It’s been a hard few months for my grandparents, who lived at the same home for 65+ years. My grandpa (98) was truly in good health up until this spring. He developed aspiration pneumonia and was suddenly hospitalized in March. He never returned home - and after rehab, nursing home and multiple hospital stays, he passed away two weeks ago.
My grandmother (95) was also doing pretty well, considering, and insisted in staying home alone without wearing her emergency call button, despite many family members trying to convince her over and over otherwise. The morning of my grandpa’s funeral, we arrived to her house to pick her up and found her laying on the floor. She had broken her hip just 5 days after my grandpa’s death and required surgery. She’s since been moved from the hospital to rehab where she is absolutely miserable, being very mean to us (her family) and nursing staff, complaining about food/tv/temperature and refusing to even get up and move or try PT.
I really think she may be going through a mental health crisis (which I understand after so much happening in a matter of days), but I’m unsure of how we can help get things moving in the right direction. She heavily relied on my grandpa to take care of everything for 70 years, so she is grieving the loss of him and dealing with a very fresh reality of never returning home to everything she knows and loves. She is sure she’ll be home, even with no effort to get out of bed.
My family does not know what to do. She makes us all feel horrible when we visit everyday (this isn’t necessarily new, she’s been verbally abusive to my mom and aunt for years). We want to help, but also are losing steam as it’s been such a tough few months and everyone’s at their wits end with negative visits.
How can we all stay sane and help her at least try to recover from all this? She seems to want to just give up, but also lays on the “poor me” guilt to literally everyone she talks to - whether she knows them or not. I’m exhausted and at a loss. Bottom line: I could really use some advice on how we can get through this difficult time. Thank you in advance for any help you can provide!
There is fear behind that too, People who are verbally abusive often are fearful so they try to be bossy to feel a sense of control.
I think reaffirm yes it is an awful time for her. we Americans tend to want to cheer up the grieving or talk about a future better time. People in other countries grieve loud and long.
Just continue to tell her there is a plan to keep her safe and looked after, tell her you will try to do as good of a job as your grandpa but you know you won't because he was great. And talk about him and all he did for her. Confirm her feelings.
Then take breaks and go out and do something for yourself, journal your frustrations, remember there is life beyond where you all sit right now.
Put yourself in her shoes. It helps to be empathetic and know you dont have to solve this all or fix her.
She is in crisis and will get better.
Talk to her primary care physician about psychiatric needs. We got a geriatric psychiatrist (that was wonderful). She may be able to have appointments via Zoom since she is at rehab.
If she is put on meds, it will take 30 days to see the full change. Watch her closely to ensure no overmedication or interaction with other drugs.
She needs something to look forward to. Perhaps doing your visits on a regular schedule would help if you can do it. That way, she knows your coming and for how long. Hopefully she begins to look forward to it. If she gets nasty simply tell her you are leaving and will be back the next time to check on her. Make it clear you will leave early if she shows you that she does not want your company. Bring her anything that is a favorite thing/food but don’t stay if she is nasty and take it back if she doesn’t want it.
She will most likely be better off in a facility for everyone involved. She misses her husband and life and you can’t give it back to her. But if her mental state improves or is found to have an underlying medical cause, then you could consider home care with sufficient aide coverage to care for her. She will need to use LTC insurance if she has it or do private pay if she has no LTC but has the financial resources (Medicare will not pay for routine home care or nursing home care except for 90 days immediately after an approved three day hospital stay.) The cost of 24 hour home care is very expensive and out of reach for most people, so unless family members are willing and able to support home care a nursing home is the better option. I try to maintain patience with my 94 and 95 year old parents - just as they did with me. It does not always work. Everybody’s situation is unique.
Truly pray for her as you want her better
'My grandmother (95) was also doing pretty well, considering, and insisted in staying home alone without wearing her emergency call button, despite many family members trying to convince her over and over otherwise."
No mention of possible cognitive issues. Since they lived together, presumably alone, is it possible she was in early dementia and grandpa was hiding it from everyone? It does happen! Even if she was okay cognitively before, anesthesia can bring on dementia-like symptoms and behaviors. Often this is transitory, and will subside over time. Sometimes it never gets better and/or never goes back to the "norm" before surgery. It is somewhat dependent on how she was before the surgery.
"She’s since been moved from the hospital to rehab where she is absolutely miserable, being very mean to us (her family) and nursing staff, complaining about food/tv/temperature and refusing to even get up and move or try PT."
Having spent nearly a month in the hospital, I can relate to being miserable, although I didn't take it out on others. There wasn't anything I could do about my condition other than harp on them that I wanted to go home. In my case, this WAS possible and finally my wish was granted! However, the big problem for grandma is going to be her refusal to "get up and move or try PT", because Medicare has rules and failure to make improvement will terminate her rehab. If she still can get up and do for herself, she will need a NH (unless some poor schmuck is willing to take her in! I would recommend against that!!!)
"She is sure she’ll be home, even with no effort to get out of bed."
If possible, try to make it clear to her, before she gets into her abuse routine (or cutting her off, to the point of being rude), that she will NOT be able to go home if she isn't willing to work on getting up and participating in PT. Make it clear to her that those who don't try end up in a wheelchair, most likely in a NH. Be blunt. She can dish out the nasties, then she can be fed them too. Even though it's not in your nature to be like that, take cues from her!!! She needs to be told, over and over if necessary, that her refusal to help herself will result in NH, and probably a wheelchair, period. No amount of grousing will change that. Tell her if she's miserable here, she will be even more miserable being stuck in a wheelchair and NH, but it WILL be her choice. BLUNTLY state her choice is TRY or go to NH. If she won't try, then her choice is made. Make it clear that NOTHING any of you can do will change that. She either has to WANT to go home, and therefore make the effort, or she goes to NH.
"She makes us all feel horrible when we visit everyday (this isn’t necessarily new, she’s been verbally abusive to my mom and aunt for years)."
As noted above regarding getting the point across to her, cut her off when she starts her routine. Be blunt. Grandma, I don't like being treated this way, so either we have a nice visit or I'm leaving. IF she continues, walk out. She may never have the epiphany and stop behaving that way, but it removes you from the hostility and nastiness. If she doesn't get the point, cut back on visits. Why put yourself into the firing line, when you know what will happen? Less often means less stress on you!
There's only so much we can do. We CAN'T make other people happy, that comes from within. We CAN'T force them to help themselves, we can only encourage and point out, bluntly again, what will happen if they don't try. Limit your exposure to her hostility AND nip it in the bud when she starts OR walk away.
If we could all visit grandma, many of us would be in her face with GET UP AND TRY or SHUT UP! Rude, blunt and totally out of character, at least for me, but if there's no dementia, I would likely be pushed into this by her nastiness.
Short answer: Call for a psych consult and insist on ongoing psych counseling!
First, realize grandma has suffered 3 "deaths" in a short span. 1 real death of her life partner upon whom she greatly depended; 2 the death of her life as she knew it; and 3 the death of her physical independence.
These rapid fire losses can cause a critical personality to become quiet nasty, and even say and do shocking things that are out of character. Be prepared for worse behavior and know that depression, anxiety, fear and denial are all in play here. I good antidepressant antianxiety med with counseling will definitely put GM on a better track, but it's not an overnight change.
What triggered my opinion is that you said GM was always critical of her daughters. BEEN THERE. My mom was so nasty after her loss of independence when the doctors in rehab told her that she will never be able to live independently again. omygosh, it was the most miserable experience for us. Nothing we did made her happy or satisfied. Docs in ATL GA refused to medicate her because of her age (what's the use attitude). We moved her to TX to live we me and, upon a routine visit to MD Anderson here, she threw me under the bus and made suicidal stmts to the nurse. THEY called psych down immediately and admitted her, to her shock, on suicide watch.
Prior to all this, Mom never see a counselor, only her pastors. Her critical nature signaled that she was really unhappy with herself and her own life - projecting all those thoughts onto others, esp. daughters.
MD Anderson and TX docs didn't hesitate to start my mom on meds. Through meds and ongoing psych counseling, she lost the nastiness, is much less critical (has even started admitting verbally when she's snappy that she's angry with herself, not mad at me. However, I do vocalize and refute the bites with "I'm doing my best." My favorite: "I didn't deserve that." etc.
You guys are going to have to modify your response behavior and actions too. It's like parenting a toddler who is in tantrum mode 24/7. I disagree with others who say GM can't change her ways. She will if you modify your behavior because she will have to if she wants your attention, visits and interaction. Remember though that love must be unconditional and never transactional.
If you've even had a high school semester of psychology, you'll know about Pavlov's dog. Here's what worked for us:
LO gets nasty: stop what you're doing ( as long as they're safe), grab your stuff and leave the room. Don't verbally respond except to say outloud to her, " I'm leaving now. See you tomorrow/later/whatever" Don't say why, just do it.
LO demands immediate attention (for non-safety issues): If not present in the room, Consistently delay responding for 10 minutes! Make her wait. If it's telephone calls or, heaven forbid, a buzzer or bell, answer with a bright voice "What's up, GM?", but delay responding to demands AND use language like 'be there in a minute' 'when I finish what I'm doing' 'i can do that later/tomorrow/next week/whenever'. If you're with her, delay and don't jump to. Always acknowledge with 'just after I finish xzy" then be methodical and caring in your actions.
When you do respond, always make her repeat the request by asking "What's up? What did you need?" with a friendly smile on your face. It's amazing how just smiling activates muscles that make your voice sound lighter.
I'm running out of room, so the next important thing I can say worked what just not responding or taking the bait at all. Sometimes silence is best.
In all, when GM ignores you, continues to demand, becomes abusive or snappy, get up and LEAVE without a word.
Don't respond to guilt. Find a friend to vent to, but don't do a bashing session about GM; that isn't healing for you.
We teach others how to treat us by how we allow them to.
When you do call her on her abusive behavior, use tact, simple language and stay in the specific moment. Sometimes, IMO, it's necessary to let the LO know their behavior is unacceptable (as long as they have cognitive abilities). My Mom doesn't have any dementia issues. She's in full control of her mental status (outside having a UTI or great physical pain), so we're all aware that she knows exactly what she's doing.
The point is your grandmother is in a lot of emotional and physical pain right now - she needs someone to care for her physically, mentally and spiritually. She needs a good Support group....and that means her family also.
There are several stages of grief and they are not played out in sequence. One of these stages is anger and it sounds like perhaps this may be a part of what your grandmother is going through. She is 95 years old and just lost someone who has been with her for the majority of her life, she is helpless, at the moment and can't do anything for herself, she is in a lot of mental and physical pain - and frankly, I doubt that she is thinking too much about being "nice" to anyone - this doesn't excuse her actions....however, there are times - like these - that we need to be there to support our family - try to overlook your feelings when she may snap at you or be harsh in something she says. She is also loosing her independence - which is something ALL of us have a hard time doing.
Please take care and I wish you luck and much love and many prayers.
She likely doesn't know how to be any other way and at her age, she is not going to change.
At her age, I do not believe she will 'recover' as you say.
1. Change your expectations to 'being where she is' emotionally. Instead of pushing or whatever you may be doing to help her recover, simply be where she is at emotionally. Say:
Yes, I understand.
This is a very grief filled time.
2. Keep your visits shorter (if possible)
3. #2 change the people around her to ease stress on all of you.
4. Shift her attention as much as possible - music, tv, go through family photos. While family photos won't shift her thoughts from family, it will help her 'get out her feelings' which is important, too.
The reality is, grieving is personal and hard. It is grief.
While this may sound cruel, she needs time to be with herself to feel what she feels. Hold her hand (hand massage) and let her talk 'poor me'.
Any abusive behavior towards family, leave immediately. Do not engage.
This isn't 'mean'; it is self-preservation. If you/family do not set boundaries, you will exhaust yourselves (as you already say).
* If you need, get caregivers who will sit with her and let her talk. This might be the answer. Get breaks. A day, two days, etc. You MUST keep yourself as healthy and whole as possible.
Gena / Touch Matters
She is going thru pain morally and physically and it's he'll living in a Nursing Home and Rehab.
She would be better off dealing with all this and recouping at her own home with Caregivers if she can afford it, if not then she would be better off, happier, feel loved, safer, ect staying with a family member.
Sign her up with Palliative Care and Home Health. Her Insurance will pay for In Home Rehab and will pay for Aids to come out 3 times a week for helping her to shower or Bed Baths and a Nurse will come once a week to check her vital signs.
If her husband was in the Military, she could get 20 or more hours Caregiver Help thru the VA.
Rugh now, she probably has about lost the Will to live.
Her best chance to recoop is to move in with a loved one.
Did you love her before, mean and nasty though she might have been? If you put up with it then when she was healthy, why would you object now when she has been pushed beyond all limits in the most vulnerable time of her life. If you dig deep to find patience in yourself for this sort period of time, you may find you love and and respect yourself more when she passes.
Period.
If one believes as you do / say, a person's health and well being will deteriorate. It depends on how a person values their own life and the quality of their life. The situation has nothing to do with respecting yourself 'more' when she passes. It is self-respect. Period.
It is called tough love. Love from a distance.
Do not put up with abuse.
Luckily she is where she should be and not at home. Reasoning will not work. You would be wasting your breath. When you visit take a few mental health breaks. She complains, leave the room and come back in 5 minutes. Repeat. While you are on your break try to remember to thank the people who are dealing with her on a daily basis. It is amazing how much they put up with and how little thanks they get.
She is angry
She is frustrated
She may also be mean, nasty and abusive
You can not do anything to change any of those things.
She has to.
Grief takes a while
Her anger could be at herself, at her husband for dying, (and that may make her more angry at herself.)
Her frustration may well be because she can no longer function the way she used to.
You can not do anything to help any of these things.
What you can do is not deal with her when her anger, frustration is heaped upon you.
Go visit. If she begins to treat you in a way that is not acceptable tell her, Grandma, I love you but I can not be treated like that. And leave.
If you call her, the same rules apply. Grandma, I love you but I am not going to be spoken to in that way. And hang up.
If everyone does that it might get the point across but if she has been doing this for 95 years you probably will not change her.
And you might be right about her giving up it is not unusual when a couple have been married that long when one dies the other is not far behind.
It's certainly worth trying... If she can't change her stripes, then all calls and visits will be VERY short. Refusal to participate in PT will also result in a very short stay in rehab! Time to research alternatives for where she will live.
You can't make a person want to fight to live or do anything. Trying to make someone do anything is exhausting so best advice is to just visit and accept this is where she is and who she is. Keep visits short and not as frequent since she is safe in a rehab.
Be sure that you all have a care conference with all the staff involved in her care before she is discharged. If she makes no attempts to improve then Medicare will not pay to keep her there. The care conference will discuss with you the next steps…as in placement. This is where you can decide to not send her home if she isn’t safe there. You must think with your head and not heart. Yes it's sad, but if we all live this long life will probably not be rosy and her situation leads to the inevitable. You all can decide if she will attend the care conference or not. Sorry but this is how it is.
As for the negativity, keep the visits short, don’t play into it or try to reason with her. I know it's hard.
Then you can have further conversations along the lines of "you can go home when you have convinced physio you can cope" so you will need to do your exercises. etc.
You have to know more of what is in her mind. Does she want to carry on living, does she want to return to the home she shared with Grandpa, does she worry she cannot cope and would like to find a facility where she can be looked after.
However along with this goes the tough love - "if you are going to be unpleasant we are leaving now" which is probably the only way you will bring home to her that her actions are unacceptable. Visit and leave if she is rude or unpleasant, saying you will be back tomorrow when hopefully she is feeling better. You have the right to lay down some rules, and sometimes the are needed to snap people out of self pity and unpleasantness.
Hard to do, and hard conversations to have, but Grandma is an adult and is entitled to make her own decisions whilst having to accept she needs to be civil at least to those trying to assist. They were together a long time, so there will be good days and bad days which have to be accepted, but if you can discuss with her her aims - and accept them - it might be a start.
There may be some legitimate complaints about the Rehab facility. I know. I broke a hip and spent 30 days in Rehab with neglectful, careless and sometimes mean staff, but PT, OT and other Therapies were the point of being there.
If she does not participate in therapy and "shows no improvement,," she will be dismissed.from Rehab. If she is unable to go home, you will have to finding long term placement care for her.
At 95, things can turn from going well, to end of life very fast.
Grandma's recovery is not up to family. It is up to her. Grandma's mind & body + medical treatment + fate.
Her living arrangements will most likely need to change. Likely need round the clock care. If this can't be done in her home (hardly ever is) then somewhere else, likely a full care NH.
But you are well. You do not need to put up with verbal abuse. I presume you have legs to walk you out the door.
Your Grandma can not.
This is how it goes sometimes. Sad. But life. I'd rather be in it, with all the heartache, the pain, the stress then have no life.
Do not tell her she will never go home. They did that with my 92 yr old MIL. She stopped doing the therapy, stopped eating, willing herself to die, which she did. All from a UTI. Breaking a hip is a very serious thing. Its a shock to the system. As said the anesthesia may cause some problems.
I think I'd be miserable too. Just the thought of being in a rehab makes me anxious. Its not home. Your Gma has lost the love of her life. Her world has been turned topsy turvy. Not easy for a 95 yr old to bounce back from. Therapy is maybe 2x a day. The rest of the time she is just sitting around in a strange place with strangers. She will be discharged though if she doesn't do the therapy. I think its 3x you can refuse. Then ur family is going to have to make a decision quickly.
I'm sorry that you lost your grandfather, and that now grandma's life has been turned upside down, but you and I both know that she is exactly where she needs to be right now, and more than likely for the rest of her life. She will adjust. And if she doesn't, well that is on her and not you or your family. There is no way that she will be able to return to her home, especially since it was your grandfather who you say "took care of everything."
Often times when one spouse dies(in couples that have been married a long time)the other one goes shortly after, as they don't want to go on with out each other, so don't be surprised if that is the case with your grandma. I wish you and your family well.
She’s 95, and in a span of very brief time, lost everything that for a very long time, brought structure and security and meaning to her life, AND THEN suffered a catastrophic injury that under the best of circumstances, requires time to improve, and most likely at her age, may NEVER yield a result anything like what she was before she fell??
Would you, a generation or more younger than she, slap a smile on your face and ask a bunch of therapists for a roadmap back to “normal”?
And this is within less than three weeks?
”….lays on the ‘poor me’ guilt…”? No one is ever responsible for ACCEPTING GUILT. Under incredibly trying circumstances, you and your family have NO DOUBT done your very best on her behalf.
You are all in shock from the terrible circumstances that have dropped on you. If it is too difficult for you to visit her, arrange for a therapist to see her. Sometimes VERY DIFFICULT PEOPLE respond much better in dire circumstances to people outside the family. She may be like that.
She also may have suffered as a result of the anesthetic given during her hip surgery. The recovery from such surgery is often horrific.
None of you are responsible for her suffering. If her current conduct is making ANY of you feel worse than you already do, DON’T VISIT.
You are all richly entitled to be comforting one another and thinking ahead to “the new normal”. She is not participating in this thinking and planning, and MAY NEVER DO SO. If you all have done everything possible to get her the best care possible for her situation, YOU HAVE DONE ALL YOU CAN.
If you find the right opportunities, encourage her to work with the rehab staff and say how much the family all loves her and wants her to get better; certainly if she wants to return home this is her only possible route there, but I wouldn't suggest it as an approach to motivation for a while yet. Don't be any more specific than that - e.g. don't lecture her about diet or exercise or being "nice." You'll be wasting your breath and fraying your nerves and it won't make any difference.
Has anyone contacted the social worker at her rehab to discuss how to deal with this situation? Or perhaps a minister to speak with her? I am sure that she is dealing with so many emotions during this time and having an injury only made her time of grief more miserable.
I realize that it is frustrating for the family. I am so sorry that she has always been difficult. This makes it harder for all of you to comfort her. This is why I feel that she may do better with speaking to someone neutral instead of your family. She may be able to open up to them a little easier.
She can’t live alone anymore. She is losing her independence and I am sure that is overwhelming for her as well.
Just try to reassure her that she will be taken care of. Speak to her social worker as soon as you can. They have experience with situations like this and will walk you through the process of her mental and physical health.
Wishing you peace during this difficult time in your lives.