My 77 year old mom suddenly got her first case of diverticulitis 5 months ago which lead to bowel obstruction, bowel perforation and then 2 bowel surgeries leading to a permanent iliostomy. I have been traveling back and forth from my state to her state to help her all this time. She is very stubborn and wants to stay in her house and die there (her words). I'm trying to convince her to look at assisted living places. She thinks if we give it 6 months perhaps she will get better and stronger. The problem is her iliostomy is a difficult one. She has leakage an has to change the bag about 2x a day...not due to it being full but because her output is so thin and watery. The doctors have her on all kinds of thickeners and medications. Even worse is every 3 or so weeks she starts feeling terrible and nauseated and has to go back to the hospital due to severe electrolyte imbalance. Then she spends about 4 days at the hospital. Then they send her home again. Each stay in the hospital makes her so weak. They have her on salt pills and they have her coming in to do a blood test weekly...but it still happens like clockwork. Once again she is very sick and needs to go to the hospital. I feel bad because I am not there and am busy with work and kids. Even if she were in assisted living, this would happen. The doctors so far are not coming up with any solution. What can be done? I am flying out there in July to show her assisted living places, with the hopes that I can convince her. She is adamant she will not move into one and that her plan B is to just shoot herself (her words). It's extra hard because she was always a spender/shopper and never saved any money for retirement or medical expenses. She she has very little money to help with all this. She's a very stubborn and self-centered person, so it's difficult dealing with her.
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The reason an AL would be out of the picture is the staff is mostly CNAs who are not medically trained so can't help her with her problem. There should be a nurse in charge. You would have to ask if they would be willing to help Mom.
When you visit next month (June has come around quick!), if you're not preoccupied with the AL argument you will have that much more time and energy to see what can be done to get her diet and management under control, AND because you'll be onside with her (on the face of it, anyway) she's much more likely to engage with you. And if you keep your mouth shut, and it doesn't require her to "back down," she's more likely, maybe, to come to her own conclusion that she needs help in future. AL can wait.
I am secretly building a dossier (aka Book of Wrath) of cases of people sent home from hospital with new stomas and new catheters and not the *ghost* of a chance of handling them correctly. A man with a brand new stoma and no diet sheet - though actually this happens time and again, client and spouse will look at us hopefully and ask "what foods are allowed, please?" as though it never crossed anyone's mind in hospital that it might be a really good idea to tell a patient that before you send him home. A cancer patient who'd been in hospital for three months, then got discharged home alone on Friday with a brand new catheter, four night bags, no instructions, no stand for the night bag, and no inkling of where to get more supplies. It makes me apoplectic.
So. If your poor mother were my mother I would want to know:
what caused the diverticulitis
has that been effectively dealt with by the surgery, or are there remaining issues
what does the dietitian recommend
what do the stoma manufacturers advise
what is at the root of the electrolyte imbalance, and which way round is this going every time she begins to feel so unwell
how are her other organs holding up, e.g. what's her renal function like
what information has your mother been given
has she been properly supported in understanding what she has to do
The thing is, your mother isn't really elderly (77 doesn't count for much, these days) but she is, or has been, really ill. Hardly the best state for her to take instructions on board and then follow them efficiently when she's on her own at home.
Just for example - she's taking salt supplements, and then every three weeks regular as clockwork she begins to feel appalling and ends up back in hospital. That sounds like some kind of cumulative effect, don't you think? Make them draw you a picture of what her levels are when she's sent home, what they are when she's readmitted, and how they think the imbalance is happening over that time. It might be instructive for her doctors as well as for you.
Help your mother get this under control, don't mention the F (for facility) word, and see how she is towards the end of your visit. You might find her much more willing to listen once she sees it's good to have you on her side.
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She should not be living alone, AND I question (like others) if an AL is enough. I am often surprised how much people think that ALs can do, when the reality is that a greater level of care is often needed than will be provided by an AL.
Do you have POA/HCPOA for your mother? It sounds like she is mentally competent, so you can't force her to do anything or force facility placement.
But you CAN back off from doing increasingly more as things get worse. What happens when she gets hospitalized for 4 days every 3 or so weeks? Do you go there and stay with her until she is released from the hospital?
77 is still relatively young and she seems to be optimistic of improving, if she was given a simple way to double down and chart her own intake so everyone could see what is going wrong would she be willing and able to comply?