I have kept my mother in law at home with me and my family for 17 yrs. She is basically bed bound now and requires 24/7 assistance with all daily needs. For the last 3 yrs I have literally stayed in the house with her. I am tired, worn out, and just frustrated because no one will give me any relief. My husband works long hours and does what he can when he is home. I wouldn't have made it this long if it hadn't been for him. His sister or brother visit every few weeks for an hour and then go home to their lives. They always have excuses as to why they can't come or stay longer. My mother in laws health is quickly declining. I feel its time to put her in a nursing home where she can get the best medical care for her situation. I'm not physically or mentally able anymore. Since her children have always told her they would never put her in a home, I am faced with them fighting me on this discision. How do I help them understand its for her well being as well as mine? How do I approach my mom in law and help her not feel like I am trying to throw her out to die? I'm at the end of the rope, hanging afraid there will be nothing to catch me when I fall. I'm in desperate need of professional advise and don't know where else to turn.
Expert Answer by Carolyn L. Rosenblatt
Dear Pamalakay: It's sad to hear about your struggle, though your problem is not uncommon. I just wanted to give you some other ideas to consider when trying to choose a nursing home. First, you can let go of the guilt. It is appropriate to move your mother in law to a nursing home when the burden of caring for her is too much. The siblings who don't help aren't going to change. Those who aren't doing it don't understand how much work is involved and how hard it is, so they can stand there from afar and be critical. Don't let that stop you. You have the right to make this decision with your husband and your mother in law.
Next, if you need to pick a nursing home, be very careful in your choice. I've worked in them both as an aide and as a nurse, and I've sued them as a lawyer. Don't rely entirely on medicare.gov's website. It has numerous defects. Use several websites to narrow your choice. Visit. Follow the good suggestions given by others about dropping in unannounced. Do the best you can in finding one that is close, so you can visit often. You'll need to for your mother in law's safety. No nursing homes are perfect, but some do a much better job than others. I've written up how to evaluate nursing homes from a lawyer's point of view in my mini-book, How to Choose a Nursing Home, which you can download in minutes from AgingParents.com. I wish you courage and the best in your caring for your mother in law. Carolyn L. Rosenblatt, R.N., B.S.N., Attorney, AgingParents.com
Expert Answer by Ann Cason
Thank you for writing to ask this very important question. How can you find relief for yourself, proper care for your mother-in law, and not end up fighting with the family?
First, I want to share with you what a very elderly woman taught me many years ago. "Pride goeth before a fall." I am afraid that all of your kindness and good intentions have, with the passage of time, turned into a form of pride. It is too heroic to think that you can give 24 hour care to a woman who is mostly bedridden.
You must find a way to convince yourself that you won't be throwing your dear husband's mother out to die. You need to get a respite caregiver in each afternoon. You need to spend part of the time seaching for a proper nursing home. You also need to spend the respite time caring for yourself in a way that works for you. Can you go to the gym, go for a walk, get a massage? Can you spend time in contemplation, yoga, meditation or prayer? Perhaps a support group or counsellor could help. It is going to take time to unwind after what you have been through for the past three years.
As soon as you find the nursing home that suits you, talk with your husband. Then both of you should talk with his mother. Explain that you are tired and need help nursing her. Assure her that you won't just be leaving her there, but will still be with her as much as possible. Ask the nursing home administrator to help you explain to your family what their mother needs. You might also hire a geriatric care manager or social worker to help with the communication with the whole family.
Be patient. You have been carrying a burden for so long, that the family dynamic is out of balance. They may feel threatened at the idea of change.
Show them the nursing home. Show your mother-in-law. Get her in a wheel chair, if you can, and take her around.
Good nursing homes bring relief to the patient who needs bedside care. A good nursing home may even be able to get a patient out of bed and walkiing. The nursing home staff can become extra eyes and arms and legs for the rest of the family. Also, sometimes people who go to nursing home heal and come back home for awhile. Or sometimes the elder's time on earth slips away.
Communicate to your family as clearly and genuinely as you have reached out to ask for help. Don't hold back out of false pride. After a time you will have helped your whole family work together instead of fight.
Also, I would like to invite others in the caring.com community to share their experiences to help you walk this difficult and delicate path of communication!
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So many times one person in the family takes over the major portion (or all) of the care for a sick family member. This is my situation as well. Just as often it is the non-caregiving family members who have strong opinions of how this care should be carried out. It is obvious that you care for your mother-in-law or you wouldn't have had her in your home this long or be going through the emotional turmoil concerning her possible placement. I would suggest that you visit nursing facilities taking special notice of urine smells, how long it takes for nurses/CNA's to answer patient pages, and whether patients who need help eating are getting this help. If you are satisfied with these things, you have probably found a good facility. Also, check on www.medicare.gov to compare nursing homes. Another possibility may be to hire a nursing agency to come into the home for some of the bathing and toileting care. I have had an aide come in for 2 hours a day since January and it is such a relief. Maybe the other family members could take on the financial responsibility for this, since you are taking on the physical responsibility. Good luck. I know how dificult these decisions are.
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DEAREST pamalakay,
I know ALL about this...
Just like you, I had once dug myself into a VERY deep hole. Once the hole was dug I realized I was at the very bottom of it, and I asked myself "How am I supposed to get out?"
I will tell you the answer...
FIRST: The CHILDREN-in-law WILL NOT HELP in any way. You know that.
SECOND: What you do NOT know is that YOUR HUSBAND WILL NOT HELP either. Not that he doesn't care - just that he cannot COPE. I know you feel grateful to him for what he does when he can do it, but have you ever asked yourself WHY HE WORKS SUCH LONG HOURS? (Now, be honest with yourself, and NO, it has nothing to do with YOU!)
THIRD: The last thing (which you probably already know) is that YOU (you, especially) CANNOT HELP! Pamala, YOU ARE THE PERSON WHO IS MOST IN NEED OF THE HELP...
RESPITE CARE will not get you out of the hole. A HOME AIDE will not get you out of the hole.
All the advice that has been given is good advice, but none of it should be directed at YOU! The last thing you need is "one more thing to do."
YOU are EXHAUSTED. SEVENTEEN YEARS! If you have not already taken action with respect to placing your mother-in-law in a care facility I am going to give you the BEST ADVICE you will receive from anyone.
RIGHT NOW.
RIGHT NOW CALL 911.
Tell the 911 Operator that two adult women are in immediate need of medical assistance.
Tell the 911 Operator that one of them is elderly and bed-ridden.
Tell the 911 Operator that the other is the elderly woman's caregiver, and that the caregiver is suffering from nervous exhaustion.
Answer any questions the 911 Operator asks, then sit down and wait. Don't bother calling anyone - they are all too busy.
When the EMT's arrive they will understand immediately. When they ask who is responsible for the elderly woman, tell them she is YOUR HUSBAND'S MOTHER.
Give them HIS office and cell phone numbers.
While they prepare your mother-in-law for transport to the hospital they will check your vitals and ask you if you feel you require hospitalization. Of course, you do not. TELL THEM YOU ARE JUST EXHAUSTED. (All you need is bed and sleep for a month.)
When they drive away, DO NOT GO WITH THE AMBULANCE TO THE HOSPITAL...
FIRST: TAKE THE PHONE OFF THE HOOK.
SECOND: Pack a small bag of your mother-in-law's things for your husband to take to his mother at the hospital.
THIRD: Take a hot bath or shower, THEN GO TO SLEEP.
The hospital will call YOUR HUSBAND. HE, in turn, will call HIS SIBLINGS.
At the end of her stay, HER CHILDREN will be responsible for researching and visiting care facilities, meeting with facility directors, touring, and then fighting about all of it. A hospital Social Worker will assist them with the process. They can even fight about how to pay for it.
And you, Pamala, YOU will sit back and WATCH...
9 1 1.
BECAUSE YOU NEED HELP - IMMEDIATELY.
All my love and care to YOU.
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Dear Lady ~ It sounds to me like you are way past getting in-home help. There comes a time when our elder loved ones absolutely must have 24 hour skilled care and anyone, regardless of financial circumstances, can obtain that care. You cannot do it alone and you won't be of any use if you drive yourself into physical and emotional collapse. Even if you were a registered nurse or MD, no one can provide 24 hour care - it requires a team of people. Ultimately, what may be more difficult is dealing with the guilt associated with turning that huge responsibility over. If I may be so bold; don't beat yourself up and do NOT let anyone else batter you emotionally for proposing and implementing that decision. My father's four sisters disapproved to our "turning dad out" but only one of them had stepped up to helping. One of them who had taken care of Grandma in her home, said, "I promised Mom I would never send her to a nursing home!" Yes, but, Grandma only weighed 80 lbs, was in control of her bodily functions, could sit up and walk around and didn't have dangerous dementia and frequent seizures either. What was worse was that although Dad didn't always know what was going on or who he was with, he was cognizant enough at times to be mad at me for "putting him in there". I had to remind myself that not only was he receiving quality nursing care in his inevitable decline but he had frequent companionship with other seniors and family members who couldn't bring themselves to visit him in the home setting.
You have to be convinced this is the right thing in order to marshall support from your husband, to stand firm against the inevitable guilt trips and to lovingly share your decision with Mom. What helped me was that after his last fall - he was trying to get himself out of bed - the doctors said he must have 24 hour care and what I emphasized with Dad and everyone else was that for medical reasons he needed SKILLED nursing care. I think what may have helped ease the transition was that after numerous hospital stays, this place was just one more medical facility. May the Good Lord bless you in this difficult time! Sue
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In home care is an excellent way to get you a break. I agree talk with mom in law to get her input, if she's able. use the time the care aid is there to researh facilities in the area.As a former home health aide I advised families to visit places both announced and un announced. take one good whif of the air as you walk thru the door.Any smell of urine or feces, don't waste your time or theres simply leave. unannounced visits are a good way to get a candid view.also look carefully at her assets as she will likely be expected to apply for medicaid.Apply for nothing until you see an attorney skilled with medicaid. ther is another section on this sight about financial issues. checkthat out as well.
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You can find a national database of geriatric care managers, searchable by zip code, right here on Caring.com. I wish you all the very best!
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I work with many familes in your situation which is very difficult. My job is to save you time and help them to find the right care, either in-home or care community (full skilled nursing or assisted living). My service is free and I can provide you with a path to help narrow the choices in your area.
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