My MIL is almost 97 and was "stable" despite congestive heart failure until a recent hospitalization for a UTI. Once she was home and finished with the antibiotics, she was rushed back to the hospital to the ICU with very low potassium and a c. diff. infection. She almost went septic, but somehow pulled through and has started 90 days of a Medicare covered nursing home stay. My husband is finishing the process of applying for Medicaid, because years of 24/7 home health care have depleted all of her money and the reverse mortgage funds are also almost gone. There is no more money for her to go back home to receive care there. She is mentally alert but, in addition to CHF she is almost blind from MD, profoundly deaf (doesn't want to wear her hearing aids), and cannot walk due to knee and hip joint deterioration. Despite knowing her physical limitations and financial trouble she thinks that she'll only be in the NH for one week and then will go home to "care for myself if there is no money for an aide." If we try to talk to her about the reality of her circumstances she gets very upset, which is understandable, and says she wants to die. That is something she's been saying a lot lately, anyway. Does anyone have a suggestion about how to break the news to her that she'll need to remain in the nursing home permanently without sending her into a deep depression?
I think I'd throw in something along the line of - "you're still medically very fragile and your doctor doesn't want another situation where you go home only to return to the hospital a day or two later - like this last time. It's important that your strength get built up and we know for sure that the c-diff is under control. Returning you home too soon could be very dangerous for you. We love you very much and don't want anything to happen to you."
Good luck to you - it's a tough situation to be in.
Honesty is not always in the best interest of an elderly person and having hope is pretty essential
After caring for my wife at home for nearly 24/7 for two years my heart gave out. She had experienced a massive stroke. After two months in the nursing home I realized I could no resume giving her care on my own due to my health...I told her that the doctor said I would die if I continued to take care of her at home (In fact, that was a lie.) She rebelled vehemently, but after a day or so she accepted it graciously. ...She has no dementia and is very sensible and loving. by nature. That was in 2007. From that point forward, we spent north of a half million dollars on nursing home fees and she finally qualified for Medicaid....I visit her twice daily to assist her with eating and I hire a lady every day of the month to visit and assist her for the supper meal. She is very happy...
You may want to soften the language of saying " few months" to a "few weeks" but I see the "gradual" approach as being sensible.)
Grace +peace,
Bob
Her routine was kept intact during the day which was going to the restaurant and doing what she could do of course, over time with dementia that ended. But there was enough time in the interim to ease her out of her routine at the restaurant. To where eventually she could not go to the restaurant anymore and I had to bring in outside help.
I would pick her up at night to take her home. I would answer her question of why I was picking her up with saying I don't like to stay alone and would really like her to stay with me if that was ok. And she almost always said ok. On the other days when she didn't say yes, I waited for 10 to 15 minutes and asked her if she was ready to go and she would agree to stay. Eventually, she stopped asking and was more than willing to go home with me.
I would imagine in your case with it being a nursing home that the advice above about saying the doctor just wants to have you stay another day to make sure you are ok, would be the best way to go. Perhaps, change up the way you say it from time to time and over time she will probably stop asking. Some people ask every day for years and others don't, so it's hard to say in your case.
My best advice is to take every moment of every day and live in that moment. Get creative with your responses. Never say never.
Good luck and take care of yourself.
I can't imagine circumstances which would make it ethically or practically essential for you to spell it out to your MIL in terms that she will never go home. Expressions of time such as "for now" and "until you're stronger" are so usefully extendable and ambiguous. But are there reasons for needing clarity that I haven't thought of? Do you need her consent to a house sale or something?
All grandma cared about was that she had a visitor or two per day and that she knew all of her family were fine. She calmly planned her funeral and was able to tell us how to divide up some of her jewelry and such. She was between this world and the next for a couple of days, seeing her husband (who had died 35 years previously) and when we all told her she should go with him when he came to visit, she was at peace and passed a couple days later.
Having her beloved dr tell her it was time was the tipping point. Hearing it from her daughter or son was pointless.
At 97, with so many health issues, you can fib a little to your mom and likely she isn't really aware of the passage of time. Visit her often and be loving. There's nothing more you can really do at this point. Make sure she has good care, and let her know you love her. People need to hear that.
Having it come from a 'professional' is usually easier to hear for
a patient.
And it can be ''' It's best for right now'''
The conversation could go something like:
'Stay a few months to get really strong before you go home so you
don't end up right back here'
Ask the doctor, nurse or agency on aging for good ways to have this conversation without devastating the patient.
Sometimes having a 'problem solving' conversation with them - helps
THEM to decide that assisted living or nursing care is the right option for them, even if they need to believe that it is only a temporary solution until they can 'return to normal', or 'return home'.
It is hard to feel powerless, and worse when you watch all of your independence slipping away, and the worst when you feel there is no hope for improvement in the future. It can look like a bleak future - until the
'new normal' is found to be not so bad.
Help the 'new '''temporary''' normal' be a good experience, so that it can help with a positive outlook and there by cooperation with the whole process.
What makes the patient happy, visits, snacks, hobbies, games, music, tv.
If they are on a ground level and have a window - can they have a bird feeder outside? Can you bring in music or cds of nature sounds that they enjoy? and of course any favorite items like a blanket, quilt, photos, photo album, keepsakes.
It's never easy, and it is hard to truly imagine what the patient feels like and the impact it has on them.
One person said " I feel as hopeless as if I was in a bad car accident and was told I could never go home and my life would never be the same. I can't bathroom by myself, I can't choose my meals or snacks or when I have them, I can't shower any time I want, sometimes I'm not even allowed to pick out the clothes I am going to wear that day" - she said 2 year olds have more freedom and options than she did. She told me one night she couldn't sleep and she just wanted to go in her kitchen and make a cup of tea and some cinnamon toast - not an option since she didn't live in her home anymore. Something that she used to enjoy that was so simple and basic, is now an unobtainable 'luxury'.
That really put it in perspective.