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She wants to go home but has no money to pay for a caregiver. How can I help her understand that she has to stay where she is?

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Need a little more information before I can answer.

How old is she?
How long has she been there?
How often do people visit?
Does she have dementia?
What are her other medical issues?
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Your profile states she is 93 and has dementia. Dementia robs people of their ability to use logic and reason (and therefore impairs their judgment process), and it takes away their ability to empathize with others.

Please don't waste any more effort trying to "help her understand" because she literally is not able to, and probably wouldn't remember it anyway.

Instead, use therapeutic fibs and redirection. Here's what I tell my MIL in LTC: "When you can show the doctor you can perform your ADLs then s/he will consider discharging you." Then, it's the doctor's fault and not yours. Just keep telling her this story whenever she asks.
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CaringinVA Jun 2023
Putting this in my back pocket to reference when we visit my MIL. She is totally disconnected from the fact that she is ailing, thinks that she gets up and gets dressed and goes to the bathroom on her own. Unfortunately, she has been bedbound for 1 1/2 years. Its challenging for sure.
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Juse keep your answer simple and repatative such as you are waiting for the doctor to say it is safe or that you are still working on it
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She's not going to understand why she needs to stay. Instead, listen and acknowledge how she feels, "I understand you want to go home." Then slowly redirect her to something else. "I see you drew a picture here" and so on.

Bring a snack or magazine or something of interest.
Wish you all the best
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Beatty Jun 2023
She's not going to understand why she needs to stay. Instead, listen and acknowledge how she feels, "I understand you want to go home."

Such good advice 🤗

I have copied this out today for my own family. I see some trying to smooth over, make everything feel ok, look on the bright side etc.

Grief at losing one's home is real. People want to feel heard.

I have to move soon from a long loved home - very different I know - but while "you'll adjust" & "you'll get to like the new place" & "look at all the positives" may be true enough the fact that I feel sadness is still real. My feelings are valid.
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bring music, strawberry milkshakes, people, framed stories of her life, photos, fun things she liked to do... dance.... dance... go get into a game and game...have fun... Play... Play bingo.]

watch a good ole blackened with move
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With dementia/AD at play, you won't be able to "make her understand " anything, unfortunately. You can distract her with activities and snacks during your visits, and ask the doctor for calming meds to help ease her agitation which could happen ANYWHERE, even at home, since demented elders always want to go home, even when they ARE home. Please don't buy into guilt trips others enjoy inflicting around here. It's unnecessary to give any advice here but the useful, helpful type since we can't understand another posters position in life. Not everyone has the financial means, abilty, or opportunity to stay home 24/7 to care for elders. Period. To cast judgment on them is an ugly thing.

Wishing you the best of luck with all of this.
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Sorry you are having to deal with this, hugs.

It is so hard to wrap one's head around the reality of dementia (what ever the form), as we watch often in slow motion a once able and competent person become someone we cannot recognize, much less reason with. But this later part -- being able to reason with them or "get them to understand" -- is just not possible as others have said. Dementia (regardless of the type) causes the brain to not function as a healthy, adult brain.

Almost like expecting a two year old toddler to understand why they cannot have candy for dinner; trying to explain a permanent and necessary placement in a nursing home with an elderly person well into dementia lands one in the same spot: you frustrated, angry and perhaps felling guilty w/your own frustrations and your LO not able to grasp/understand/remember/agree with YOUR reality of what they need. Your LO w/dementia is stuck in their reality where logic, reasoning, retention of information, managing emotions and a myriad of many more things is lost and the decline in their abilities will continue.

My mom (86 w/dementia and a host of other things -- basically bedridden) has been at her nursing home 2.5 years and still asks to "go home." This many years later she has not adjusted nor does she understand what is going on. She is getting the care she needs, irrespective of her liking, agreeing or understanding this is what she needs. It is what it is.

I have found working with a great therapist to unpack some of my feelings and struggles with this to be helpful. Something you might want to consider.

Nothing prepares any of us for this journey and a journey NONE of us want to be on.

Hugs
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CaringinVA Jun 2023
Thank you Sohenc for sharing. My MIL is in pretty much the same situation as your mom. I wish that she could adjust to being there and be more involved in activities and meeting others. Nope. While she has a pleasant demeanor(which I am grateful for), her conversation each visit is very much one-track: getting out of the facility. And she doesn’t connect that she is ailing, at all. Sigh…
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Short visits, perhaps spaced out a bit through out the week... This gives her both assurance that you will come and let's her have time to establish trust with letting staff help her w/ o you there .

During visits answer her question about being there with love and focused on safety for her .... then redirect the conversation to something positive ( take a walk together, look at favorite pictures, read a book together etc etc) .

If she insists on perseverating on not being in facility, then gently tell her you love her and that you'll be back soon .( Do not give exact day, time ). Then leave.

When you come the next time, do the same thing if needed. You can also explain to her that continuing the conversation about her not being there is not healthy her ( nor you).... It increases anxiety for everyone and prevents positive visits.. repeat the safety issues for her ...

Practice good self care. Remember that it is not unusual for people to grieve the changes needed and moves into a facility. Be sure that she and you are receiving emotional, and spiritual support from chaplain or faith leader of choice. Have one visit her when you are not going. Social workers may also help her with the grief associated with change.
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In reading this my thought was "why do you have to make her understand why she needs to stay to stay there" Where is your DH, her other children? My SIL told me once, she handled her parents, my BIL handled his. Meaning that my BIL would be trying to explain to his Mom why she needed to stay.

When my MIL (not my favorite person) was in Rehab, I did nothing for her. For one, I thought she was playing her sons. My husband was the one who sat with her and held her hand and he should be the one. I did not expect him to do that for my Mom. I supported him and he supported me. But we took care of our own parents.
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While you do not state if she has / the level / kind of dementia, it does matter in terms of how you talk to her. I also do not know her background, prior living situation, age.

"Mostly," it is best to talk to her in a way that will support her emotionally to stay even (= not get upset) however you need to respond (and it is not only perfectly fine to tell her what may not be true IF it supports her current well-being / emotional state). The 'truth' now translates into 'words of compassion and caring' i.e.,

"its just temporary until ... the house is painted (or something).

"its just until you get your strength back (if there are physical challenges)."

"We need to wait until your lab work results come back and see how best to keep you healthy!"

* As someone else said, there is no 'reason' to tell her that this is her new home FOREVER. (Why?)

- Try to stay in the moment as much as possible.

"We'll take a day at a time and see how you do."

(I used to tell my friend/companion (he was in a nursing home and bedridden. I would say, "when you get stronger and can stand up on your own" (he couldn't).

Still, these OPEN ENDED RESPONSES / STATEMENTS leave the door open for HOPE - and that is often all we can give a person with dementia, in a nursing home / in a room / away from family - and just about everything they've known all their lif is gone.

HOPE and COMPASSION, and letting them know they are loved, and that you understand how they feel (reflective listening) "I understand this is hard for you - use her words 'reflect' back to her.

* As is possible, spend more time with her during this transition period.
Professionals in the field will tell you that people 'do' get used to it although how long depends on the person, disability/dementia medication, their personality "MO."

* As you can, change the subject. Acknowledge her words

"Yes, I understand how you feel. We are here to assess your health. Would you like to go outside and see the garden?" (or something). Shift the conversation.

* Can you/someone she is comfortable with introduce her to others, or activities. Stay with her ...

Expect her to voice her feelings about the situation (anger, repetitive words, frustration/anxiety ... see the situation from her point of view. She is scared, everything is new / she has / is losing control of her life. Of course she'll want to 'go home' to what is familiar and feels safe. She doesn't feel safe now.

Try more gentle touch (tactile) to comfort her, if she is receptive to this.
Give her a massage (her hands, feet, neck/shoulders, even face). I am a massage therapist and find that elders gain great value from just 5-10 minutes of gentle touch. They are not otherwise touched at all unless it is a caregiver dealing with them for hygiene reasons.

Inquire at local:
* Colleges for students who might volunteer (nursing, social work, geriatric programs). Or be willing to pay them to visit.
* Contact massage schools for students who need / want to practice their skills. You may want to clear massage with her MD. I still require a medical release for all massages I offer to elders.

Gena / Touch Matters
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Rapunzel55: It is a futile effort to make her understand virtually anything since dementia is at play. Distraction is a key element that you can use with your MIL with AD. It is a common statement when the ill patient states they want 'to go home.'
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Simple fact: she can go home when she can take care of herself. Until then, she needs to let these nice people help her.
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