Prior to these falls, she has advanced rheumatoid arthritis in her knees which gives her a bad gait, has balance problem and is type 2 diabetic. In April she fell & had hip surgery. After that, we transfered to a skilled nursing facility. Each day she complained about the facility and insisted on going home. She was discharged (reluctantly but we had equipment ready).
I live with her & my sisters hired a 24/7 caregiver for safety and help. She would not accept being helped & it lasted 5 days. The Medicare benefits provided at home PT and weekly nurse checkups, but she refused them. Used mainly a cane instead of walker and I couldn't stop her from walking outdoors on grass and slippery cement alone & w/o a call button or cellphone. Six months later, after using the toilet (it's made for disabled w/bars) by herself, she lost balance, fell and broke the neck of her other leg & had hip replacement surgery.
Placed her in highly rated & recommended skilled nursing facility for post-acute rehabilitation. It's been less than a week and I'm seeing the same attitude of complaining about procedures (like trying to have me remove the leg restraints for stabilization of bones), writing daily to-do lists for me of items she wants with her (like a checkbook!), yet asking us to hand feed her meals and then barely eating. Wants one of us 4 girls to visit at least every other day. I live in the family home close to the facility and after 1 week feel exasperated and even mad for her refusing to comply with at home therapy and the hired caregivers assistance.
I dread her coming home now, after the earlier experience. The nurses there agree she is quite difficult and put her close by their station to respond quickly but I feel overwhelmed from seeing her put herself in unsafe situations. Is there another perspective for me besides being worried for her return and the anger?
Has she been evaluated for dementia? Think loss of logical reasoning skills and safety awareness. Those are part of executive functioning, something that is lacking in those with dementia, sometimes.
You can only control YOUR behavior. I would not show up, and would hand feed her if she's capable of doing it herself.
Is there a geriatric psychiatrist at the facility who could see her?
I'm glad your sisters all help, but it's YOU that it's going to be most affected, when/if she comes home again. Since she fell at the house (refused help), this is proof that the house is an unsafe living environment. She needs to be in a facility fulltime. And do you work? If so, if she refuses caregivers, what is going to ensure her safety while you are away from the house? (And if you are home, do YOU want to be her caregiver???)
What's her financial status? Can she afford a facility? What would it take for her to qualify for Medicaid?
To some extent, you have been enabling some of your mother's unsafe behaviors. Your mother might have wanted out of SNC but someone else drove the car that took her home. Mom might have wanted to use a cane instead of her walker, but someone else made that cane available.
I'm going to encourage you and your sisters to be the difficult daughter, the mean daughter that acts in what you and the medical professionals believe is Mom's best interest. Tell her no one is taking her home until she completes the rehab/treatment program the doctor has prescribed. If she has only been cleared for a walker when she comes home, then put the cane in the garage or the trunk of the car until she has been cleared to use only a cane. You're going to hear about and probably called all kinds of names but is that really more stressful than the constant worry about another bad fall?
Before she comes home I really encourage you to arrange an evaluation by a geriatric psychiatrist. Her unreasonable behavior could very well be vascular dementia like my father had. There are some medications that can help calm Mom's anxiety and let her return to a more normal level of disagreeable. With just a little more cooperation, her fall risk would be greatly reduced whether at home or in SNC.
I experienced something similar with my LO when she sustained a fracture. Resistant to care, refused therapy, unreasonable demands that she didn't see as odd at all, etc. I was suspicious, but, didn't know why she had become so selfish and moody. Even her healthcare providers said she as spoiled and lazy, BUT, they were wrong. We all were. She had dementia and soon it become very apparent.
If that is what your mom has, she isn't mentally capable of protecting herself or making sound judgment calls. The same things will continue to happen, as long as she is left on her own.
She can get 24/4 supervision in one of 2 places.
In a facility where there is staff 24/7
or
At home where you will have to have someone that can be there if needed 24/7. That can be done by family or paid caregivers or both.
This is the conversation you have with Mom.
"Mom if you want to come home you have no option but we must have someone here to help you at ALL times. If you will not accept that you can not come home and we will find a place for you. There can be NO discussion about this other than will you or will you not accept help in the house?"
When I was caring for my Husband I said I would keep him at home as long as it was safe. Safe for me and safe for him. That was the only thing that would have made me decide to place him. At this point it is not safe for your Mom at home without supervision.
I also wonder about some dementia of some type. The big problem with surgery and dementia is the recovery from the anesthesia is long, much longer than you would think. Sometimes months before the effects are gone. And there may still be a mental decline afterwards.
If your Mom is resistant to all types of help, resistant to the physical therapy there is a good possibility that even with a surgical repair on this she may not walk.
You might want to look into Palliative Care as an option. Palliative care will help manage pain as well as trying to maintain a quality of life.
if mom has dementia and won't accept help, then you're in for a difficult journey if she returns home again -
mom lasted 6 weeks after a 2 month rehab stay in which she agreed to caregivers while I was at work -
during those six weeks, she ran away from the caregiver and fell and broke her ankle
the neighbors called the police when she yelled out her bedroom window screaming for help
her last day and night at home she fell twice and I had to call 911 twice -
that was nearly 3 years ago
I hate that I had to place her in a facility but I do my best by her and I know that even now that she's immobile that it's nearly impossible to rely upon caregivers when you work and don't have family support for back up or I'd be tempted to bring her home
Dexieboy - your words do sum it up perfectly. "I do not have the skills to give her the proper care as she progresses deeper into the world of dementia and Alzheimers. She deserves much better than I am qualified to provide for her. She deserves qualified, skilled nurses and doctors." Great words to live by. Thank you!