What options are there to help someone 65+ with serious health issues?
April 1, 2013 6:43 PM   Subscribe

My mother-in-law is very ill. In short, she is suffering from obesity, diabetes, hoarding, incontinence and mental health issues. Her husband is beyond the end of his rope and is thinking of leaving her. What can we do?

We just had a family meeting of the two kids, my father-in-law and me. He dropped the bombshell that he is thinking of leaving his wife. I'm surprised he lasted this long. She is incredibly hard to deal with, especially when she feels cornered. She is manipulative and lies. She has been on a downward spiral for about fifteen years. She is obese and now somewhat incontinent, she has diabetes which she controls with medication. She has had breast cancer which was removed and she was treated and appears to be under control. She may be taking an anti-depressant but it's not clear because she lies about medical things. She has refused therapy.

She compulsively shops and hoards and that has been an ongoing problem for many years. When she and my FIL moved from their last house, he took 3 tons of "extra stuff" to the landfill. Granted, they'd lived there for quite a number of years, but, really there was a lot of extraneous stuff. Her refrigerator is a constant nightmare. She has a super sharp mind, though, and will know if you got rid of something that was mouldering in the back of the fridge or unused in what appeared to be a forgotten cabinet.

When you confront her on these things, she gets very nasty. My husband has hung up on her many times. My SIL gets the brunt of a lot of nastiness. My FIL really hates confrontation and most everyone kind of tiptoes around her from time-to-time.

She is very effective at keeping people at bay who want to help her. She lies to her doctors about what kind of exercise she is getting. She hides from the housekeeper so that he thinks no one is home and he goes away. Anyway, I could go on and on. She's tough to deal with. She has put up barriers pretty effectively. On the other hand, on her best days she has a heart of gold, will do anything for anyone and is happy to help always. Of course, that's part of the problem. At any moment, someone seems to need more help that she does herself.


Before he leaves her, we have suggested that we try to find an inpatient facility that can take her and give her a full workup. I think she needs someone to go over all her meds. I think she needs mental health treatment (shopping, eating and hoarding addiction) and I think she needs a line in the sand drawn about how serious things have gotten and about the fact that she needs more care than her husband can provide. She had a fall the other day, couldn't get up, laid on her bathroom floor for several hours before her husband came home. Then she laid there for awhile longer while he got help because he couldn't pick her up.

I think, also, that a facility like that would work with the family members to figure out how they can work to support her. Like, I think my FIL needs a therapist, too, and someone who can be on his side figuring out what he's supposed to do at this point. I think he needs his own intervention because his fear of confrontation has led in some small way to this point.

So, is there a thing like this? He has financial resources but they aren't limitless. Can you make someone with these kind of health problems go to an inpatient facility? I just think, before he leaves, that he needs to make one big gesture. And, if it doesn't work, I think everyone will support him leaving. His health has suffered. If her addiction were drugs and her terrible behavior were called abusive (I think it is), everyone would have been telling him to "run" years ago. But, because it's eating and yelling, he has stayed with her -- encouraging, hoping, praying. It's just not working any longer.

Also, I don't know WTF all these health professionals she has seen over the years are doing but either she's a great liar, or they don't care that their patient has been on a serious decline. It's baffling to me.
posted by anonymous to Health & Fitness (18 answers total) 6 users marked this as a favorite
This is crazy because this woman sounds exactly and i mean EXACTLY like my mother. It's so eerie the resemblance. Except my father just kept hinting he would leave and never did and he ended up dying first. Now she is alone, still struggling with all her problems and very unhappy. I just want to say that you can do very little in this circumstance. When someone does not want to change, or isn't willing to do the work involved in changing you cannot force them.
posted by TestamentToGrace at 6:54 PM on April 1, 2013 [3 favorites]

If you can afford it, consider using a geriatric care manager. They are trained to look at the big picture, make an assessment, and make recommendations. They are also familiar with the quality and availability of resources in your area.

See National Assoc. of Professional Geriatric Care Managers.

As with any professional, make sure you check references, and vet the person before you involve your in-laws. I've worked with two care managers. One was great, and the other was terrible.

Good luck to you. It sounds like you really care about all your family.
posted by valannc at 6:57 PM on April 1, 2013 [2 favorites]

I just think, before he leaves, that he needs to make one big gesture.

Why? I think putting up with 15 years of a hoarding, lying, abusive spouse is a pretty grand gesture.

There's some magical thinking that an inpatient facility will be able to produce some work up which will convince her to suddenly behave differently. It's not that her doctors don't notice or care, it's that they can't force her to change.

If he leaves her, what are you planning to do? Can she live without assistance or does she need to go to a care facility? Start planning to do that. The conversation with your father-in-law should include how to provide for her financial needs. They may choose to stay married for insurance/financial reasons.
posted by 26.2 at 6:58 PM on April 1, 2013 [10 favorites]

Can you make someone with these kind of health problems go to an inpatient facility?

Probably not. You're talking about an involuntary psychatric hold. I believe that the criteria for those vary by state; here are California's critera. I can't evaluate her of course, and if you think it's warranted, you should have a professional evaluate her. My guess from what you've written is that you'll need to proceed with voluntary treatment, not an involuntary hold.
posted by insectosaurus at 6:59 PM on April 1, 2013 [1 favorite]

Can you make someone with these kind of health problems go to an inpatient facility?

Probably not, it's hard to get someone committed beyond some initial observation period, and even that is going to be difficult if she's not obviously an imminent danger to herself or others.

I would suggest looking for a NAMI group in your area and see what they say. They will have resources for your FIL as well.
posted by desjardins at 7:00 PM on April 1, 2013 [2 favorites]

I'm not clear on why you're asking this.... Did your FIL say he wants to make the gesture so he can leave in good conscience, and you're trying to help? Or are y'all pressuring him to do so? I think the answers will depend greatly on which it is.
posted by Metasyntactic at 7:00 PM on April 1, 2013 [2 favorites]

This sounds like my ex's mother. In addition to the problems you mentioned, she was dead set against going to an assisted living facility, and you can't force someone to go. Inpatient mental health care would have been out of the question, but we didn't look into it because it was clear that was a non-starter. But I think to the issue of voluntarily going to such an institution, you can add scarcity of programs. I have to think that if this sort of program were available, like assisted living, it would be culturally known.
posted by chainsofreedom at 7:12 PM on April 1, 2013

How about if leaving is itself the grand gesture?

He moves out. He tells her he still loves her, but he can't live this way any longer. He tells her he'll come back if she makes certain specific, verifiable changes. He doesn't move back in unless and until she does.
posted by feral_goldfish at 7:20 PM on April 1, 2013 [2 favorites]

It has been said but I will reiterate: your mother in law's physicians are certainly aware of her decline, but it is very difficult to help a patient who isn't taking care of herself, lies about it, and doesn't want help to begin with...

You cannot force someone who is of sound mind to adhere to a treatment regimen. Competent adults can choose to risk life and limb by ignoring or opting out of treatment. That is their prerogative.
posted by treehorn+bunny at 7:21 PM on April 1, 2013 [8 favorites]

Almost all states and localities have offices on aging. Call your local office and tell your story. Chances are good they've heard it a thousand times and will be able to advise and refer you. Good luck.
posted by Mr.Know-it-some at 7:27 PM on April 1, 2013 [1 favorite]

This is so sad, and my heart really goes out to her. Just wondering, as far as any of you know, did she experience heavy abuse as a child?

It sounds like she mainly just gets nasty when others interfere with her ways of coping (hoarding, eating in a way that might exacerbate the diabetes/obesity, etc.) And when other people interfere with her methods of self-protection (secrecy, protecting her body from other people doing things to it or knowing things about it.) Is that right?

I am really, really skeptical that "a line in the sand drawn" is going to magically give her new and different fully functional coping mechanisms than the ones that have been serving her for half a century or more. Trying inpatient treatment could be worth it for sure. But even that might not do it, just because she might not be able to relax enough to let go of her self-protective behaviors, if that's what they are. I have major anxiety from time to time and even though it's really miserable to have a high anxiety level, sometimes it's hard to relax out of it just because it also feels self-protective.

If inpatient treatment doesn't work, you could try paying for an individual counselor for her and letting her slowly, slowly, SLOWWWWWWWLY build up trust with that person over time. Because here's the thing, I think if she starts feeling pressured to give up this behaviors NAOOOO, or on a time frame of weeks or even months, then her reaction could be to double down on being defensive. I think it could be more effective for the counselor (or a different kind of person if she would trust them more, like a pastor) to just slowly build up trust first and then work on adding different ways of coping and living to her arsenal rather than taking out the ones she already has. It might be best to find a counselor who specializes in hoarding and issues with self-care.

If none of that works, honestly, I think the best thing you can do for her is just love her and let her live the rest of her life as comfortable as she can be with the coping mechanisms she has. She might be close to the end of her life no matter what you do. It might be best to just give her some grace.

If you can swing it, you might help your father in law rent his own little place nearby. Or maybe, if they have property and he would be open to this, you could get him a single or double wide trailer so he could have his own space. Maybe even an old non-working but fully furnished RV would be enough of an outlet for him to have his own private den that wasn't taken over by her hoard.
posted by cairdeas at 9:04 PM on April 1, 2013 [14 favorites]

Ultimatums don't work to change the behaviour of even averagely dysfunctional people, and they definitely don't work with hoarders.

Tragically, in most places, you're unlikely to be able to make your MIL do anything until she runs into problems big enough that formal agencies can't help but get involved (e.g., the hoarding threatens to create a public health concern in the neighbourhood, and an inspector is drawn in; your MIL is hospitalized and shows such obvious cognitive decline that the staff can't get away without assessing & referring her on & maybe institutionalizing her [& people on the service end are not highly motivated to pursue that until they absolutely must, because it's complicated and draws on resources that are never enough. And it could involve liabilities]). And what it means, effectively, is waiting for bad to get worse. And trying to manage yourselves in the meantime.

If you're inordinately lucky, your municipality might offer something like what this agency in Canada does. It's specifically geared to support people who hoard or suffer from Diogenes Syndrome (don't know if that necessarily applies, but the search term might help you find relevant resources). Their initial referral process is wide open, but the actual program, again, relies on the client's (ongoing) consent. In general the favoured approach (and only legal one, until incompetency can be demonstrated) is client-centered and oriented towards harm reduction.

I feel so much your pain. An obviously physical illness may be mysterious or unpredictable, but it at least has a frame around it that makes it in some way acceptable. The profound ambiguity of this kind of illness/not illness is torturous.

This book may help your husband a bit, in terms of working out a way to cope with his mom. This one is specific to families supporting hoarders, and is excellent, I think (though many of the practical solutions suggested presume the availability of certain resources; still, it's a helpful way of thinking things through. Like, choosing your battles - which issues need to be urgently handled? Which are maybe off-putting to you or your husband, but not dangerous? Bad wiring, pests, and infectious diseases are actual hazards. Piles of crap aren't [unless they threaten the floor]. There's also advice on approaching, e.g., bill payments, medical issues, etc. Everything with consent, basically. It is a lot of work. It is not manageable alone).

I think your FIL should do whatever is necessary to protect his own life and sanity. Maybe, he could get advice on investing some of that money, to grow it into enough that it could be a greater help to your MIL when the times comes to use it, in case of institutionalization (or guardianship).

Wishing you all strength.

(I think/hope that in 50 years we will know more about the relevant neural correlates, and find a way to begin to manage this better. Obviously unhelpful now. But one belief that has helped me find patience: I cannot believe that anyone who knows or is able to live differently would choose this kind of misery [and I don't believe that hoarders are any less miserable than their families].)
posted by nelljie at 9:16 PM on April 1, 2013 [5 favorites]

Seems like you (individually and collectively) need to work toward two legally separate households, one for MIL and one for FIL. Is there enough money? (Does she have SSI/SSDI?) That seems like the only humane outcome.
posted by ClaudiaCenter at 9:45 PM on April 1, 2013

Followup from the anon poster:
Metasyntactic: "I'm not clear on why you're asking this.... Did your FIL say he wants to make the gesture so he can leave in good conscience, and you're trying to help? Or are y'all pressuring him to do so? I think the answers will depend greatly on which it is."

Well, I think the kids (myself, SIL and my husband) feel that she can't live on her own. And that, frankly, we don't want the care for her to fall on us. We live across the country (west coast, U.S.) from her and my father-in-law (the south). And, if he does just walk out tomorrow, we'll still be pushing for her to get a comprehensive evaluation.

I think my FIL would probably like to just walk away. That way he still doesn't have to be confrontational. However, if he walks out tomorrow, I think we can support him in that. But, I don't know. I'm the more impartial observer of this and, of course, my husband and his sister have some different feelings. It's just a tough situation all around.

I had suggested that several carers/services be employed -- a home health aid, a therapist, a psychiatrist, a physical therapist. But all these things can be thwarted while she has some agency. And I don't think we (or she) knows who to go to and who would be most effective anyway. Thus the idea of a big evaluation and one where she has to sort of contemplate the future a little bit and know that we are all serious and that we're over the brink.

I don't really think that my FIL will ever come back once he leaves. And I don't really think that she will "get better." What we are left with is a person who still has a working mind but is killing herself slowly (and dragging her husband down with her) and no idea what we ought to do for her. My husband is worried that his FIL leaving will just result in a constant haranguing and guilt tripping from his mother until she croaks. This is probably true. But, well, this is the burden of the situation, I guess.

It's just a terrible scene all around and I'd like to see what options I can find before we all "walk away." I think that we have all tried and given up over the years. And, yes, I agree that a grown adult can do what they want with their lives but it's awfully hard to not try.

Okay... too much followup. Thanks for the resources already listed -- it's given me a few new directions to look.
posted by LobsterMitten at 10:05 PM on April 1, 2013

There's no simple way around the competency issue. Your husband and SIL's options are between engaging with MIL and leaving her to her own devices, to a greater or lesser degree. Without her cooperation, not even the best-equipped facility can help. Forcing a solution will almost assuredly make things worse, in that it will undermine trust, which is the only leverage you have, here.
posted by nelljie at 3:17 AM on April 2, 2013 [1 favorite]

Your FIL has a right to enjoy his golden years. His wife, your MIL has come to a point when he can't deal with it anymore.

As long as your MIL has agency, makes decisions for herself and refuses to do anything about her situation, there is no-one in the family that will be able to change the trajectory of her hastening death.

You can try an intervention.

Your husband, SIL, FIL can all sit down and as a united front say:

"Mom, we love you. Your spending, hoarding, compulsive eating and inappropriate care of your health are affecting me in the following ways: 1, 2, 3. As of today we are asking you to do the following things: Take your medication, go into therapy, stop spending money, eat properly, get rid of anything in the house that is broken, garbage, etc. If you refuse to do so, these are the consequences, Dad will be leaving and filing for divorce, neither, Sis, nor I will help you continue in this self-destructive path, we will only speak to you if you are getting help for these issues. We love you, but we won't love you to death. You have serious mental and physical health problems and unless you address them, you must deal with the consequences on your own."

Then be prepared to follow up. If your MIL was an alcoholic, would you continue to enable her? No. This is no different.

No one person, no matter how much you love him or her, has the right to hold you hostage.
posted by Ruthless Bunny at 6:26 AM on April 2, 2013 [1 favorite]

While I was reading this I seriously thought, holy crap, did one of my siblings join metafilter?

So the hard truth here is that your MIL is a sinking ship, and it's up to you guys to decide if you want to go down with the ship. Your FIL clearly does not want to do so. What is not a realistic option is your MIL willingly going to see a bunch of medical professionals and telling them the truth about her condition and working with them to improve her health. Not going to happen. Seriously. Pigs will fly first. As cairdeas excellently said, all the stuff she does is her way of coping with the world, and that is not something she is really able to just give up.

The most likely scenario here is that she is left to her own devices until she manages to injure herself in a way that requires emergency intervention and removal from the home. The best case scenario for her safety is that whatever happens requires nursing care and she is sent to a nursing facility. If she is released home, prepare for the cycle to repeat until her health declines enough that she doesn't get released home again. This is likely even if your FIL stays, but if he leaves that will probably speed up the timetable.

Alternatively, the hoard/damage to the home/lack of utilities/whatever might attract the attention of public officials and they might become involved and that is another avenue where she might be removed the house. Given her already poor health, I think the first is more likely.

I recognize that this sounds terrible and makes me sound so, so coldhearted, but the people who think that have never had to deal with someone like your MIL. It is not a conscious choice she's making to live like this, I think it feels safe emotionally to her and she is terrified of leaving that safety behind. My own mother was sexually abused as a young child by a disturbed young man who killed himself shortly afterwards. She never received any kind of help when she was a child, and as an adult she repressed the memories as best she could, but it didn't work and now she's in her sixties, in terrible physical and mental condition, with her hoard for protection. It's a goddamn tragedy, and I would not be surprised to hear that your MIL has a similar story. That doesn't change how frustrating the situation is currently or make there be any magic pills for treatment. I'm sorry. I wish I had something more hopeful to say.
posted by crankylex at 6:34 AM on April 2, 2013 [8 favorites]

I just think, before he leaves, that he needs to make one big gesture. And, if it doesn't work, I think everyone will support him leaving.

You're fooling yourself if you think anything is going to change, gesture or no. Don't make him put up with more to appease your own conscience. What you can do is help your father-in-law make the transition from being held hostage in what is effectively an abusive marriage to, hopefully, having some happiness in the later part of his life.
posted by Dasein at 7:18 AM on April 2, 2013 [6 favorites]

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