How do I manage this?
October 13, 2019 10:02 PM Subscribe
I'm struggling to communicate to my parents the necessity of taking my elderly maternal grandmother to the hospital when something alarming happens.
Context: My grandma is in her late 80s, is a high fall risk and has chronic dizziness and weakness. She lives with my parents in a North American suburb. I live an hour away and don't drive; my brother is a 15 car ride / 30 minute public transit trip away. We're Eastern-European immigrants who have lived here for almost two decades (a decade for my grandma). Both my brother and I have distant/working towards civil relationships with our parents due to family trauma. We come from a Soviet bloc country with free but not particularly good public healthcare, and a "what the doctor says, goes" mentality. Grandma uses the walker and has a PSW visiting her twice a day for 2 hours a day to prepare food and help with personal care. This is the best we're able to get for free on public healthcare; grandma does not want to attend a day centre for seniors, and residential care is neither financially possible nor culturally acceptable.
The problem: For the past few years, this has been the family pattern: something scary happens to my grandma in regards to her health, my mom just casually mentions it to me the next day, I panic and either take grandma to the hospital, go to the hospital with both of them, or, on one occasion, am convinced she's fine. My mom has yet to be the person to take grandma to the hospital after something bad happens:
Two years ago, it was my mom calling me to say my grandma had a fall at home. I called grandma in panic to find out she hadn't been taken to the hospital and was slurring and confused, left work mid-day to take her to the ER, and learned she had two fractured vertebrae, which were very painful (the pain has been mostly reduced with physical therapy, massage, and medication). Her vertebrae fractures has since progressed to a full break due to age. She fell due to wearing fabric slippers on tile (if you have elderly family members, please insist on them wearing non-slip shoes!).
Today, it was going to visit my family for Thanksgiving, my mom mentioning that "grandma gave her a fright yesterday" (translation: grandma had a large dinner, then fell unconscious in her chair with her head lolling on her chest for two minutes and couldn't be roused, was then nauseous, vomited, and felt better), me insisting on taking her to the ER, and getting the all-clear after a CAT scan, blood tests, and a cardiogram - it was a vagal nerve response to overeating, which means she now needs help with portion control.
I feel like I've been beating my head against the wall. I've talked to my mom many times about: better safe than sorry; healthcare is free so we should go to the ER if we need to; scary or strange health things happening to seniors NEED medical attention; we are not qualified to determine grandma's okay based on appearance; checking her blood pressure or using my mom's TENS machine does not constitute a diagnosis ; if mom isn't sure it's ER-worthy, she can always call me and I can be the second opinion.
There have been other incidents in the middle. Despite my conversations with mom, nothing changes.
I'm also highly aware that, due to sexist division of labour at home and grandma being my mom's mom, my mom is the primary caregiver and is overwhelmed and has no day-to-day relief beside the PSW. I have stepped in a few years ago to take over gran's medical needs - I found and take her to a family doctor I trust, gerontologist, and neurologist. My mom is now taking her to her cardiologist and other specialists, and provides for the vast majority of her at-home care. I have set her up with available support services at home. Despite this, I still live an hour away. Both my mom and I are the most involved in grandma's care. My dad will drive her places or pick up her prescription, but is in that school of "tell me what do to and I'll do it" masculinity, and has never been a caretaker in the full sense of the word or performed emotional labour. My brother visits them weekly, but is pretty much uninvolved in grandma's care, except an occasional Amazon order/being a second opinion if I'm worried about grandma's health.
The other problem: I'm not on great terms with my parents. There's generational trauma between grandma and mom, and I'm just coming out of being triggered when mom overlooks grandma's medical needs (the same way she overlooked mine as a teen). I can work towards a relationship with mom where I call her every week to check up on grandma, and I talk to grandma on the phone. However, grandma is not a reliable narrator of her health, and I'm walking a fine line of being civil/friendly with mom without giving her an inch so she can take a mile (she and I have a storied past of boundary issues, "your mother is your best friend"-type gems and treating me as an extension of herself. This has shifted with a LOT of time, therapy, modelling behaviour, moving out, and not being dependent on her anymore). I've also dealt with a lot of guilt about moving out and not taking care of grandma in a more daily, involved way.
I'm trying really hard. Because of how distorting it is to be in my family environment, I call trusted friends when a gran medical emergency comes up. Today, I also called a provincial nursing phone line, who seconded my call. I'm really struggling with the idea that, to help grandma better, I need to get closer to mom and risk her wanting me enmeshed again. I'm also afraid that, even if I get closer or try harder, my mom's mental block about medical care isn't going to be budged.
What I'm asking: What can I do better to help grandma? How do I communicate better with mom re: grandma's medical needs and when it's necessary to go to the ER? And am I doing enough?
Context: My grandma is in her late 80s, is a high fall risk and has chronic dizziness and weakness. She lives with my parents in a North American suburb. I live an hour away and don't drive; my brother is a 15 car ride / 30 minute public transit trip away. We're Eastern-European immigrants who have lived here for almost two decades (a decade for my grandma). Both my brother and I have distant/working towards civil relationships with our parents due to family trauma. We come from a Soviet bloc country with free but not particularly good public healthcare, and a "what the doctor says, goes" mentality. Grandma uses the walker and has a PSW visiting her twice a day for 2 hours a day to prepare food and help with personal care. This is the best we're able to get for free on public healthcare; grandma does not want to attend a day centre for seniors, and residential care is neither financially possible nor culturally acceptable.
The problem: For the past few years, this has been the family pattern: something scary happens to my grandma in regards to her health, my mom just casually mentions it to me the next day, I panic and either take grandma to the hospital, go to the hospital with both of them, or, on one occasion, am convinced she's fine. My mom has yet to be the person to take grandma to the hospital after something bad happens:
Two years ago, it was my mom calling me to say my grandma had a fall at home. I called grandma in panic to find out she hadn't been taken to the hospital and was slurring and confused, left work mid-day to take her to the ER, and learned she had two fractured vertebrae, which were very painful (the pain has been mostly reduced with physical therapy, massage, and medication). Her vertebrae fractures has since progressed to a full break due to age. She fell due to wearing fabric slippers on tile (if you have elderly family members, please insist on them wearing non-slip shoes!).
Today, it was going to visit my family for Thanksgiving, my mom mentioning that "grandma gave her a fright yesterday" (translation: grandma had a large dinner, then fell unconscious in her chair with her head lolling on her chest for two minutes and couldn't be roused, was then nauseous, vomited, and felt better), me insisting on taking her to the ER, and getting the all-clear after a CAT scan, blood tests, and a cardiogram - it was a vagal nerve response to overeating, which means she now needs help with portion control.
I feel like I've been beating my head against the wall. I've talked to my mom many times about: better safe than sorry; healthcare is free so we should go to the ER if we need to; scary or strange health things happening to seniors NEED medical attention; we are not qualified to determine grandma's okay based on appearance; checking her blood pressure or using my mom's TENS machine does not constitute a diagnosis ; if mom isn't sure it's ER-worthy, she can always call me and I can be the second opinion.
There have been other incidents in the middle. Despite my conversations with mom, nothing changes.
I'm also highly aware that, due to sexist division of labour at home and grandma being my mom's mom, my mom is the primary caregiver and is overwhelmed and has no day-to-day relief beside the PSW. I have stepped in a few years ago to take over gran's medical needs - I found and take her to a family doctor I trust, gerontologist, and neurologist. My mom is now taking her to her cardiologist and other specialists, and provides for the vast majority of her at-home care. I have set her up with available support services at home. Despite this, I still live an hour away. Both my mom and I are the most involved in grandma's care. My dad will drive her places or pick up her prescription, but is in that school of "tell me what do to and I'll do it" masculinity, and has never been a caretaker in the full sense of the word or performed emotional labour. My brother visits them weekly, but is pretty much uninvolved in grandma's care, except an occasional Amazon order/being a second opinion if I'm worried about grandma's health.
The other problem: I'm not on great terms with my parents. There's generational trauma between grandma and mom, and I'm just coming out of being triggered when mom overlooks grandma's medical needs (the same way she overlooked mine as a teen). I can work towards a relationship with mom where I call her every week to check up on grandma, and I talk to grandma on the phone. However, grandma is not a reliable narrator of her health, and I'm walking a fine line of being civil/friendly with mom without giving her an inch so she can take a mile (she and I have a storied past of boundary issues, "your mother is your best friend"-type gems and treating me as an extension of herself. This has shifted with a LOT of time, therapy, modelling behaviour, moving out, and not being dependent on her anymore). I've also dealt with a lot of guilt about moving out and not taking care of grandma in a more daily, involved way.
I'm trying really hard. Because of how distorting it is to be in my family environment, I call trusted friends when a gran medical emergency comes up. Today, I also called a provincial nursing phone line, who seconded my call. I'm really struggling with the idea that, to help grandma better, I need to get closer to mom and risk her wanting me enmeshed again. I'm also afraid that, even if I get closer or try harder, my mom's mental block about medical care isn't going to be budged.
What I'm asking: What can I do better to help grandma? How do I communicate better with mom re: grandma's medical needs and when it's necessary to go to the ER? And am I doing enough?
I would be really curious why your mother doesn't call for help? I can imagine so many different answers - she has a fatalistic view and if it grandma's time, it is her time, she has a phobia about hospitals or doctors and makes up any reason to avoid it as much as possible, she is overwhelmed and really, really wants to just pretend things are OK, she likes the drama when you get all involved and so waits for you so she can get your attention, she is resentful of grandma and Ok if grandma dies on her watch. It could be any of these, several of them or none of the above. However, the best response will be different depending on your underlying theory of your mother's motivations.
posted by metahawk at 10:16 PM on October 13, 2019 [4 favorites]
posted by metahawk at 10:16 PM on October 13, 2019 [4 favorites]
When we lost my granddad, I took a lesson from my best friend and roomie: every single day, she called her grandmother. Sometimes it was just a two-minute heads-up, sometimes it would be a longer talk. So I began doing that, and after a while, so did my cousin. By calling every day, we got a very good sense of her state of mind and health, and we could do something when she needed help. Our parents were of no use, their relationship with gran was not good. In the beginning, our uncle was helpful, but that deteriorated after a couple of years.
I was a single mother with no car, my cousin had more ressources, but between us we could manage most things, and for the first many years we just saw her once a week or less, and took turns taking her on holidays. When she was over 90, and couldn't cook for herself anymore, we moved her to an apartment near my cousin's home and my workplace, and I'd go by on my way home from work to do some shopping and cook her a meal.
So my experience is: if you call your gran every day, just for a few minutes, you will get a better sense of how she is doing. You won't need to go there to see or rely on your mother's interpretation of what is going on.
Maybe you can engage your brother in practical tasks. Meaning: if you get a sense that something is wrong, you can call him and ask him to go over ASAP, check out the situation and call you back. The years my cousin and I spent caring for our gran together as a team has created a closer bond between us. It was a a good thing.
Finally, things changed over time. Maybe you will need to move closer to your family in some years, but not now. Looking back, I should have focused more on me and my kids in the years where I still had the freedom, to build up strength for those last two years where it really was tough because we had to go there every day and talk with doctors and nurses and take her to the hospital often.
At the time, my cousins and my relationship with our mothers and our uncle were really strained. They barely cared to visit gran when she was dying and each in their own way, they tried to create some drama/get attention. But my cousin and I did our best to not engage and to support each other. Now, five years after our gran died, things are improving a lot. Our mothers have begun to acknowledge that we were and are doing the right thing and that we are adults with our own ideas and purposes. Just yesterday my mother admitted something extremely hurtful she did to me when I was a teenager, which she has always lied about. I didn't need her to do it like I did back then, but I appreciated that she now sees me as a person with my own feelings. Things can change.
posted by mumimor at 12:33 AM on October 14, 2019 [8 favorites]
I was a single mother with no car, my cousin had more ressources, but between us we could manage most things, and for the first many years we just saw her once a week or less, and took turns taking her on holidays. When she was over 90, and couldn't cook for herself anymore, we moved her to an apartment near my cousin's home and my workplace, and I'd go by on my way home from work to do some shopping and cook her a meal.
So my experience is: if you call your gran every day, just for a few minutes, you will get a better sense of how she is doing. You won't need to go there to see or rely on your mother's interpretation of what is going on.
Maybe you can engage your brother in practical tasks. Meaning: if you get a sense that something is wrong, you can call him and ask him to go over ASAP, check out the situation and call you back. The years my cousin and I spent caring for our gran together as a team has created a closer bond between us. It was a a good thing.
Finally, things changed over time. Maybe you will need to move closer to your family in some years, but not now. Looking back, I should have focused more on me and my kids in the years where I still had the freedom, to build up strength for those last two years where it really was tough because we had to go there every day and talk with doctors and nurses and take her to the hospital often.
At the time, my cousins and my relationship with our mothers and our uncle were really strained. They barely cared to visit gran when she was dying and each in their own way, they tried to create some drama/get attention. But my cousin and I did our best to not engage and to support each other. Now, five years after our gran died, things are improving a lot. Our mothers have begun to acknowledge that we were and are doing the right thing and that we are adults with our own ideas and purposes. Just yesterday my mother admitted something extremely hurtful she did to me when I was a teenager, which she has always lied about. I didn't need her to do it like I did back then, but I appreciated that she now sees me as a person with my own feelings. Things can change.
posted by mumimor at 12:33 AM on October 14, 2019 [8 favorites]
Also, it might seem like a scary thing, but it may be worth contacting any sort of elder-abuse or elder-support resources in your area for help. Ignoring a dependent adult's medical needs would likely classify as abuse in the U.S. Here, at least, Adult Protective Services doesn't have nearly the same legal authority as Child Protective Services, so they can't just sweep in and remove an elder adult from their home, and so they tend to focus on providing social work and resources to the family to make sure that everyone is safe and cared for.
It sounds like you're not in the U.S., so you may want to google around or ask here for people's experiences with adult protective services in your area, but it's something to keep in mind.
posted by lazuli at 8:03 AM on October 14, 2019 [1 favorite]
It sounds like you're not in the U.S., so you may want to google around or ask here for people's experiences with adult protective services in your area, but it's something to keep in mind.
posted by lazuli at 8:03 AM on October 14, 2019 [1 favorite]
> the same way she overlooked mine as a teen
> I'm walking a fine line of being civil/friendly with mom without giving her an inch so she can take a mile
> she and I have a storied past of boundary issues, "your mother is your best friend"-type gems and treating me as an extension of herself
Your mom sounds a lot like my mom. In my case, I know that my mom will never, ever change, no matter how much I try to reason with her. What will help, is if I get a person of authority, specifically a MALE person of authority, to tell her what she needs to hear. Next time you need to take your grandma to the ER, or next time your mom takes your grandma to her regular doctor, see if the three of you can go and if you can get the doctor to tell her that she needs grandma to the ER next time something happens. This needs to be done by a doctor, preferably male and a little older; def. not a nurse.
Moving closer to your mom and grandma might allow you to be check more on your grandma, but don’t expect your mom to change, because she won’t. I’m sorry. The advice given above by mumimor and lazuli is also good.
posted by eierschnee at 10:09 AM on October 14, 2019 [4 favorites]
> I'm walking a fine line of being civil/friendly with mom without giving her an inch so she can take a mile
> she and I have a storied past of boundary issues, "your mother is your best friend"-type gems and treating me as an extension of herself
Your mom sounds a lot like my mom. In my case, I know that my mom will never, ever change, no matter how much I try to reason with her. What will help, is if I get a person of authority, specifically a MALE person of authority, to tell her what she needs to hear. Next time you need to take your grandma to the ER, or next time your mom takes your grandma to her regular doctor, see if the three of you can go and if you can get the doctor to tell her that she needs grandma to the ER next time something happens. This needs to be done by a doctor, preferably male and a little older; def. not a nurse.
Moving closer to your mom and grandma might allow you to be check more on your grandma, but don’t expect your mom to change, because she won’t. I’m sorry. The advice given above by mumimor and lazuli is also good.
posted by eierschnee at 10:09 AM on October 14, 2019 [4 favorites]
Good news is the PSW is there every day. That means someone other than your mom is laying eyes on her every day. So if someone comes in and sees altered mental status , loss of mobility etc, that person will most likely panic and call EMS.
You can dispatch emergency medical personnel (an ambulance) to their house, you do not need to be there, take off work, ect. I understand doing so, but if you get the call from your mom that grandmother suddenly can't talk anymore etc, you can just call.
I get the need to encourage your mom to respond, my mother is a chronic under responder to things. I get so angry and frustrated. Try to remember that your mothers actions and outcome aren't super linked, your grandmother is in her late 80s, even with perfect response times in emergency health situations good outcomes gets less and less. I'm saying this because I spent alot of time in grief and what ifs about many things that were shrugged off and over time, and now years later I'm not sure if she had responded like i wanted the outcome would have been much different. That may not apply to you, and that's ok if it doesn't.
posted by AlexiaSky at 10:34 AM on October 14, 2019 [2 favorites]
You can dispatch emergency medical personnel (an ambulance) to their house, you do not need to be there, take off work, ect. I understand doing so, but if you get the call from your mom that grandmother suddenly can't talk anymore etc, you can just call.
I get the need to encourage your mom to respond, my mother is a chronic under responder to things. I get so angry and frustrated. Try to remember that your mothers actions and outcome aren't super linked, your grandmother is in her late 80s, even with perfect response times in emergency health situations good outcomes gets less and less. I'm saying this because I spent alot of time in grief and what ifs about many things that were shrugged off and over time, and now years later I'm not sure if she had responded like i wanted the outcome would have been much different. That may not apply to you, and that's ok if it doesn't.
posted by AlexiaSky at 10:34 AM on October 14, 2019 [2 favorites]
Response by poster: Thanks for the advice, everyone.
Metahawk, if I knew why my mom is so medicine-resistant and could talk to her about it, my teens and early twenties would've been very different. Unfortunately, I think you're all right - she's not going to change and I need to manage things as much as I can from other directions. My brother and dad are also equally complacent, despite multiple conversations about why we have to take a senior's symptoms and health more seriously. My parents definitely have a "if the GP tells you to do an X test or give you Y medication, you're fine" mentality and have no understanding of patient advocacy. I can try reminding them about the nursing phone line but I think it falls into the category of "medical help" and they wouldn't seek it. My dad called me today for a very small-talk conversation - no mention of yesterday, or concern that it was abnormal, or sense that they should've done something right away. This is very par for the course.
I will keep a direct line with my grandma (I'd dropped it down to 1-2 times a week, but I used to call every day - I'll get back on that) and will see if I can contact elder abuse lines for advice and information. I'll talk again with dad, brother and PSW about what we do when things are alarming. I feel at least the PSW would respond.
I was hoping writing everything out would give me a different perspective (as well as having everyone else's input), but this is just where things are right now.
posted by elsmith at 6:44 PM on October 14, 2019 [2 favorites]
Metahawk, if I knew why my mom is so medicine-resistant and could talk to her about it, my teens and early twenties would've been very different. Unfortunately, I think you're all right - she's not going to change and I need to manage things as much as I can from other directions. My brother and dad are also equally complacent, despite multiple conversations about why we have to take a senior's symptoms and health more seriously. My parents definitely have a "if the GP tells you to do an X test or give you Y medication, you're fine" mentality and have no understanding of patient advocacy. I can try reminding them about the nursing phone line but I think it falls into the category of "medical help" and they wouldn't seek it. My dad called me today for a very small-talk conversation - no mention of yesterday, or concern that it was abnormal, or sense that they should've done something right away. This is very par for the course.
I will keep a direct line with my grandma (I'd dropped it down to 1-2 times a week, but I used to call every day - I'll get back on that) and will see if I can contact elder abuse lines for advice and information. I'll talk again with dad, brother and PSW about what we do when things are alarming. I feel at least the PSW would respond.
I was hoping writing everything out would give me a different perspective (as well as having everyone else's input), but this is just where things are right now.
posted by elsmith at 6:44 PM on October 14, 2019 [2 favorites]
I'm in the US and not sure how things work there.
I hear in other places you can go to the ER without having to pay thousands of dollars? Maybe your parents would be more amenable to using ER services if you frame it as this is why they are paying taxes, these services are for them, they should get their money's worth.
I've tried a similar tactic to convince my own parents to go to the doctor, but due to how medical care works in the US there's often a surprise big bill even when you thought you would have coverage, so in practice that hasn't worked out very well.
If it costs money to use an ambulance or emergency room where you live that could be a factor in why they don't want to take her, I know for my own grandmother we had to pay hundreds of dollars for ambulance costs alone. Some places have a sort of "ambulance membership" where you can pay a yearly fee to cover all of your medical transport needs, perhaps that's available where your parents live.
posted by yohko at 1:50 PM on October 16, 2019
I hear in other places you can go to the ER without having to pay thousands of dollars? Maybe your parents would be more amenable to using ER services if you frame it as this is why they are paying taxes, these services are for them, they should get their money's worth.
I've tried a similar tactic to convince my own parents to go to the doctor, but due to how medical care works in the US there's often a surprise big bill even when you thought you would have coverage, so in practice that hasn't worked out very well.
If it costs money to use an ambulance or emergency room where you live that could be a factor in why they don't want to take her, I know for my own grandmother we had to pay hundreds of dollars for ambulance costs alone. Some places have a sort of "ambulance membership" where you can pay a yearly fee to cover all of your medical transport needs, perhaps that's available where your parents live.
posted by yohko at 1:50 PM on October 16, 2019
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posted by lazuli at 10:16 PM on October 13, 2019 [1 favorite]