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Old 12-30-2003, 06:15 PM   #1
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GoldenRetrieverGirl HB User
What is the next step?

I posted a thread in October regarding my inlaws. This is a recap: My MIL has dementia (she is 59). They live next door. My FIL (he is 60) has gone back to work to get away from her and she attends adult day care, grudgingly, two days per week. A dear friend takes her one day per week out to lunch. I fill in when my FIL asks, where ever he needs me (next door or pick up/drop off, Dr.'s appointments, etc.).

Problem: My FIL is nearing his wits end. He phoned the week before Christmas to say that he could no longer live with her. He wanted to kill her and he just could not take it any longer. A couple of days later he explained that he was venting and that he was "insane" that night. My husband and I decided that our 3 year old son is no longer allowed next door without us. Anyway, my FIL is scheduled for neck surgery next week and will be home for two weeks and then maybe working part time until he is out of the neck brace (6± weeks). He also needs to have both knees replaced (sometime soon) and has diabetes.

My MIL is not a well woman, but we all know that she is not at the stage where you would put her in a residential facility. We don't know at what point her health will warrant an institution, but the situation next door is not good. My husband and I both help out as much as we can, but I am 29 and hubby is 33. I run my own consulting company (part time) and hubby works full time. We have a 3 year old son and I am in my last trimester of pregnancy with son #2. We just don't know what to do. Any advice would be appreciated. We are scared and sad.

Jennifer

 
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Old 12-30-2003, 07:22 PM   #2
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Re: What is the next step?

What, exactly, do you mean that your MIL is not at the stage where you'd put her in a residential facility? There will never be a point where her health will warrant an institution--the time for placement is when the caregiver/s can no longer do it. It's for the caregivers, not the patient. AD patients are usually fine no matter who cares for them or wherever they are, so long as there's no abuse or neglect. Your FIL is hanging on by a thread, no telling what he may do and his health is every bit as important as hers. Your boy needs his g'father, and you won't be able to do much with the new baby on top of everything. The entire family is putting their health and well-being behind what your MIL needs, and her needs will increase endlessly, her illness is sucking all of you dry. Either get a full-time caregiver in the home or find placement--nothing is going to get better. Sorry to be so blunt, but if things are as you say, there's nothing I know of that anyone can advise you to do otherwise. You have to come to grips w/the illness and determine if your marriage, your boys, and your FIL are going to always come in 2nd to your MIL's disease.

 
Old 12-31-2003, 05:36 AM   #3
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Re: What is the next step?

When I say that she is not ready, I mean that she is still cognizant of her surroundings and some of her behaviors. If my FIL were not in the picture, there is no way that she would be living in that house at this point. At the same time, how can the family explain to her and the rest of our family/friends that the current situation cannot remain as is, warranting her placement? She would freak. She doesn't even like going to adult day care two days per week. She tries to get out of it every chance she can. She tells me that she just wants to be at home.

I just don't know. There is no question that she is taking a tremendous toll on my FIL's health. He has felt trapped and frustrated for a long time. She is so argumentative and antagonistic at times. I would not be able to take it if I were him. My husband called her Dr. last night to talk about a medicine change. Her Dr. is putting her on a low dose of Risperdal. I am going to look it up this morning to see what it is.

We all, the three of us, just don't know what to do. I understand what you are saying and a large part of me is in agreement with you. I just can't imagine telling her that she needs to live somewhere else. Not yet. At the same time, she is taking him with her at this point...

I appreciate your honesty. We need to hear it. I just don't know what to do with it...

Last edited by GoldenRetrieverGirl; 12-31-2003 at 07:21 AM. Reason: I spelled the medicine wrong! I wanted to make sure that people know what I am talking about.

 
Old 12-31-2003, 08:18 AM   #4
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camachinist HB User
Re: What is the next step?

If my FIL were not in the picture, there is no way that she would be living in that house at this point

You explained exactly why you should consider placement. FIL's had it and MIL can't live alone.

Her Dr. is putting her on a low dose of Risperdal. I am going to look it up this morning to see what it is.

Antipsychotic.....just approved for bi-polar mania, IIRC. You might search this site for more information and practical experience.

I just can't imagine telling her that she needs to live somewhere else. Not yet.

What Betty does know (and has told me a few times ) and may not have said clearly enough is that there is no "right" time or "yet". It is not a decision the patient makes (MIL is no longer competent to make such decisions).

Do your legwork (both regarding placement and planning for the financial end of care) now and, when the time is right for you (not for her), take action. A trip to the new "day care" is all it will take. In that regard, you've at least got that habit grudgingly instilled. She just won't get picked up. Remember, she's mentally ill, not a bad person.

Keep us updated on your progress.

Best wishes!

Pat

 
Old 12-31-2003, 11:53 AM   #5
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Re: What is the next step?

Dear Girl: When I asked what do you 'mean', it was retortical, because I mean there is no 'time' she will ever be willing to leave her home. She may always appear aware of her surroundings, and I don't mean to be harsh, I had to place my husband for my own well-being and he still had awareness. And if you think that was easy---. Your MIL can stay in her home for years if there is someone willing and able to take care of her full time--so who is willing and able, your FIL, your husband, you?

You are under no obligation to explain anything to anyone. If someone challenges you about placement being too soon, then let them take care of her. No one has the right to criticize your decision unless it's one of abuse and neglect. Most people don't understand jack about AD, just do what has to be done. And your MIL won't understand, and it is so hard--yes, she'll freak, she'll cry, all those things, but you have to weigh all sides and do what's best for those of you who still have a future--especially your boys. All of this turmoil in the family about their g'parents is not good for small children. They need to feel safety and serenity, and what do you tell them when they can' visit their g'parents just next door? If you need a reason for placement, for heaven's sake, your boys are it. You are describing a very bad environment for adults, little children should not be part of it. Your FIL no doubt wants her placed, his health depends on it. I'm surprised his doctors don't tell him he can't have this ongoing trauma. You don't say how your husband feels, and you still seem ambivalent. Others are reading this and I ask them to join in with their opinions. I could be missing something.

 
Old 12-31-2003, 01:20 PM   #6
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camachinist HB User
Re: What is the next step?

Thanks Betty :-)

I wish to emphasize the last part of your post, as it warrants repetition...

You don't say how your husband feels, and you still seem ambivalent

I recall this being a case of DH not wanting to take the bull by the horns....GRG can correct me if wrong. Given the challenges ahead for FIL and MIL's condition, he needs to get with the program if he doesn't want a complete meltdown to deal with. I can't emphasize that enough.

I strongly suggest you have him post his observations and positions here so we know where he's coming from, as we all perceive things differently. Perhaps we're unaware of an important fact or nuance which is skewing our understanding.

Anyway, you can take Betty's advice to the bank, literally. Over time, it'll save you a lot, both in money and grief.

Best wishes!

Pat

 
Old 01-01-2004, 04:25 PM   #7
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GoldenRetrieverGirl HB User
Re: What is the next step?

It makes my husband sick to his stomach when he thinks about placing his mother in an institution. That being said, he is scared to death that he is going to lose his father too. He is an only child and very torn. It has been a rough fall. My MIL's sister died in September very suddenly of cancer (had it less than 10 weeks, we knew for 6) and my MIL's mother died unexpectedly in the middle of November.

I have set up an appointment for tomorrow morning for us to meet with his father. We all need to be on the same page. I spoke with the director of the adult day center yesterday to discuss this topic with her. She suggested that the three of us (Hubby, FIL and I) meet and discuss the surgery next week as well as a plan for beyond that. She said that my FIL will continue to say that he can take it a little longer until he "breaks down", in which case it may be too late. I will support my FIL 100% if he says that he is done, but how can I advocate to remove her? Nobody feels ok with even talking about this. We all feel horrendous guilt and pain. I do not want to push either of them, even if it is for the good of my FIL. How could I? They have spent their lifetimes, thus far, with this woman.

Neither my FIL or our son know that our son is not allowed next door alone and we generally don't discuss my inlaws in front of our son. I know that he senses my MIL's vulnerabilities and tries to take advantage of them, but he really doesn't know anything at this point. He does, however, feel the stress in the house. That is obvious.

I will update after our meeting tomorrow. Thank you for taking the time to offer guidance in this very difficult time.

Jennifer

 
Old 01-01-2004, 09:18 PM   #8
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camachinist HB User
Re: What is the next step?

From what I've read thus far, your emotions are perfectly appropriate. I'd challenge anyone, who's gone through this, not to have felt this way at one time or another during the process.

Perhaps, during preparations for FIL's surgery, you might wish to visit a couple of NH's, preferably those with AD facilities, and get a feel for what it's like. You never know what could happen to FIL during surgery, and, if he has complications, he may end up needing skilled nursing prior to home discharge. You'd be ahead of the game if you had an idea of where you wanted MIL to go for a safe, healthy environment; FIL could make use of your research.

Like I always say, hope for the best and plan for the worst

The thought of putting my mom in a NH is only marginally less depressing to me than it is to her. I know it is something that I'll have to do at some point and it won't be pleasant. But that's how life works; getting through the bad times makes us appreciate the good ones even more....

Because she is still healthy and high-functioning, I've limited my research to the state surveys and other info gleaned off the Net. I have a feeling, though, that I really need to start visiting my picks and arrive at a short list to apply to. I've always had good instincts and I really need to overcome my inhibitions and listen to this one.

What do your instincts say here?

Pat

 
Old 01-02-2004, 04:12 PM   #9
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Re: What is the next step?

My instincts say that the time to place her is drawing near. We had our meeting this morning and the three of us decided to give this Risperdal a chance, knowing that it is very temporary at best.

My FIL does not want to place her, but knows that his abilities have been maxed and that he does not have a lot more to offer.

I think that part of what is making this stage so difficult is that her level of functioning is not where we expected it to be when we let our minds wander and contemplated placement at some much later date. She can still get dressed by herself, for the most part. Items may be inside out and/or backwards, but the pants are on the bottom, etc. Her short term memory is pretty much gone and she has started making stories up (delusional). She cannot see items right in front of her, like a refrigerator, or items on her plate. The area that causes the difficulty is her mood. She is so negative, antagonistic and just plain unbearable sometimes. This is what makes my FIL nuts for the most part. She is rarely happy, and if she is, it is not for long.

As far where to place her, the adult day center where she goes has a residential facility. My FIL put her name on the list last summer. I don't know where she is on the list at this time. The facility is beautiful and the staff is wonderful. But it is still not home.

Hubby and I have discussed and agreed that if this medication does not change anything and my FIL cannot make the decision, than we will. We are going to give it a little more time and see how she does. We have not tried the memantine, but I have not heard many stories of triumph in that department. Also, she has vascular dementia and I believe that one of the Dr.'s said that she still has very slow leaks in the front of her brain. Not really sure if memantine would help her situation.

I can't thank you enough for your guidance. I will continue to post as changes occur, for better, for worse.

Jennifer

 
Old 01-03-2004, 12:40 PM   #10
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Re: What is the next step?

Dear Jennifer: For all your sakes, I'm glad you are making some moves in a positive direction. Most people are like I was, I told our children I'd just continue to live with my husband as I always had, what was a little forgetfullness. What I didn't know, and what you are painfully learning, is that it's not just a matter of forgetting, they get combative and downright dangerous long before they lose all awareness, and they need 24/7 watching. Who can do that for years on end and give up everything else? So, like your FIL, I did not want to place my dear husband, I loved him so much even w/the AD, but I had to for my own well-being, and even then, it all had a negative effect on my health. Well, I think I've said this before, I just want you to understand that we all know it is so incredibly painful--and you will have 2nd thoughts, and 15th, and 27th and lots of 'what if we'd done something else's'. I know I still do and everyone said I was doing the right thing, the doctors, the children, but it still hurt--and, yes, I, too, know that I did the right thing, but--

You'll all get thru this in time. Take care of yourselves.

 
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