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My mother in law had a brief hospital stay which made me staying with my father in law necessary. Being there for a month 24/7 noticed he was sleeping most of the day, sitting in soiled diapers, not checking his sugars (both in laws are diabetic) and mobility was greatly impaired even with the walker. Once she came home I saw their normal routine, wake (between 10 & 11 am), eat, sleep, not talk to each other watch old TV shows go to bed at 1 am and repeat. He was physically unstable, was not taking his medication correctly, and developed sores on his backside. We had him professionally evaluated by the staff of the personal care department in their retirement village. It was determined that he should be in Skilled nursing. We moved him in mid April. We have been told he is high functioning for skilled care but very low functioning for personal care which is a step down with less hands on care. We have all seen a huge improvement in his quality of life but when it is just my mother in law visiting he keeps asking how much longer he will be there. She is not well with health problems that still need to be evaluated so he will never go back to living with her. She goes to sit with him every day for anywhere from 3 hours just sitting not talking, occasionally sitting on the porch not talking, or occasionally playing cards in silence except to tell the score or do you want to continue playing, to 6 hours when she stays for dinner. She complains how bad she hurts after being there sitting in uncomfortable chairs. I keep trying to get her to spend less time there but she feels guilty that he is there but doesn't want him to be home. My husband and brother in law both also feel guilty for making him go to skilled nursing. Does anyone have any advice to help them not feel guilty for doing what was necessary? I know he is where it is best for him but his wife and two sons keep asking what if. What if we had hired someone to come into the home to help out, what if we would have just let thing as they were. I always point out that if he had been left at home he could have died the night his sugars dropped to 31 had I not rushed him to the hospital. If at home and fell my mother in law is not able to get him up, too many bad things could and have happened while he was in the home. In Skilled nursing he has people to talk to and attend to his medical issues he is more alert and is eating well. How do I help them see that skilled nursing is the right place for my father in law?


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If she has that much guilt, is it possible they could live together in AL? You didn’t make it clear if she needed skilled nursing. AL will do meds, dressings & she can still be with him comfortably, they can move own furniture in, so easier for her.
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Mrsmichelleboyd Jun 2019
Unfortunately she will not move to AL as it is a very small two room one bathroom unit. We had a very difficult time getting her to agree to moving into an apartment which she is on a waiting list for. It is quite frustrating as they are both very stubborn and both have medical issues.
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Have them read what you wrote, it explains well why the decision was made. Even if they did the running around, getting at home care, a lot of time is required of family  weekly.
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I believe there is a middle ground between skilled nursing and going home. The lead in statement says he is high functioning for SN but low functioning for PC. In AZ, personal care is Assited Living. If he does not need daily nursing care, could he do well in AL. It sounds like both parents need that. My 93 and 94 year old folks are in AL in a 2 bed 2 bath unit. Mom gets a high level of support with meds, toileting, dressing. When needed, we have had a nurse come to AL to deal with post surgery wounds and it has been covered by Medicare. Perhaps your FIL would qualify for hospice or palliative care as well. So perhaps the nursing home is not necessary, considercall options.
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After a serious car accident my 84 year old brother, who lives in same state but airplane life away (76 myself and do not drive, particularly So Cal freeways), was diagnosed with a brain tumor which is benign but pressing on his medulla. Causes balance issues that are quite severe. And a possible beginnings of Lewy's Bodies Dementia (not dx until post mortem, but some dreams and brief hallucinations. He is very high level functioning and with a good memory but entered assisted living (saying primarily so I would not worry for him, and that he may go home after the summer heat, in the fall). Home is very tiny and in a small community, but he will not drive anymore, difficult in a town without transit. There is no support. He would have to hire people to shop and move about whereas at the assisted living there is transportation provided. I worry that he will try to go home again, because the truth is that things ARE NOT GOING TO GET BETTER. That is first. For you, it is even more crucial that your father stays where he is. He may always ask to go home. That provokes guilt. But it is clear that he will not be getting enough care for Mom, and she is unable to provide it. At the Assisted Living I was told that guilt is their middle name. It is what everyone they meet is dealing with at this "normal " passage and stage in life. I hope my brother does not return home, because if he does I will return to him the trusteeship of his trust and give back the power of attorney on his things; I would not handle it again. And would not/could not help again with further moves. We are too close in age and I recognize that I cannot. We are very close and able to discuss everything. It is not easy even when all involved are fairly whole and rational. And guilt will ALWAYS be a part of it. It takes normal lifelong family relationships to a place no one ever wanted to go, and adds tremendous stress for all. Consider the family speaking with a Licensed Social Worker who deals with end of life issues. Speaking with people can help comb out all the issues, and bring some peace.
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You're comparing his living situation as it was before with the skilled nursing facility he's in now. But that's actually not the choice.

Before, he was living with his wife in a retirement community but he was not receiving assistance with personal care, and that's why he got into the state he was in. He is, thanks to the SNF's care, much improved. Could that improvement now be maintained with personal care at home?

If you want to set your family members' minds at rest, I'd suggest having a follow-up conference with the retirement community's personal care team to see what they think. If they can come up with an affordable, practical plan to provide adequate support, it can be considered. It doesn't commit anyone to anything.

And get your MIL a cushion.
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Guilt is natural even when you know you've made the best decision for the person. In this case the decision is best for both FIL and MIL. When he asks about going home your MIL can tell him "When the doctors think it's safe," or words to that effect. She wouldn't be lying; if it ever were safe for him to return to his previous residence he could.

If they have a decent activities program maybe they could attend these together. Do they have sing-alongs? These are often so enjoyable that even those who don't otherwise socialize much will become part of the group singing. Best of luck, and the family is lucky to have you.
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Thank you to everyone for your advice. Right now I have poa, and all were in agreement when the move was made because mother in-law is not able to take care of him. She doesn't even do what she should for her self. All agree he is doing so much better in SN than at home. I guess it is just human nature to have guilt for doing what is best over what he wants.
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redanan Jun 2019
Is MIL living alone? Many facilities allow spouses to live together. That would be a solution for her lack of self-care, a two-fer! Since her situation isn't going to get better on her own, either.
Not to mention everyone's relief of one less stressor.
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Keep him safe in long term care; he needs assistance with daily living activities. From your description, his wife is not capable of helping him with day to day needs. So keeping him safe where he is located will improve his quality of life.
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There will always be guilt either way. I dont know if in home care costs more or less than skilled care in a facility so it might not be doable. Maybe he could come home and they could try it but thet might be uncomfortable with caregivers in home. Maybe eventually when mil is ready she can move in nh with fil and they can share a room. Its a hard thing for everyone to adjust to. My dad is in AL. But not getting much care there. Not candidate for nh yet though according to staff there. We are thinking about bringing him home and hiring 24/ 7 care . We have to look into the cost and cost of remodeling bathroom for walk in shower etc. Right now he is safest at AL but he wants to leave. Best luck to everyone going thru these decisions.
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No one can help someone else not feel guilty. Who has POA? That person should be making the decision. I suggest the family meet with the evaluation team to review the pros and cons of SN vs. PC. Then make the best informed decision possible. The family probably feels cu out of the decision making process.
Good luck and let us know how it works out.
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