How do I explain to my mother she needs to be in a care facility?

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How do I explain to my mother she needs to be in a care facility?

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10 years ago, after a stroke, my mother came to live with my husband and I. At the time she could walk with a cane, go up and down stairs on her own and bathe herself. She's now 88 and is only able to walk (with a walker) to and from the bathroom. Unless she has an "accident" it's the only thing she does unassisted. I do have a few hours of help each week through medical. I am so burned out I don't know where to turn. I cry a lot, I feel guilty about everything. At this point it's taken a huge toll on my marriage and my mental health. I was a full time college student and now I'm down to one class per semester. We recently took her to her primary care physician hoping he would help us explain to her that it was time for a care facility. I think he didn't want to be the bad guy, he was very vague, and mom's reply was "that is the last place I would want to go". How do I explain to her that I'm done, I can't do this anymore, that my marriage is suffering, I'm suffering. I honestly believe she would be happier and certainly better cared for in the facility. But she harbors a fear of nursing homes. How do I explain to my mother what caregiver burn out is? How do I tell her it's time? I see all kinds of information on the web about caregiver burnout, list, tips, symptoms... but nothing on how to tell your loved one that you personally are burned out. Sometimes I fear I will never be the person I used to be, that I will never recover from this.

Burnout

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You can ask these things:

1. Do you feel that you need to be socializing with others?

2. Do you feel that you need activities during the day?

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Thank you for your discussion forum posting. That is a very hard decision to make because my father and I have had to make that decision regarding placing my mother. It was very hard. My advice would be to do the following:
1. Stay calm as much as possible.
2. Try to do as much research as possible.
3. Figure out how to approach the situation as best you can.

My mom and dad have been placed for about three months now and they are doing great. My dad and I did our homework and we made sure that we found the right place and I believe that we did.

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I would do these steps in order to talk to your mom about going into a medical facility:

1. Talk to her calmly about the reasons.

2. Use a reassuring voice.

3. Always be careful about how you say it.

4. Always keep an open mind.

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I would ask her these questions and then see what the response would be:

1. Do you feel that you need help while you are at home?

2. Are you able to cook meals?

3. Can you do your everyday ADL's effectively?

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The advice that I can give you is the following:

1. Tell her in a calm manner that she might need to consider receiving more help during the day and night.
2. Ask her about how she feels and what she is feeling towards that decision.

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I found some really good answers here. Involving the parent in the decision making could help a lot. Not always but worth a try. I wish I had advice on this one but I am in a similar situation where my mother pictures the homes of the old days and says I owe it to her to care for her. So, yes she is resistant but in the end it will be my decision about when I cannot take care of her anymore and doing so will be to my detriment. She does not care how it impacts me at all. So the advice here was sound, and it is for your mother's best interest as well as yours.

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DoveSoup, thanks for your update back in October.... keep us up-to-date about your Mom, and has she picked out a new apartment? If yes, how is she doing.

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Here are the things that I would do:

1. Show her pictures of a picture book about good Senior living care.
2. Tell her that these apartments are really nice and that can be your new home.
3. The apartment is just like that in that it is an apartment that can become your new home.

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I would just tell her these things:
1. Can you walk on your own?
2. Do you need help during the day?
3. Are you able to cook?
If she answers "NO" to those questions, then she might need assisted living. That could be your starting point.

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I had to talk to my mom about the same issue and these are the questions that I asked my mom:
1. Do you want to cook three meals a day?\
2. Can you walk long distances without getting tired?
3. Is your asthma under control or do you need a constant climate?
After I mentioned those things, she understood why the assisted living was the best for her.

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I had to do the same thing with my mom after she fell and she came home from rehab center. I told her that this assisted living place is like a hotel where you have less stairs and less places to fall. All of that is true because the place that we placed my mom is very much like a hotel or an apartment and it looks very pretty. She can have her pets with her and bring her own bed and furniture. So, it made the transition much easier and better. Try to find a place that looks more like a hotel or apartment. I wish you the best.

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If she is able to have a conversation with you, the best way to do this is to ask your mom a few questions and they are:
1. Do you need help with meals and preparing them?
2. Do you need help with your ADL's?
If she answers yes to those two questions, then it is time to consider the possibility of moving into a place where they help you and they provide meal service.

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I went through something very similar with my mother and can totally relate to the burnout, guilt, marriage/health suffering, etc. I would suggest you and any siblings check out small group home/elder care facilities. I eventually had to move my mother in one (she passed last month), and although I still felt guilty that I could no longer take care of her, the reality is that she got better care and attention there. The smallness of the facility made it more homey, and definitely not anything like the nursing home nightmares you hear about. Also, perhaps consider having her there for a month just to gauge how she's doing there, and also for you to see how confident you are that they're taking care of her, that they treat her with dignity, the place is clean, etc. Good luck to you!

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It is rather tricky, but without the doctor's support, it really makes it an uphill battle.

Anonymous67, you say that the social worker is pressuring you to select a facility for your mom. Do they have Guardianship over her? If so, I'd let them handle it.

If not, then, I'd use that to discuss it with mom. If the social worker feels strongly about it and her doctor is on board, she needs to think about it. Is she competent?

My cousin's doctor recommended AL and gave her a few days to get on board. The doctor said it wasn't a suggestion. I knew what she meant. If my cousin had refused to go to AL, she was going to report it to Adult Protective Services, since her welfare was at risk by living alone. Her doctor was a female and didn't look to be in her 30's.

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I believe in talking about needing more care in this manner by using the following ways:
1. Tell her that she needs to be in a place that will care for her 24 hours a day.
2. Tell her that they provide meals and snacks for her and will give her 24 hour nursing care.
I wish you all the best.

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It is a hard thing to do. My Dad has dementia and was still driving, going to Safeway, not knowing his way home...and on and on. I live in Canada and he lives in Arizona. I have one brother who refuses to help in any way at all. He thinks he can call once in a while and has fulfilled his obligations. I recently had him put into a group home. He is alert enough that he thinks I have done the rottenest thing there is to do to anyone. Told me he would not do this to me. It is very difficult and I live thousands of miles away. It is burning me out so cannot imagine what you are going through. I have to fly there every few months and the costs are killing me. He also managed to get himself in a whole lot of debt when he did not know what he was responsible for...or what he was doing. In one way it is good that you are so close...you know what she is up to. I had the guilts for a while...but have to do what is best for him...and also what is best for me. If you were not around what would happen. You have more than fulfilled your obligations to your Mom. You also deserve happiness in your life. My Dad has become very selfish which I understand. But I matter too...as do you.

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Thanks to the support from all of you a did have a conversation with mom. It was a rocky start, mostly because I really wasn't sure how to open rhe conversation. But after we got to talking it went well and she was totally understanding and willing to give it a shot.
The following day I asked her how she felt about our conversation and to my great surprise she said she felt a little relieved.
I'm searching for a geriatrician and care facilities near by. So we are moving forward.
Thank you
Dove

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DoveSoup, you just described sundowning really well.

Chances are that things will not get better unless she responds unusually well to some kind of medication trial. And yes, if your PCP knows what is going on and has not offered anything along those lines, a comprehensive geriatric eval or at least a geriatrician would be an appropriate next stop. Unless you think it is more anixety about what to expect will happen next, or just not knowing where you can and cannot set limits, than just the sheer demands of care that is burning you out, it will be best for her to get into a facility and begin to get used to the people and the schedule of everything while she still has more capability to do that.

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anonymous67, this is an odd situation medically. most facilities will not LET you take someone home on a vent without nursing support and without being fully trained in care so mom not wanting to go to a facility may be moot. Go to each facility the SW suggests can meet her care needs and bring Mom back pictures and impressions of each one. You might imply it might be a temporary necessity until you have had a chance or a longer time to learn care.

That said, a lot of people do learn ventilator care by either trach or non-invasive means and manage it at home; especially with someone cognitively OK and not posing extrem demands or behavioral challenges, if they can line you up some respite (can she be by herself at home while you work, BTW?) maybe you can bring her home. The key is to be realistic, not just fearful - and to insist the SW helps you think realistically about what is possible. If you have told her there is no way you can help Mom with the night time vent, and have not had the nurses try to teach you any of it, that's why she is telling you to pick a facility. They do not want to - and should not - keep her in an acute care hospital long term.

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DoveSoup, I was going to suggest what Veronica suggested. Book a 2-week vacation and tell mom she's got to go on her own vacation while you're on yours. Of course, you'll have visited a couple of places and picked the one that is most suited to her. Let her have her own "vacation" (and maybe book some kind of special treat(s) for her there while you're gone like a visit to the salon if they have one) and then when you come home, you have the conversation that you realized you just can't do it anymore.

I told my parents the stress was killing me when they lived 3 hours away from me. I wanted them to move nearer to me and they did. Fourteen years later, my mom is still here, but she lives 1 mile away in independent living. You HAVE to take care of yourself! Your life and mental health are just as important as mom's. If your mom is starting with some dementia and cognitive decline (and it sounds like she is), she may not be capable of making any kind of logical decision or understanding what you need. My mom at 96 has lost her ability to do any kind of problem-solving. So I have to be the adult and make the decisions that are in her best interest because she simply can't at this point in her life. You're in the same spot.

It's tough being the adult, but you need to do that for all of your sakes.

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I was wondering the same thing only my mom is on a ventilator at night only and I am the only child. I have to work and cannot care for her by myself and besides would be too nervous to. Unfortunately social worker is pressuring me to choose a facility and as my mother is completely in her right mind due to having cardiac arrest and then having this outcome, she is saying she does not want to go to one. I am scared for her and for me. I am past burnout as I am dealing with a callous less than understanding job. I turn 40 in less than a month and am single with no children or friends to lean on.

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DoveSoup, look up the term " sundowning". Folks with dementia often have periods of delusional and agitated behavior late in the afternoon/evening. Is she on any psychiatric meds?

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I really appreciate your question. I too am going through that phase right now with both my mom and dad. I have been helping my dad make the right decision regarding my mom and right now the right decision is to put both her and my dad into an assisted living facility. So, we have been telling my mom that she will be going to a wonderful place where meals are provided, she will have her own kitchen, there is a sun room, and all sorts of activities and therapists to help with her therapy. I wish you the best.

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Thank you all for responding, I didn't expect so many thoughtful answers so soon.
Not sure who asked which questions, but I do have some paid help. It's not enough, my day starts with her breakfast and ends with me tucking her in bed every night after administering her meds.
Now I sound like I'm complaining but... with the paid help it seems as if my mother just gets more demanding. Don't get me wrong, I am deeply grateful for the help, but she's kind of acting like a spoiled child.

We have noticed some dementia, when she has an episode I can see it really scares her. She gets a terrified look in her eyes, it usually happens at night, I've had to climb into bed with her until she calmed down.

As for her doctor, no, he's not new, hes probably in his late 50s and just too nice. When we spoke with him prior to our appointment, he said "Oh, she'll probably hate me for it". I replied better you than me. Seriously, isn't that part of his job?

I'm going to have to start some kind of conversation, even if it's awkward.
Perhaps ask her PCP to refer her to a geriatric specialist.

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"Mom, I cant9do this anymore. You need ,ore, and betterr care than we can give you at home. We're going to have a social worker come to the house and assess what your needs are. Then, we're going to make a plan for your care.".

You can't do this by yourself. Ypu need to get yourself, asap to YOUR doctor for an evaluation of your physical and mental health.

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Hard as it may be you just have to "do it" Oan you arrange for her to go somewhere suitable for a couple of weeks respite while you and hubby take a vacation or what ever you fancy course she will not want to move into any kind of facility. Can you send her to a suitable facility for a couple of weeks to give you and hubby the chance for a vacation or whatever is most important for you.
Maybe she would agree to go if she knew you were remodeling her bedroom or bathroom or something similar. After so many years I am sure her bedroom needs painting or the carpet changed. You will think of something.

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Did her doctor understand your predicament? Is the doctor new? It would seem to me that a doctor would be on board with encouraging a senior to get to a place where they needs can be better handled. My cousin's doctor was very helpful and told my cousin that AL is where she needed to be. Of course, her case was a little different in that she had dementia and lived alone. Still, you need some backup.

Are there any other family members or friends who can lend you support? Do you know of any seniors who live in Assisted Living that you and mom can go visit? That might be a good way to get her foot in the door for a visit and to see what kind of activities they have going on. It can be quite social if your mom likes that kind of thing. Plus, more friends there in her age group.

Has she bee assessed to see what type of facility she needs? Nursing home or Assisted Living?

You might locate the place you are interested in and find out if they have an entertainment night with some singers. Arrange with the facility to show up with your mom to have dinner and enjoy the singing. Then tell mom that a friend from school has a gig that he has invited you to attend. A little fib, but for a great purpose.

OR you could just tell her the truth, say it's for everyone's good and that you want her input in selecting a place where she can be happy. AND that you'll be able to visit her and give her so much more with your time and energy with her living in AL.

Sometimes we make thing worse in our head than it turns out to be. Just having the conversation may bring you more peace.

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DoveSoup, the age group that your Mom is in, it is not uncommon for them to remember the nursing homes of very long ago.... those homes were asylums where everyone was put together. Not a cheery place. Thus the fear of your Mom wanting to go into one of "those places".

I don't know if your Mom would be willing to visit an assisted living facility or a nursing home, have lunch there, and see that the places are usually very pleasant, and the people are well cared for. My parents, mainly my Mom, had refused to even preview any place.

Ah yes, caregiver burnout... I had crashed and burned... mainly because my parents still viewed me as their "child", not someone who was ALSO a senior citizen with my own age decline issues. Even waving my Medicare card and AARP membership card didn't sink in with them :P

Any chance of bringing in a paid caregiver? You could tell Mom that the caregiver is there to help you, yourself, because you can't do everything because of your own age. You are becoming exhausted and it is making you sick. Usually Moms don't want their children to be sick. It might be worth a try.

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How do I explain to my mother she needs to be in a care facility?

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