need advice on longterm care for my mother in law

Shannond

My mother in law just recently went into the hospital in Oct for high blood sugar and a UTI, she was exhibiting dementia like symptoms with that, however when that cleared up,  she still had those symptoms, hallucinations, illusions, paranoia.  I was hoping that would clear up but here we are in Dec and she is still having those issues.   I had put her in skilled nursing for a while, but she is not getting any better.  Some days, she says she is not a diabetic any longer and does not need her insulin, then other days, says that they are not giving it to her.   Some days, she says that they took her out of the facility to go shopping or her dog is on her lap,  her dog is living with me at my home with my husband.  Every time I see her she wants to go home, or that she is in her new apartment where she is at.  She lived in an independent apartment community up until now and had a caregiver come in 30 hours a week.  She also cannot bathe herself by herself and will not eat and only drinks soda and eats candy and pb and j sandwiches, not good for a diabetic.  I just dont think she can care for herself any longer. Its not safe for her without someone there with her 24/7.  She does not understand that.  According to her, its all of my fault that she is in there.  I was told for years that i was her MPOA, but I do not have proof of it so my husband and his brother and I make the decisions on her care.  I am just so frustrated and stressed and I am hoping I am doing the right thing with keeping her in the skilled nursing.   Any advice would be much appreciated since I am new at all of this and my husband and brother in law are no help emotionally on their mothers well being.

King Boo

When the going got rough, I would 'chant' to myself two very important 'mantras' learned along the way:

1. Care needs drive the decision making.

       This lets us step out of our emotional upset temporarily, away from family dynamics, guilt trips, etc, and do clinical decision making.

What you describe (bathing, lack of medication, proper eating, no insight, no judgement) is not a situation where she can live in Independent Living or Assisted Living.  She is Memory Care or Skilled Nursing level.  Period.  Even if your husband and sibs cannot see that.  Denial, irrational thinking fueled by emotions hits the adult children harder than an in law.  This is your great strength.  Point this out to hubby.

Efforts to get MIL to understand-counterproductive, it's about saying what gets the job done.  Validate her feelings, Distract and deflect the negative conversation.   It goes like this "Wow, I feel you, you are in a new environment and it feels strange, doesn't it?  Well a good thing is there is a personal chef for you, let's go get lunch in the dining room, I hear the stuffed shells are good."

Don't engage in a reasons why conversation.  It' won't be productive, she cannot reason, process and retain in a productive manner.

2.  The best answer is the one that brings the most comfort.

Not "your dad is dead", but "he's not here now.  He loves pumpkin pie, doesn't he?  I brought you a piece"

Lastly, go to the apartment and look for financial information and legal documents  a key part of your puzzle to deal with.

At some point, you  may have to sit your hubby down and have a firm conversation.  Along the lines of   "I know you love your Mom and care but you are lost in emotions and guilt and are not being rational.   Here are the facts..........a person like this cannot be left in their own apartment out of your wishful thinking, if something terrible happens to her (wanders away, diabetic coma) it's on you because you failed to act and provide appropriate care.   I know it hurts, but I am here to support you and help your Mom!"

King Boo

Sorry to hear of your family dynamics; happy to hear that you have a pretty solid idea of the level of Mom's care needs and reading between the lines, you seem to indicate that keeping her in her home is a stop gap, very temporary measure.

May I suggest that you eliminate that in between step, which seems merely to be to appease your sister, and has this out in a very straightforward manner?

24/7 in home care, which is what your Mom needs, is very expensive.  Patching together part time care is not advisable and puts your Mom at risk.

Your sister may be expressing what she wants, but as a Medical POA you have the responsibility to make good medical decisions for your Mom.  In families where there is disharmony, you could also be held liable for her wellbeing.

So, the conversation goes something like this with your sister:

-Gee, Jane, I am so very glad you care so much for Mom.  I do too.  But her care needs require round the clock supervision, which we can't provide.  It's more expensive to hire it for 24/7.  I am unable to be part of her daily care team, the demands of this disease can take a whole family down.  We are not nurses.  This would not be a good decision for Mom.  I have made the decision to find placement for her, I would love it if you could help me make her move as easy as possible for her, you are so good at_________

Sister may pitch a fit, in which case, stronger speech is needed.  "This is not the right decision for Mom.  If you intend to provide full 100% hands on care for herself with a nurse check in twice a week, we can trial that"    But only if you feel this would meet Mom' s needs.

If you have concerns, leave that option off the table.

If you don't have a CELA lawyer (www.nelf.org) you need one

A Geriatric Care Manager can also be hired to work out a few of the family dynamics.  Some family members will listen to an outside third opinion but not their sibling.

If it needs to be and your sister creates difficulty releasing funds to provide for Mom's care, you have legal recourse.  

Iris L.

Blame the placement on the doctor.  "The doctor wants you here for now." 

Read about anosognosia.  They think there's nothing wrong with them, why can't they go home and take care of themselves?  King Boo gave excellent advice.

Iris L.

towhee

You are doing the right thing. She has to be in a place where they can provide the proper diet and control her food intake and give her medicine correctly, and that is skilled care or possibly memory care. It is not impossible that when she gets more used to where she is that she might improve slightly and you might want to keep an eye on what medicines are proscribed and how much she is eating and especially drinking. Unfortunately, infections can cause a worsening of dementia symptoms. Keep what King Boo said as a reference, she is exactly right.