Senior Parent Issues with Caregiver, Rehab, and Attitude
August 10, 2019 8:26 PM   Subscribe

I've been taking care of my Mom since she had a partial hip replacement in May, and she is a terrible patient. How do I explain to her the difficulties of this situation?

She is 82 and has always had poor walking mechanics due to pigeon-toe surgery in medieval times (~1950) which did not work. For the past 10-15 years she has shuffled with a gait of heel-to-toe at a maximum, and since the hip replacement it's grown worse. We are in the process of getting a caregiver (CNA) for her right now, which is happening about 3wks later than it should have, but should be in place in the next week or so. She is 100% fall risk with light cognitive issues. I have not figured out a way to tell her that she forgets, though I think she knows she forgets more than she lets on.

She has amazing insurance, so her recovery resources have been great. She had inpatient rehab for about 2 1/2 weeks after the hospital, with PT and OT a few times a week. She then had in-home PT and OT for a few weeks once she was discharged from the rehab. She was great for all of that, super compliant and involved. Then, when everybody's gone, she resists my cueing for walking and the walker, which is composed of a series of phrases the PT taught me. She tells me to leave her alone. She tells me she doesn't need her walker. She says she doesn't want to do her exercises So, one issue is my lack of authority, coupled with a "you're an adult, that's your choice" attitude that doesn't move the ball down the field at all. You can't tell someone not to have cancer, so to speak.

The OT diagnosed the cognitive issues as normal non-Alz memory decline (now that I'm looking for it she does forget a lot and possibly has about 10% short-term retention), and perhaps more serious, she underestimates the risk of her actions. Her discharge orders included the recommendation of 24hr companion care, but she will not accept that.

She'll resist using her walker all the time. "I'm just taking some recycling out," she says as she crawls along the walls teetering to backs of chairs and railings. She'll walk with her walker, but also a newspaper in one hand and a glass of orange juice in the other. "I'm just going down here," to her chair on the other side of a step, guiding her walker with her pinkies. She will say "Let's go to Popular Restaurant X for dinner," at 7pm on a Saturday night, where the tables are on the other side of a full sports bar that is packed with people most of the time. She'll want to go to get a steak at a place she simply cannot walk to the table (but she doesn't think so). She has trouble getting to the closest table to the door at a Chinese restaurant. She wants to go where people are I get it, and I want her to be there, too, but the process of...everything except sitting at the such a chore that I have to shut her down, and she'll get angry saying I never take her anywhere.

My role in these situations is to walk beside her at all times, reminding her at every third step to stay in the walker and not push it out in front of her, cues like "hip and knee" when her feet freeze in place, "marching," "full steps," that kind of thing. Stopping the walker from getting too far in front, reminding her, "catch up!" At home I have to watch her out of the corner of my eye or the walker will wind up back in the bedroom with her imitation of Spider Man down every wall in the house, all day long. I am the person who will deal with any resulting incidents.

At the beginning I had thought during this time that I'd be able to do a bunch of project work, continue job-hunting, maybe some book reading...two birds with one stone type stuff, but there is zero headspace for any of that when all day long I'm consumed with anxiety, looking out for disaster to strike at any moment.

She will not ask for help, and has told me so. She resists adding safety items around the house because "she doesn't want it to look like a nursing home." There are other things she doesn't want to do because they'll make her look like an old lady. She was an RN for 40 years but will not do her exercises, will not practice with the walker, will not (or cannot, see cognitives above) focus on walking with deliberate walker technique. She just does everything by instinct, which is to be hunched over, shuffling a few inches at a time, stopping to rest every three feet. She will admit unprompted that she's a bad patient, which serves to push me away and not coach her on her walking. When people call, though, she'll go on and on about how much I've been putting her through her paces. Her days are spent watching the news, Drs Phil and Oz, Steve Harvey game shows and general network afternoon TV. She loves to shout out how much she hates Trump (though probably a lifelong Republican until now). Hopefully not burying the lede, there is quite a bit of dysfunction involved, both historically and with patterns continuing in the now.

I've thought I should say "If you do your exercises I'll take you to X," but it feels transactional (which I feel is bad for some reason). "Let's go for a drive," rather than get out of the car anywhere. I don't have children, so all of these aspects of familial relationships are new to me. There are also plenty of dysfunctional patterns that have been in the family (or between us) for decades. In general I don't get the feeling she's decompensating or "crawling under the house."

I have not been the best caregiver. As I've read (maybe here), you can be a caregiver or a family member, but not both, and I very much relate to that. I don't crack the whip on what should be daily exercises (leg lifts, dumbbell work, sit-to-stand) and daily walks to increase her endurance. There have been times at the grocery store where she basically runs out of gas once she gets from her handicap parking spot to the cash registers, so like less than 50yds before she has to sit down for awhile, before even starting shopping. She doesn't think it's a big deal when I say "you aren't going to make it that far." I feel like I'm being selfish (I'm in therapy, yes) and borderline abusive by keeping her inside. I have not had much help from family, whom she has increasingly pushed away since Dad died 10yrs ago. She is rarely the one to initiate a phone call.

I guess my main question is, how do I explain to her that I don't want to do certain things because her walking sucks and she's not doing anything to improve it?
posted by rhizome to Human Relations (26 answers total) 2 users marked this as a favorite
To answer your main question, you could try to explain that you are concerned about her safety and how tired she gets, but it sounds like you have already been trying this approach without success. You don't sound selfish at all, nor abusive - it sounds like you are doing what you can to keep her safe and feeling well in response to her worsening health condition and multiple challenges related to providing in-home care.

I suggest that you consider a consultation with an attorney (MeFi Wiki) who has a practice that includes a focus on Elder Law. She's not listening to your warnings about imminent fall risks, not using her walker properly, refusing the recommended 24-hour companion care, not asking for help when she needs it, refusing to install safety items in the home, and not compliant with her rehabilitation exercises, and it puts you in an extremely difficult situation. Sometimes it can be very therapeutic to consult with an attorney, who can validate the emotional hardship while also offering you potential options to help keep her safe if she is not willing or able to do so.
posted by Little Dawn at 9:12 PM on August 10 [3 favorites]

A few thoughts
- an experienced caregiver will be much better than you at getting her to do things because (a) they are experienced at coaxing old people and (2) the caregiver is not their daughter. So yes, things should get better if you can get that in place
- bottom line, in my experience, she will probably have some more falls before she accepts that she really can't keep living life the way she always had. If you are lucky the falls will not be so bad that she ends up in the hospital but I think you need to resign yourself to the fact that you are not in control and just hope the learning won't be too painful.
posted by metahawk at 9:15 PM on August 10 [13 favorites]

"If you do your exercises I'll take you to X," is fine. You can also try, "we can go to x after you do your exercises"
You can also say "I feel like a drive today" or "that restaurant is too noisy, let's do something else"
posted by metahawk at 9:19 PM on August 10 [5 favorites]

This sounds like a very similar situation that my aunt had with my grandmother.

I would plainly tell her what you just said to us. "We can go more places if you use your walker. If you don't use it, these places are not accessible for us. When you do your exercises, that will help keep you strong enough for us to go out. If you don't do your exercises, we can't go out. I love you and am scared that you might fall. If you don't use your walker, I dont feel that it's safe and that's scary for me."

Is it viable to get more caregiving help, so that you're not her sole caregiver? I think that the mother/daughter dynamic most likely won't change. If she listened to instructions from professionals but is stubborn and resistant to you, I'd say stick with their help if at all possible. You're already nervous about her falling. I would try your best to get someone else she'll listen to to inform her of how precarious a fall can be at her age and state. I don't want to use scare tactics but hands down a fall for an elderly person is often the catalyst for further decline and it's rare that they recover. My grandmother fell and it was downhill from there. My aunt immediately put her into a facility and that made her worse because she missed her previous social life and independence. I wonder if there's a convincing way to encourage your mom positively that using the walker will help her stay independent longer though she probably feels it does the opposite. And that if she doesn't do these exercises, again, it's a quicker way to lose her abilities to function. Don't forget your own self-care and hang in there!
posted by jj's.mama at 9:57 PM on August 10 [4 favorites]

I am a health professional with copious credentials, and I have family who won't listen to me tell them they need to do their exercises and do X to remain safe in their life etc etc.

You are doing amazingly, and there will be plenty of helpful suggestions.


At some point, our capacity to affect the actions of others is limited, no matter that we have done our absolute best. If your mum falls and you have tried to provide her with the mobility devices required, get her to do her exercises, brought in alternate caregivers, it is not your fault.
posted by chiquitita at 10:36 PM on August 10 [30 favorites]

It sounds as though she might be much better off with a self propelled manual wheelchair - easier and safer to use, and much easier to have a sitting-down rest whenever she needs one. Can she talk to an occupational therapist about this?

Doctors are often unreasonably obsessed with keeping people from using wheelchairs, but often using a wheelchair is how you prevent a fall that causes a concussion/acquired brain injury/broken hip. And lots of people use a walker on good fatigue/pain/balance days and a manual wheelchair on bad fatigue/pain/balance days.

Also: mobility aides can be very stylish, this one is beautiful and converts to a carer-propelled wheelchair.
posted by Murderbot at 11:01 PM on August 10 [6 favorites]

It also sounds as though she is suffering from a lot of internalised ableism, and that she would benefit from connecting with the Disability community - is she on Facebook or Twitter?
Connecting to other Disabled people provides emotional support and also practical advice about mobility aides etc.
posted by Murderbot at 11:06 PM on August 10 [2 favorites]

Also: she could be avoiding her exercises because they are causing her physical pain. Maybe her physiotherapist needs to modify her rehab exercises, or maybe her Dr needs to prescribe her better pain medication. There's an epidemic of under-prescribing pain medication for people who really need it in the US [due to disproportionate fears about addiction potential] at the moment.
posted by Murderbot at 11:08 PM on August 10 [4 favorites]

This sure reminds me of my parents. Especially my Dad, who took a long time to accept using a walker. He did some exercises regularly, for his sciatica, but nothing to build up strength; and my Mom refused to do exercises at all. I feel like that generation just didn't believe in exercise.

My Dad had a walker that had an attached shelf. He could also sit on it if needed. This helped a lot with the temptation to carry things in both hands and try to use the walker as well.

You could try to make the house elder-safe as much as you can. She can't stop you! Railings on the walls will help. Our rehab place sent out someone to look over my parents' house to make recommendations. The bathroom can be terrible for seniors.

For restaurants: some of them should be better accommodating: short walk to the inside, no wait, friendly servers who will find a table near by, no stairs. Insist on going to one of those.
posted by zompist at 11:16 PM on August 10 [1 favorite]

As someone who uses mobility aids, if you don't have the right mobility aid? It can cause pain and exhaustion, even though it's supposed to help with mobility. I have experience with this*

I'd suggest another evaluation with a different PT/OT, if possible, to get a second opinion on what mobility aids will help the best. She may be obstinate and dealing with her new mobility limitations - or she may be in actual pain when trying to use the device. Probably a combination of all of these things.

* I was originally prescribed two canes to use for leg spasticity, and while I did, it caused pain and exhaustion and frustration. Another PT re-examined me 6 months later, put me on forearm crutches, and I've been a happy camper for the past decade, because that's the aid that actually fit my needs. (You can also totally share this story with your Mom).
posted by spinifex23 at 11:26 PM on August 10 [7 favorites]

Also: for people with pain when they weight-bear and/or falls risk, the gold standard for rehab is hydrotherapy in a heated swimming pool under the direct supervision of a physiotherapist. Many physiotherapists supervise hydrotherapy classes of 5 to 20 people. She should talk to her physiotherapist about this.
posted by Murderbot at 11:27 PM on August 10 [1 favorite]

If she's having trouble carrying things while using the walker, this walker has an attached bag with excellent storage capacity.
posted by Murderbot at 11:30 PM on August 10 [1 favorite]

She should talk to an occupational therapist about what is right for her, but I've heard many people in the Disability community rave about these forearm crutches which make it easier to carry things.

They're also colourful/stylish and don't look “medical”.
posted by Murderbot at 11:33 PM on August 10 [1 favorite]

Talking to a podiatrist about suitable footwear - adequate ankle support, good grip soles - and whether she needs custom made orthotic inserts - could also reduce her pain/fatigue when walking/standing and her falls risk.
posted by Murderbot at 11:38 PM on August 10

Sorry I feel your pain. Taking care of an elderly parent is very physically and emotionally taxing. It's very difficult to reason with an elderly parent with memory issues. I would try limiting the stress you feel about a potential fall. There's only so much you can do to prevent it. Especially if they're non-compliant with memory issues. Hopefully things will improve when the CNA comes. My Grandpa definitely listened to the CNA more than my parents or myself.
posted by mundo at 11:38 PM on August 10

This is a free online resource by the Australian Government about things you can do to reduce falls risks, from medication to shoes to reducing hazards in the home/garden.

Among other things, it points out that eyesight is a factor in falls - so she should get her vision checked by an optometrist if it hasn't happened in the past 12 months.
posted by Murderbot at 11:43 PM on August 10

I think you may be over-estimating your ability to effect how she behaves because you want so badly to be able to do so. Your mother got an RN degree which means she has a good deal of ability to understand rehabilitation, cause and effect, investment and reward and a host of other concepts that might motivate her to walk the way that will recover and retain her mobility. If she hasn't picked this up from her circumstances and from what she was taught in the hospital, nor did she pick it up from what you said to her the first time she's not going to pick it up from you, no matter how you say it.

The only way you could make her comply would be if you could put enough pressure on her that disobeying you made her more scared than the possibility of a fall and losing her life and losing all mobility can make her. Those possibilities already either have her crying silently at night, or so scared that she refuses to think about them at all. This means that you could only get her to cooperate with the exercise program if you terrified her that you would do something worse to her than throwing her to the floor, or leaving her stuck in a bed or a wheelchair. Maybe the threat of full abandonment would do it but the odds are not good.

If you and she are lucky, as she recovers she will get less afraid and less resistant. Right now she is too distressed to consider the challenges of walking from the handicapped parking spot to the closest cash at the grocery store or from the front of the restaurant to the back. Every time she does an exercise she has to face the terror of helplessness and right now she can't do that. Denial is a much more comfortable place for her.

With luck as she recovers from the emotional stress of the hospitalization she will become more capable of looking at ways to improve her functioning. However it has been since May. I wouldn't give up hope but I wouldn't assume that she is going to ever be willing to use her walker.

There may be a dynamic going on that your fear for her is helping keep her in a state of denial. As long as you are saying "Mother, hanging onto the wall is not safe!" she can only inhabit the opposite position, that crawling down the wall is perfectly safe and using her walker is much too inconvenient. There is some chance that if you can get over the anxiety she will be able to manifest it herself. If you are completely blase "Oh, did you fall? Shall I call an ambulance? I'm not going to be able to help you up," she maybe able to move to the position of "I should have used my walker." But there is no guarantee that it will. Your anxiety is not the cause of her denial. She might have exactly the same problem if her caregiver were someone else who was completely detached.

But it sounds like you really need respite care, and so does she. Your anxiety level is so high that you need a break from it, and she needs a change of perspective, which is more likely to come when patterns are broken.

As for explaining that you don't want to do things because her walking sucks and she's not doing anything to improve it - usually the best paradigm is to work from the assumption that she can't do anything to improve it. That way you have to face your own feelings about the situation. Suppose she was doing her exercises, desperately, constantly and not improving. Suppose that she kept losing control of her walker because it's on wheels and keeps moving away from her. What would you do then? Suppose that after three months of regular exercises and even using the walker she got to the grocery store and had to sit down right away. What would you do? Would you refuse to take her to the store? Would you rent a collapsible wheelchair and firmly relegate her into it for such trips? Would you budget an extra two hours for the grocery trip and follow her halting progress grieving and sorrowing with every step? Would you research ordering groceries on line and set her up with a website and cheerfully discuss what brands of canned food she usually buys? Whatever you would do if she were completely cooperative and still had to creep down the wall and still had to rest every few feet - I think you need to do that.

Maybe people will blame you. Oh, if only you had made her do her exercises... If someone else wants her to do her exercises, let them try. You know how hard you have tried. Try harder and she will get even more distressed, but odds are you can't change the dynamic that way, no matter how distressed she gets. Maybe you will blame yourself. While you are at it, you can blame yourself for not going to medical school and studying orthopedic surgery. This is not what you want for her, not what you want for yourself and not fun at all. If you could change the situation, don't you think you would?

Remember that difficult relationships are the ones that are the worst because of our ambivalence. If you hate someone you can break away. if you love someone you can grieve. But if you are in a power struggle you are enmeshed, you can neither cleanly grieve, nor rage.

If the resources are there I would say that you need to get in a daily visitor to stay with her while you leave the house, go to the library and job hunt and read while that nice woman who wears scrubs from Home Help gets to be with her and bring perspective to how many exercises she is doing and how well she might be progressing.

Job hunting? You've got an issue with realistic expectations going on. If your mother requires such close range caretaking that you can't job hunt, what are your prospects for being able to to take sixty hours away from her to work, commute and do the self maintenance that holding down a job requires. The situation you describes is 24/7 care with major fall risk. The situation you aspire to is near complete autonomy on her part. But the resolution of that difference is not her doing some exercises because even if she did for the next few months at a minimum she will still be at high fall risk and need a walker. You need to recalibrate how trapped you are. And that, I think is the source of the intense anxiety. It's not that she has such a serious fall risk, it's that her fall risk means that you can't get away. Every time she scrabbles down the wall to get to the bathroom, you get a reminder that you have no more autonomy than a two year old who isn't allowed to leave the room without permission "Stay in here with Mummy, Dear..." You may be in the role of the two year old's mother but you are equally trapped.

It also sounds like you are way too anxious to assert yourself with your mother. You can coax and wheedle, of course. "Please, Mom, just a few toe lifts..." but you are not saying, "Nope, not going to that restaurant. Takes too long the way you walk. We can hit a drive through and sit at one of those picnic benches beside the parking lot at Sunset Park if you want to go out." And because you are trapped unable to assert yourself, you are missing solutions. If your mother complains that you never take her out, you can always come up with a list of places you are willing to take her. Your discomfort with transactional negotiation is a big part of the problem. Transactional negotiation is normal between equals. "Want to go out for Chinese?" "Nah. Restaurant is too noisy." "How about Chinese take out?" "Sure." I am guessing that family history makes it impossible for you to disagree with your mother and get your own way with things other than as a supplicant. So that means you are doing a lot of things you don't want to.

What would happen to your Mom if you were hit by a bus and hospitalized for six weeks? It's not unthinkable. It's responsible to think like that. You either need respite care, or to get out of care-taking. You need care-giver support. You can look into that. You can also look into what other people do in your situation to be a better care giver. There is a balance between autonomy and control that you can tinker with.

You may or may not be a good care-giver. Some people are good at it, some people are bad at it. Chances are statistically you fall into the bottom fifty percent at being a caregiver and that is just fine because this is not the job you have always wanted all your life. What you can say is that you have been trying very, very hard to be a good caregiver. That is what deserves recognition, that you have been doing a job that is so incredibly difficult that the majority of people won't do it. You stuck it out since May? Your Mum owes you big time - 'course that doesn't matter, you don't get pay back any more than a parent is entitled to anything but respect once you have grown, but give yourself the credit for having done a lot. People go to community college to get certificates to learn to do what you are doing. You have been doing something HARD.
posted by Jane the Brown at 12:00 AM on August 11 [19 favorites]

I went through this with my Mom & my father-in-law. Oh so good when the nurses and PT folks are there, oh so bad when they leave.

Did have help with my Mom, as a sibling & my Dad were around also, but she would always "forget" to use her walker, and trip on rugs, and someone would find her there. We'd ask why she didn't call out, and she'd say, "oh, I didn't want to be a bother." One time, she fell & broke a finger, and no one knew until one day she held it up and asked, "do you think this finger is broken?" It had been at least a week, possibly happened on a night time trip to the bathroom, and she didn't tell my Dad because she didn't want to be seen as elderly.

My FIL had dementia related to heart failure, and he would take a nap every afternoon. One day, I was sitting in a chair right outside his room, and heard a thump. He'd gotten out of bed, walked past his walker, and gone for his cane, which was propped up in the corner behind the door. A natural instinct, as the walker was new and the cane was something he'd used for a while. Well, that fall led to a head gash requiring 12 stitches. He was on blood thinners, so it really bled, thank goodness for the EMT's and their calm manner.

My Mom died as a result of being on blood thinners and falling. She was not using her walker. Scans revealed she not only had a subdural hematoma, she'd likely had another one previous to the current one. So if your Mom is on blood thinners, be extra cautious.

Definitely get on the horn to the PT or OT, or the doctor in charge, and explain your concerns re: her not using her walker. If you do not have Medical POA, or ability to make medical decisions for her if she becomes incapacitated, make sure you get that paperwork in place ASAP. My FIL got bad w/his dementia, and we had the medical POA, which helped immensely when I went to his doctor's visits and when speaking to staff during his hospitalizations.

Eventually, my FIL's care become too much for me. No one human being can watch another 24/7, it isn't physically possible. Toward the end, we did put him in a nursing home, albeit a very nice one, they even gave him his glass of wine (okay'd by his doctor) at lunch every day. At that point, his dementia made him forget everything fairly quickly, and they had the bed alarms, etc. and staff to make sure he didn't fall again.

Tell you mother if she wants to stay out of a home, she must comply with the exercises, the rehab, and installing devices to make both of your lives easier. My husband is in his 60's and has 2 hip implants. He will happily use his sock puller, his grabber, and sometimes his cane. He has a power lift chair that has improved his life 110%. When we had a tub, we had the grab arm installed, we even put a grab arm on the outside wall of a house we lived in, that had steps that were difficult for him to manage due to loss of hip mobility. His left hip is wonky, so he can't squat or bend at the knee, as the hip won't follow along.

Hopefully the CNA will give you some much needed relief. But yes, been there at the crowded restaurants, in 20 degree weather, TWO elderly people who want to go to the steak house on a Saturday night, one with a walker, it's fun times, I get it. And use those scooters at the grocery store, tell her she can either wait in the car or use the scooter. Put your foot down a little, you don't have to be mean, but if she doesn't like the consequences of non-compliance, maybe she will sit up and take notice that you mean business. Sorry you are going through this, some really helpful comments above. Pat yourself on the back for all you've done, most people wouldn't do what you are doing, they'd just put her in a home.
posted by Marie Mon Dieu at 1:25 AM on August 11 [6 favorites]

As someone who uses mobility aids, if you don't have the right mobility aid? It can cause pain and exhaustion, even though it's supposed to help with mobility.
posted by epardoseli2019 at 2:44 AM on August 11 [4 favorites]

Oh, I feel you. I've been through similar situations with my dad, and my grandma, and now I'm in the middle of it with my mum. Of the three, she is the most like your's and it is the worst because I'm up against her stubbornness and irrational behaviors rather than actual physical issues, like cancer. This winter, when she became suddenly worse, I broke down completely, even though I've always been a bit vulnerable to depression I went completely down into a black hole, which was good in a way, because I realized I had to help myself before I could help her.
So that would be my first advice: think of what you need right now, in order to be strong and forgiving. Take this very seriously, you don't want to break down like I did. Maybe tell your mother you need to take ten days off from helping her and go visit a friend, because this is putting a strain on you. When I did this, my aunt helped me, even though my mother pushes her away. I was so weak, it was helpful that my aunt told my mum she had to back down.

When you have taken a literal and figurative deep breathe, be completely honest with her. Tell her how you feel about her attitude and your relationship, if you can, go with her to the doctors she needs and tell them how you feel. Make sure you turn every stone in conversations with medical staff, bring lists. Confront her with reality. Don't be emotional, be precise. My mum hates this, but she loves it too. Obviously she hates it because I'm bursting her bubble. She loves it because at this point in her life, reality is overwhelming, she needs the help and because her head is just fine, she understands that realism is the path to proper aid.

That things are overwhelming for her doesn't mean she is cognitively impaired beyond what is normal for all of us due to old age. This is very important. If her doctor says she isn't, she most probably isn't. Don't treat her as if she is (I'm not suggesting that you do, at all). This is one reason you need to be honest and upfront with her: that is how you should be with any able person, regardless of who it is. It's basic respect. So yeah, no bargaining, ever. It isn't even good practice with four-year olds, and least of all with retired professionals. I have not always treated my mother this way, to be honest. A lot of my life I have avoided confrontation with her, for reasons. Speaking up for the last few years has been as liberating for me as for her. We can even joke about it now.

Your mother may be mildly depressed. Limited activity does this to the brain. Talk with her about it, and with the doctor. Anti-depressants have helped my mother somewhat, but in the end, her refusal has led to her not recovering her surgery which was several years ago. She finally got so bad, with no other reason than lack of motivation, that last week, she had to move to a nursing home. I am so relieved. She is very angry, but not at me, or at her new home. She is angry that staff are telling her she is well in body and mind, and she needs to move. She is angry because the staff can do what I couldn't, because I am family. They are saying she can walk, and she must walk. They are saying that if she wants a hot dinner, she will have to go to the dining room. Because this is a workplace as well as a home, she needs to use her walker to get from her bed to her chair, from her chair to the bathroom. There are no cluttered furniture or narrow hallways for her to spider along. (I love that expression!). So she walks. And even though she has only just been there a week, she is already better. Angry, but better. I expect that in a month, she'll be eating every meal in that dining room, and in three, she'll be going out.

Because someone mentioned it, I want to add a bit about pain treatment. I am a big fan of proper pain-treatment using specialist doctors; for instance my aunt suffers from arthritis after a long life of physically hard work, and she needs her medicine. BUT if your mother is like my mother, more medication is not the answer. I have no reason not to believe my mother when she says her back hurts, or her knees hurt, and she does get strong opioids. But the reason she feels pain is that she has no muscle strength at all, because she failed to do her training after hip surgery. She can literally not hold up her body. Painkillers may help momentarily, but in the end, they worsen the problem. The training she needs at this point is painful, and she needs to be able to tell the therapist where it hurts and how, in order to get the right help. That she has ended there is the result of her stubbornness, not fate or evil.

Sorry, this ended up being longer than planned. You need a big hug for doing what you do. You are a good daughter, and you need to take care of yourself, too.
posted by mumimor at 3:54 AM on August 11 [5 favorites]

I'm just starting a similar journey with my own 79yo mother, so I don't have much practical advice yet. But this stood out to me: "I have not had much help from family...She is rarely the one to initiate a phone call."

Is there any way YOU can make some phone calls? Can you get someone in the family or extended family to come over for an afternoon and chat or play cards or watch her shows with her? Or even just agree to regular phone calls? And then maybe you can get away for a HUGELY-needed break.

If no one in the family is able or willing, maybe there is some kind of community or church group that could help out?

My mom is much easier to talk to and to reason with when she's had regular social interaction with other people. When she's gone a while without socializing, she gets grumpier and more obstinate.
posted by SuperSquirrel at 4:18 AM on August 11

I feel your pain.

I'm living with and taking care of my 84 year old mother. I am an only child, my father died years ago, and the only involvement with other family is occasionally her brother, who is elderly himself.

Like yours, my mom has age-related mental decline but not Alzheimer's/dementia. Like yours, she can be stubborn about not doing the things she needs to do to stay safe and medically compliant.

A lot of people answering this thread are giving reasonable-sounding advice that won't work at all. Promising to go X place if she does Y only works if she can hold that in mind, for example, which it sounds like she probably can't.

I second the idea to just go ahead and modify the house for safety however you see fit. This has worked for me with regard to digging out of 40+ years of stuff my mom has accumulated. If I consult her, she *always* either wants to keep the dusty, broken item in question, or sell it for unrealistic money. For many things, if it's clear she hasn't used them in forever, I now just trash/sell/give away. She never misses them.

Likewise, I think you should just start adding brighter lighting, more grab bars and handrails. Just get a different walker for her to try. Etc.

You could try adding big signs around the house reminding mom to use her walker, how to use it properly.

I used to argue with my mom about her using the 12+ hours of oxygen the doctor told her she needed. What works better is just me turning on the machine and handing her the nosepiece. She will then use it 90% of the time. I'm wondering if your gently physically guiding your mom into position would help more than discussion.

Maybe this can be a point of hope for you: My mom has gradually accepted certain things and adjusted herself. She now uses a scooter, for example, when we go shopping. But she resisted every step of the way, the cane that she needed, the walker that she needed, and then the scooter that she needed. My promptings never worked. She had to come to the realizations herself.

Good luck!
posted by nirblegee at 6:10 AM on August 11 [8 favorites]

My late friend Sue, at 79, hated walkers with a passion. Hated them. Her house was also way too cluttered, by her choice, to allow her to get around inside it with a walker even if she'd wanted to.

She also had so little strength left in her legs, and so much pain in her spine, that walking unaided for more than two or three steps was simply impossible for her and getting in and out of bed needed assistance.

Her own mobility solution was a cheap lightweight office chair on castors. She called it her Purple Transporter and she'd lean on the back and push it along in front of her as she shuffled from one end of her house to the other. Less stable than a walker, sure, but also much more manoeuvrable and much lighter, and capable of carrying useful amounts of stuff on the seat.
posted by flabdablet at 6:59 AM on August 11 [2 favorites]

Ask her what she dislikes about the walker. It may or may not be resolvable, but worth finding out.
Get her a different type of walker or scooter to see if that would help. Go for a walk with her outside and use one yourself. Can the walker be painted, decorated with colorful tape?
Would her favorite music make the exercise more fun? Music is a big motivator to get me moving. If she has a mobile phone, load it up. If not, get one. Plans have gotten reasonable, and it's essential for safety. Make sure the walker has a basket or bag it can go in.
Try humor. Get up and start doing the exercises yourself. C'mon, join me. I'll bet I can do 4 for every 1 you do. Winner buys lunch.
Be straightforward, loving, honest. Mom, I love you so much, and I want you to be around for a while, and with good quality of life. The walker is essential. The physical therapy is essential. When she completes any task, give her a hug and encouragement. An occasional surprise gift. You made progress with the exercises, so I thought you deserved chocolate/ a book/ wine.
Once you have done all you can do, you have to accept that she is in charge of her life and choices. My Mom shortened her life with cigarettes and not one of her kids could persuade her not to smoke.
posted by theora55 at 9:52 AM on August 11

I can't speak to the mom part, but I can speak to hip replacement part. I had one a few months ago and I was like, "Oh man, what's the big deal? I don't really need the walker!" as I pushed and pushed and went walking and running (!) and hiking because nobody's gonna tell ME what to do.

And I really, really borked my recovery, to the point where when I now have knee and ankle and feet problems because I totally overused all the wrong muscles and taught myself how to walk post-recovery really badly and with terrible form.

Tell your mom if she ever wants to be out of pain and be able to go out to eat and do fun stuff and not have to use a walker, then use it NOW and do the stupid PT exercises or in 6 months she'll be seeing the doctor with knee and ankle issues and REALLY be unable to walk.
posted by yes I said yes I will Yes at 11:36 AM on August 11 [2 favorites]

This is one of those sucky situations most people go through in life. I think it helps to consider your mom probably doesn't want to use a walker because she's afraid of always needing to use it from now on. It's admitting that she's frail. It's not because she wants to make your life harder, even if that's what it results in.

Brutal honesty is sometimes called for. I've been stuck being the hard ass for my mom. It sucks but it's done the best in getting results. You don't want your mom to use a walker to make her feel old. You want her to use it as a safety measure because if she falls, she's going to have to be in a nursing home again to recoup and go through rehab all over again. I would tell her that.

If she wants to go out to a steak house on Sat., it's okay to say it's not safe. If someone bumps into her, she could fall and have another break. Try to think of an alternative like going for lunch when there's less people if you think she's up to it.

There are stores that sell rehab equipment where you can try them out. It tends to cost more than ordering online but your mom might feel more if control if she picks out what she wants. My mom likes the rollator which have a seat which you can set a cup or frozen dinner on if you move slowly.

One other walker hint is a lot of older people use a grocery cart as support like a walker. It would let your mom get into the store to use an electric cart without having to find somewhere to store her walker. It also doesn't make her look different from other shoppers if she can handle just using cart.

On exercise, it's too easy for your mom to ignore you because you're her kid. I've had the same situation with my mom and haven't had much luck. The best thing that's helped is if she sees me exercise, like stretches or balance exercises. Sometimes she'll march in place or get the mail but I'm not ever going to get her to use bands or weights. You might see if she'd be willing to do an exercise class. The YMCA has swimming or some senior groups offer chair yoga type. Since a class is social, it might be more fun than exercising at home.

You sound really burned out. Ask relatives and friends to help out, even if it's once a week. One person trying to take care of someone 24/7 is too much. Even if it's just someone coming over and watching a weekly TV show, it would give you a little time to relax and not be on call. If you can get a couple of people on a schedule, it would make your life easier. This internet stranger hopes things get better for you. You've been dealing with a hard situation.
posted by stray thoughts at 9:59 PM on August 14 [2 favorites]

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