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Caring for my sister-in-law 53 has breast cancer psoriatic arthritis end stage liver failure. Worried about how it will affect my kids (college students) and her brother ( my husband) and my mom who lives with us. She's been on since the new year. We've been caring for her for 3 years but now she's suffering psychosis on top of everything so it's constant watching her. She keeps waking in the middle of the night trying to do things...nobody can sleep

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NOBODY, including Doctors have seen anything like her before. They gave her 6 months to live 3 1/2 years ago. Literally this past Christmas eve, she was very near death....dr. Told me to make calls to family. She was put under to get an MRI and put on a ventilator and she became reliant, her blood pressure was dropping, they had to artificially keep it up......Today she's dressed herself in a bright coral short-shorts terry romper and wants to go outside! Granted we live in California lol, but it's a little cold for that. She's 53 but looks 83. :(. She has to be watched constantly. Plus she's got these two little dogs who drive me nuts, I'm not a dog person and have never had dogs in my house before. I've finally put down the law the dogs can be outside or in her room with her period, and if she wants them in the room they can't be coming in and out all day...before it was every 5 min, I want the dogs in, I want the dogs out...now I say if you want the dogs in its for 3 hours so think about if you want the dogs in because you have to hang out in your room with them....haha that seemed to work. When she doesn't have ammonia level problems, she seems pretty lucid, she's gotten stubborn and manulipitive just recently. She actually told me she was going to act just like her mother did and scream and cry to get what she wants....I told her she is not MY mother so don't even go there. I'm so glad I have my mom, she's strict when I'm too easy....my mom is older (by 10 years) and isn't about to put up with nonsense, she didn't with us kids and didn't when my grandma got sick and she's not about to now....she's nice about it, but firm. Now SIL is sticking her tounge out at my mom when she's not looking heehee. It's a roller coaster....it was bad when she (SIL) was all there, but we did all the er and dr. Together, now she's altered its like a belegerant 3 year old..she keeps getting into stuff, making messes and gets angry when we stop her.
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This situation certainly would be very stressful on you and your family. It sounds like your SIL may not understand what's going on or how to control her behavior. I'm not sure what the answer is. You say Hospice workers say they've never seen anything like it before. I'm not sure I could handle that on a long term basis.
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You are a gem.
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Hospice is very helpful. Even they are surprised at the rate of her changes, she's comatose then highly active. Literally, they say they recognize the house and us, but not her! Until the las 8 mo. It has been realitivly easy to help, I mean it was a lot of ER visits and dr appt and keeping up on things with dr and specialists and handling all medications....actually hospice has eased all that. Now it's her trying to do things that can hurt her and being up all night and sometimes cussing at me and the psycosis. When I say over dependence, I mean she wants ME to get her soda or do little things when my mom or daughters are there, she wants ME to do all.
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I would hesitate to call it over dependence, but I know what you mean. SIL is terrified to be alone and needs you there every minute for reassurance. Impending death is a traumatic thing, and death in the home is not the norm here in North America any more. It sounds to me that everyone at your home is mature enough to make this journey but of course it will affect each of you. Does hospice provide someone to counsel you if you need it? When my brother was dying he chose to go to a hospice facility to spare his wife and young kids, that you can do this in your home is a wonderful thing. Do not hesitate to ask for more help if you need it. And remember this is about the quality of the time she has left, don't be too reluctant to help her with needed pain meds.
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Hansolos, it sounds like you are doing a wonderful thing for your SIL. Such kindness is rare. I know it will make such a huge difference in your SIL's last days and mean so much to your husband.

I'm not familiar with your type of situation, but, due to your concerns, I was wondering if you had looked into a Hospice Center. I have been seeing where they have locations where those with terminal illnesses can stay. They allow family input and interaction to any degree the family wishes. Some of them are called Life Centers.
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Hansolos, this hugely disruptive time for your family is coming to an end. SIL is dying. You feel you need to provide her care. As long as that is your decision, get through this as well as you can, leaning on the hospice staff for emotional support. I am sorry that SIL got dropped on you. Perhaps it would have been better back then to place her in a care center. But you can't turn the clock back three years. You made the best decision you could at the time. Now it will soon be over.

Hang in there!
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Hansolos Hospice means no more ER, no more 911, no more office visits. Hospice comes to you. BUT if you panic and say OMG we have to go to the ER, you have to steel yourself inside, because there are no more aggressive interventions. Sometimes you need anti-anxiety meds to do that.
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Omg, yes, over dependence. Now she wants me every moment. I'm 43 and went back to school a few years ago, I was a stay at home mom and waited years and years to go back to school and then my SIL got dropped on me after their mothers passing. Within a month it was constant er visits and dr apps and has grown progressively worse. I mean, she was just a normal sister in law, we weren't espically close, she moved to minasota for over 10 years, but for me family is family and she and my husband grew up close and I KNOW how I feel about MY brother.....lol, he's a little jerk sometimes but I'd give up a whole lot for him! My mom gets paid to help out (by IHHS)so I could continue to go to school, but I had to drop to part-time because all SIL needs. She is disrupting every facet of all our lives but if I put her in a home she will be restrained constantly and over medicated because they even do that in the hospital....with her liver you have to watch how she behaves and can't give pain meds on a schedule or she will go under. This new psycosis on top of the rest is just so difficult
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For me, it's the running every time my mother calls that disrupts the rest of my family life. Then my granddaughter's time with me is continually interrupted by her great-grandmother's needs. One thing is to play within sight of my mother, so she knows what we are doing and where we are. Another thing I did is to put a flag inside her bedroom door. When the flag says "OFF DUTY" that means she is only to call me in an emergency. I also installed an intercom so I can answer non-urgent needs, and let her know when I can get there.
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Hansolos, you are right about the ER visits doing more harm than good at this point. Even long before he went on hospice my husband's kind geriatrician tried to avoid having him come into the clinic more than absolutely necessary.

This transition from actively trying to "fix" everything that goes wrong with SIL and now switching to trying to maximize her comfort is appropriate as she nears death. You are doing the right things for her. It is an adjustment in how you look at things, but I suspect your entire family can make this adjustment. Hang in there!
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It's getting harder, and switching from all night ER visits to hospice is unnerving, yet I know she can't be cured, and everything at the hospital does more harm than good at this point. My mom helps with her too, so I can get sleep and take a breather...my moms in great health but I worry about the affects on her.
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How very sad. And how very wonderful what you are doing is!

I think you have enough on your mind just taking care of SIL. Your adult children, your husband, and your mother will have to be responsible for their own reactions.

Hospice can help you and your family as well as your SIL, if you want them to. The social worker and/or the chaplain could meet with all of you as a family and discuss their concerns and explain what to expect.
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