I've posted before about in-law care-giving. Aged mother in law, lives in same town.
We are at the tail end of a visit from sister in law from several states away. Sister in law has been here for 3 weeks caring for her mother. A much welcome respite.
It had been discussed, prior to her arrival here on the scene, she would be talking it over with her mother, to try and get her mom to come up to her home, for a stay of maybe a few months.
This, in my opinion, is absolutely essential, as I am expecting twin grand-children, due in about 1 month (if they don't come sooner, as is the case a lot of times with multiples pregnancies). The expectant mother also lives locally here, and has a 4 year old daughter. I will be on that front, helping .. as much as is needed. And not on the front with mother in law and care-giving, and have made that as obvious and apparent as I know how to make it. It would be great if mother in law would agree to go to her daughter's home (several states away) for a period of a few months .. and allow me the latitude to put my energies where I want them to be, on my daughter who will have had a c-section .. and my grand-daughter (4 years old) and new twin babies.
Nothing doing. Mother in law has dug in her heels, and will not hear of it, going to stay with her daughter for any period of time.
What are her reasons?
In mother in law's defense ... her daughter ... I don't even know how to describe it. I will say that when her daughter comes here to visit, she all but breathes for her mother and if she could find a way to do that, she'd do that too. She is the most nervous nelly, never sit down - ever ... worry wart, do everything, all the time .. person that I've ever encountered.
A great example, as I was taking her to the airport yesterday for her departure, . I reached into the fridge to grab myself a bottled water and shut the fridge and turned to walk away, as I've done for all of my 50 plus years living on this earth .. and she said to me, "Oh make sure that fridge shut". WTH???? Like I don't know how to shut a fridge? That's just a small, very small slice of what she is ... how she is.
She is so very hyper-vigilant, seeing to every minute details down to it's finest most minuscule point, fine tooth comb, questioning every point along the way, "should we do thus and so, but maybe if we do thus and so, then such and such will happen, maybe we should do it thus and so .. but then so and so might happen, maybe we shouldn't do thus and so, but do "x" "y" and "z" instead, but if we don't do it that way then ..........", on and on and on and on it goes. And usually in hyper warp speed, as to every single friggin thing.
If her mother moans .. "what's wrong mother?, why did you moan, are you alright?".
Mother: "Yes, I'm fine, I was just sighing out loud".
Sister: "Why did you sigh? Are you hurting, are you sure you're alright, why are you sighing what's the matter?"
Mother: "For God's sake __________________, I was just sighing, .. calm down, I'm fine".
Sister: "Are you sure, .. because if something is wrong you need to tell me".
Mother: "Everything is fine, I'm fine".
Sister: "Are you sure, we did a lot yesterday, did we do too much, maybe we shouldn't of gone to two doctors in one day .. was that too much for you, are you too tired now, maybe we need to move those other doctor appointments so we won't have two in one day, is that too much for you, for one day .. is that why you were sighing .. what's wrong, are you sure you're alright".
Hopefully that kinda gives a little bit of a snapshot of what goes on when sister is in the ring directing things.
So in mother in law's defense.. I do get it, why she wouldn't be chomping at the bit to go to her daughter's home.
BUT ....
The only experience she has with her daughter, in the last years as mother in law has aged and been unable to go anywhere much, has been the daughter coming here, periodically, for periods of about 3 weeks at a stretch. When her daughter comes here, she moves heaven and earth for her mother and then some, and doesn't sit down, doesn't stop .. the WHOLE ENTIRE TIME.
Is there a possibility maybe (as I said to mother in law, when she expressed that isn't happening - talking to me - her going to her daughters .. ever) .. could it be possible that maybe if you would go to where she lives .. she'd be more busy managing her own life in that setting than your's and she would get out of your backside .. and not be as hyper-drive-vigilant as you experience in her, when she's here, could that be possible.
The daughter is retired, lives several states away. Does come here, generally, every few months .. and stays for a period of about 3 weeks at a stretch. I wish I could make a list of everything the daughter did when here this last time, but it would take up the whole character allotment:
We don't know if MIL would remember not to eat the cake, since SIL probably swooped in before MIL had a chance to process what was in the cake. As far as the meds, the only time I ever needed to advocate for meds with all of the many family hospital stays, were my FIL's pain pills because it was listed as PRN. By the time he asked for them, the pain was rolling in, so I requested that they ask him about his pain level when they were checking on him thru the day. The nurses were usually on top of the med passes at the right times. Staff will try to get her to back off, but she won't hear what they tell her.
At least SIL didn't pull up a cot and settle in for the night. She went home and hopefully slept some.
Is SIL really so out of the loop that she could even THINK that this rehab place isn't going to be on top of MIL's meds? That's one of the main things they DO.
She checked her into the facility at the WORST POSSIBLE TIME OF DAY. So she needs to not let that color her image of the whole place. MIL's lack of cognition at this point is so bad, you can't rely on her memory or ANY comments she makes about this place, you already know she's going to hate it. Best thing that could happen is SIL's vertigo comes back and doesn't abate and she CAN'T get to the rehab place and MIL is going to have to learn to truly "manage".
This is going to be a real hard learning curve for SIL-- as she comes to realize that (gasp) there are OTHER PEOPLE IN THE WORLD WHO NEED CARE!!!
I can envision her haranguing the staff about rehab and they haven't gotten MIL checked into the system yet. She better watch it or she's going to make enemies at the rehab place--not that that would affect their care of MIL, but they can actually ban SIL from visiting if the Drs and staff feel she is endangering MIL's safety--mental and physical.
Does SIL plan to spend every day and night with MIL? For, like, ever?
Yes, MIL needs an advocate, but it should not be SIL, Maybe DH can stand up for that. He's not nearly so invested and could handle this w/o drama.
I imagine she was simply bringing to the rehab place PJ's, undies, some personal grooming stuff. I hope that's all. Mother wound up with half her bedroom in her rehab place, bit by bit it migrated to her.
I can SIL "letting" MIL stay there for a day or two--she'll find something lacking and pull her out and bring her back home and then in a few days we'll have another UTI and....well, this is the merry go round SIL just cannot seem to exit.
I have little to no faith that she'd going to allow MIL to stay ANYWHERE for long and she'll NEVER accept placement in a NH.
I think SIL Has some serious cognitive dissonance herself. I've never seen ANYONE in my life fuss another person the way SIL coddles MIL. It's so very, very sick.
Glad you are out of it.
Its a lot to process. For anyone. Yes, it’s helpful if people have an advocate. They are in the facility because they are sick or injured, they are not 100%. Everything is strange. My parents, without dementia, both experienced being given or almost given incorrect meds. Much worse in the rehab.
Hospitals today are constantly checking meds against wrist band ids to make sure they are giving the correct med to the correct patient. I see less of that careful checking in rehabs. Plus food trays are often confused. Orders get switched. Just being in a hospital or rehab or even in public venues increase the opportunity for any of us to be poisoned or exposed to negligence or disease. So, yes. It’s good to have someone with a vulnerable elder especially on the first day of a hospitalization or rehab just to make sure the meds are on hand (some facilities don’t order until the patient actually arrives) and to make sure the diet is understood and noted. My mom wound up back in ICU due to her diet in a rehab. Her pain meds weren’t on hand for hours. I finally went home and got them for her.
The staff can not be trusted to know everything that is important. Not in my experience.
Not everyone has the luxury of a daughter who understands her mom’s meds and diet. Most make it fine, many don’t.
I saw situations where if the medication nurse would have just had her readers on she would not have made mistakes when dispensing meds. The head nurse came in once to give an insulin shot to my mother WHO WAS NOT DIABETIC. Another time she was walking around with an open depository that she said she was on her way to give my mother. I was leaving for the evening and just happened to pass her in the hall. I told her that she should check her records. It wasn’t for my mom. Sure enough. She had patients mixed up again.
I totally believe in rehab. I think the therapy can be life changing but it’s not without risk. And of course, SIL needs this time to rest and regain her strength.
Many don’t do therapy over the weekend but some do have therapy one day of the weekend. Hopefully everyone will feel better by Monday.
What do I know? Maybe they don't.
She has a private room. I don't know if SIL intends to camp out there. DH urged she not do so. We'll see.
For right now she's sick (sure don't need MIL to catch it). So she's staying away for today anyway.
Said they are to shower her tomorrow and wash her hair so she's going to roll her hair.
I think she needs to stay away and not risk getting MIL sick.
But, I stay out of it.
lol. I just realized that I created a new term for suppository. Sorry.
We assumed that Medicare would pay.
The story ..
It sounds like MIL was cold! SIL can't talk .. she has no voice, other than a whisper.
I'm not sure why she didn't prompt her husband who is right there, to do it .. but I know .. he with his issues .. I guess one has to tell him step for step what they want done .. and maybe it was easier, in SIL's view, to reach out via text, to DD.
That the nurses need to be called. MIL is cold .. she would like extra blankets. She wasn't given any blankets and she's cold, could they bring her more blankets.
DD was on her way over here, .. and called to let me know that she'd been detained, . not here yet .. dealing with the above, on SIL's behalf. I asked DD, .. "does she have a nurse button she can use . do you know?". DD didn't know . she only knew that she did call and get the nurses' station and asked that they bring her extra blankets . maybe turn up her thermostat . .she's cold. The nurse said she was right across from her room, at that moment and would do it. No problem.
I guess that then brought forth some dialogue between SIL and DD .. and DD now being directed upon her visit there tomorrow, which she told SIL she'd be doing .. would she talk to the doctor about ____________ and if she could, check with the nurse on ___________ and maybe if you could take her something of her favorites to eat .. maybe she'd like that, she's not eating .. maybe if you could check on ______ and _____, maybe if you could wheel her in the wheelchair outside, she might like that.
DD sharing this with me. I said to DD .. "well there ya go Dorker Jr. .. go girl!, now you can take direction".
DD's response: "yea I don't have a problem ignoring her .. I'm going to see granny tomorrow and we're gonna do what granny wants . that's what we're gonna do, I asked granny if she wanted me to bring her some chicken salad and she said no . that she doesn't have any appetite, .. I'd of gotten her some, but doesn't sound like she wants it . but whatever .. I'll just go visit her and hang out a bit . and roll her hair for her, so SIL won't go there and get her sick".
So then .. nothing more on the MIL front. It was the DD and kids show here for a while, then they left. I needed her to help me move a huge piece of furniture, so I could get to the electric outlet behind it . and she did that.
They left.
That's when I noticed an email from SIL to me, . had come in .. I guess . while I was busy with the DD and kids show here. Read the email, .. "poor mom .. she sounds so down and forlorn .. she's lonely .. if you can call her, her number is _____".
I did that. I called her ..
OY VEY.
She has no appetite .. I knew that .. but assured her .. likely those anitbiotics you're on . maybe those are messing with your appetite .. are you drinking though, that's important . are you drinking?". She said she is (I don't know if she is or isn't). Asked her how she likes it there. SIGH. I think .. suspect .. a pity party of sorts ongoing.
Her responses: "oh it's so cold here, . you know DD called them before for me .. and asked them to bring me some blankets . and they did .. they came in with a stack of blankets if you want to call them that, one of them looks like a bedspread . but I can't get covered up .. you know, I'm tall .. if I get it on me . on my body on my chest . then my feet are out from under the covers and I can't bend down to get my feet covered up .. It's so cold in here .. I haven't done a thing all day .. (she goes on later to tell me that a nurse came and took her for a little walk in the hallway and I happen to know that PT was by to do an eval . but okay .. you haven't done a thing all day. She goes on from that to tell me that she's been
Working to move a chair over from by the A/C .. that she can only do a little at the time .. and that she's struggled so with the covers that she gave up .. and that she has tried to move that chair . away from by the A/C .. and that she just can't seem to get it moved.
Me: "Do you have a nurse button? Can you call them . I mean .. they can adjust the thermostat in there, or tell you/show you how to do it .. they can help with moving that chair .. or your blankets, have you called them".
MIL: W-E-L-L .. I'll just work a little at the time on it .. I probably should do that .. but It's just so cold here .. ".
Me: "Well when I hang up from you I'll see if I can get one of the nurses at the nurse station . but why don't you . while I'm on the phone with you, go ahead and use that nurse button .. and call them . I'll hang on . .go ahead and see if you can do that".
MIL: "Oh well .. I need to do that .. you know I just haven't done a thing today .. it's just . nothing going on here, . I can hear them all laughing and whooping it up out in the hallway ..
Me: Well that's good then you know they're there .. better than dead silence . go ahead and see if you can use that nurse button while I'm on the phone .. can you do that".
MIL: "No . well I uh .. I will work on it some here and see if I can't get the chair moved . a little at the time . you know I can't do a whole lot at this point.
SIGH
With that, . we just went on talking . and I shared with her some funny stories from working with the nurses yesterday at the wellness clinic .. and she seemed to enjoy hearing some of that. And .. we talked about DD's visit for tomorrow . and she lamented that she isn't eating .. has no appetite .. she lamented that she'll do a little at the time .. that it's so cold there, etc.
With that, we pretty much ended the phone call . . and I did call the nurse's station . and asked .. "sounds like she's still cold .. I know my daughter . her g'daughter .. she called you guys earlier for some extra blankets and you guys were kind enough to get her some blankets . but sounds like she's unable to cover up with them .. can't bend over and get her feet covered up .. and so forth .. and it's so cold in there, . and sounds like she's trying to move a chair or something ..???... something to do with moving it away from the A/C .. and I wondered if you guys could maybe take a look at her thermostat or whatever .. maybe help her with the blankets.
Nurse Bethany: "Is there a reason that she isn't calling us . we're right across the hall . she has a nurse button . is she oriented .. I see her in the chart that she is completely oriented and doesn't suffer any forgetfulness or anything is that the case".
Me: "Well . I might give a little different picture of that than what you have".
Bethany: "Well .. we can only go on what we're told when they are admitted and it says here that she doesn't suffer from any dementia or anything .. I just am wondering why it is that you guys are having to call . and not her".
Me: "Well I have tried to encourage her to call on her own .. using that nurse button . but she seems maybe confused about how to do that .. and I know that her daughter showed her how to use it .. but .. it's MO that you can show her . but she'll forget how to do it.
Bethany: "Does she suffer from confusion .. ??.....".
Me: "Yes .. she does .. not sure where that assessment states that she is oriented . she isn't .. she doesn't take her meds unless they are handed to her, . she doesn't really even know what day of the week it is . or what year . that kinda thing .. ".
Bethany: "Does she know who she is .. why she's here?".
Me: "yes .. she could answer those questions".
Bethany: "okay so it's her short term memory then?".
Me: "yes I'd say so .. I think she'd benefit from a look at that .. maybe an assessment".
Bethany: "So you want a psych consult for a cognitive assessment".
Me: "YES . if they can do so"
Bethany: "well yes .. I mean .. that's a great tool at least to look at whether there are some deficits .. and so .. we may need to get that ordered .. she should be able to let us know if she needs anything .. we have her placed here based on her ability to do that .. so we'll need to look at that".
With that I thanked her . and she assured she'd go by in a bit when she does her meds dispensing here in a few, to the patients in her charge . and make sure she's comfortable.
Oh boy here we go.
So I then called to let SIL know that I had called her . and what all had transpired . .and SIL .. said thru her husband who can hear her . I was talking to him, not her (she can only whisper and it hurts her to do so) . she said the following:
"I showed her 3 x's last night before I left there, how to use that nurse button .. and had her do it . to make sure she could . I don't know why she's not using it .. "
Her husband chimed in .. "I think she's just not gonna get the attention there that she gets here at home .. with SIL .. doting on her, I don't think Rehabs are staffed like a hospital .. they just aren't gonna be as attentive there".
Me: "Well . I'm gonna go on the assumption if she was well enough to bounce her outta the hospital and into rehab .. then .. the deduction there is that she's functional enough to be able to help herself to some degree .. to push a nurse button to ask for help . if she can't do that . then we have a whole set of other problems".
And with that, that pretty much summed it up.
DH had come in while I had MIL on speaker phone and he asked her .. loudly so she could hear him . "how do you like it there mom?". Her answer to him . "Well I haven't seen a soul all day .. it's just kinda boring here".
She's having a pity party . and .. at least for now, SIL is too ill herself to be plied into it all.
She'd told DH . "I just would rather be home, that's all . it's not home".
She's starting it ..
She also complained .. she fears . they will try to force feed her. She isn't eating . and she said the gal had come in and said to her, "I see you didn't eat your food again" . and that the gal had then gone about cutting it all up small .. (??) .. and that she put it all in a styrofoam cup .. and tried to feed her .. and she just didn't want it. Said that it still sits there . in that cup .. she went into the fear that she thinks eventually they will try to force feed her ..
I didn't answer to that .. I just changed the subject. Surely they won't try to do that .. but I don't know what that was all about ..
She also said to me . that she thinks these people here get irritated with you ... and maybe just aren't as nice.
Yep .. it's starting.
(Been there.)
What worked for me a bit to turn it around was to say that they won't think you are ready to leave if they don't see you getting stronger and better, which means trying to eat, drink, and working with them on the p/t. It is up to you to show some effort, mom!
That helped - they are like toddlers, and sadly respond to being treated like a toddler... Mom would say "I forced myself to eat today, even though I have no appetite! (all defiant, like - "that'll show 'em!")
BTW - first rehab, after hip surgery 10 years ago, Medicare did provide transport to the rehab. Second rehab - due to general failure and frailty issues, no. My mom's non-compliance with the lasix-water-bathroom issue had caused water retention that would obviously accelerate, even cause dementia symptoms. (She hated getting up to go to the bathroom so much, that she didn't drink enough water, and skipped the lasix, etc.) The hospital would admit her (sounding just like MIL's episode) and iv in the proper amount of lasix, and she would lay there peeing and peeing and peeing to drain the excess water. (again - like you described MIL) and then she would start to feel and think better again. Made me wonder if MIL had some water build-up too?
I think she likely has no appetite .. because the antibiotics are causing her to feel icky. But I don't know that for sure.
I know she always complains that she has no appetite. But I'm here to tell ya .. if we fix a steak dinner and take one to her . she can polish it off . .she eats it. If I fix a casserole of some sort and haul some to her, she eats it.
I don't think she is eating presently . but I think that is due to the antibiotics .. maybe . .for all I know.
I don't know if there was any edema ongoing as of the latest calamity. I know her dx was UTI and a flare up of the Diverticulitis.
On another interesting note that I forgot to mention . having to do with this outpatient for observation label that so often gets slapped on a hospital stay (didn't this time . for MIL, finally .. she finally got inpatient as her label . this time). But .. SIL telling me her conversation with the intake person or whatever there .. that it was said to her, .. "you know . even a broken pelvis .. doesn't qualify as inpatient".
I found that absolutely HORRIBLE. That an elderly could be suffering from maybe a fall, and broke their pelvis .. and they'd be bounced outta there . and no rehab to be had . because they were "outpatient" classified.
Is MIL cleared to get out of bed on her own to use the bathroom, or does she need to ring for help? If she's not comprehending the call button, or is disinclined to use it " because they're all whooping it up out there", that will be problematic.
About the "force feeding" thing...I've mentioned before that I think somewhere in the past, MIL must have heard stories about someone in an institution which has colored her ideas about what rehab or ALs are like. I think it might be worthwhile when she says something like that about force feeding to challenge her with "why ever would you think that?"
You want to challenge her incorrect interpretations and get her fears out on the table if you can.
I don't know the answer as to whether she is to be assisted when out of bed. I asked her when I was on the phone last night talking to her, do they still have her on a bed alarm and she has to call them if she needs to get up.
Hwe answer to me, no there's no bed alarm and they want me to call them if I need to get up but I haven't done that.
She then went on to explain that she's trying to move that chair and that she had, earlier, stood there and struggled to get the blinds adjusted and trying not to fall.
All of this then prompting my dialogue to try to figure out why she won't use the nurse button.
Still don't know why. I assume, she maybe doesn't know how, even though SIL says she showed her 3 x's and even had her demonstrate that she can do it. I'm sure staff have gone over how to do that.
So ... not real sure why that's a struggle.
Coming soon.....broken hip.
I just kind of assumed .... lack of bed alarm, PT eval has been done. Obviously they think her able to ambulate on her own.
When I asked her and she said "oh they want me to call them if I need to get up but I'm just getting up on my own and going to the bathroom and ......."
As she then told me about struggling to adjust the blinds, move the chair, etc.
They must not be real concerned or they'd have that dreaded bed alarm in place.
They've asked her to call when she needs to get out of bed.
Bed alarms are considered a restraint and have to be medically justified.
Someone should tell them that she's moving furniture on her own.
assessment ordered- or a close to it as it’s ever been. Hell just might be close to freezing over!
THANK YOU, Dorker!!!
i almost blew a blood vessel in my head reading the recounting of your conversation with Nurse Betty. Cause we all know - while sil will admit to you she had to show mil THREE TIMES how to press the red button with the drawing of a nurse on it - she sure as heck didn’t let on to the THE PROFESSIONALS - the ones who are there to MAKE Mil BETTER- or at least chart that path - that mil gets confused and is forgetful- regularly.
Heavens no!!! It’s just a little UTI, right?
Sils attitude towards admitting to anyone outside The Circle of Trust- that MILs exhibiting signs of dementia makes me nuts. I mean, she can even put lipstick on it and call it “cognitive impairment”. Its like sil would rather say mil is a card carrying Klansmen...
Barb is right - where do these people get their ideas regarding old age?
Her over riding concern at that point, in convo with me, then seemed to dial down to why is it we are all calling as to MIL need/want. Why isn't she calling.
Iindeed!
Maybe she isn't as "oriented" as has been reported.
Which I also weighed in on, in convo with the nurse.
When it is explained to her and demonstrated to her, she understands it perfectly well and agrees to comply.
When she is alone in the room and thinks she would like to get up and move around, the entire call button concept does not enter her head. It is a non-starter, quite literally.
I would have saved myself months of heartache and apoplexy if I had understood this when I needed to.
If the current falls prevention strategy relies on the use of the call button, they need a different strategy, or they need to accept the falls risk. Either approach is reasonable, bearing in mind that no strategy will prevent all falls.
We all know .. they could find in MIL severity that warrants all kinds of red flags as to any cognitive abilities and report same to SIL.
Her response will STILL fall under the heading of: "well she was out of her familiar surroundings and disoriented and confused and doesn't feel good ... they shouldn't test people in those settings .. "
Been said before at assessment/screening and cognitive impairment noted.
Not a doubt in my mind that's how it'll go.
Ccertainly her choice if she wishes to live her life .. to the beat of a drum of a mom so compromised that she is definitely mobility compromised but worse .. also so compromised mentally that one has to be her brain also for her.
There is very good reason I exited the whole circus.
Look, my mom fell with 2 aides and an alarmed bed. Falls will happen, but SIL is playing with fire when she represents her mom as cognitively okay and compliant when she's not.
And yes I would press the facility to do their own assessment of MIL's abilities and not rely on what they've been told.
Just expect a blow up from SIL and maybe DH. But you're strong. It's the right thing to do.