How can I get my mother-in-law to care about herself, her hygiene and her living conditions more?

my mothers Primary Care physician of 15+ years just last month said " that's it, I cant do anything else for you, and you Refuse to follow my advice ( check into a psych ward for further evaluation). Her depression and hygiene has worsened. She has lost of appetite, less bowel movements and going blind. She refuses to come live with any family member. HOWEVER, she is married to my FatherinLaw for years and years. He too is depressed and his hygiene is very awful. He still drives, but wont do dishes. They have a health care once a week, (of course if they dont fire this one). HELP us all.

indyrose, you are so right -- often drugs alone are not sufficient. Often they are necessary, though, to allow receptivity to other approaches.

Having seen the depths of depression myself, it takes more than just meds to draw you out. Such things as a reason to live, something to care about (besides yourself - like a pet or a cause), and some physical exercise. I know it's really hard to find all those things, especially if you are physically infirm.

I'm struggling with that with both my parents right now. It seems that they are just waiting to die. I'm trying to get them involved with the Senior Citizen's Center (which has a lot to offer, including senior exercise classes) and our senior's group at Church. I've met a lot of resistance.

Drugs alone won't give her the will to live.

If her primary doctor suggests a psychiatrist for any further medication adjustments, I would take that very seriously. It is a sign that that the PCP feels that the case is outside his area of expertise. I wish more primary care doctors recognized that kind of limitation.

My primary doc once treated me for "anxiety" -- she tried one pill after another, and none of them worked. Of course they didn't work. I had undiagnosed diabetes, not anxiety. She prescribed based on a few questions. When I later went to a psychiatrist (for depression) I had to fill out a five-page questionaire, and talk to the psychiatric nurse for an hour. Then I talked to the psychiatrist for 20 minutes and she prescribed two meds, telling me what side effects I should call immediately about if they occured and other side effects the I could ignore and they'd probably go away. I vowed that I will NEVER take those kinds of drugs from anyone but a specialist. If your MIL's primary doc doesn't want to go further with depression treatment, respect that.

thank you all for your suggestions and comments. No worries, no one offended me and I just appreciate the input.

I am so sorry for the fact that I did not read your profile and did not know you have breast cancer... and thank you for answering my questions.. I am happy to hear others know of the situation, my answer was because of things we have heard about her on the sight about misunderstandings, so I am sorry if I offended you, it just takes time to understand things via cyber space...
And I am very sorry you are having this horrible battle with cancer on top of everything else....
But it sounds like she needs medical attention whether it makes her angry or not... What is the worst that is going to happen when you insist she get medical attention. if she flips out, then you go to plan B, she goes to the local behavioral center anyway...Sounds like as difficult as it may be for you and your husband you are going to have to stand up to her and insist.. you are not going to let her live in her own filth, you have your hands full with your own health issues and do not need all that stress while you are trying to get healthy..
But something is wrong and it is not going to get better with ya'll talking to her, or it would have already improved... I wish you luck in finding some answers and again I am sorry if I offended you, no harm intended...hugs

I think the situation calls for a thorough geriatric evaluation, by a specialist. At this point I would not leave her depression meds to the PCP, but have an evaluation done by a psychiatrist, preferably a geriatric pyschiatrist.

I'd wait for one of her more "normal" moments and explain that this is what has to happen in order for the two of you to feel comfortable continuing to help her. You need guidance to do the right things, and a professional evaluation will give you valuable insights to help you understand how to treat her. Without this kind of guidance you feel that you are not able to provide the environment she needs, and will begin looking for a placement for her. DO NOT present this as a threat or an ultimatum. It is simply the reality of the situation as you see it.

Then set about making an appointment.

And I'd give up on the lengthy discussions about why she is behaving this way and how she has to do better. All it gets you is blue faces and it probably makes her feel worse.

She doesn't know why she is behaving this way. Enlist the help of a professional who may be able to determine that, and suggest effective ways of dealing with it.

Yes, Mark is very supportive, it is his mom after all, and although he works full time, just as I did before getting laid off a year ago, he and I make all decisions with regard to her care together. He too has talked to her until he is blue in the face. He apologizes to me all the time for taking in his mom, but we made the decision together so there is no need for sorrys. It is harder on me since I am with her 24/7, but when I go back to work it will be better for me but I worry about her. I don't think we are at the point of calling social services, or worrying about APS being called. Most people we know do understand the situation, they all know what we are going through and like I said, she does rise to the occasion when it is warranted. I think the thing that bothers me the most is that I have to come behind her on a daily basis, when she is capable of cleaning up after herself, and I feel overwhelmed sometimes. I mentioned in my profile that I am undergoing treatment for breast cancer, and it was especially hard for me taking care of her while I was undergoing chemo and now radiation treatments. She was supposed to be there for me, helping me, swearing that I did not have to worry, blah, blah, blah. Then as soon as I started chemo, she had a health issue that required surgery and a 5 day hospital stay, and she has not been available to me since. She is fine, she has been fine for months. If she can't be there for me, which again "I don't know why" is her response when asked why she has not been there for me, then she can at least take better care of herself, her room, her bathroom, her hygiene, etc. That is not the case, however. I continue to have to remind her to do normal things like taking her pills, eating, drinking her water, getting dressed, doing her laundry, cleaning up after herself especially when she soils her bed, or soils the bathroom rugs, etc. The fact that she can ignore these things and I have to come behind her really frustrates me. Mark cannot believe she is likea this, he says this is not the mom he knows. And yet sometimes, not often, but sometimes, she does do what she needs to do. It just does not last more than a day and does not occur very often. She is like a little kid and we are the parents, constantly after her to take a bath, pick up her room, clean up after herself, eat your breakfast, lunch or dinner, change your clothes, comb your hair, drink your water, blah, blah, blah. Right now she is not depressed, so I feel that her meds are okay, it is just this spaced out, child like behavior.

My dad was like your mil, I talked to him, he agreed to go to the Dr. finally, we got in there and changed his mind. Believe me, it wasn't him that was mad that day... So, if she is "in her right mind" then maybe you need to get the primary Dr. to order Home Health. at least she will get a bath a few times a week..
I do have another question, why does the primary Dr. just not try another antidepressant, depending on how long she has been on it, and sometimes it is just not the right medication. instead of having to see a psychiatrist ?? I am sure she is going to fight you on seeing a psychiatrist, and her reaction to the Alz/dementia test was over the top...There are meds to stabilize her moods. Is your significant other supportive in any way?? Does he try to talk with her??
It sounds like a loose loose situation, but there has got to be a way to get her some help. Talk with her PP and see if you should call in Social Services to assist you in getting her some help, before someone calls APS on you. People may not understand the situation and assume you are not taking care of her and then you would be in trouble. I don't mean to sound like an alarmist, but these things do happen.... I wish you luck and hope you find a solution soon for all involved... hugs to you...

Thanks to all of you for your comments. She is 77 years old. She lives with me and my significant other, it is his mother. She takes a dissolvable Prevacid each am, an Evista tablet for her bones, Mult Vitamin, Vitamin D, and at night she takes her anti-depressant. So I don't think there is any adverse reaction to her combination of pills. I don't think she is catatonic, when she is in her low state during the winter months, she does respond when spoken to and she does eat, drink, etc on her own. She does however have that why bother attitude. I have had conversations with her until I am blue in the face, and each time we talk she tells me "I don't know" to any question I ask her regarding her behavior, her disregard for her environment and hygiene, etc. naheaton may have a point in that she may have some bi-polar going on, and I have thought of that before. Her son tells me that she has had episodes of being overly demanding, bossy, frantic, etc., as well as acting spaced out even when he was younger, particulary during times of stress. The main issue I have now is her lack of regard for her hygiene, cleaning up after herself, ignoring messes and soiling, etc. I keep trying to tell her that the whole reason she is here living with us rather than in an assisted living facility is that we love her and we don't want her to end up neglected in a smelly, unsanitary environment. I told her yesterday that I felt like she ignored these things because she knows that I will come along and take care of it. She said to me that she would try to do better. But we have had these same conversations many, many times. I have talked to her primary care physician and she wants to have her see a psyciatrist if this 100mg level of antidepressant does not work. I don't know if we could convince her to see someone. She was so mad at us the one time her primary care physician gave her some tests for dementia and alzheimers. She passed those with flying colors but I understand that people with early onset can "rise to the occasion" when needed. I have a feeling if we attempted again to have her tested or see someone, she would refuse.

If she was 30years old and acted like that, I would think she's bi-polar or what we used to call manic-depressive. Maybe Ed is right in the fact that her meds need to be looked at and/or changed. Or maybe it's like Clagraffe said, she needs more sunshine/light I'd also check into that.

C:

Wish I could take a peek into her mind, but since I'm not a psychiatrist but want to help I'll give my opinion. Her "catatonic" state might be caused by an adverse reaction to prescribed medication. Sometimes, people with catatonia will hold rigid poses for hours and ignore any external stimuli. So you can waste your breath talking to them while that wall between your reality and theirs comes down. Also, keep in mind that when there's no hope there's no movement. Tidying up and others bursts of energy might be fueled by boredom or habit, but the severe depression tells her there's no point in continuing to do what she used to because it's not going to make any difference anyway. I suggest you pore through all the medications she's taking, paying particular attention to adverse side effects. Then talk with her doctor, and chat with her when she's up and about her feelings. Do it before she goes back to that broken down state complete with the whole give in and give up demeanor. Good luck my friend.

you didn't say how old she is, and is she living alone??