If my mom doesn't want assisted living, what should I do?

A fellow caregiver asked...

I have an 89 year old mother who suffered at least one stroke in the last 5 years, causing her to move to assisted living, occasional nursing home rehab, permanent nursing home, back to assisted living. During that time, she made one half-hearted attempt at suicide, perhaps as an attention-getting device.

She has issues with depression and anxiety, for which she is getting medication but not real treatment. She does not like discussions of psychological issues.

She is currently in assisted living, but has been told that she must call for transfers to the bathroom -- and she refuses to follow that rule. Almost every time she self-transfers, she falls. They have not yet kicked her out, but probably will, soon. Even when she returns to nursing care, she will probably self-transfer. I honestly don't know if her claims that "no one comes" when she calls for help are true, or if she forgets, or doesn't understand, or is rebelling against the rule. OR, is hoping that one good fall is the only way she has to end what she considers a miserable existence, OR she thinks it's the only way to get attention.

Any suggestions for getting her to stop self-transferring, other than restraining her? She could've really made a go of assisted living, if not for this (and a lack of interest in occupational therapy).


Expert Answer

Maria Basso Lipani writes a popular website on geriatric care topics, where she puts her expertise as a Licensed Clinical Social Worker to good use answering care planning questions. Maria is a graduate of Columbia University School of Social Work and is licensed in California and New York.

I don't have any suggestions for getting her to stop self-transferring, but I do have a suggestion for determining the best setting for her: ask her where she wants to be. You might be surprised by her response and it could save you a lot of unnecessary back and forth. Plus if you can gather this information from your mom it would be the first step in getting her to work with you to stay there.

That said, in reading your question it's not difficult to see why your mother might regard her existence as miserable - I'd be miserable and I think anyone would be bouncing from one setting to another having to rely on others for the most basic and private of tasks like toileting. While we'll never know her true motive for trying to do things on her own a part of me thinks she may do it because she really doesn't want to need the assistance and may not have accepted that she truly does.

Also, you're probably right about the assisted living getting fed up sooner rather than later and asking her to leave; she presents a huge liability by not following the rule. However, if you want to try once more to make this work I'd suggest finding out which attendant she has the best relationship with at the assisted living and asking if she can be the one to respond to her calls. I can promise you that your mother is more likely to call for the help of someone she likes rather than someone she doesn't.