My Mother-in-Law, one of my favorite people, was in “respite care” for approximately five weeks. This was a much shorter period than I thought was necessary. I have some expertise in this area. I was a social worker for a good many years.
After spending several weeks in hospital recovering from the cellulitis that could easily have become septic and taken her life, she was too weakened to be able to care for herself at home. Recovery in a place that could offer her care, and perhaps a few challenges, was needed to help her regain some physical competence.
However, prior to her entry into hospital, she’d already proved herself unable to make good decisions about her health. I suspected this but it was hard to convince my husband or his brother. My previous article about all of this detailed the discovery of her cellulitis which she’d hidden from us for many weeks, through several visits. Why? “I didn’t want to bother anyone.”
When the cellulitis was at last discovered it brought with it a round of doctor’s visits and several courses of antibiotics while I screamed into the insensible wind that ‘she belongs in hospital!’ It also brought the realization home for her sons that perhaps she needed much more help than she’d been getting.
My lovely MIL is 92. She’s in very good shape, other than the cellulitis, diabetes, high blood pressure, and erratic heartbeat. She isn’t overweight, nor is she too thin. But up until this episode she was already beginning to worry us.
She couldn’t be depended upon to always wear her alert necklace. She’d insist upon going out to the garage which substitutes for her very own shop, to collect what she needed to eat, drink or use to clean up. This garage ‘store’ is in addition to all the necessities she stores in the house. The trip outside, down steps, through rain, hail, sleet, snow, and blazing sun posed a very real possibility of falls. Indeed, she’d fallen at minimum twice, once suffering for at least two admitted hours before she could work herself around to get herself up. She hadn’t been wearing that damned alert necklace. She’d also fallen in the kitchen and injured her head. All this was just the tip of the iceberg.
She has form. She does not report incidents that may worry us or cause us to believe she needs a greater level of oversight and care. This alone showed she is not thinking clearly about her needs. So we had carers go in for the minimum, thinking that she’d get used to them and they could help us make sure she was safe. The carers came in just after we discovered the cellulitis before they finally listened to me and put her in hospital to fight this insidious bacterial infection.
After the hospital, I found a care home near where my husband and I live. If trees and houses weren’t in the way, we’d be able to see it from our front door. We contracted with them to take her for respite for at least six weeks. She agreed very reluctantly but even she could see she was not up to being at home, mostly alone. I honestly thought that once she was there she would make friends and get to like the place. Three good meals a day, no need to lift a hand, people to help you bathe in an actual tub — she only has a shower — and people to talk with almost at all hours. My MIL is a social lady, previously somewhat isolated at home, I thought she’d fit right in. I was very, very wrong.
My MIL decided that ‘these people have never had a deaf person here before’. She refused to go down to the dining room, quite a nice dining room, I might add, and mix with ‘those people’. She ‘felt sorry’ for all the old people there though she was probably one of the oldest. There were no activities she wanted to participate in, she sniffed at Bingo, refused the twice-weekly exercise program meant to help her regain strength, refused the games meant to engage her and increase memory, and refused to go out on the bus to the local shops because that meant she’d have to show them she relied on the rollator. I could go on.
The care home was a bust even after my husband, her son informed her that if she didn’t participate, every day inactive meant another day tacked on at the end. It’s not nice to threaten old ladies but it did the trick. The next day she walked down the hall outside her door holding on to the rails. At least she was out of her chair.
It was my belief that she needed to spend another month or two actively working on getting stronger but I was overruled. Her sons, my husband and his brother, sided with their Mum when she insisted that she wanted to go home. I will admit she is hard to resist.
I wrote a care plan. It’s second nature, I’ve done it for years. I passed the care plan on to the agency that knew her before. But this time the plan is much more ‘robust’ as we say and so carers are there twice a day.
There is now a new, smaller freezer in the kitchen and thus, no need to go out to the garage, at all. She’s already felt this as a loss but agrees that she is only one person and the days of her presiding over a Sunday Roast are over. She will also have an escort whenever she goes outside to collect those things that are still there. We’ll help her use them down until the garage is empty.
The carers will also help her in and out of the shower. The bathroom was another place where she’d fallen and again not told us.
She argued while she was at the care home that if she couldn’t take care of herself she belonged where she was when I told her that she’d have help to get her meals. However, just after that pronouncement, she told me that she couldn’t stand in the kitchen for any length of time and that she thought she’d have trouble just making a cup of tea.
Now, comes the worst part. The signs of memory problems and cognitive loss are becoming clearer. She tells the same story every time I see her. It’s quite a complicated story, poignant and illustrative of a loss she cannot get over. But I have heard it so many times I could recite it word for word. I get that she feels the need to tell me this particular story. It’s relevant in her mind, to our relationship.
She has difficulty adapting to any change, even minor ones. Routine is vital to her so that she feels secure. At the same time, she’ll forget that she’s already done something. She sometimes forgets her medication and has to be reminded.
She worries incessantly about things that have no relevance. For instance, she worried that my husband’s brother had left the shower head too high for her to reach, forgetting entirely that my husband would be taking her home and could pull it down for her, forgetting also that she would have carers helping her whenever she took a shower.
She also worried that one of the carers at the home where she stayed might have taken something from the bathroom in the middle of the night. She actually wrote a letter apologizing for complaining about this when she discovered she had everything she’d come with when she got home.
My husband stayed with her for a few days after he took her back home. He called me every day, the strain in his voice evident because she wasn’t ‘settling’. He said he felt like a ‘helicopter parent’ stepping in at every worrisome situation. He wondered if we’d made a mistake bringing her home.
I think we made a mistake.
I thought at one time, futilely, that she’d come around to her own understanding of her situation and realize she needed the help and perhaps agree to 24-hour care somewhere. What a foolish idea. First, cognitively she’s already compromised and can no longer make that judgment. She is in her mind, still the active carer of others that she always was. To suddenly need care just does not carry the weight of truth for her. Now, my husband, my brother-in-law, and I all need to be parental and take the hard decisions for her. But first, we hope she’s safe at home. For a time. We hope that in time she’ll get used to her new routine and be happy and well. But each of us involved in this harbors the belief that we are just waiting for evidence of just how bad a mistake we’ve made.