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95 year-old MIL (long)
Old 03-29-2009, 09:48 AM   #1
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95 year-old MIL (long)

REWahoo's comment about "face to the wall" in his stroke thread prompted me to post this regarding my MIL. It takes awhile to get to the comment about "face to the wall."

Up until 6 weeks ago, my 95-year old MIL has been in virtually perfect health living in her studio apartment in an assisted living facility. She has now moved to a nursing home and has pretty much lost the will to live.

On February 17th, MIL called my BIL (who lives relatively close to her, we are almost 3 hours away) and said she needed to go to the hospital because she was "sick" and she was dying. She was complaining of some non-specific stomach pain (no vomiting or diarhea) which she could not describe in detail. She has never had any tolerance for pain (no practice since she was so healthy) and it is my understanding the tolerance is even lower for the elderly. BIL took her to the emergency room where he waited about 8 hours for her to get completely checked out. $688 in claims submitted so far (including an X-ray) but Medicaid plus her MD state retiree insurance will cover everything. BIL takes her home to her assisted living apartment.

On February 18th, MIL called BIL again with same complaint of being sick and dying. BIL made appointment with PCP. PCP saw her and said she has advanced Alzheimers and needs to be go to a nursing home. MIL may be experiencing some dimentia at 95 but I'm not sure where the advanced Alzheimers diagnosis came from as she had been living successfully in assisted living until several days before. Can someone with advanced Alzheimers use a cell phone on their own to call family members? PCP arranges for MIL to get admitted to the hospital to check out the abdominal/stomach pain.

After about 6 hours waiting in the emergency room, MIL is admitted to the hospital where she spends 3 days. MIL had a very bad experience being scoped about 8 years ago for a bleeding ulcer and refused to be scoped. Blood work done and all normal but still complaining she is "sick" and is dying due to the pain in her stomach and/or abdomen. Can't really get a specific answer to what she is experiencing. She is discharged without the cause of the pain being diagnosed to the rehab wing of a very nice looking nursing home. So far, I can see claims submitted on her insurance website for $13,000 related to the hospital stay and transport to rehab.

My husband is a nursing home ombudsman where we live so he checks on MIL's nursing home with its ombudsman in Cinci who says he probably wouldn't put his mom there unless there was nowhere else. A confirmation you can't necessarily tell the quality of care by the look of the facility. MIL pretty much lays in bed the first week of rehab still complaining of pain. She would be fine one day or part of a day and then be "sick" and dying again. She was treated for acid reflux (prilosec, don't lay down after meals, foods) and she started doing PT but root cause of pain or "sickness" could not be determined.

On March 4th, she decided she was done eating and drinking and was going to die. It's her life (and death) so in support of her decision we started to make arrangements with the nursing home. Within about 36 hours she had changed her mind and had decided to hang around. By March 14 she was doing so well she wanted to know why we were keeping her "in that place with sick people." She wanted to go back to her apartment NOW! The pain was pretty much gone as far as we could tell from her comments. On March 18th, she was released and went home. We had things set up for having her meds dipsensed and daily nurse visits to her apartment. The assisted living facility has a contracted nursing staff on-site and would provide assistance.

Total meltdown on first day back to her apartment. "I'm sick, just let me die. Please take me to a nursing home. I can't do this." Knowing this might be coming, we had checked out local nursing homes and found one close to my BIL with high ratings and recommendations for their quality of care. The building is older and the facilities are not as nice as the first nursing home/rehab but that's not our main concern.

MIL has no enthusiasm for life. She doesn't want to do anything but lay in bed. Like WAHoo's experience, she often turns her face to the wall when BIL and DH try to get her motivated and interested in life again. It's heartbreaking to see her with no interest in life when she was full of life 8 weeks ago. She is and has been on anti-depressants. Other meds are lisinopril and Aricept. PCP put her on that when she left the rehab facility although I didn't really see the point.

She has been having diarhea since moving to the nursing home (no issue in rehab, only new med is Aricept). She was on ringers for several days leading up to the latest issue which is a blood clot in her leg which put her back in the hospital. She told DH on Wednesday her foot "felt funny" so the staff at the nursing home took a look but saw nothing. By Thursday, the foot was cold and turning blue and she was taken to the hospital. A vascular surgeon was called in to take a look and he said he wouldn't touch her with a 10' pole given her age so the only option was to put her on blood thinners. BIL is watching over things at the hospital. Luckily, he is retired and his schedule is flexible and he is his mom's favorite.

BIL had his appointment with whoever authorizes Medicaid. MIL has SS and a small pension ($1400 per month combined) but no assets so it looks as if her application has been approved and the cost of the nursing home will be covered.

We are preparing to put our house on the market in the next week or so to begin the process of moving back to FL. That's another post.
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Old 03-29-2009, 09:59 AM   #2
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My mother -90- is in an assisted living care home. She must use a walker and can not leave the grounds of the place. She can not cook for herself. She is going crazy with the boredom.
I don't know how I would handle that life. I don't know why I would get out of bed in the morning if all I had to look forward to was eating, television and things that just kept my body alive.
Maybe when I get there my thought process will not be the same.
Your support of her is great.
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Old 03-29-2009, 10:01 AM   #3
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Same thing here with MIL. Very similar story. Caregivers must have a heavenly reward, cause there isn't much of one in this life.
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Old 03-29-2009, 11:00 AM   #4
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MIL has no enthusiasm for life.
My 96 year old grandmother still lives independently, drives (a frightening thought, I know), plays bridge (and wins), and travels internationally. I keep her well-supplied with library books (mysteries and thrillers) as well as see her once or twice a day. I figure that 'use it or lose it' applies to the mind as well as to the body, so I try to keep her mentally stimulated.

I'm sorry that your MIL isn't doing well. There aren't any easy answers.
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Old 03-29-2009, 11:14 AM   #5
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I'm so sorry about your MIL .It's so hard dealing with our aging parents . My Mom is 93 and now she is afraid to be alone .She was living independently until last September when my sister talked her into moving with her to Florida . Now she has become so dependent she's driving my sister crazy . We really are the sandwich generation .
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Old 03-29-2009, 11:23 AM   #6
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I just want her to be happy and it breaks my heart because she isn't. She has never driven so we didn't have to deal with that issue but until 6-8 weeks ago she was happy and vibrant and totally engaged in life with no aches or pains. She just fell off a cliff. About a year ago she flew back to Baltimore on her own (with family's help in the airports at each end) to visit her SIL for a week. She even voted last year for what I believe was the first time in her life. She has told us for the last couple of years she prayed each night to die peacefully in her sleep but it's not working out like she had hoped.
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Old 03-29-2009, 11:31 AM   #7
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MOEMG - We definitely saw the transition from "confident on her own" to "scared to be alone." For my MIL, the attitude change happened while living in her assisted living apartment. I wouldn't assume (if you were) it happened because she moved in with your sister based on what I have seen. I understand the strain on your sister but its probably good the transition happened while your mom was in her care. You would have been scurrying to arrange your mom's living situation if your mom had lost her confidence as quickly as my MIL did (within weeks).
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Old 03-29-2009, 11:40 AM   #8
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A confirmation you can't necessarily tell the quality of care by the look of the facility.
This is so true. My 90 year old MIL was in a facility that looked beautiful but the care was awful. We were horrified when we visited her once and found her strapped to her bed, crying, and begging for help. The facility she is in now is old, not very pretty, but has well trained and compassionate staff.

Buckeye, this is story is so heartbreaking and I hope she improves. One thing I've found is how situations like this can be very difficult for the loved ones. Not only is it hard to see a loved one suffer, but the thought of eventually ending up in a similiar situation is depressing.
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Old 03-29-2009, 11:51 AM   #9
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I found the book,“My mother, your mother” by Dennis McCullough very good at describing the stages of decline. Here’s a thread on aging and slow medicine:

Article on aging and "slow medicine"
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Old 03-29-2009, 01:39 PM   #10
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There is, IMHO, a deeply imbeded 'spirit' (if you want to call it that) which can shut the body down. When that 'spirit' says it is time to move on, the time has come. That 'spirit' cannot overcome overwhelming disease or injury but can make the difference at a tipping point.

I say it is time to consider that the healing your MIL needs is emotional, that which you would want at the end of life. Were I in her shoes I would be scared of the unknown that she is facing.
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Old 03-29-2009, 01:49 PM   #11
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Cuppa - My MIL and the entire extended family, in OH and in MD, all agree with the slow medicine approach. I'm just worried what will happen if the clot doesn't dissolve and the foot gets gangrene. She couldn't and/or wouldn't survive an amputation. I only had her sign all the necessary paperwork (financial and medical) less than a year ago. What were we thinking? MIL is donating her body to the medical school at the University of Cincinnati. She had signed the papers a couple of years ago so BIL checked with them when she had decided to stop eating to determine if they were still interested. They were.
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Old 03-29-2009, 06:27 PM   #12
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Buckeye and REW, I don't know if I can say anything helpful. I mentioned the McCullough book because I read it three years after mom died when I was still wondering if we did the right things & it helped me get past that sense of we could have done something else, along numerous decision-making points.

On her deathbed, mom asked sis to leave the room because she said it was too awful. Sis called me from the waiting room & I suggested she ask the nurse to give mom morphine. Sis went back into the room & stayed, said mom was better after the drug and was gone within an hour.

I wonder how common it is to want privacy at that time and ask your next of kin to leave, I'm very independent and might well prefer that. I've also known people who talk the patient into letting go.

All the best, keep us posted, it's really hard.
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Old 03-29-2009, 07:03 PM   #13
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I'm not sad MIL's life is ending, but I am sad at the way it is ending. We are all getting closer to death everyday and as someone said "no one gets out of here alive." She has had a great life and she has always voiced her appreciation to me and DH for the things we have been able to do to help make her happier and her life more fun. Her needs have always been very minimal. A box of Cheryl's cookies absolutely delights her. We would have taken her on a world cruise if that's what she had wanted but she much prefers just going to Steak 'n Shake for lunch. I hope to have as happy and complete a life as she has had.
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Old 03-29-2009, 07:39 PM   #14
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You are a beautiful person. I only hope when my time comes I have someone like you around who cares.
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Old 03-29-2009, 08:06 PM   #15
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Purron - I love cats so I must be nice! Aren't all cat people?
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Old 03-29-2009, 08:10 PM   #16
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Purron - I love cats so I must be nice! Aren't all cat people?
No doubt Hang in there.
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Old 03-29-2009, 09:58 PM   #17
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She has been having diarhea since moving to the nursing home (no issue in rehab, only new med is Aricept).
Buckeye,

I suppose with all the other issues, this isn't the most important, but most of the meds used to treat acid reflux tend to cause diarrhea. DW and I both have experienced this side effect though we use a different med. Dr. sort of gave me a choice. When reflux is bad, it's an easy choice, so I'm on the meds. Did try several different ones and they all seem to have same effect though it varies from time to time.

Bless your MIL. You stay well too. If you need assistance for the stress, by all means get help.
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Old 03-30-2009, 03:49 AM   #18
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I have had several near and dear relatives who between 90 and 98 and after living an independent life just seem to have decided that they want to go. They took less and less interest in life, did not eat or drink like before and at one point just went. Some were in assisted living facilities, some were at home, some had a stroke before, others not.
We as younger relatives tried to revitalize their spirits and offered alternatives but finally had to accept that that was just the way they wanted to leave. Fortunately the professionals did not interfere too much.
I miss still all of them, but find some comfort in that they had their decisions respected.
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Old 03-30-2009, 01:52 PM   #19
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My MIL is 82 and has decided that she should have died about 6 years ago. She can't remember multiple conversations about the same thing, her birthdate, her SS number, and says she hopes she's not around when our dog dies (she's said this about a dozen times). She tells the same awful stories (like when her father beat her) over and over again. Her internist send her to a neurologist and, when he asked her a series of questions, she answereed every one correctly. He is now in the process of a diagnosis - he told us that he didn't think it was Alzheimers but that it probably was something along the lines of depression induced pseudo dementia (or whatever it's called). The mind can be a very dangerous neighborhood.
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Old 03-31-2009, 08:16 PM   #20
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Koolau - It was determined she has c. diff. Actually, from what I have read, it is an overabundance of c. diff as we all have c. diff. in our gut. When I googled c. diff., a root cause off the over-abundance of bad flora was anti-ulcer drugs (read acid refux). This makes me think her relatively recent (3 weeks) start of Prilosec is a problem. Apparently, the PH is affected when the acid is reduced (duh!) and the "normal" bad flora gets out of hand and diarhea is the result. I'm not sure how she is being treated but apparently she is doing better according to DH who is with her. DH and I take a very good probiotic every day (see mercola dot com). I sent his vitamins including his probiotic with him when he left for the week so maybe he can sneak her a couple.

chriss2008 - It's hard to accept I cannot do anything to make her happy. Even if she wants to go, I want her to be happy on her way out.

Sparky - I agree with you on the power of the mind. It's amazing. It reminds me how careful I need to be with my thoughts.

She is now taking oxygen. I'm not sure what that is all about. At this point I am continuing to work (2.5 hrs away) and let DH and BIL handle things in person at the hospital and nursing home. I love her as she is DH's mother but she is their mother and it is very cool how they are taking care of business. I know how women can jump in and take over these types of things so I am resisting the desire to meddle other than bugging them over the phone......"have you asked them this, have you suggested that?"
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