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MIL fell today transferring out of bed onto chair, hit her head hard. She was amboed to the ER, where they discovered a suspicious spot in her brain. Doctors think it’s either a brain bleed or that the cancer has come back. She’s in the hospital pending another scan.



FIL has been refusing to take his pills because he’s positive he already took them.



SIL came home frazzled because they made appointments the same day and so she had to take both of them. Two people. One wheelchair.



Brother confided that he can see the need for AL as his relationship has been suffering with his wife being the day aide.



But everyone dreads to have the talk, even if it’s just about getting another aide to maintain aging in place. We anticipate they will be rejecting all options.



Ideas?

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Thanks Barb!

Besides more money and less commuting, he will make connections. Get recommendations. See and hear who seniors are working with, and what they’re doing for help.

If his hours are irregular, parental requests may increase, so he may need this information sooner than later.
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BarbBrooklyn May 2022
If his hours are irregular, how will they know that?

The less they know, the better off your lives will be. His work schedule is none of their d@mn business.
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PeggySue, that is SUCH good news!
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SO got the second job, a better one!
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The a-ha signal finally went off. MIL is now arranging paratransit with SIL.

SO declined to drive her for two weeks. They then found a safer plan.

This plan still means that one of them is to be alone while SIL is accompanying the other one. The worst that can happen isn’t that they soil themselves and have to sit in it, the worst is that they’ll try toileting themselves alone.

But then again, up to them.
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MIL called me. I ignored it. She quickly sent me a text.

She wants SO to take her to the doctors next Wednesday. SO told her he’d be back at work. He brought up paratransit and believed she seemed receptive.

So he’s going to go talk to them.

The county’s rate is 9.50 round trip. The brothers wife would come with to wheel them wherever paratransit won’t, plus be available during the appointment itself.

This would leave one senior home without an aide. But, at least, this is where we were before.
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Beatty May 2022
A.B.C.

Advise options.
Be what may - let them decide.
Consequences are their own.

A. Suggest hiring the help, try para-transit, a sitter etc.
B. MIL decides.
C. Whatever happens, happens..

I just thought of D.. Disengage or maybe Detach. Detach emotionally from the outcome.

What's the worst that happens here? MIL misses an appointment & has to rebook it? Maybe MIL learns what works & what does not? Learns what is realistic.
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What an amazing service!

It doesn't have to be framed as a "confrontation".

"Mom, it's not possible for us to transport you by car any longer. Here is the service we'll use".

Present it as "now it's time to....."
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PeggySue2020 May 2022
That’s how he plans to deal with it, Barb.

The issue isn’t just who drives. It’s also the car. The safest option is to transport her in a wheelchair van that’s certified with all the osha bells and whistles and with trained staff to actually fit the person in and out of transport.
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SO wants to confront them over the driving situation. Fact is, brothers wife is no longer comfortable getting her in her car and EITHER is he. The county has paratransit that will transport wheelchair bound and their caregivers to appointments. Or they can select a concierge medical limo.
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They told SO he was top of the list due to his test scores.

They also asked him if he’d had experience dealing with older people. Oh yes.

The members, as they call them, are with it. The complex is high end independent living with bocce ball, extensive gardens, warm water pool, library.

SO parents couldn’t live there anymore. But I wish they would splurge a little bit. If brothers wife can’t get you in the car, pay for a medical transport or an aide who can get you to the medical. If brothers wife is preferred to attend the exam, the other aide can come home and make sure the senior is assisted to the toilet before heading back to drive the one brothers wife can’t get in the car.
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Whoa. He came home all dejected because they’d told him to take aptitude tests and then said they were going to lunch. He left the aptitude tests there and came home.

Not one but two managers called him. They weren’t finished with the conversation. Could he come back right now?

Well sure. The site is only five minutes away. Whereas the other will require about 150 per week between bridge tolls and gas.

His brother texted him saying that moms appointments were now virtual for this week.
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Beatty May 2022
Virtual eh?
Interesting.. Fancy that! A DIFFERENT solution was found.

I hope he really imbeds that deep into his mind.

When he is NOT the solution - they find a NEW solution!

PS answer to virtual apt? Not Oh that's great! But shrug. Whatever they like, Bro.
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I had a friend who went through something similar… major triangulation going on there.

”Thanks, bro, but Mom can reach out directly if she wants to ask me for a favor. Our relationship is going to suffer if we act as go betweens and I don’t want to lose what we have.” (Or whatever, depending on whether they like each other;)

”If she cancels, she cancels. I can’t care more about her health than she does. She has an option in taking a ride service and chooses not to. That is *her* choice.” Most elder appts are routine anyway. Even if not, again, her responsibility, not your SOs.

and in the specific case of your SO…
”Mom (or bro), I finally got a great new job. My focus is going to have to be on that for a while. Long hours and an unreliable schedule, but a better work environment. I’m letting you know now so you can put things in place to handle that change.” He doesn’t have to tell THEM that the hours are better. Make it sound worse in order to use the job change to break out of some of these unhealthy patterns.

If he can find a way to stay calm, say things in this non-personal, unengaged way, he stands a good chance of getting through eventually.

Another good tip is to STOP telling them so much. He doesn’t have to give them a run down of his week. He doesn’t need to say what he did on his days off or which days he has off. They probably complain enough anyway. He can just listen and not try to justify his life by sharing it with them, know what I mean?

He just has to be prepared for “people to think he’s the bad guy” or “not like him” or for her or FIL to “be mad”. They don’t sound like a barrel of laughs and are going to be mad anyway. If they are going to be cranky anyway, he (and you) may as well have a life, lol.
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Beatty May 2022
Excellent responses to give!

SO may need to practice this cool & professional 'detatchment'. I did.

At first, I had dread at the phone ringing. More dread as requests came in (often 3rd party). Then dread at saying no, can't do. But I improved!

Now I have no emotional attachment to whether someone attends their own medical appointments or not. Well, maybe a little sadness, but it was never my responsibility to get them to it. It certainly was never their right to assume, insist or be upset if I was not at their beck & call.
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SOs phone rings. It’s his brother calling on moms behalf. She wants him to drive her today and tomorrow. The brothers wife is now having issues getting her into a car. Mom is insisting that if SO won’t transport her, she will just cancel her appointments.

He told brother that he has additional interviews. He can’t. Then he told me to text brother the name of a medical transport. I texted his wife by mistake.

No no, really, it was an honest mistake.

But wth. Seriously, mom calls brother to issue requests because mom knows so is pissed at her over these requests. She threatens to not get medical attention if SO won’t snap to it.

When SO got out of the shower, he said to me, “I had a horrible thought. I wished she would just die.”

I said this was not a novel thought among caregivers.
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Beatty May 2022
"..brother calling on moms behalf".
Call that what it is - Manipulation. Or known as 'sending out a flying monkey'.

"..just cancel her appointments".
Call that what it is - Blackmail.

Both manipulation tactics.

Mom wants stuff. She will use all her tools.

SO's eyes are being opened. His 'death wish' is the flicker of anger that just ignited. While not a nice thought - celebrate the anger. It means he FEELS his boundary being run over. The fire is lit - means
he has the energy to fight back now!
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Someone else reached out. If he gets the interview, why not talk to them? He hasn’t started yet, and two birds in the hand are even better than one.

The person calling was from a senior living establishment.
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BarbBrooklyn May 2022
That sounds...amazing!!!!
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It looks like the shift is Tuesday Saturday now. Eyebrow raised, I stated to him that if he tells his parents, that is just inviting them or sil to make him their driver or sitter.
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CTTN55 May 2022
Good news on the job, but you are right - the ils will make medical appts. on Monday now so he can be the driver or sitter if he tells them!
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PeggySue: Amazing news!!!!!

"I'm here to support you, but not to do hands on care" is an expression I've heard.

"What level of care is appropriate for mom and dad right now?"

"What is in place isn't working."

"I can't provide what y'all are asking of me."

Just some verbiage that might be good to have on one's back pocket.

So I said to my mom one day "I can't do this anymore". It was the hardest thing I've ever done. Your SO can do it too.
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PeggySue2020 May 2022
His shift almost exactly overlaps dil, and he’s pressed that they need more help during that time.

If they choose to be left alone and urgently need to toilet, accidents are going to happen whether it be filling a diaper or falling while attempting to reach the toilet. I feel bad. It shouldn’t be that way, but only they can decide to bring on the additional personnel or take the risk.
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SO got that job. Monday thru Friday 8-5, on site, in a different county.
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SnoopyLove May 2022
Great news! Truly a “win-win” situation! 😉
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He ended up having to leave before sil got home with dad because of the phone job interview.

He was then invited to an in person interview to meet the managers this week.

The money is way better. And if the days off are Saturday and Sunday, he won’t be available for sitting or driving any more than brother is.

Sil took dad to see the doctor about his bowels. The doc told him to get more Metamucil or similar product and instructed him on how to do anal Kegels, but the fact is a third of his bowel was removed last year.

When the sil takes either of them to the doctors and the other one needs to toilet at home, they’ll have to go in their depends as the safety option. Or they can organize appointments into doctor days and get another aide.
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I can be sitter;

At a time that works for BOTH of us. I am not 'on call' staff.

I WILL do company & minimal transfer assist.
I WILL NOT do toilet assist.

Therefore, if you cannot toilet yourself independently, then I cannot be your sitter. You will need to arrange someone else.

Polite. Firm. Repeat. Repeat. Repeat.

The the toileting job creeps in; No. I told you no. If you cannot manage, that's unfortunate. You will need to wait until your caregiver arrives to assist you. I did warn you. Many times.
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Wait....mil doesn't want her sons to see her private parts, but I thought SO's line in the sand was that he wasn't going to do bathroom duty? So did he go over to momsit today or not?

Who's going to nag indy's BIL to build the platform? It might never get built. Glad SO isn't going to do it.
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PeggySue2020 May 2022
No, he IS going over to do it. He’s under the delusion that this won’t involve bathroom duty, and MIL is under the delusion, I suspect, that as long as all he has to see is her naked crotch and butt that he doesn’t have to personally wipe it’ll be ok.

Its fully up to him to decide that it isn’t or is. As far as her so called humiliation, I think of that less than her bodily waste.
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Turns out that the indys bil is now allegedly building this device.

But like I thought she still wants him over there to momsit her.

That’s gonna involve at the bare minimum his having to at least see THAT area sooner or later. If you’re the person wheeling her into the toilet, you’re gonna have to see when she pulls her pants down. And if there’s already a deposit in the Depends, you are gonna help get them off and her new ones on.

She can cry all she wants about how humiliating it is for her son to deal with and look at THAT. I have no sympathy for her whatsoever as she could hire someone else to do it, and am rapidly losing sympathy for SO in indulging this. He’s got that interview lined up today, and frankly he should just tell mil he is booked with interviews in the future so she doesn’t try making him her personal diaper changer
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Does SIL know about your SO's interview, and the changes in the family dynamic that will take place should he get this job? DO MIL/FIL?

Could this be a deliberate attempt to sabotage the interview? To ensure that things won't change?

I certainly hope your SO tells them all "nope, sorry, that time doesn't work. If you want me to do favors, you should have the courtesy to CHECK with me first, to make sure that time works for my AND MY family."

I've had, in the past, family members that have *assumed* that, since DH and myself are retired, the only thing we have going on in our lives is sitting around waiting for the phone to ring with someone asking for a favor they need immediately. After a few "no, sorry, busy...next time check with us first before you figure us to be the letting in repairmen/letting dog out/running out to get your prescriptions" they learned to ask first.
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Certainly not the nicest.. but won't kill someone if they have to sit in a wet pad for an hour or so until their personal caregiver returns.

If SO can't say "No, I can't do that" then a blank stare while staying immobile could work too.

But why even go at 1pm in his workday? Why not say 'That time does not suit, I have an appointment myself'.
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"She now wants him over at 1 pm. That’s when Brothers Wife is taking fil to the doctors."

So is he going over there? And what happens if SIL w/FIL is delayed from returning from the dr. appointment. Will he leave Mommy alone to return home for his job interview?

And what happens if Mommy needs to use the toilet? Will he assist? Can he tell Mommy no?
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When your in-laws are assessed for a facility, don't be surprised if neither one qualifies for AL.

Much of what you say leads me to believe they are headed for a nursing home.

However, they are way to accustomed to one on one personal care, they will never willingly go anywhere that they don't have a personal caregiver.

Honestly, I don't blame them for wanting to stay home. Their biggest error is not hiring professional help and using their sons to prop them up. If they would implement those changes this would be a fine situation for everyone.

A professional would say no movable commode stand. I still laugh when I think about this really dangerous solution that everyone is helping with.
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PeggySue2020 May 2022
Hey Real, I agree with all of this.

She now wants him over at 1 pm. That’s when Brothers Wife is taking fil to the doctors. He has to be back by 330 in front of his computer for a phone job interview.

Theres no way he can finish the box in two hours. At most, he could take the measurements and get the plywood. While he’s off doing that, mom will have no one around should she need to toilet.

I mean, at this point that’s what it’s mainly about. Toileting. FIL at least has a urinal but she needs to sit down, once every 2 to 3 hours. If SO is the only person around, he’ll have to be The One.

SO is like, you two wanna die together fine, but it can’t be here. It will have to be in an al, or as you say, a Ltc. I say, like you, that they can actually stay in that house by just engaging one or two more people or agencies.
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I just can't wrap my head around the WC dais idea..

Not sure I follow how it helps the transfers?

Would a height adjustable electric bed be beneficial?

If unable to stand & pivot for transfer from bed to commode - it's time for a Sit to Stand machine or a full Hoist machine.

Then an over toilet frame?

I also just can't wrap my head around why SO is abliging?

Can he practice pursing his lips, putting his tongue to the roof of his mouth, release his tongue while making the sounds of the word November. Just stop at the first syllable: No. Practice this until it feels natural.
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PeggySue2020 May 2022
I didn’t get mad because the whole situation is as absurd as you said, Beatty. Like, you can’t just roll or slide or whatever onto a platform commode, The stand to pivot thing is a bit easier with a raised commode, I suppose, but I f you’ve ever done CrossFit you know that a plywood box heavy enough to hold a human being can’t be dragged extremely easily.

So no I don’t think it is a solution, but they’re in eff around and find out land. They won’t learn until they are made to.
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"The difference is that my parents know what this might mean in terms of separation. My in-laws don’t."

I was actually wondering if that's the main impetus behind their refusal to even consider entering into care. I mean, no one wants to give up their independence, but if they are afraid they will be separated...

Peggy, if FIL MUST go into a facility, do you think that might be the driving factor in getting MIL in? Assuming it's a facility where they can be together?
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PeggySue2020 May 2022
They’d rather both go to al rather than be separated. And they’d almost rather die than go to AL. It’s the dilemma most of us have here.

SO is going over there to do this box while Brothers Wife takes dad to yet another pre op appointment. Which puts him in the box with Mom should she have to toilet. I’m fairly confident that he’d rather take the job experience of having raw sewage baptize him, so to speak. That is just part of work.

Speaking of which, he has a phone interview tomorrow at 4. Wish him luck. A Saturday Sunday weekend would eliminate most mommy requests including what I think is a sneaky toileting request.
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SIL is never going to agree to any arraignment that costs her her cush $33.65 an hour job.

BIL isn't going to encourage anything different, 70k and an occupied wife is invaluable to him. Think how self righteous he feels? I mean, look at everything his wife does for his parents, all while you don't, tsk, tsk, tsk.

Hopefully, SO can learn that "No! I can't possibly do that." Is a viable answer.
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PeggySue2020 May 2022
Lol. I’m in the fortunate position of not being called on to help, not even by SO. I can’t for physiological reasons, nor am I gonna be bullied by SIL.

I think the in laws are exactly on the same trajectory that my parents are, but frankly I believe my mom will just place my dad. There is a certain detachment about their relationship that has always been there.

The in laws are a 180. No a plywood box won’t fix the issue. How is that thing supposed to be even safe? Again they will muddle along here.
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Peggy Sue; glad to hear that he's going to do so.

Sometimes, with very stubborn folks, it's better to get someone else to be the bad guy, to say, "you need to do this, or that".

It doesn't always work; but it's something that he can keep referring back to, and that he can keep in the back of his head when his parents are making unreasonable demands.
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PeggySue2020 May 2022
Thanks Barb.
Honestly and in general, I believe it is nigh impossible to retrofit a home to be compliant with what Al or SNF has.

Take the bathing issue. Their hair looks clean when we visit, same as with my parents. They don’t smell. At least one of the in laws aides is getting them over and into their high tub to accomplish this. My own father mostly lives in their upstairs where there is only a Roman tub. He can only shuffle now so I have no idea what he and my mom are doing.

My mom is 86, my father 90 this year.

I had a chat with my HPOA sibling over Mother’s Day. She’s like, Dad doesn’t want to change. It’s his right to refuse even a stairlift let alone aides. If he does start falling or becomes double incontinent, whelp the plan is that he goes to an snf.

My sibling is an md, a cancer surgeon, and the head of her department.

So maybe the only thing to do is advise them, but it’s their ultimate prerogative to eff around and find out.

The difference is that my parents know what this might mean in terms of separation. My in-laws don’t.
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Peggy; Have these folks EVER had a professional "needs assessment" either from the local Area Agency on Aging, or one ordered by their doctor?

If one wants to age in place, then one needs to have an over-arching and well-thought out plan, not a box of bandaids.
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PeggySue2020 May 2022
Therapists and nurses have been over there off and on for two years. No, this hasn’t been done. Yes it should be, which is what SO is gonna say.
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I passed on the recommendation to So that an ot look at the platform plans just to make sure that this is a safety improvement. There’s also the issue of Brothers Wife having to drag a largish wooden platform in and out as there’s not room for it and her wheelchair.

I would frankly feel better if their decision was to move their present bed with the drawers underneath it to the indys room, replacing the bed the Indy had brought from her own home (!). They need a double hospital bed that can be lowered to whatever optimum height for getting them transferred, and with lift stands already almost inevitable, the bed has to have space under it for the forks to go under.

Theres a profane but accurate saying. Eff around and find out.

FIL has been able to use his walker lately for 10 steps but if his goal is to display functionality enough to get his fourth brain op and third heart op, the odds of the interventions costing him that functionality plus his cognition are well, everyone effs around hearing what they wanna hear until something happens.
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Fawnby May 2022
Old people often don’t make it to the toilet in time. Imagine her peeing or pooping herself as she transfers from bed to toilet. The patients need to be told in no uncertain terms that they are no longer in charge. Over and over again. They get no say so. Social services should help.
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I think having an OT come in and advise on this plan would be a wise step to take.
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Beatty May 2022
Or a better plan..
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