How can we talk to my mother-in-law about the reality of her health?
How can I force my mother-in-law to face the facts of her health? She has high blood pressure, borderline diabetes, congestive heart failure and she has blackout and vertigo spells. She is virtually unable to walk, yet she refuses to use a four prong cane or a walker. It appears that she is not taking her medications or following doctor's orders. She is belligerent and angry with everyone. She is putting enormous stress on our family and our marriage, and she doesn't seem to care. My husband says it would be better is she would just die and get it over with. He is hoping for a fall so she is forced into a nursing home. How can we get her to face up to reality?
Expert Answer
When a family is as exhausted as yours sounds and the care receiver has as many health conditions as your mother-in-law, the first thing that’s needed is a consultation with her physician. Call once and ten more times if you have to, but make an appointment for her to be seen and share with the doctor in advance what you’re dealing with at home. Based on what you’re describing, the doctor might admit her to the hospital to find the cause of her blackouts and/or to stabilize her other medical conditions. Following that admission she could be eligible for physical rehabilitation services that could take place in a nursing facility. Hospital to nursing facility for “rehab” is the typical route after a fall, but if she is really unable to walk well, I don’t see why you should have to wait for one. The “rehab” would be covered under Medicare and if the physician feels she’d be unsafe to go home when it’s time for discharge, he or she may recommend that she remain there indefinitely. There are a few additional things that could impact the long term picture. First, heart disease is a qualifying diagnosis for hospice services, so it would be important to speak with the doctor about the severity of her congestive heart failure (CHF). Her belligerence (if this is something new) may be an indication that she is feeling worse, possibly because of advancing CHF. If so, she may qualify for hospice services now. Lastly, it’s also possible that a cognitive impairment may be impacting her behavior –non-compliance with meds and other doctor’s orders are often one of the first signs. A five minute test called a mini-mental status exam (MMSE) can be administered in the doctor’s office to get a baseline measurement of her cognitive functioning. Many primary care doctors miss dementia all together so you may want to ask directly if he or she thinks it could be playing a role here.