The "Difficult" Elderly Parent

The "difficult" elderly parent: Here is a basic fact-to-be-faced in caring for elderly parents. An elderly parent who has a decent capacity for positive relationships with others (including her/his own children) is most likely to be cared for in the home of one of his/her children, if that ever becomes necessary; and, at the same time, an elderly person such as this would also have the best chance of faring well in assisted-living facilities. But, of course, the reverse is also true: if your elderly parent is (and probably always has been) what we euphemistically call "difficult," then you most likely do not want to let this person destroy your life, under your own roof; and the assisted-living people (and the nursing home people, and the home-care people) don't want to deal with her/him, either.

I saw a review, in the NYT, of a TV documentary, "Caring for Your Parents." One physician, John Murphy, was quoted as saying that "the single most important variable to never spending time in a nursing home is having a daughter." And of course that tore at my heart... I am a daughter! Why can't (or won't) I just take care of my own mother, in my own home, like I ought to? Certainly, that is what my mother expects of me, and has always expected of me. She has always demanded that I be at her beck and call, at the drop of a hat. She has been perfectly capable of hiring caregivers, drivers, housekeepers, but unwilling to do so (perhaps knowing that they would not put up with the abuse she routinely dishes out)... But the review also notes some unpleasant facts that are often disregarded in these chirpy, upbeat TV shows:

“Caring for Your Parents” examines a handful of families... who have turned their lives over to the physical and emotional needs of elderly parents. The sense of devotion that [these caregivers display] display, the idea that whatever compromises they are making are intrinsically worth it, permeates the film and hampers it, creating a world in which all men and women behave honorably and admirably.

In each case study the camera lingers on the images of the elderly when they were young and happy, the presumption being that all the parents we’re seeing gave their children lives rich and full. No one resembles the ornery and selfish patriarch of “The Savages,” the recent fictional film that regarded the same subject with more complexity and skepticism, examining how grown children respond when they are obliged to care for parents who failed (spectacularly) to care for them. “Caring For Your Parents” leaves the impression that we all love our mothers and fathers without ambivalence or reservation... "

It turns out that in this TV documentary, Dr. Murphy (who made the comment about daughters) "is in the employ of an affluent 65-year-old woman... who cares for her 91-year-old mother... with a staff of seven rotating aides at a cost of $250,000 annually. Dr. Murphy oversees [the mother's] medical care and meets regularly with the aides as if he were a corporate leader running a project... "

In the NYT "New Old Age" blog, I found this heart-rending comment from "Eliza":

"My aunt is belligerent, loud, uncooperative, demanding, and mean in her dementia. When she was in the hospital for a broken hip, the nurses continually called my uncle, very frail himself, in to control her so often that he nearly died from exhaustion. They didn’t hesitate for a minute to demand that he come in 24/7, even though he was visibly weak from cancer treatment.

Nursing homes reject her because they can’t handle her.

Now what? Rejected by the experts, this difficult, dangerous woman is supposed to be successfully cared for at home?

Our medical community is geared to take care of the frail and cooperative dementia patient. The families who really need the help are being rejected."

My mother has been rejected by two assisted-living facilities, so far. In the nursing home that she's now in (hating every minute of it), she has been "difficult." She has used foul language, she regularly refuses her meds, she won't eat dinner in the dining room, and she has hauled off and hit some of the staff members. When I go to visit her, the "visit" usually consists entirely of her demands that I take her home, and her bitter accusations against me and the nursing home staff (and I am convinced that they are very good with her). And the history section in her chart reveals (to anyone who is making decisions about her) that she has a long history of firing her doctors, and getting into arguments with her neighbors. All of this is quite heartbreaking, and also totally beyond my influence or control. She has always been "difficult," but now she is demented and difficult.

So here is another thing I have recently learned about this whole business of taking care of the elderly parent: getting them placed into a good facility is sort of like selling a house. You really have to clean them up nicely and market them effectively. But, in the case of elderly people, the "sale" is never final; if a care facility takes in an old person, but then finds that s/he is too much trouble (they will say: "we cannot meet her needs"), then they will either call you and tell you to come and get her, or they will over-medicate and neglect her. I found that I was not able to do this "marketing" of my mother effectively, by myself. So, I have retained a professional care management person, and I have temporarily taken my mother "off the market." The care manager person I found is a nurse, and she is very experienced in this field. She knows which doctors are best at which areas of elder care; and she knows the directors of all the elder care facilities. She has gotten my mother an appointment, next week, with a neurologist who specializes in dementia and other disorders of old people. She hopes that she will be able to get an accurate picture of what is really going on with my mother, and (we hope) some changes in her medications that might help with some of these "behavioral issues." We'll see. I am cautiously hopeful.





Here's a picture of me when I was a little girl, 3 years old. My mother and I were visiting her parents (her mother was a lot like she is, now; her father was very stern and distant). We were all out on my grandfather's boat, on the St. John's River. The adults are enjoying their evening cocktails. I think I look a bit like "Fluffy/Zuul" in the LOL Cats photo just below (yesterday's post).