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My mom is 6 mos post hip replacement, and her recovery has been slow at best. She has been told by surgeon, physical therapist, nurses, etc. that she NEEDS to stand up every hour, NEEDS to make more of an effort to walk with her walker, etc. yet she sits in her recliner all day long. The closest she gets to walking on her own (even if I offer to follow her..she always refuses or makes an excuse why she "can't" right now) is transferring from chair to wheelchair. When the therapist is here, she complains about not being able to do what they're asking her to do, but the PT says she can and she makes her walk the hallway and back and she does it (LOVING this PT!)! There is no good reason my mom CAN'T walk again, nor should she still be wheelchair bound, due to anything other than her lack of compliance and motivation to do the prescribed exercises in between PT visits ("I'm not an exercise person"). If I suggest she do them/walk/etc. I get snapped at, so I basically told her it's all up to her & left it in her lap.
Enter karma. The past few days we noticed her right leg was a lot more swollen than the left, so the home nurse told us to go to her primary dr. & be evaluated. He sent us for an ultrasound of the leg, which revealed a DVT that runs the length of her thigh. From there, we were sent to the ER and she was admitted last night. My Mom, upon hearing what she had, couldn't understand why this has happened! We've all told her the past few months that if she didn't get busy and MOVE that this could happen, along with her muscles atrophying further, etc. It's as if she doesn't "get" that her behaviors are a direct cause to a majority of the issues she is facing - she just complains that now she's got "one more thing" to deal with... "if it's not one thing, it's another..." as if these events are being cast upon her instead of caused by her actions (or non-actions). The "oh poor me" attitude is wearing reeeeally thin.
So at this point, the hospital is starting her on anticoagulant therapy, and may be inserting a filter into one of the veins in case the clot breaks off & becomes an embolism. Not sure how long she will be in the hospital, but to be honest I am grateful for the breather. Part of me hopes they will send her to a SNF afterwards for in-house physical therapy, and depending on her progress there we can decide whether she should even come home again or not. I just can't continue to care for someone who won't help themself get better, and then drags the entire household down with her attitude.
Of course the "good daughter" in me feels guilty for thinking this way, and I know NONE of this is my fault and I can't fix someone that doesn't want to be fixed, etc. - I KNOW all of this in my head...I know I have NOTHING to feel guilty for, so why do I feel this way??? The neverending question....

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I so feel what you are going through. We have had my Mom almost 14 years now.She hasn't wanted to be involved in any way for years. Now she is in skilled nursing. I have had so many at the hospital and SN tell me I need it as much as she does. My husband hasn't stated as clearly as yours, but he feels the same. It is so hard. Hugs to you and your husband. I am learning to lean on God more.I don't want to bring Mom home. I love her, but this person is overwhelming and wants me to do everything. I cant and I understand the guilt.
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Purplesushi, I'm so glad for you that it looks like your mother will be able to stay at the SNF. My mother too refuses to take responsibility for her well-being in many important ways and it is quite tormenting to watch while being able to do nothing and "wait" for something awful to happen. In your mother's case the something awful has happened, but now it has now you can be free and you mother can get care from professionals who will find it easier to deal with her. I too hope that the doctors tell her she has to stay so you don't have to be the bad guy.
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My Mom has been at the SNF for a week now. I was there the other day, and the social worker saw me. I told her that I was wondering if they had any long-term beds available, and how that process works. She said "I've actually been meaning to talk to you - come into my office." She shut the door, and told me that she had just been looking over my Mom's records earlier in the day - she noted that she has been in their facility 6 times in the past 2 years, and was also concerned about the fact that she doesn't seem to be getting any better over the long-term. I explained a lot of the concerns I have, and felt that she wasn't listening to me where her best interests are concerned. She told me their long-term beds are full at the moment, but also told me not to worry about that right now. She said there comes a time when our parents have to face reality - that they require more care than they can be safely given at home. She said that they don't have a "waiting list" - they would work with us. We talked for quite awhile, & I told her that I have to get back to work - I can't afford to stay at home with her all day any longer, and it is not safe to leave her by herself for more than a couple of hours. She agreed, and said "We'll see how things go with her for the next couple of weeks, and we'll definitely talk about this again." Soooo the ice has been broken with the SNF on the matter... I just don't know what to say to my Mom, or when to say it...or do I say anything at all, and let the SNF or the doctor be "the bad guy" by saying they don't think it's safe for her to go home, etc.? I guess I'll just play it by ear & see how things go for now.
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Let her go somewhere else. They will push her and hopefully she will do something. My mother's husband let her come home. She laid in bed for over two years. She wouldn't do the home PT. Finally, her heart gave out. It could have been so much better...
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Your Mother's lack of interest in her own health, her thwarting of your best efforts to keep her healthy is a complete mirror of my mother's behavior right down to spending all day in a recliner, incontinence and all, and thereby suffering unnecessary life-threatening conditions. When she landed in the hospital, and then rehabilitation, there was no way that I was going to allow things to go back to where they were before, and believe me, all that rehabilitation would have been wasted if I didn't get her into assisted living with additional services and then communicate to the medical folk that she needed to stop pushing her in a wheel chair and push her to walk with the walker. Now she has maintained the health and capabilities that the rehab facility gave because of the large number of staff that can care for her, and is happier because the gerontologist knows what drugs to use to combat depression. She is seen every week by the visiting doc. Best place for her.
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She may listen to others better than she listens to you. She also has to comply absolutely with her anticoagulation - if she is on Coumadin (warfarin) there are some dietary concerns and higher risk of bleeding, plus just taking the meds correctly and getting regular lab work to monitor it. It would seem that you are making a good call - and even she knows it wouldn't work out to do otherwise!!
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See - that's what is scary - the doctor said it could take months for the DVT to resorb, so a portion can break off at any point between now and then and become an embolism. I don't think it's doing her any favors coming back here for the very reasons you have stated - she is not respecting anyone's orders or concerns and does what she wants anyways, so it's a complete waste of my time & the doctor's breath to even try & get her to listen anymore if she doesn't plan to take responsibility for her own health. To be blunt, I think I finally decided that I don't want her dying in my home, under my watch, due to her stubbornness & my inability to get her to MOVE. I told everyone that I am not washing my hands of her - obviously I will still be involved in her care, and will be her watchdog where her care at the facility is concerned - but I just have to take a step back & reclaim my life, and my home, for my sanity's sake.
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You have gotten good advice here. If Mom knows she can just go home with you and sit in her recliner and be waited on, it won't be very motivating for rehab. If she knows she does not get out of a care home until/unless she phyiscally makes herself able to, she may have a chance. If she is too lacking in insight or judgement to do the hard work of regaining strength or mobility, she may not, but that does not mean you have to be the caregiver. This is hard, and sad, but physically caring for a large, immobile adult requires more than many of us can do in our homes, even with the best techniques and equipment.

The DVT from being so sedentary is not the worst that could have happened. I know of a mom of a patient in my practice who basically decided to be lazy, indulged in overeating and substance abuse, and more or less took to the couch -she got a DVT that went right into a pulmonary embolus and killed her, leaving grandmom to deliver all the care. Not a nice situation. Move it or lose it may refer to a person's LIFE.
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The last time she was there, she voiced that she "wasn't ready" to go home & the social worker told her she could stay if she had Medi-Cal. Well, at the time she hadn't been approved yet so she had to be released. I am pretty sure they have long-term beds there - can't imagine they would've asked her if she wanted to stay if they didn't. I do like that place - we haven't had any issues with them at all in the several times Mom has been there. I am crossing my fingers that they have room for her there & that I don't have to hunt for another.
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Is the SNF where she is for rehab where you would also want her to stay, if she needs SNF? (Between my mother and my husband I had experience with 3 TCUs. Only one of them would I have considered for permanent placement. Mom doesn't have to stay where she happened to wind up for rehab.)
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I would call the social worker at the SNF and set up a meeting with her to discuss what paperwork you may need to do. The sooner, the better in case she gets released soon. Good luck!
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If she is on Medi-Cal now, I don't think there is another application process to go through. (At least there isn't in this state.) Yay! It is so helpful when the application is taken care of far in advance of care center need.

I don't think it matters when you inform the TCU's social worker of your decision -- that she is not returning to your home. I don't think you can decide where she is going next -- they will need to determine the level of care they think she needs. But you can definitely determine that she is not returning to your home.
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Since she now has Medi-Cal (California's medicaid program), is there another application process we have to go through? Do I talk to the social worker/case manager at the SNF now regarding my decision, or will that throw up red flags for medicare? Should I wait & bring it up at the care conference in a few weeks instead? I'm at a loss as to what my next step should be, and I don't want to do or say the wrong thing & wind up screwing us over.
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Oh Purple, you really have had to deal with so much in the two years you've been her caregiver! ("If it's not one thing it's another." Sorry, I couldn't resist. :D)

You have given your mother a two-year opportunity to get back on her feet both figuratively and literally. That was very generous of you. I'm afraid your generosity was being exploited. I am so glad you have decided that a care center would be a more suitable place for her. I imagine that she is being transferred to a Transitional Care Unit of a nursing home, for rehab. As you probably have learned, Medicare covers that for a limited number of days and only while she is making progress. If she is noncompliant, Medicare stops paying. After she is through with rehab she can become a SNF resident. Medicare doesn't pay for that. Medicaid does if Mother cannot pay her own way. So part of the fun that begins now may be the application process.

You are making the right decision. Guilt is the default screen saver for caregivers and I suppose feeling that is inevitable. Learn to push it into the background and don't let it drive your decisions. You are doing great!
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It's been a few days, and I don't think I've slept soundly since the night she went into the hospital with everything spinning around in my head. I sent a letter to all of her siblings regarding this latest issue, and let them all know that I just can't do anymore for her when she isn't willing to be responsible for her own health & meet us at least halfway. I got a couple of replies (she has 10 living siblings) - the ones who responded were very supportive. One of my uncles told me "you need to get your life back - now that she is in the hospital, this may be the perfect time to transition her into a permanent nursing home. It's too much for her to expect you to keep doing what you are doing." I just cried when I read that - I've gotten that exact advice on this site, but for it to come from a family member really made it hit home. I guess I've been afraid that I'd have people angry with me for making that decision, but so far the ones who have responded have been supportive, and at this point I don't care what anyone else has to say.

I went to see my Mom yesterday - the swelling in her leg has gone down considerably, but the lower portion of that leg is purple, I suspect from the poor circulation due to the clots. I know what is coming down the road, and it's not good. I told her "See Mom - THIS (pointing to her leg) is why everyone has been on your case about getting up and walking and moving your legs - so THIS doesn't happen." Her response??? "Well I don't think THAT has anything to do with this." Ignorance? Denial? I don't know...but I'm done. Right then and there I made the decision that she can't come back to my house, and guess what? I had the BEST night's sleep last night - coincidence??? She is being transferred to a SNF either today or tomorrow...the fun begins.
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Give a standing ovation to your husband! Time for tough love and no more enabling. If mom can hear you and understand you, it's time for her to follow the rules. Y'all have gone beyond the call of duty to help her but she must help herself also. I hear too many people on here miserable because they think they can't honor their parent if they speak up for themselves. That's crazy, IMHO. My home, my rules...it works if you enact it. You can't be a doormat if you don't allow yourself to be. Good luck with the decision making. You'll be a lot happier once you've found the solution. Hugs!!
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Thanks both of you. I had a long talk with my husband today. He told me that he doesn't want her coming back to this house unless she is going to follow orders and take responsibility for herself and her predicament. By refusing to help herself get better, she is basically taking our help and the sacrifices that we have made for her for granted - I guess I never looked at it that way before, but (as usual) he is right. She has been here for over 2 years now, and she has only gotten worse instead of better - which was the whole point of her moving in with us...to help her get better. I now feel as though I've become an enabler - something I have NEVER been - by "allowing" her self-destructive behaviors to continue, even though I am powerless to stop it really. I have decided I need to do what is right for US now, and if the only way I can stop this cycle is to have her leave my home, then I need to face that fact and make some hard decisions...soon. Again, my siblings aren't any help - they told me to do whatever I think we need to do (doesn't surprise me....I may as well be an only child at this point). I haven't even gone to the hospital yet today because, quite honestly, I've been enjoying some time to myself this morning - isn't that horrible? ;) I'll be talking to the doctor today to find out what her treatment plan is.
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purplesushi, I imagine you're thinking this way because you're exhausted and frustrated. You saw this coming and now through no fault of your own you are paying the price. Yes, I know your mom is suffering but you are in actuality suffering the consequences also. It grates on my last nerve when I hear people say "if its not one thing, it's another". My ex used to say it all the time. A little gratitude for the good things can sure make the bad things seem less drastic. But some people don't, won't or can't get it. I read this somewhere "we are the architects of our own misery", I have it framed on my wall as a daily reminder to be careful how I react to life's misfortunes.
I sure hope you can get your mom in rehab as Chicago suggested. I think you have too much on your plate as it is. For your sake, your mom shouldn't come home right now. Good luck and let us know the outcome.
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We just simply had to refuse to be available for our Mother. So, she went to a rehab facility. There, they will not take no for an answer. It is much easier to make the move from the hospital, than if you let her come home.

Any normal person feels guilty, though.
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