Friend feeling trapped by husband's traumatic brain injury
November 3, 2018 8:00 AM   Subscribe

I've got a close friend who is in an unfortunate situation. Her husband had a traumatic brain injury about 5 years ago. As a result he is disabled and can't work. He has some physical limitations but the primary issue is cognitive. He can't concentrate for extended periods and his personality has changed for the worse.

He is often very mean, controlling, verbally abusive, and has occasional rage attacks. He can be (rarely) physically aggressive. This is all new behavior as a result of the brain injury. He is also 100% dependent on her and fears being abandoned.

They have two kids in high school. They are reasonably independent but they both are struggling a bit with school and moderate mental health issues probably related to the long term stress they have all been under. They no longer have a good relationship with their father. Kids and mom are constantly concerned about triggering him.

She has a decent job working in IT. Has health coverage for the family. But she is barely making ends meet. They have no savings and are living paycheck to paycheck. 

She's feeling personally trapped. She's effectively lost a husband and gained a perpetual dependant. She is being run ragged taking care of him and the kids while working full time. It is hard for her to envision spending the rest of her life in a caregiving job. Especially for someone who now has become so difficult. It also looks like as time goes on he is going to need more and more assistance. In the not too distant future he will likely need support while she is at work.

She has admitted fantasizing about leaving him and focussing on the kids and herself. She is envious of a "normal" life. This of course makes her feel incredibly guilty. The whole family has been in therapy and it has helped but this is an additional financial strain.

As far as we can determine she makes too much for them to qualify for any caretaking or other assistance. And neither of them have any other family willing/able to help.

I'm helping as best I can. A little bit financially. Lots of listening. Trying to help her think things through. But all this is really complex. One scenario she's explored is that they divorce, she stays heavily involved in his care but is no longer his sole caregiver, and she moves on with her life. She will only consider this route if she is sure he will be taken care of. It's unclear if this would be financially better or worse for them. She has talked to a divorce attorney. If they divorced he would be entitled to about 40% of her income, about $30k/yr. In a few years he can access some social security income. But he would no longer be covered by her insurance.

The questions are:
1. How can she get the resources necessary to unload some of this burden? Location is USA.
2. How does one reconcile the ethical issues here?

Any other thoughts, especially from those who have dealt with this sort of issue, are appreciated.
posted by socktherapy to Human Relations (19 answers total) 5 users marked this as a favorite
This will vary by state. In Iowa, TBI qualifies for Medicaid. This would co er his health care costs but also provide a respit worker to care for him for some hours during the week so she can have a break.
posted by Lutoslawski at 8:05 AM on November 3, 2018 [5 favorites]

This is the sort of situation where a local TBI-caregiver support group could be especially helpful.
posted by DrGail at 8:13 AM on November 3, 2018 [8 favorites]

1. A good psychiatrist should be part of the solution. Managing his mood/behavior with medication will reduce the stress on her and the kids and give her some breathing room to strategize for the future.

2. The ethics are tough. If there are issues around decision-making capacity consulting an attorney would be a good idea.

I agree that government resources will greatly vary by state.
posted by 6thsense at 8:18 AM on November 3, 2018 [4 favorites]

If she is looking for permission to reclaim her life, she has it from this internet stranger.

I agree she needs to revisit with his doctors and/or get second opinions. There absolutely MUST be more options than to live with a frightening individual who will eventually harm her or the whole family if/when someone has a bad day. She can and should seek assistance for this situation.

It’s not cruel to deal with the situation as it is today.
posted by jbenben at 8:35 AM on November 3, 2018 [27 favorites]

What state is this? 40% sounds like a lot of alimony. Divorce law is also extremely local, depending on things like what judge you end up with. Sometimes attorneys tell clients the worst case scenario—because that’s their job—but they don’t mean that’s what will absolutely happen. It might be worth getting a second opinion from someone who specializes in elder / disability law and related estate planning.
posted by Rock 'em Sock 'em at 8:49 AM on November 3, 2018 [7 favorites]

Can he get disability?
posted by jessca84 at 8:50 AM on November 3, 2018 [4 favorites]

We have a family friend who went through a similar situation; in the end, they had to divorce. She was being abused, it was hard on the children, he was not her husband anymore -- he was a rage-filled, abusive dependent. When they divorced, he went to live in a supportive care facility, and honestly he's a lot happier there and able to have his children visit and interact with them positively. (She still visits too.)

They are super-Catholic so she was very reluctant to divorce, but both her family and his family supported it (despite all being super-Catholic), because it was just such a bad situation for the children, and they were able to receive an annulment from the Church with very little hassle (basically on the grounds he was literally no longer the man she married).

It was hard and shitty and more upheaval, but it was a LOT BETTER once they were divorced, she was starting her life over and focusing on herself and the children, and he was in a supportive care environment getting the help he needed.

Has she investigated whether he can live in a supportive care environment without them getting divorced?
posted by Eyebrows McGee at 8:52 AM on November 3, 2018 [83 favorites]

If he's abusive, it doesn't actually matter why. What matters is the behavior, not the cause. Nobody should be expected to tolerate abuse for any reason, period. Your friend should seek a divorce.
posted by Anticipation Of A New Lover's Arrival, The at 8:53 AM on November 3, 2018 [19 favorites]

1. She is being abused. She has access to all of the resources that abused women have, including shelters. If she needs time to think and a safe place to get advice, she should feel free to take her children to a shelter (assuming it's a nice shelter) and decide what to do. She doesn't have to be committed to leaving if she wants to stay in a shelter, she can just take a break.

If she is the target of an aggressive rage situation, she can call the police. She can decide if the situation is a regular domestic violence situation or if her abuser might benefit from a psychiatric hold at the hospital.

2. There is no ethical struggle here. Your friend is a mother, her children do not deserve abuse, and it's her responsibility as a mother to separate the children from the abuser. This trumps the marriage vow of "in sickness and in health".

I get that it's hard. My ex-husband was not working either because of his physical and mental disabilities. I really believed in the "sickness and health" part of the marriage vow, and it would be wrong for me to leave him because he was sick. It took my daughter witnessing the abuses to make me leave. I wanted to set an example for her, so she understood that it is wrong to treat women and children that way and that we deserve a life free from violence. I hope she carries that through to her future relationships.

It's not all sunshine and lollipops with my ex. His parents are supportive but my ex is incapable of maintaining good household relations, so he got kicked out of their house. He is homeless. He had an episode and was committed to the psychiatric ward. He turned to drink and went to rehab. He wanders to my daughter's school and makes inappropriate attempts at contact. It is so, so, so hard. But worth it. I invite your friend to reconsider the idea that she be involved with his care, being involved in his health problems only prolongs the drama. This is his family's task now, like it or not for them. And they can be the ones to arrange supportive care, not your friend.

My only regret is not leaving my husband sooner, it would have reduced my support obligations to him. They are tied to the length of the marriage where I live.

Good luck to your friend.
posted by crazycanuck at 10:03 AM on November 3, 2018 [28 favorites]

I think - ethically there are two imperatives. She should separate the children from him - but she doesn’t need to divorce him for that. It sounds like the reasons she wants to divorce him are so that she isn’t financially responsible for what is essentially a dependent anymore. This is on far less solid ethical ground than just making separate households would be.

How much actual support does he need vs what he wants? Why is she envisioning he will ultimately need a caregiver at home while she works? How much of this could be sorted if they got him a shared disability living apartment?
posted by corb at 10:22 AM on November 3, 2018 [2 favorites]

If he worked before his TBI, he may qualify for SSDI, the social security disability insurance program. She can apply for SSDI for him online at the Social Security Administration website. (Note on rereading: you say he worked enough to qualify for Social Security "in a few years", I'm assuming you mean SS retirement. If so, he has likely worked enough quarters to get SSDI.)

If he is eligible for SSDI, he is also likely eligible for Medicare coverage and a lump sum SSDI back pay award for all but the first five months from his disability date till now.

This is an emergency situation because of the TBI-caused abuse, and need for separation, so she may be able to put in the SSDI application and have it expedited. I have found my local Congress person helpful in lighting a fire under the SSA to get a lump sum back pay award paid out to my loved one who is similarly affected by a TBI three years ago.

Collecting more money, and a different source of medical coverage for the husband, is the key to setting him up in a separate living space. Then she has to figure out what space that can be.
posted by KayQuestions at 10:32 AM on November 3, 2018 [17 favorites]

SSDI definitely seems like something to explore if he is disabled and unable to work, particularly if age-related benefits are expected in a few years. Accessing public benefits quickly could help alleviate some of the financial concerns, especially for things like supportive housing.

In the meantime, there is help, including confidential support hotlines, and your friend could talk to another lawyer, and she may qualify for a free or low-cost attorney, depending on the specific circumstances.
posted by Little Dawn at 10:39 AM on November 3, 2018 [1 favorite]

Hi. I am an attorney in the disability field. I am not the attorney of anyone in this thread, or your friend, or her husband, or their kids. This is not legal advice, but please feel free to hit me up if you have other questions.

TBI is very serious, as you've noticed. He needs to file for SSI/SSDI, and also contact the state-level Department of Human Services because states offer benefits including PCA care, homemaking support (errands, housecleaning, cooking, that kind of thing), getting on the Section 8 list, getting SNAP benefits, etc. He also needs to see a psychiatrist, get meds if that's possible, and get counseling. Before you say "but wait, they're married and she makes too much!" let me point out that SSDI is not income dependent, and often state level benefits aren't either - at least not all of them. He won't be constrained on income after she divorces him, either.

For your friend, she needs to get a divorce and take full legal and physical custody as he is not a fit parent. The ethical issue is protecting herself and her children from ongoing abuse, because at the end of the day it doesn't matter why he is abusive. What matters is that he is abusive and it's not getting better. This happens with a lot of people who have head injuries - they get violent and abusive and are not able to sustain relationships as a consequence. It's sad, but there's no reason she and the kids should spend her life tiptoeing around him. Her fantasy needs to become her reality: she needs to get away from him and focus on herself and the kids. He is not the same person he was when they got married, he's not getting better, and wishing it won't make it so.
posted by bile and syntax at 10:51 AM on November 3, 2018 [74 favorites]

A childhood friend's father had similar issues after a head injury. While he did have the classic symptoms that you described and was unable to work, medication kept the anger problems and some of the other stuff mostly under control. It still wasn't a great situation, but he was able to drive the car to do school dropoffs and pickups, do the grocery shopping, and otherwise handle some of the load of keeping the household running.

Despite that, he'd fly off the handle (ultimately nonviolently, but still rather unpleasantly..I was present for a fair number of these incidents over the course of 6 or 7 years before I moved away) once or twice a month. It took a year or two to get there after the initial injury and several subsequent brain surgeries, though.

This isn't to say that your friend has to stick around and put up with the situation, just that it might be possible to get them to a better place with the proper medical intervention.

Also, the ideas above about getting some respite care are excellent. It can provide everyone involved enough breathing room to figure out what has to happen going forward if nothing else. Your local Area Agency on Aging or similar will have resources if he's legally disabled. (My mom was by no means aged, not even 40 actually, when she first began receiving in-home help from them a few times a week after she became disabled thanks to MS)
posted by wierdo at 11:16 AM on November 3, 2018 [2 favorites]

If they're anywhere near a military base (especially an Army or Marine Corps base), then there are definitely doctors and psychiatrists and therapists around who know about TBI treatment and related issues for families. You might not have access to the ones in uniform, but there will be civilians in the area. MeMail me if you need more precise directions or can't make sense of whom to contact or how.
posted by Etrigan at 11:31 AM on November 3, 2018

The ethics are so hard and heartbreaking. Would it help her to think about what her husband, pre-TBI, have wanted for his family? Would he have been happy seeing how they are now or would he have wanted her and the kids in a healthier situation?
posted by avocado_of_merriment at 12:17 PM on November 3, 2018 [5 favorites]

Thanks for all the excellent responses.

SSDI and Medicaid have been looked at before but there are complications. bile and syntax's post has given me the kick I need to look for and hire an attorney on her behalf to see if anything can be done.

He is under the care of a psychiatrist and it helps.

I agree with the divorce recommendation and have advised accordingly. The kids are safe, they actually do live seperate from the dad now. She is going back and forth between the nearby apartments... part of the reason funds are so tight.

crazycanuck, thanks for your post. I agree regarding leaving sooner rather than later. My friend is getting there, but, as you know, it's really hard. In his case there is no family option. She is his only caregiver. I'm committed to helping her find her replacement as soon as possible.
posted by socktherapy at 6:52 AM on November 4, 2018 [4 favorites]

Two suggestions:

For SSI/SSDI, check for a local attorney affiliated with NOSSCR (the National Organization of Social Security Claims Representatives). They’re very good.

For state level disability stuff, talk to your local state disability law center.
posted by bile and syntax at 7:03 AM on November 4, 2018

My mom recently retired from a non-profit social services agency in New Hampshire. Her job as a Social Security coordinator had her driving all over the state checking up on clients and their families who were receiving Social Security benefits and making sure that they were getting the care and benefits they needed. Her clients had a variety of disabilities including some with TBI.

This is the agency she worked for. There may be something similar where your friend can get this kind of case management for her husband.
posted by bendy at 4:15 PM on November 4, 2018 [1 favorite]

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