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my mother

Posted: 5/1/2004
shirley, IN:

I AM TAKING CARE OF MY 92 YR. OLD MOTHER. SHE IS ALWAYS DEPRESSED. IT DOESN`T MATTER WHAT I DO OR ANYONE ELSE FOR THAT MATTER. SHE IS ON MEDICATION. SHE THINKS SHE IS FINE & IT IS ME. I HAVE BEEN THINKING OF PUTTING HER IN A NURSING HOME BEENING THAT SHE IS NOT HAPPY ANYWHERE. THE PSYCIATRIST & DOCTOR SEE HER REGULARLY. HOW CAN I GET IT THROUGH TO HER THAT SHE IS NOT FINE?

Karen:

Dear S,

You describe a complex set of issues. May I assume you are your mother’s primary caregiver? Being a family caregiver is a tough role but win-win situations are possible to achieve.

A key question is, has your mother has given you Power of Attorney for Health Care? If not, does she have a legal representative designated? Your mother is able to speak for herself otherwise and physicians today are taking the new privacy act very seriously. You could have very little power for taking any action where she is concerned.

Your question, "how can I get it through to her that she is not fine?" is probably best pursued by you first focusing on how everything is affecting you then showing you care enough to find new ways you can make things better for both of you.

I recommend taking a time out to diffuse the conflict currently between the two of you. The caregiving situation sounds like a hot button for both of you right now so I suggest you not trying to get her to see things your way. Try just relating on more neutral topics while you problem solve.

Even if you do not have legal representation, an avenue you can take starts with you. You have stated that your mother says it’s you who is not fine. The take away for you here is that you are being negatively affected by her behavior(s)that make up the caregiving situation.

Because your concern also affects you, I recommend you make an appointment with your physician or your mother’s physician(s) to describe how you are negatively affected by your mother’s behavior and that you are concerned about the welfare of both of you. The physician will take your concerns more seriously if you provide a simple chart of your mother’s daily behaviors you encounter. Record them by day, time, and situational factors (her reactions and your reactions) but do so confidentially so the recording does not make her change how she acts/reacts. Having at least two weeks of data is very helpful to the doctor to begin to see behavior patterns. Include the medications your mother takes and you take as well.

During this doctor visit, discuss some of the ways you have tried to work with the current situation and what you have tried in order to cope. Keeping the focus on YOU will help the doctor have the bigger picture. Along with assessing the effects of caregiver stress you are facing, the physician will also reflect on your mother’s current plan of care in addition to where you fit in and provide recommendations for follow-up. These recommendations may include scheduling an appointment or referral for your mother for further evaluation particularly if it becomes evident to the doctor that the medications she currently takes are not working as intended.

Two questions you should ask the doctor are, "what exactly is a geriatric assessment?" And, "would this be a direction you’d recommend going?" Keep in mind that unless you do have legal authority for your mother, what the doctor is able to say concerning your mother’s part of this problem will vary. How you can best cope is information you will take home with you.

You also mention nursing home placement. Another question I have is does your mother require skilled care for her depression or other diagnoses? Go ahead and raise this question to the doctor when recommendations for follow-up are being discussed. You need education on how best to meet her needs if you are the primary caregiver.

If nursing home placement is not the direction needed, an alternative is adult day care where activities and companionship could help lessen her depression. This intervention and getting out of the house really can lift an elder’s spirits. Another idea is respite care. Many assisted living and nursing home facilities offer respite care. Respite care takes the burden of care off of your shoulders so you can break free for a while - duration is something you help determine. You may only need a few hours or a few days may be in order and your mother is cared for by the facility for a set fee. Since she will be leaving the facility at some point, generally elders are far more agreeable to go for a short visit and you both get a break from the stress between you.

By taking a closer look at your mother’s needs, how they are being managed and the demands on to you, more effective changes can be considered and put into place. She may need a simple prescription change rather than something as drastic as nursing home placement. For you, again, education about what you are dealing with may help your coping and caregiving efforts.

Seeing a healthcare professional about the specifics of this conflict will guide your next steps. The time out you started with should enable you some neutral ground to approach her on. I also recommend you look into the legal aspects concerning your mother’s representation. Team players on the same page will help produce a more win-win situation.

Granted, a little appreciation here would work wonders for you. Elders truly can have a terribly tough time adjusting to being cared for and sometimes they are down right abusive to their primary caregiver(s). I am sure you are doing the best you can, and hard as it is, do try to not take her actions personally. Often, they are extremely frustrated to be going through what they are. They feel helpless and hopeless along with ill health. Love, validation and support are what they need most when conflict is high. Remember to be good to yourself, too. It really factors in.

Good luck and thank you for writing. Karen Rice