My FiL is not Giving my MiL the Care She Deserves

concernedsoninlaw0

My wife's dad is one obstinate man to say the least. He's the full time caregiver for my wife's mom who has middle to late stage Alzheimer's (sorry, I'm not quite sure). My wife and I have tried to get him to accept in-home assistance to no avail. Recently, we've even offered ourselves to assist more, but he just can't let go.

It would be one thing if he was taking good care of her (and himself), but frankly, he's not. In a recent conversation he casually admitted to occasionally leaving her alone in a vehicle while he was otherwise occupied, maybe even in a store. He tried to brush it off like it's fine if he keeps her in sight, but this still doesn't seem at all acceptable to me. She's not a dog. I can't possibly be in the wrong here, right?

In another instance when I was staying at their house for a night I heard him yell and use threatening language towards her. I'm trying to understand how stressful it must be for him, but I couldn't imagine ever saying those things to his daughter. My brother-in-law has told me he's heard abusive language also.

My wife is aware of these things and has her own anecdotes. We just don't know what in the world we can do. Where do we draw the line? How can I possibly negotiate this to get my MiL the treatment she deserves?

Crushed

My father was probably the worst dementia caretaker that I ever saw.  My mother had vascular dementia.  He would leave her in the car while he went grocery shopping.  He was extremely self centered and the the world revolved around his needs.  He refused to accept that the dementia caused her sundowning outbursts and would call the kids to tell us we had to "talk sense" to mother.  

 Good luck

Ed1937

Welcome to the forum. I wonder if it would help if he were told that adult protective services had contacted you about the problem. You could say they wouldn't tell you who contacted them, but they were trying to find out what information you could provide. You might tell him you expect it was the doctor or something. Get the heat away from family members, if possible. It doesn't hurt to tell a little fib if it helps the situation.

dayn2nite2

How often are you taking care of her so he can get away for a few days?  Or are you taking care of her only a few hours at a time?  He needs you to take over at least weekly for a day or two or a meaningful amount of time weekly ( a whole day and ideally into the next day).  Can you do that or provide funds for that to be done?

Cynbar

You could try talking to your mother-in-law's doctor, who might be able to talk him into accepting some help.Actually "talking" isn't the right word because the doctor's office can't give you info due to HIPPA regulations. But they can listen and take in information. It's usually a good idea to send a letter or email outlining your concerns and what you would like to see them accept --- that way there is a written record and they can refer back to it. An involved doctor can sometimes arrange for services and explain dementia in a more effective way than family ever could.

Jeff86

What a terrible dilemma.  Thank you for being so concerned on behalf of your MIL.

The nuclear option is that you and your wife contact Adult Protective Services.  Both neglect and abuse are reasons to do so, and it sounds like both are happening.  

Before you consider doing so, one suggestion is to call the Alz Assn help line and speak with a care counselor to see what avenues they may see to address the situation.  They have seen and heard it all.

Good luck, and let us know how you make out.

LadyTexan

First of all, THANK YOU for being such a wonderful son n law and watching out for the people in your life.

My father is VERY obstinate as well. He cares for my mother with moderate dementia. He gets very frustrated with her. He is not unkind to her, but I see him creating some of his own challenges when he is not patient or tries to use logic to gain her compliance or to care for her.

Here is how I handled it:

1. I learned about the disease and caregiving. My intense studying was due to my husband's EOAD. 
   • I read books like the 36 Hour Day and Untangling Alzheimer's. 
   • I watched videos and attended conferences. 
   • I attended support groups, and 
   • I engaged with this forum which is where I get the BEST tried and true and actionable suggestions.
2. I became my dad's private support group, where he could unload his frustrations and talk about my mom's frustrating behaviors. I let him talk as much as he wanted, without judgment. I did not scold or preach. Then I would share the pearls of wisdom that I had learned in my experience and on this forum. For example: 
   • talk calmly and gently (as hard as it is). One is more likely to gain compliance and maintain harmony in a calm voice. 
   • Be aware that what is not dangerous to most of us, can be very dangerous to an impaired individual and that's why supervision is needed. Be sure to emphasize that if he puts his wife at risk, the authorities may get involved and that is a hassle. 
3. I was careful not to cram my knowledge down his throat all at once because I wanted him to see that we were in this together as a family. I am a resource, not a nagging daughter.
4. I shared with my dad some online videos about making the home safe and suitable for someone with dementia.
5. I still casually drop hints about things I think are will be helpful to him (out of her hearing range). For example, her brain in impaired. She's not doing this on purpose or to be difficult. She wants to please you but she is not sure how. Patience and acceptance are necessary.

Based on my father's upbringing, he is reluctant to take suggestions from his youngest daughter (me). Furthermore he is a professional engineer and not especially aware of the need for kindness and understanding when facing a problem. He is focused on an immediate permanent fix. Caregiving is so different, it requires many incremental adjustments and a human touch that does not come easily to many.

You have received great advice from the caregivers on this forum. If you have concerns that your MIL is in danger or being abused, PLEASE contact her doctor or a social worker. 

ElaineD

Dear concernedSIL,

Perhaps writing to your MIL's doctor would be the wisest approach.  I wouldn't expect anything to change, however, in your FIL behavior.

Ages ago I would have recommended contacting your MIL's clergy person to intervene, in the guise of a home visit.

I don't think Adult Protective Services would 'step in' at the level of abuse that you have observed.  And of course, if APS did step in, would they want your MIL out of that house?

What is a reasonable alternative living situation for your MIL?  A Memory Care facility, a Long Term Nursing facility, living with another family member?

Perhaps you could offer respite care for you FIL to provide an opportunity for your wife to talk with her father.  He may welcome some respite and an opportunity to 'vent'.  He may also need to consider the long term plans he has for his wife's treatment and care.  Or he may be so stressed he hasn't thought through implications for the future.

To be considered:

    1.  Outside help in caring for your MIL, to give some relief to your FIL.

    2.  Plans for future care of your MIL. (MC, Hospice, etc)

    3.  Financial planning for care of your MIL. 

My experience is that most people are anxious about having 'outsiders' observe closely what is going on in their very private lives.  This is a very sensitive issue.

Best wishes,

Elaine

Quilting brings calm

I would  agree with  involving your in-laws primary care doctor.  Believe me, they are used to concerns from family members.  If your wife is on the HIPPA forms and/or has medical power is attorney, she can have a discussion.  If not, then they can read what you email them or listen to a voicemail on the nurse line. 

Your FIL may be in denial.  He may be scared of the future.  May be too deep in the caregiving forest to see the trees. May be in over his head.  Or he may have physical or dementia issues himself.  We can all share stories about one of our parents not understanding the truth about the other parents’ prognosis. It’s especially hard for men of an age who were never expected to be  caregivers or ‘house husbands’.  For some, managing running the house is beyond them.  Managing a person is way out of their league.

If your FIL is computer savvy, get him a link to this forum.  Get him links to websites.  Dementia care central is a good one. They have good descriptions of the stages and average durations.  If he is ( or will consent to be) on Facebook - Dementia Through Daughters Eyes is a good private group,  not just for daughters or females either. 

If he is a reader, casually leave a copy of the 36 hour day somewhere at their place in the open. Maybe he will pick it up.

If you know anyone of his age  (that he also knows ) that is a caregiver for someone with dementia ask them to give your FIL a visit.  A natural discussion can then come into play about caregiving and things that work or don’t work, etc. 

Be prepared for this education  to take a while.  It’s taken my step father 18 months and several doctor visits to begin to acknowledge. that Mom isn’t faking it. He admits she has issues, but I don’t think he understands that this is permanent and progressive. 

star26

Leaving a PWD in a car while shopping is not always a terrible thing. Your FIL may be in the best position to know the risk involved. He may be correct that the risk of leaving her in the car while he runs into the store is small and is the best option in certain circumstances. And if he doesn't have any help, he has few options. Is there a specific reason you feel this is definitely unsafe for her?  

It's impossible for anyone to truly understand the stress involved in caring for a PWD without taking it on oneself. I was full of judgement and so sure of myself when I was a family member of a PWD but not the one that was doing the full time live in care. Once I became a full time caregiver myself years later, I realized how very ignorant I was. A caregiver losing his cool on occasion is not a reflection of the overall care, it's a reflection of the circumstances. He has a 24/7 job. He can never relax, let his guard down, or take a reliable break. Sometimes nothing is easy. That stress and fatigue builds up at times. Is she being fed? Given her medications? Being taken to her medical appointments? Clean and clothed? Is the house relatively safe? 

I recommend that you start bringing over meals on a regular basis. Plan regular visits and do some housekeeping while there. Plan visits where you take your MIL on an outing or to your house and then return her home later at a designated time. Don't ask, just tell your FIL and do it. Make it about you and your wife's desires, not about his need for help. After FIL gets used to this, and Covid fades more, you might research and visit some adult day care facilities. If you find one that may be appropriate, you can give the info to FIL as an option that's up to him. Same thing with professional help. Do the interviewing, find a person or agency, and present the info so it's there if and when he's ready. Meanwhile, continue providing regular help yourselves.

(IMO, contacting APS should be a last resort action used only in extreme circumstances. Nothing you've said here warrants APS. I think it would be inappropriate, ineffectual, and could cause long term relationship damage to contact them at this point or to even bring it up to your FIL. Likewise, pointing out that he's not doing a good enough job in your opinion or that your MIL is not receiving "the care she deserves" is likely to go over like a lead balloon.) 

If you and your wife put your efforts into creatively and gradually becoming more involved in your MILs care, I think you will both feel better and also be in a better position to help and fully assess the situation.

Ed1937

Star, it's good to see another perspective on different situations. I agree with much of what you said. If she is mid to late stage dementia, it seems (to us) that it might not be a good idea to leave her in the car while he is occupied. But you are right. He would have a better idea of what the risks are. 

And I also agree that calling APS should be a last resort action. Calling APS could lead to broken relationship with him that might not be repairable, at least not in the near future. But if it truly is needed, that's why it exists. Thanks for the post.