My mother in law is 64, in a rehab nursing home after open heart surgery, 6 additional hospitalizations for various health issues, a sternum repair surgery. After the final surgery she was released to a nursing home. The 3rd day she fell, because she wouldn't call the nurse for assistance. Her oxygen tubing wasn't very long and she said she forgot her cannula was in her nose, stood up and was pulled backwards onto the bed lost her balance and fell to the floor which then caused a hairline fracture in her pelvis.
We all love her but she has been rude and mean to her son & daughter, and makes unnecessarily ugly comments about their spouses, when they try to help.
Both have families of their own and have suffered panic/anxiety attacks from the stress of trying to assist their mother. She makes it hard to help her both verbally and physically.
Now she is in rehab and wants them to handle her mail, pay her bills as if she needs a secretary.
She acts very clear minded in front of certain people and then when her son or daughter is present she becomes very weak, she can't focus and shakes as if she has Parkinson's, and is so nausea she spits all the time. The doctors have run so many tests and they state physically she is in great shape. She does have type 1 diabetes & severe depression her mental state has made here look more like she is 85 than 64.
My husband & sister-in-law feel it is important not to give into these whims because she needs to maintain some independence. We do not know what to do or how to help her. Should we step away?
If she is exaggerating her symptoms in front of family, in either a deliberate or unconscious attempt to gain sympathy and attention, it seems odd that she would then sabotage her own efforts by being rude and mean. But lots of behavior when we are sick is odd!
What if family made an effort to reward pleasant behavior with longer visits, lots of attention, etc. And as soon as she goes into rude mode, or great weakness, say, "It looks like you are having a sick spell. I'll let you get some rest now. I'll see you on Thursday," and leave. Pleasant responses = extended visit, rudeness = end of visit. I don't know your MIL ... do you think this might have an impact?
I'd also mention that if she is having memory problems that can be very disorienting and lead to fear which might be expressed as anger. You say that she "wouldn't call the nurse for assistance." It is very possible she forget that she was supposed to. Even if she makes excuses and says "Oh, I don't need the nurse if this tube were longer!" she may just be covering for memory loss, because that is hard to admit.
I had about 6 weeks of severe short term memory loss immediately after my husband died. Yikes! I am really more sympathetic than ever for what people with this condition experience.
The frequent spitting can be a sign of swallowing problems. Does she have any problems eating?
I don't know how probable this is, but it is at least possible that her behavior with you represents the "real" MIL, and her clear-mindedness in front of others is "showtiming." Many dementia patients, for example, can put on an act good enough to fool doctors into concluding that no severe problems are present, but when they let go of the act (which takes an increasing amount of effort) they really fall apart.
I'm just throwing out some ideas to think about. I sure don't have any answers. Please keep us informed of what you try and how well it does/doesn't work. We learn from each other!
Yes, I like the idea of positive enforcement for pleasant behavior. Let us know how it works.