my mother has been morbidly obese for most of her life. For years she’s let her health get worse. She needs a total knee replacement but can’t because she is too heavy. She now has congestive heart failure and kidney disease. She’s had a second bout of breast cancer recently. She can barely get around her house and is in constant pain. She has refused for years to get pain medication or ask about pain management. Last week I couldn’t get her in the car to take her to the doctors because of pain in her arm. She was taken by ambulance to the hospital. After a 7 day hospital stay, she’s in rehab to try to get her strength up. She hates it there and is crying to go home. I am so mad at her for not taking care of herself for years and now I am responsible for her. I don’t want to be frustrated with her but I’ve never wanted her to let herself go let alone now have to make all the arrangements to help her. I just want her to stay in rehab to just get her strength up and not cry and shake and be miserable. She thinks she will do better at home yet can’t wipe herself. I feel absolutely terrible that I feel this way.
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DON’t feel ‘absolutely terrible that you feel this way’. Don’t feel guilted into caring for your mother. You CAN feel ‘absolutely terrible’ that her behavior has put both of you into such a difficult situation, but SHE is the one responsible for it, not you.
YOU are not responsible for her obesity. (unless you are the one providing the food, in that case you are an enabler.)
You need to talk to the Social Worker at the rehab, or the Discharge Planner and make it perfectly clear that mom is not safe at home, YOU are unable to care for her in YOUR home.
You also need to make it perfectly clear to your mom that you can not care for her, that you will not be responsible for helping her. And you can not back down on this. You need to establish clear boundaries.
The last thing a person who is sick, in pain, and pretty much down and out needs is another person (especially a family member) getting up on the pulpit and preaching about what they 'should' have done. Or a performance from the 'I Told You So' singers. Your mother already knows what she should have done. Telling her now and getting angry over it will not bring it about.
Let me tell you something about weight. I am a person who struggled all my entire life to stay thin. I could never eat like a normal person because I'd get fat. I was bullied mercilessly in school and by my family until I developed an eating disorder that almost killed me when I was a kid. So unless you have had the obese person struggle, you don't have a clue. Learn a little before passing judgment on your fat mother.
Also, did it ever occur to you that your mother turns down pain meds because she's afraid of getting addicted or being wasted all the time? Talk to her about it.
I was a homecare provider for 25 years to every kind of client. I agree with you that a morbidly-obese person with severe mobility issues who cannot wipe themeselves independently should be in rehab. At least until she gets to the point where she can toilet herself and do her own hygiene care.
So here's what you do. Your mom needs a lot of support. She also needs a bit of tough love from you. Not judgmental love and not condescending love. You tell her plainly that she can shake and cry to Kingdom come but it won't get her better or out of rehab.
Give her a rehab goal and promise to help her with it. When she gets strong enough to toilet on her own and wipe herself, and also loses a few pounds she can go home because she'll be able to help herself.
The rehab will put her on a controlled diet if she asks for it. They may even help her get set up with mental health services.
You can help your mother with these goals by being supportive of them. She has to do the hard work to achieve them though. No more crying and shaking and complaining. When that starts up you walk away. If it's on the phone, hang up. If she wants help to help her help herself, then you're there. Not if she doesn't though.
When you say morbidly obese, are we taking 230 pounds, 300 pounds, 375 pounds? I’m curious because obviously someone who is 230 is going to be a lot easier to manage than someone who is 350 pounds.
Is she morbidly obese or super morbidly obese? I’m thinking she must be 300+ pounds if she can’t wipe herself. If she can’t wipe herself, is she able to shower herself and get all of her folds clean, etc?
Maybe you should talk to the folks at rehab and find out what you and mom can expect. Mom should be informed by them about how her lack of participation will affect her (not that I'd expect it to matter, since she hasn't taken care of herself in the past).
I had a LO in rehab, and they were quite clear with patients about what needed to be accomplished while there. It gave them a goal and an understanding of what life would be like if they didn't take advantage of the opportunity to help themselves. No one will do it for you - that was the message.
She is correct.
You say: " and now I am responsible for her. "
No, you are not responsible for her.
Not unless YOU yourself MAKE yourself responsible for her.
That is a CHOICE.
How old is mother?
How old are you?
Are you living with mother?
Is she living with you?
You are an adult. You must take responsibility for your own choices.
Now is the time to call in the Social Workers and Discharge Planners at the rehab and request they sit down to talk with you and your mother. Tell BOTH them and your mother that you cannot continue in her care. Tell her that you have now to live a life of your own, and will not be sacrificing your own life to her bad choices and the end it has brought her.
This is ongoing and will get much worse.
Will you throw your own life upon this funeral pyre?
Because honestly, if you choose to do that, no one can help you.
As regards "responsibility" a PARENT is responsible for their CHILD until that child reaches the age of majority. NOT THE OTHER WAY AROUND. The child is then responsible for their OWN children should they bring them into this world.
I think you should seek psychological counseling if you cannot now, with this perfect opportunity, free yourself.
You will not (and never) be able to control what she does or convince her using reason and logic, as you have seen that even real-life consequences haven't (so far) motivated her. You can only be a spectator.
Do not enable her in any way (do not bring her unhealthy food, do not do things for her that she is capable of doing herself even if she doesn't do it well or fast enough... if she can do it, you must let her struggle). Eventually she will get the hint and be better at it.
If she doesn't succeed in rehab her next stop is probably LTC. Medicaid will cover this if she also qualifies financially. You cannot possible take care of her by yourself -- or even with help. At the very minimum it will wreck your back. It is already wrecking your mental and emotional health.
Please step away and stop being her only solution. She has other options -- she just doesn't want those. You have other options, which is to step away and let the available resources be her solution. In the end, she will decide how it goes.
It will look and feel awful at first. Then, if she "rights" herself, it will improve.
May you receive peace in your heart on this journey.
- she was a 7 day hospital stay then a discharge to rehab, correct?
if so then Medicare should have been paying hospital bills as it’s Part A coverage AND she is now on Part A rehabilitation benefits. Medicare pays NH rehab abt double or triple what State Medicaid Long Term Care programs pays for room & board, so NH is happy right now as it’s Medicare $$$.
- Rehab pretty much will pay first 20/21 days @ 100% then 50% up to 100 days with her secondary health insurance paying other 50% if she has a better supplemental/ secondary health insurance, otherwise it’s on her to pay that 50%.
HOWEVER
- to stay on rehab she has to - HAS TO - be progressing in her rehab. Therapists (PT, OT, ST) pretty much do real time notes on how it’s going. She has to be making a solid attempt to do exercises / tasks. If not, will get written up as non-compliant for care. Same goes for if she says to staff “not now I don’t feel like it”. Once viewed as non compliant, Medicare will stop. Like could stop the very next day. A POA doing an appeal can be filed but kinda futile & won’t work as her health chart with its detailed notes shows noncompliance. Only way imo around this would be IF she has another health incidence, eg. a TIA, blows out a knee, runs a fever. Otherwise toast on staying on rehab.
AND
- then NH will want in short order a decision to be made as to if she is to stay at the NH and transition from rehab patient to Long Term custodial care resident with a residential contract and financial responsibility affixed to someone. LT is either private pay, LTC insurance or LTC Medicaid program.
- if the NH really doesn’t want her to become a resident there (as morbidly obese require more staff time), you may find they will try to push the concept that she can return home as there will be supportive programs provided by the State…… if you do this, then she totally become your responsibility to find those programs and do whatever paperwork to get her enrolled. Right now she’s the responsibility of the NH to provide a safe and secure environment BUT if you take her back to her home or your home, it’s all on you. Ya have to decide this and make it your mantra that you cannot provide a safe and secure living environment for her and you cannot proved to any degree the type of 24/7 oversight for her.
So is very much in your interest to do whatever needed to motivate mom to stay doing her rehab as it’s means Medicare paying and gives you time to figure out realistically best path AND go thru her financials in her home to see if she could be able to be eligible for LTC Medicaid application filing. NH social worker or admissions should have details on LTC filing and list of the items needed to accompany her application. Personally I’d go and get this info this week, then start hunting down stuff in her house as could be a substantial # of items needed. If you find she has $ in the bank, then that takes her filing for LTC Medicaid off the table till she spends down assets by private paying for her care and perhaps her $ used to do whatever to get her house market ready to be placed on MLS listing. Fwiw most States have assets at 2K max & monthly income at max of $2742 and home value under 550K/750K.
If she’s going to file LTC Medicaid, it too has its own timeframe for submission of documents. Personally I think it’s best to submit all documents needed in a single drop.
But I digress…. If she’s the type to need a cheerleading squad to do rehab, then try to do that. If she needs a fixed reason to do it, hit on that. If her nature is “you can’t tell me what to do”, then that’s sadly the reality. You know her best. Also speak with therapists to see how’s she’s doing as they can let you know if she’s being compliant.
Really by end of March a decision as to what path to take will need to be made. Good luck!
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