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She went to the ER, now at rehab and still refuses to. She has been in and out of rehab 4 times within the last 4 months and in and out of the emergency room more than a dozen times in the last 6 months. I don't know if i should have her cared for in a skilled nursing facility. She refuses to do anything.

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Is your mother's appetite good? Does she use a bed pan or potty chair or does she toilet herself? These are very important to the whole picture. Is it just that she doesn't want to come to the table and prefers her meals in bed?
Perhaps it's time to get some counseling for her depending on the answers to the questions above.
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I think she would be better off in a NH now! she sounds depressed arnt there any shrinks looking after her there?
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I don't see how she can be in AL. My MIL is there and she has to be independent, except for meals and baths. My mother was a little worse off, but she was there as long as she was a "one person" lift.

She likes the NH better, because they wait on her. But, unless it is the hospital wing, no one is allowed to just lay in bed. Everyone is clean and dressed and in the dining room for meals.

I was shocked that my mother would comply. But, she does. She is 95, with CHF and mobility issues. No doubt she would lay in bed, if everyone else did. But, no one does.
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Old age, particularly one that is beset by illness and disappointments, frequently result in depression. This is a natural response, but a sad outcome.
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Has your mother been evaluated for depression? She may be giving up on life due to her circumstances. Maybe the assisted living place has people you can talk to to help you make the best choice for your mom. And don't feel guilty.
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I am only 80, but when I become elderly and have no one dependent on me I shall please myself whether I get out of bed or not and whether I east or not.

I have taken care of many elderly people that continued to exercise their personal choices over a wide variety of activities, and always encouraged them to please themselves if what they choose to do, or not do, pleases them.

Often there is far more to a person's choice not to eat than plain bloody-mindedness. Becoming old is not a signal for anyone to replace us as the masters and mistresses of our own fates or day-to-day decisions.

Some times our choices do not work for the best outcomes for us, but that is not limited to us geriatrics. Age is only a number, and not a magic one at that.

Anyone that has been to ER and NHs that many times in such a short time is entitled to feel upset with what is happening, and to express their dissatisfaction in a any way they choose as long as it does not endanger the life or health of others.

As a caregiver to my disabled and elderly wife, I would never presume to attempt to take control of her life. She has earned the right to be well treated, loved, and cared for without having the insult of having to yield the reigns of her life to another.

Her life is the better for it. So will all our lives be better when we can express ourselves freely.
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SUE, What is she in rehab for? Did she break a bone? My mom fell in AL, after her stroke last year. She was taken to er, xrays were negative. She started declining quite rapidly, seemingly refusing pt. The physical therapist finally insisted on new xrays. She had a broken hip. Make sure, really sure that nothing like that is going on.
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Have you tried talking to the activities director at the community? If she is no longer eating you may have no choice but to place her in a skilled nursing home because most communities are not equipped to handle feeding the residents.
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I also agree with GardenArtist that it seems the mobility injuries do take a huge emotional toll on our loved ones....I know when Mama had her fall, and then her hip fracture, she was initially very resistant to rehab, but with slow and steady and caring effort, she began to see she was not in it alone...prayers for both of you...I know it is difficult.
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Over the course of the past five years, and in particular the past 2 1/2 years with my Mom and with and around other elderly people both in and out of my family...I cannot imagine what it must be like to be "inside" their heads...to have once been able to sensibly voice their opinions, handle their situations, know what they want to do and then do it on their own, unassisted, and now to find themselves confused, frightened, alone and so often at the mercy of a system that seemingly does not care and thinks of them as disposable and / or in the way, my heart hurts so often when I come to this site these days. I am not necessarily speaking to this post or any other one in particular, just a recurring theme that presents and seems to remain....my levels of aggravation and exhaustion are often present, and I have voiced them frequently, but once again, in the quiet of the night, watching Mama sleep and remembering what a self sufficient lady she has been all of her life and that now, because of a disease that is still such a mystery, slowly taking my Mama away from me, seeing the frustration and fear in her eyes, wondering what is she thinking. Occasionally, she tells me she doesn't know who I am...that breaks my heart, but also further exemplifies the horrific extent to which my Mama and too many others like her suffer in silence. I do not believe my Mama wants to die, I believe she wants to live with dignity...and now her definition of dignity may be somewhat different. To be cared for without being hated, to be loved without being resented for living...I continue to get tired, but that is my problem, not hers...My Mama is not some "thing" to be tossed in a corner or to have her life examined under a microscope when she is now unable to speak for or defend herself...We are all going to be there one day...unless God decides to take us sooner....again, this is not a response necessarily to this particular post...it is just a recurring theme that seems to pop up and it troubles me. Mama cannot help the condition in which she now finds herself. She depends on me to respect her wishes, to let her be content and happy as long as she is able, even if her definition of happy may be different from the rest of the world now. I trust God to do what is best for her. On many occasions where Mama's body seemed to be failing, I have made peace with her and she knows I do not expect her to remain at the cost of her own comfort...and I believe when God calls her home, she is ready and will happily go...in the meantime, I will do the only thing I can now...surround her with love and comfort, to the best of my ability, keep her clean and well fed, and make the best decisions I can based on our conversations through the years knowing what her wishes are...that's all we can do.......and in the interim, we can try to comfort one another along the way...it's a very difficult journey for all of us.
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"...that's exactly what's going on in this case, a totally defiant suicidal person."

On what information from the OP did you base that conclusion? Do tell.
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Human mortality rates remain at 100%. At what point does an elderly person cease to be thought of as suicidal, and instead earn respect for his or her acceptance of approaching death?

From the original post, I have no idea what is going on in this lady's life which is why I asked for clarification. Is she depressed, and able to recover with good support? Or would intervention amount to flogging a dying horse?

Today and every day to come, many thousands of people will die of entirely natural causes. To insist that every one of them must be kept alive at all costs, regardless of their own wishes and of their own understanding of themselves, is idiotic at best and at worst has the potential to be extraordinarily cruel.
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Shakingdustoff, I really think your comment is cruel, callous and inappropriate. Susie15 is I believe sincerely concerned but got nothing but sarcasm from you.
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What is the advice of her doctors and the staff at the ALF?
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How old is she? Has she suffered hip or leg fractures? What are her various medical conditions and are they under control with medication?

Sometimes the mobility injuries like fractures take a higher emotional toll on recovery and emphasize a stage of delicate balance in life toward the end. That can frighten them and be a potent reminder of their frailty as well as their impending decline.

From all the rehab and ER visits, I think this might be the case. She may be overwhelmed with the issues causing the ER visits and rehab and just feel as though life has become hopeless and it isnt worth trying any more.

Do you have a good enough relationship with her that you can have a heart to heart talk about your concerns, her desires, and plans for the future? She may be reluctant to tell you she's concerned about being immobile and limited for the rest of her life, so approach this cautiously and stop if it's too upsetting for her.

Also, have you discussed this with the nurses, therapists and social workers at the rehab facility to see what insight they may have.

Good luck; this is a frustrating situation for both of you.
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