PT says she's able to go to toilet, she refuses. She states it "feels good" to have someone take care of her in that way. No significant dementia or Alzheimers. What to do? When/if PT is over, I'd like to bring her home with me; however, I will NOT change diapers.
Decision time nears as funds run out in early September.
From speaking with her, it appears she soils herself because having someone clean her up to her way of thinking means she's "getting her moneys worth" or some nonsense. PT states she is capable of toileting & bathing. She just won't.
Additionally, her muscles, specifically abductors, are not getting better due to her not applying herself as vigorously as PT believes she could.
She can't or won't climb stairs (not even one, like, say, a threshold) at all.
Finally, she won't get in a car. For her doctor's appointments she has to be loaded into the facility wheelchair van. PT has also indicated there's no reason for this behavior either (see above "rationale").
As per your posts, your 84 yr old mom can & does:
cook (which is amazing), watches and understands Mets games, reads newspapers, talks on the phone and in person coherently with others including grandkids, goes to the bathroom on her own, uses a cane and is able to walk on her own. You live with her now 13+ years, right? Your moms issues are from a bad auto accident in 2008, she’s had years to develop a system of living and thriving while handicapped & is very much cognitive and competent. You are her live in companion & aide as well as son.
the OPs mom is way way different than yours, she does not go to the bathroom on her own, will not tell caregivers if she is wet as she will sit in wet crap diaper as “it feels good”, this is not normal. The mom is not participating in the therapy the PT needs for her to do to be somewhat independent. It seems she doesn’t understand the need to do these things. She’s not “there” cognitively like your mom certainly is. If she doesn’t do or cannot do anything to get herself able to transition from lying or seated to standing and moving and toileting, she will become bedfast with all care to her being done in her bed or via a hoyer lift to get her out of the bed into a chair.
Caregiving for someone incontinent and does not understand she has voided and is bedfast is beyond way way more complicated. Someone like this cannot be left alone; someone needs to be there at the ready 24/7. It’s a 2-3 person oversite. Your mom is a spring chicken compared to her.
When our loved ones have dementia, the hippocampus is destroyed. That’s where our ability to keep information and express logical and reasonable answers resides.
If there is dementia, a person plucks old “tapes” or other weird answers from some other random place in one’s brain. A person knows that they need to say SOMETHING, so out comes some strange response, which makes US stand there, just scratching our heads.
This response is a red flag. Play attention to it.
By bringing your Mom home, you could be sliding down a slippery slope towards responsibilities that you say RIGHT NOW that you’re not prepared to undertake.
Leave her in the long term care section of the rehab SNF, that's my suggestion. Let her know that until & unless she's ready to REHAB herself completely, she cannot live with anyone and has to stay in long term care where she pays others to 'take care of her in that way' because you're not willing to do it. Sorry/not sorry mom, but that's a deal breaker.
Just how is her stay being paid? And has anyone brought up her rehab stay is ending?
MediCARE pays for rehab as a post hospitalization discharge benefit 100% for 20-21 days and at 50% after but it max’s out at 100 days. And the 100 days is NOT guaranteed. She has to be “progressing” and progress is measured and put into her chart regularly & if she stops progressing Medicare and any other secondary health paying will stop paying. Ask as you may need to make a definite decision soon. Real soon.
if you bring her into your home and she refuses to toilet herself, or help herself transition from bed to chair, or get dressed, or walk, it will be all on you to do for her. Or you hire inhome health and hopefully mom has the $ all on her own to pay for all this. Someone who cannot transition at all will end up “bedfast”. Once they are bedfast it’s pretty much needing 24/7 oversight as they cannot get themselves up and out if there is a fire or other emergency. One you take her into your home she’s your responsibility. You can’t call the facility weeks later to have her readmitted as her care & needs are beyond you. The time to have her segueway from being a rehab patient to a long term care resident is right now when she is there in the facility. Talk with admissions as to how to best do this if that is yiur decision,
Really, she thinks it "feels good" to have someone else clean her up? What happened to her dignity? I would be so embarrassed if I was in my right mind. For her to say this, there is something going on here.
Since you said you would like to bring her home with you, I will assume she has been living on her own. My stipulation for her and PT would be to take her home with you, she must be continent. If she cannot or will not use a toilet and she is not able to tell you when she needs to, she can't go to your house. She must be able to clean herself. My Mom could go to the toilet but I had to clean her. Worst part of caregiving for me.
I would have her evaluated for 24/7 care. Medicare only pays, and not fully, for 100days and they are not guaranteed. When Mom hits her plateau, she will be discharged. If the Rehab has LTC attached, it makes an easy transfer. You spend down what money she has, and apply for Medicaid.
If she is in the beginning of Dementia, it will only get worse. Its very unpredictable. If you have the opportunity to place her, it may be better to do it now then try later.
I would not consider bringing her home, if she is in diapers that should be your sign something is wrong.
Do what is best for the both of you!
It was then that I realized that a pact we’d made years before she broke her hip should have been honored.
I toughed it out for 9 very unhappy months before returning her to the facility where she’d flourished during her original rehab, and once there she flourished still, until her death at 95.
”Dementia” is like “pregnant”. No matter how insignificant it appears in a structured living situation being cared for by trained professionals working in shifts, life with a loved on can quickly become too difficult for both parties AND VERY DIFFICULT to undo.
For your sake and hers, proceed with a comprehensive eval. of what her cognitive and physical functioning is, and be FULLY prepared with what you learn from it. You have many reasons to protect her AND yourself from the stresses of adjustment to developing a care dependent - care provider relationship.
Choose the best care situation for you BOTH.
So from your pov, independent toileting is a must (fair enough). Make sure your voice is heard!
This will help staff to help Mom set this as a goal & work towards it... or.. if really no longer possible, arrange a Social Worker to help start looking at alternative living arrangements eg permanent care.
Bringing her home to live with you is going to slow down or stop your progress in finding your own way and getting better.
Make sure your mom has adequate pain medication in order to do her therapy. She may be comfortable as long as she doesn’t have to walk, but walk she must if she is to recover.
Ask for her to have a bedside commode to see if she is willing to use it.
By ”significant” dementia, I assume you mean she hasn’t been diagnosed but you have noticed some decline? Understand that breaking a hip, surgery, being in the hospital and now PT can accelerate dementia or cause hospital delirium.
Keep your boundaries. Do you have DPOA for mom? If not, time to get her paperwork in order so you can help her find the appropriate facility in case she doesn’t cooperate.
When you say "no significant dementia" does that mean that there is some cognitive decline that's been diagnosed by a medical professional?
Dementia, sadly, only goes in one direction.
I would advise a thorough work up-- the best would be a full neuropsych, but that's not likely to happen while she's in rehab.
Is there a geriatric psychiatrist available who sees patients at this facility? S/he might be your best bet as to looking into your mom's decline.
Don't discount unacknowledged pain (once dxed with dementia, my mom was terrible at identifying her problem as pain) or fear of falling as the source of her reluctance.