Saturday, July 19, 2008

Tough Decisions

Here's another wrenching (and guilt-inducing) comment (written by Cheri Miller) that I ran across in the NYT blog about aging:

"My husband and I have been caregiving for the past three years... for [my husband's grandmother]... She’s now 102... We’re still caring at home for Granny’s daily needs. She has no diseases, is frail, cannot hear, see or walk any longer, after her stroke, but she continues to live on and on and on... It’s changed our lives. We can never be away from home more than 2 hours. And, we have seven children to manage on top of this... But, at least she’s not in a home." [emphasis added]


My 88-year old mother is intermittently irrational, but certainly in better shape (both physically and mentally) than the vast majority of patients in the nursing home where she's been for the last three weeks. And the doctor (a geriatrician!) she has been assigned to at this nursing home has made no apparent effort (despite my urging, despite my complaints) to get to the bottom of Mother's cognitive problems. Eventually, I took matters into my own hands, and hired a geriatric care manager. We'll be taking Mother to a neurologist in a few days.


Meantime, I am faced with the daily task of trying to explain to my mother why she is in a nursing home, why she can't go home... Her "doctor" has only seen her twice in the three weeks since she's been there, and certainly has not explained to her that we are concerned about her poor decision-making... Over and over again, that little talk is left up to me. And my mother is not well-disposed to hear this from me. The problem is that she cannot seem to understand or remember new information that people tell her about her medical status, she does not follow through with medical (and dental) advice and prescriptions, and she often "fires" her doctors soon after she has met them. When she went into the hospital, a month ago, she had no primary care provider. She had fired them all. I am quite sure that this same pattern will start up, all over again, if she leaves the nursing home and goes back to her house. This is how it is beginning to look, to me: unless I just give up my life, and take over my mother's life, there will be no way to make sure that she is getting good medical/dental care (her teeth have been falling out, and she has refused to pay the dentists and oral surgeons... ).


Nobody wants to be "in a home," and I don't think anybody really wants an elderly relative to be "in a home." Even though my mother is, and has always been, an exceedingly difficult person to be around, I do not want her in a nursing home. Maybe my only real option will be to get my mother back into her house, with daily in-home care, and one of the bedrooms set up for the in-home care provider, if/when she needs someone there all the time... and the third bedroom set up so that I can stay there at night, too, if I need to. And maybe that would be a total disaster. Once my mother is discharged from the nursing home she's now in, they will have no obligation to take her back... and, given her dreadful behavior while she's been there, I doubt that they would take her back. No good choices, here.



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