept the consequences. Good luck to you!
The way I think of it is this. When we are young, we want to travel, go places, meet with friends, etc. Hence it is in our best interests to be without pain and to take the advice of others on how we can be healthier and live better.
However, when you get to 80s and 90s, you figure you could die any day, so unless you have something to live for, you are not going to work toward improving your health. Saying things like "your pain will go away" may or may not work because as a senior, if it isn't a pain here, there will be a pain somewhere else. She doesn't give a damn to "get stronger" until you show her why "getting stronger" will benefit her immediately.
At the age of 96, my mother didn't give a hoot about how she used her walker, how strong her leg muscles or abs were, etc. until she decided that we would go on a cruise. For 8 months, she ate healthier, did the exercises her PT gave her and took care how and when she walked. I swear she was the oldest person on that cruise ship who walked, with her walker, at the various ports in Greenland.
Once the cruise was over, she declared that was the last time she would ever travel as the plane rides were too difficult for her. Back home, she reverted back to not doing exercises, complaining about her aches, etc and of course, physically, she can no longer walk like she did in Greenland and needs 24 x 7 watch.
So regarding your question, I would back off. There are some of the exercises you need to do to maintain her ability to get out of bed, use the toilet, and walk around. You could turn the exercises into a game. Talk to the PT person to see what alternate exercises you could do that would strengthen the same muscles.
The other option would be to find a tangible goal that she is truly interested in and link the exercises to that goal.
I'm the exercise police. I told her that the day she is unable to walk from her wheelchair to the car, is the day we stop going out for drives.
So far, she is willing to keep up with some of her exercises. It turns out that the exercises also help her stay regular without meds/herbs and also help her circulation so that it isn't painful to sit, stand or walk.
It is tough getting old. It is a lot more work than I, as a child, ever realized.
At her age, I let her do whatever she wants, why not? She has lived a long life on her own terms, I think that she should continue to do so.
Your circumstance is a little different as it appears you live with her, my mother is in AL, I would never live with her or visa versa, definitely, not my thing. Florance Nightengale I am not.
Your mother will start falling at some point soon. It’s not an if any more. It will happen. It’s important she has a medical alert device so if she falls EMS will come. Get a lock box so that the keys are available so EMS can get in easily without destroying her front door.
Having a home health attendant for four hours a day is a good start for her to get used to having some help for her daily needs.
Try not to get too annoyed or frustrated. I know it’s hard. Good luck to you.
Life is worth living, but no one can tell when you get to age 80 or more; depended on strength and health.
Hopefully, I will have help to move me to assisted living or NH when I reach around ages 80 to 85 since I live alone without local relatives. My remote family has been very nice and told me to not worry about family coverage I will not run out of. My brother's extended step-family said they will step in when he and his spouse cannot help me anymore.
5 trips to the emergency room for severe dehydration, 2 by ambulance, still didn't convince her she needed to drink more. But when blood work showed she had suffered significant kidney damage from dehydration she got scared straight! And now she's used to being hydrated and enjoys all the benefits-fewer aches and pains. More clearheaded, better digestion.
Sometimes they just have to hit a real low to understand!
I read this article (linked below) on this site a while back, and I tend to read it over again, kind of like a reminder that we can’t fix old. It is good to acknowledge their old age, what they’ve accomplished and where they are in their own journey.
https://www.agingcare.com/articles/caregiver-fix-it-mentality-leads-to-burnout-152629.htm
Sometimes a parent is unable to tutor their own child for this same reason.
Can you bring in the therapists more often or hire a CNA to come do the exercises with her?
Stop watching her so closely and stop criticizing. She may be doing this to get a rise out of you or attention.
Don’t fight with her about this. She may grow bored with the game.
But I'm so far making it work, and have learned all sorts of things about caregiving, such as changing her diaper, moving her in her bed, moving her to wheelchair, etc. I have accepted that she is not going to be up and about walking and using the toilet again, and that's gone a long way to helping me be at peace with her situation and mine.
I now do everything I can just to make her safe, comfortable and happy and as healthy as possible. She still has a good appetite and even a cute sense of humor despite her dementia, and that is what keeps me close to her. She'll usually laugh at a simple joke or play on words, and loves to whistle and sing along with the music we always having playing for her.
If I'm having trouble with her--sometimes she gets combative and contrary such as when I'm changing her and want her to turn on her side, or when I'm trying to get her to help me transfer into her wheelchair--I find that if I look into her eyes and speak gently and lovingly it can change her channel and she will try to do what I need her to do. She really does respond to love and softness, rather than a controlling manner.
Of course I don't always succeed and sometimes I have to just leave her and both of us take a time out, and that works too. Sometimes.
Could you clarify "no-kay" for me though? Do you mean saying No to dangerous requests? Or as a concept of letting a situation go - instead of ok, let it go "no-kay"?
At 93, I vote on letting her do what she wants to do and pay someone to clean up her messes................that would lessen the need for the two of you to play, "Tug-o-War." Put your end of the rope down and plan a vacation.
* My heart goes out to you. These scenarios - all as different as the people in them - are not easy to manage or cope with, esp when it is a family member.
* Sounds to me that you ALWAYS need to put her safety first.
- If it were me, I might tell her "if you decide (let her feel she is in control, which she really is) to walk w/o the walker (or however you want to reflect what / how she is doing in an unsafe way), tell her you will need to hire a caregiver 24/7 to walk with her EVERY STEP she takes. She may not want this.
- However, you need to say this seriously and not as a fake threat otherwise, she'll continue on as she is. She'll test you.
* She seems to take a kind of pleasure in irritating you, like a 'child acting out.' This could certainly be underlying relationship issues between a mother and daughter, and/or she sees you as the primary 'police' / 'manager' (which you are) and she resists.
- She may realize that the rehab, etc., come 'now and then' and they will leave. You don't. So you are the target of her 'acting out,' if this is what she is doing.
* Unfortunately, unless someone is walking with her every step, she may fall. And that might be what needs to happen if she doesn't want to avoid falling. It sounds to me like she enjoys (or feels a kind of personal independence, which she enjoys) 'playing with you,' or 'aggravating you.'
Do you want to try a new strategy?
1) "If you want to walk alone and risk falling, that is unfortunate although it is your decision." If you do this, she may feel / see that there is no 'payoff' of you reacting. And, she might stop. And she might not, and fall.
2) Get a caregiver in there for one day on a 24/7 basis and be with her 100%. She may realize she doesn't want this and do what she can and needs to do which is proceed (walking) with caution, and doing her exercises.
DO REMEMBER: If she falls, it is NOT your fault. You do what you can and you make decisions based on her safety as best you can. That is all you can do.
REALIZE THAT ARGUING IS A NO 'WIN-WIN' so do not set yourself up to argue (usually answering her "I know what to do") Arguing is you biting the fishing bait, which is a no 'win' and sets up frustration esp for you and overall, for her too.
- You be clear in setting boundaries and follow-thru. Making empty threats will result in her continuing as she is doing. Say:
"if you do xxx again, I will need to get a caregiver to supervise (your every step) you day and night." Ask her: "Is this what you want?" She'll say no or make excuses...
- Her response: "I CAN do xxx by myself."
- Your response: It is not safe for you to do xxx alone. You may fall. No arguing, stating a fact. Guess I need to arrange for someone to come in 24/7 today since you do not want to xxx (use walker when walking and/or do exercise).
- When calm and she seems open and relaxed, talk to her, asking how / why she can do xxx with rehab (nurses, etc) there and not do xxx when they leave? What's up with that? (use your own words). Don't ask this in the middle of her walking without the walker.
- If she'll listen (caring how you feel) tell her: I am very concerned about you / your welfare and safety. I love you. What can I do to help you (giving her independence again)? See what she says. Sounds like a 'heart-to-heart' in this situation won't work, although it is worth a try or at least incorporate your caring in your conversation and decisions.
We do not know how an older person feels losing independence, mobility. It is likely frightening to her as well as frustrating. Remember how she feels - so (try to) proceed with compassion and calmness. Do not allow yourself to be pulled in emotionally which continues to drain you.
Touch Matters / Gena
For your own piece of mind, stop arguing. Try and keep her safe. Eventually, safety may also be something that becomes too difficult for you. Can you lift her in and out of shower/bed/toilet? If not, it may be time to consider a facility where she has 24/7 help. You then would be free to visit and spend quality time with her, rather than all your time arguing/being a drill sergeant.
Then you might have a very calm discussion with mom about the need to keep moving. It comes down to if she can keep moving and trying to get stronger, the current arrangement can be continued much longer. However, if she CHOOSES to refuse strengthening exercise, she will get weaker to the point you may not be able to care for her at home. You hope her goal is the same as yours, for her to stay where she is as long as possible. Say it and walk away so she can think about it a little on her own.
It' not easy, but keep in mind no matter how hard you try you can't prevent the inevitable... protecting her from herself. Do your best.....that is all that is required. Good luck.