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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.

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See if Office of Aging will come in and evaluate her home. Maybe someone not related can get her to understand that she needs bars in the tub. Maybe even a shower chair with a handheld shower head.

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.
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MargieRKB Jul 2023
Explain.... HA! Sorry, that sounds a little rude to you, but explain to her is not doing any good. Great idea, but has no effect. She refuses to use the shower chair or lifeline alert. Will not consider a walk in tub, home health care, assisted living. Does not remember many things we tell her or else chooses to forget. She used to be TERRIFIED of breaking a hip (old nurse) but now never considers it. She also is used to ordering doctors around (old nurse), says they don't know what they are talking about. Getting her to understand is IMPOSSIBLE. We have tried reasoning until we are blue in the face (literally since we have to shout to be heard.) She does have the bars around the toilet and grab bars installed around any thresholds in her house. She can't move those once bolted into place. She has been removing the shower chair on her own. We cannot allow her to live with us. We don't have a ground floor bathroom or bedroom in our house and she can't do stairs. Plus, her personality would make our lives unpleasant. Both of us agree on that.
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Call 911 each time she is found unable to get up on her own. Do not help her up. Too many incidences and the system will determine her ability to care for herself and unable to live at home.

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.
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MargieRKB Jul 2023
This is our current plan. Has followup with her PCP tomorrow. Will suggest testing for UTI. (That could explain urine dribbling going on. She birthed one 4 pound baby, so her pelvic floor is in better shape than most older women) Have note for PCP documenting all concerns.
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YOU step back.

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.
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MargieRKB Jul 2023
We called 911 after last fall. They discharged her. Almost did so BEFORE determining if she was able to walk. I had to tell them they needed to check that before discharge.
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Did I add she has moderate dementia? Does not remember recent events. Has no reasoning ability.
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I’m so sorry Margie that you are walking thru this with your MIL. Any and all of the situations that you have mentioned are strong indications that she shouldn’t be living alone. And then the dementia on top of that…it’s definitely thought to watch. Especially when they are stubborn. My MIL is a retired nurse as well (and not a good patient) so I understand a little bit. Prayers for you as you navigate her illness and her needs.
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CaringinVA Jul 2023
*tough to watch
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Her front-line caregivers (you and your husband) decide when it's time to withdraw hands-on care and rescuing responses.

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.
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Back away, stop being her crutch. When she falls again have her call 911 and be taken to the hospital. When it is time for her to be released be clear that you can no longer care for her, believe me they will find a place for her.

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!
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MargieRKB Jul 2023
One little problem to this. She can't reach the phone and probably would not think to call for help. Also, falling tends to really disorient her. That is why we have security cameras. We can help her to some degree as we live only 3 miles from her and I beat the squad to her house last time. We can manage housekeeping, laundry, food prep, yard work, calling in the plumber or repair person, taking her to appointments, even bathing if she would let us, but she is approaching the place where she needs something more than being checked on every few hours if the current tend continues very much further. If the microwave incident is indicative of a bigger issue, she needs her prepared meals placed in front of her or her taken to the dining room. The last two falls indicate she needs someone who would notice that she fell and can't get up. I think her legs are getting weak.
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Sounds like you are not getting far with MIL using common sense.

Has MIL explained her reasons to refuse help? If not, ask. It may (or not) uncover some barriers...?

My LO was worried about the money firstly, but also had pride & privacy concerns. MUCH anxiety about losing control plus fear of change.

A false belief is often 'If I refuse help = I am still independant'.

The first big step down from 'independant adult' to 'semi-independant elder' is a doozy.

It sometimes can take a big shock, illness or event to accept. Some never do & fight on til the end.
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MargieRKB Jul 2023
She is fiercely independent. Or was. And wants to rely on family only. Because that's the way it was done in "her day." Family took care of her grandmother. Her own parents had to be placed and she was the one who did it. She would not move in with them, which is what they wanted. And she hated how they bucked her and would not accept outside help. "They won't accept anything I set up to help them. I won't be that way when I am old." she would say. NOPE, she's WORSE!!

Her answer as to why she refuses "That's not my way. I am doing this MY WAY."
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I was in this situation with my mother .
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 .
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Beatty Aug 2023
I was in this situation too. Falls, precarious at home alone. Did have some home help but resisted more.

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.
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Ah, MIL was a nurse? so she's probably seen what some people went through.
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MargieRKB Jul 2023
A discharge planning nurse at one time.

What do you mean by "what some people went through?" Bad conditions in nursing homes or hospitals? Their illnesses? Assisted living was not a thing when she was working as a nurse. She has no concept of it. I once tried to explain it a few years ago and she thought it sounded good until asked if she wanted to move there.
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The police aren’t going to forcibly remove her and take her to a facility. But in situations like this where your LO just won’t accept help, sometimes you have to wait for an incident that triggers placement. A trip to the ER could do that. But if she is mentally competent, they will release her back to her home. It’s a tough situation but people have the right to determine their own fate, even if we think they are unsafe.
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If you have an hour or three, you can read my post "Dh finally has to step up'.

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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michelle7728 Jan 15, 2024
Midkid58: I'm so sorry your family is going through this....
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Her doctor's evaluation can also be used to decide if she is still capable of living alone. Call 911 for an evaluation every time she falls or blacks out, and keep a log. Clearly, she should have someone coming in regularly to check on her, if not 24/7 care. But it's very hard to force people who are living in their own homes to accept help in the home or to move to a senior facility. Make the house as safe as you can, and see if she will wear a medical alert necklace or bracelet to call for help if she falls. Get her a walker and see if she will accept physical and occupational therapy to strengthen her muscles to try to prevent falls. At some point, you may have to apply for guardianship, if she is uncooperative. Good luck!
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Hi. I have no answer for you, but I like your question, because I am in the same boat with my aunt. She thinks she's independent, and refuses help. We do have a caregiver, but not sure how long that will last. She will need AL soon. When I have visited her, she wouldn't let me help her. It's frustrating dealing with someone who is in serious denial. She, like your MIL is relying on family, but I can only do so much living far, and especially when she does what she wants, and not what's best for her.
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IMO, if your LO needs 24/7 home care, then they should not be at home. We tried that for 2 years, and it was a non-stop hassle. People constantly cancelling and having to find last minute replacements. And just try to find people to come in on the holidays. Plus home care is much more expensive than a facility.
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Find an attorney experienced with the guardianship process and ask for his recommendations. It may be cheaper to involve APS.

Once you have guardianship you can pick the facility that meets her needs and (if necessary) forcibly move her there. Once I had guardianship, my father was persuaded to travel to the memory care with a combination of negotiation (I swear I will visit at least weekly and do everythinh I can to make you comfortable) and appealing to his pride (do you want to be sedated and carried out of here on a stretcher or do you want to walk into the MC?). It wasn't pleasant, but my father needed to be taken care of and my mother needed to stop trying to be his caregiver.

God bless you for standing by a difficult elder!
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Margie, I was re-reading & found your reply;

"She is fiercely independent. Or was. And wants to rely on family only."

That's it there.

"..fiercly independant" (fair enough!)

"Or was". Yes, YOU see that her independance level has changed. Does she know it too? Pride getting the better of her? Causing denial?
Or does she really NOT know? Those with cognitive decline often really don't.

"And wants to rely on family only."

This uncovers the faulty thinking.. Family doing things for me is the SAME as doing things myself.
even if family are doing all my ADLs with or for me = I am still independant.
WRONG!

While this realisatiton did not help my relative ever SEE this or change her attitude, it helped ME to understand the cause.
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The falls and her being unable to attend to her ADLs( activities of daily living) is enough to warrant help. She already qualifies as being not safe to live alone. You can google and find a list of activities she needs to do to live alone. The food situation is frightening.

Get her doctor involved and if she refuses then call APS ( adult protective services).
They will do an assessment and make recommendations and help get her placed.

Some people take the elders to an ER and then let the social worker help to place her. You will need to emphasize she cannot live alone.
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Grandma1954 8/9/23

Yup..it has reached a point where she is no longer safe to remain living alone.
What will happen is that she will fall and lay on the floor or ground for hours if not days. At that point she probably will not recover from that fall. (if she is found alive)
Whoever is her POA should begin making the decision and arrangements to place her in AL if not Memory Care.
If she is taken to the hospital for a fall you can tell the Social Worker at the hospital as well as any medical staff that "she is not safe at home alone"
At that point in order to discharge her there has to be a plan in place that will provide safe care for her.
The POA at any point when they feel she is not safe can place her. If no one is POA then someone will have to become her Guardian, if there is no one that wants that task then she may become a Ward of the State.

And there is a possibility that she thinks she is "independent" because of the help that she gets. if that help stops she may realize that she can not remain in her home without help.
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MargieRKB: Now is the time for managed care facility living for your MIL. The falls are indicative of requiring it as well as her mishandling food stuffs.
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Call APS - Adult Protective Services.

And where is her MD / medical provider in all this?
They need to step up to the plate.

This is unacceptable.

The other way to look at it. If she is medically evaluated to be of 'sound mind,' she will do what she wants and a situation will (most certainly) occur which will place her in a facility or require alternative care. She won't like it either way.

Medication may help with her fears and anxiety.

I would encourage you - as much as possible to not take this 'so' personally. It is a sad situation when a person doesn't want / get the care they need although often ultimately (or sometimes) it is up to them. . . until something happens.

Take care of yourself.

Gena / Touch Matters
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My mother had mid-stage dementia and refused to leave her house. We did a lot of things for her and had paid help but she wasn't safe at home (can't enumerate them all). We took her to a neurologist who said that she needed to move and that if we couldn't accomplish it he would get the County involved (get a court order). So we had to trick her into moving. We arranged for a friend to take her out to lunch and drop her off at assisted living. We were there to move her in. Of course she was furious and went downhill. At least she wouldn't be opening the door anymore to have her purse stolen or eating rotten food from the refrigerator. She lived there 15 months and died at 102.
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If she does stay in her home, consider getting a few Amazon Echo's or something like it. They can be set up where she can say "Alexa, call 911" and she will get help.

Personally, I would tell her time has run out and if you do not have a POA, get guardianship. She is not safe at home any longer. Her choice should be daily in home care or assisted living, period.

Best of luck to you.
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Seems you are dealing with agnosia - the inability to recognize one's own true self or health issues. She also appears to have diminished mental capacity to make safe and healthy decisions for herself.

Do you have a POA for finances and medical decisions for her? If not, please get those PRONTO since she may agree to getting those legal documents before she is totally mentally incompetent.

Usually, in health care (I am an RN), we look for ability to care for self, to make decisions and understand consequences of those decisions, to be safe, and to be healthy. Seems like your mom's abilities in all those areas are greatly diminished. Start keeping a log/journal of your "discoveries of her problems" with dates and times. She will probably never remember those incidents and deny them. However, photos with date/time stamps and a journal can help her medical doctor come to the determination of mental incompetency. Then, she will be forced to have others with her at all times.
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Mommas doctor told us and her that she could not live at home anymore after she fell in her house and suffered two hemotomos. She went from two weeks in ICU to rehab to assisted living. She wanted me to move to Alabama to live with her and take care of her. That would not have worked. I have a husband, a house and a life in Georgia and me and her would not make very good room mates. I do believe she is a narcistic rooted from her childhood. She did not go back home eventhough she wanted it and fought me tooth and nail. Told all kinds of stories about me to everybody. Not very nice stories either but assisted living was really the best place for her because I am her primary caregiver that lives out of state and she qualified for her long term care policy for assisted living. She is doing good in assisted living and turned 89 this past May.
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For momma after she fell and suffered two hemotomas the Dr told her she could not live alone. After she got out of rehab I made sure she moved into assisted living. She never went back home because I knew I wouldn't be able to get her out of her house. Got hell for that! Still getting hell and she has been living in assisted living for 5 years!
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Paramedics said when 3 falls happen in a week & they are called out to respond, a person can get admitted to ER under 'falls for investigation'. Then rehab for 'reconditioning'. Then home again IF safe, into respite or permanent care if not.
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I now see this is an old post, but I'll leave my comments here in case they can assist someone else:

You have cameras....from now on if she falls, call 911 and if she goes to the hospital, meet/beat them there and tell them she can't be released to go home as she can't care for herself. Keep repeating that until they listen and place her.

My dad (dementia & 86 years old) went through 95% of the things you mention, but he lived out in the middle of no-where, 3 1/2 hours away. Obviously I could not take him in, as one person (however well intentioned) can't handle taking care of someone with dementa and not have their own health crisis or a rocky marriage...(and I had a 45-50 hour a week job as well).

He had been paying a friend of his (younger guy, but still past retirement age) to take care of him, but it became too much for his friend (he counted 32 calls one afternoon), and there were NO options for local care.

Finally I told him there was no one left to take care of him, and he relented. It was definitely NOT an easy process. I told him he either came with me to a place I found for him and I and his little dog could visit, or the state would place him, and we would have no control over where he went, or what his situation would be.

There are no easy answers. To this day I wish I could have done more, but know I could not have. Countless hours were spent on the phone on his behalf (much when I should have been working...luckily they were understanding), or commuting 7 hours round trip to help him every couple of weeks, etc. Then the clean up began....that's another story.
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July question the OP never returned to the Forum to participate in further that I can find.
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