MIL constantly falling - we are at our wits end

[FeralNun]

This is mainly a rant, I’ll admit that freely!

MIL widowed this year, has multiple health issues, and is extremely frail. She cannot move safely without a walker, although she thinks she can. Her frequent falls have escalated recently - 4 falls in 5 weeks (that we know of). Hospitalised twice for these falls, and then on Sunday, the paramedics glued her head back together and left her at home. I don’t blame them tbh.

Yesterday she fell again, and this time she’s broken her wrist. So now there is no way she can manage until it’s out of plaster and healed. The lovely nurse is talking about a rehabilitation place in the meantime.

Home is simply no longer viable. She’s got everything / every aid you can imagine l, the alarms, lifeline, the lot. But at the end of the day there are stairs and no downstairs loo.

She won’t be told. She would rather watch DH worry himself to a shadow and drive a 500 mile round trip each time she falls over. He’s had a year of this now, including caring for his dying father 24/7 for 2 months because he was too stubborn for a hospice or carers.

I honestly think my poor DH will die first at this rate.

Ideas/experiences/general advice welcome!

Thank you.

Well, I'm sure you feel you know best and may well have done in the case of your obstinate Aunt, but other people know their own circumstances and those of their relatives best. I do politely request that you refrain from messaging me about this matter any further. I find some of your comments unnecessarily snarky. For instance, you have had a go at people who "farm out problems to Social Work, GPs, Fire" but you don't know other peoples' circumstances. Most people do their best, often at the expense of their own health. I note the OP's update and wish her well in coming to a resolution which works as well as it can for all involved in her family.

Capacity is a tricky thing, but the principles are very clear, and available to read up on.

Principles are clear but general still very hard to assess. People can have capacity in some areas but not others and on some days but not others depending on variable confusion levels. I don’t envy you trying to make assessments when you don’t know the person.

@GranPepper I think you have taken my posts more personally than they were intended. I have not suggested you didn’t do the best for your father or that your action wasn’t effective. I do find you rather over-sensitive tbh so happy to end the conversation here.

Something that occurs to me is, we are talking about our elderly "loved ones" having capacity, being allowed to make decisions that may be unwise etc and having to live with the consequences. However, the family members, potential or actual carers, also need to make decisions that make sense, as hard as it may be. Otherwise what's the difference?
I still don't believe that being lodged downstairs near the kitchen is always a better option because visitors will be more comfortable or likely to visit, like they can't go upstairs????

But they don't. Even if the bedroom is downstairs friends drop off because they just don't feel comfortable. Even a spouse living in the same house will spend less time with someone in bed. Here is very little mental stimulatio - what can you do all day? When wheelchair bound MIL was still at home she took to refusing to get up during covid when there were no visitors and was just withering into her shell. Then she moved into a home and they could spend more time encouraging her to get up. She couldn't talk but had her favourite spot where she could see who was doing what and that social interaction hugely perked her up.

Early 70s isn’t that old but in my opinion it is the time to start thinking about will my house still suit me when I’m in my 80s or older. Because by that time I probably won’t be able to cope with a house move.

My house doesn’t have a downstairs bathroom, just a loo. So I’m planning to downsize when in my 70s to a house with a downstairs shower room. That will also release capital and will be nice to help my kids a little financially ( gifts not deprivation of assets!)

Wouldn't a bungalow be a better option for you than a leasehold flat?

Stair lift?

Glad to hear that your update @FeralNun and that your MIL is understanding now that she is not safe to go back home. Sympathies to your husband and you, it sounds like it was a very difficult situation, I hope it gets easier now.

We have issues at the moment with my MIL. She probably won't have a fall as lives in a bungalow she does absolutely nothing for herself. FIL is still alive and she sits in an armchair all day while he does everything for her and she has always been a very demanding person. Now he is physically and mentally exhausted with looking after both of them, he's in his late 80s himself. She is practically immobile and really needs to go into care but refuses to even consider it. She also upsets every carer they ever have so it's a job finding new ones all the time.

Ironically he is the one who is having falls, maybe not surprising as he is always on the go. I can see a situation where he will eventually need to go into hospital and then won't be allowed to return home as she certainly wouldn't be able to look after him. If he goes into care then she would need to as well, anyway so that is probably what it will take.

I do wish it was as simple as 'just ask the doctor' regarding dementia. I'm here, very tired after three years of attempting to keep my mother engaging with her support system, fighting to get doctors appointments, their refusual to discuss her with me despite having poa as she still had capacity. I'd attend appointments with her and they would only talk to her. We've called paramedics when she's fallen. She did, finally, reluctantly, sign a permission slip allowing us to talk to her surgery regarding her health. Thank goodness she did as we've needed it just to get hold of her medical summary for the nursing home. Departments do not talk to each other in the way that we imagine.
And my mum is quite charming, and generally very polite. So we have it a great deal easier than many on these thread.

She's still extremely obstinate and we have found, through lived experience, that it takes a lot to protect her from herself. We are endlessly grateful to the OT who didn't just say how lovely she is and how she's as bright as a button, but paid attention and realised she's not as capable as she believes herself to be.
Finally, my mother is going to a nursing home and I'll be able to stand down, but there's still a whole heap of admin and organisation to deal with. I'm shattered and it's not over yet. And this is a lady who did put some effort into her future planning.
So my point still stands about the wisdom of looking ahead ( not necessarily downsizing but considering the home you have, and how it can be made suitable) Not just expecting your family to pick you up when there's a crisis with no idea of your wishes because you're refused to discuss it. I really worry for the people who have nobody to advocate for them.

@WinterFrog good update. I hope you have been able to find nursing facilities you and your mother are happy with?

The facility we had to find for Dad gave us a ‘My Story’ pack for us to compete so they had a profile about who Dad is and his background. I really wish I had had this sooner as with everything else to organise I feel like I rushed it. We tried to get our mother to complete it but she chose to not engage with it. She mentioned herself, being a war baby. Not a mention of Dad or his 3 kids and numerous grandchildren.

With hindsight it was her burying her head in the sand about the whole matter.

We cobbled together what we could, well my sis and I. Again brother utterly disinterested, or on reflection his utter refusal to do anything ‘admin’ related. It’s amazing what you learn about relatives in these strange times.

Anyway if you can perhaps look at using this template from Age UK which is sort of similar but actually linked to a campaign they were doing it might get you started getting some things down on paper. https://www.ageuk.org.uk/bp-assets/globalassets/oldham/new-content/documents/life-story-form.pdf

Hope it is useful.

@WinterFrog I do understand how tricky elderly people are, I’m dealing with them daily. But you can go to a doctor’s appointment with the patient and request an assessment; you can also speak to their doctor without the patient’s consent to request an assessment. Doctors can’t share with you information about the patient, but you can share information with them.

If your mother didn’t have dementia it’s not relevant, but I got 3 elderly diagnosed by those means. It’s often the partner or relative or carer who request assessments as dementia patients can lack insight into their condition. And the same principle applies to other health conditions.

One of these questionnaire things about my father, his life and things he enjoyed was completed when he had some care at home before he was deemed to have lost capacity and before he was admitted as an emergency into a Care Home. I think that was somewhat helpful but unfortunately the carers had very limited time to read those notes due to time constraints. One thing that was incredibly helpful was when a new Social Worker was assigned to my father and she signposted me to a local befriending service I was unaware about and offered a referral. Because she referred, although there was a contribution to pay, it was subsidised by Local Authority. You could apparently self-refer your relative but cost was a bit higher (but still would have been affordable out of his Attendance Allowance). I got a bill approx monthly and paid the befriending organisation direct. The befriender visited twice a week. Occasionally, she'd ring me and ask to change the day but always turned up, sat and listened to my father reminisce, got to know him well, phoned me if she had a concern (eg, he kept losing his glasses and it was during covid. She offered to make an appointment at local Optician, I suggested he needed two new pairs in case one went missing and she asked the Optician if they'd accept a payment over the phone from me, which they did). This woman was an absolute godsend and, even after my father went into the Care Home at very short notice, she was genuinely interested to know he was ok and sent a condolence card when he died. I remain grateful to her even though naturally we're not still in touch. I've gone a long way about a shortcut to say, if there's a befriender service in the person's area, it may be something helpful to investigate. It was particularly helpful in my farher's case - he lived alone.

It's all very well having the diagnosis of dementia. It's being able to do anything to improve the situation that's the difficult bit whoever gets involved. Especially with someone who lacks the insight.

We had my MIL living 5 minutes walk away from us for 4 years - moved her to a flat in our village where she could rollator to everything. She walked up to ours every evening for supper which was nice for us all sociably and meant we could keep an eye on her - or so we thought! First 2 years were fine - then things began to go downhill - slowly at first so we didn't intially notice.

She went from walking (slowly with a rollator) about 3/4 mile p/day to developing cellulitis in her leg to the point it was red raw without mentioning it. This refused to heal - because it transpired she wasn't remembering to drink enough during the day & not putting her feet up as requested - not in the riser chair we got her (turns out she couldn't master the controls) or in bed (turns out she's been sleeping with her feet on the floor because she couldnt lift them up into the bed without help but don't want to be a problem). She didn't mention any of it because a) she doesn't like being a bother & b) it turns out she was experiencing cognitive decline but so slowly none of us had noticed, despite seeing her every night for a few hours.

In the end, we had a week of lots of things going wrong - getting lost in the walk to our house for supper, mounting confusion, sitting on the loo for about 8 hours (whilst either believing she hadn't been, didn't notice or was too embarrassed to tell us she was stuck), forgetting to take her meds. She was seen by the ambulance after a fall but managed to convince them she was fine - that was so much effort she fell asleep as soon as they left.

It ended with a 'long lie' when she fell over partially clothed in the middle of the night and forget to press the 'get help' button on her wrist. She was covered in poop & developed a bed sore but even then the paramedics assessed her as just needing a visit from the Frailty Team! It was they who decided she needed to admitted & gave DH a letter to help speed up admission - he was still at the hospital hour 13 hours before they admitted her. She turned out to be severely dehydrated & have mid pneumonia!

She was in hospital for week (being moved around different wards almost daily) By then we & she were exhausted and so we spent her time in the hospital looking for respite care. She was happy to be anywhere out of hospital & was content to go to the home for respite.

We investigated home carers & requested a dementia assessment, which took 4 months. During that time she had a number of other falls - the relief on being called a sensible time to be told it had all been dealt with was immense. The diagnosis came back that she has normal pressure hydrocephalus - so her cognitive skills, short term memory & balance are never going to improve.

The diagnosis helped us convince MIL she could not return to her own flat without a full-time carer and that staying in the care home that she had been for the last 5 months was the best place for.

She has been there just over a year now & settled in after about 4 months of occasionally asking to go back to the flat. She still forgets occasionally that we have now rented out to help pay for her care but it's fine when we explain it again. We also have friends who visit the home in a professional capacity & they tell us she's happy there too / it's not an act for when we visit. She is healthier than when she was living down the road from us at she is made to take her meds on time and drink enough fluids.

I'm writing all this to say that my DH wrestled with his consciousness about putting his mother into the home & then her staying there but a year on it was the best decision for all of us. The burden was huge (& she was only 5 mins walk away, not a long drive) and we'd sort of got used to it but now it's no longer there, all of us (including MIL) are so much happier.

Start investigating care homes near her (or you) and next time she has a bad fall insist she goes to one for respite. If she refuses then you need to step back and involve social services.

I had to go back and reread, but didn't find any offensive....but useful points.
It's very difficult in all situations.

@Mirabai I appreciate your input, and as you say you are dealing with elderly people on a daily basis, I'll take a guess that you work in elder care in some form, or in a doctor's surgery. What I have found is that in our particular surgery it was extremely difficult to get anybody to hear what I had to say, and there is no way I would have been able to get my mother along for any kind of assessment. She shows signs of vascular dementia, although was coping ok and until her stroke, her cognitive issues weren't too much of a problem. So it wasn't that important. Had she been leaving the gas on, i would have forced the issue.
When I worked in care, it was very apparent that the care manager had a lot more clout than family members. Also that all GP surgeries behaved differently.
The points you make are logical and could certainly be useful to someone, but having been through all this, it's hard hearing that it's easy to get an assessment. It's really not.

Thank you @BlueLegume for that link. I've been given one already by the nursing home, and had made a start on one of our own, but I appreciate you taking the time :)

The one positive thing to come out of all of us trying to do our best for feisty relatives, is that we will not allow ourselves to burden our own relations when we get older & can’t cope. I will try my upmost to not be stubborn or make life more awkward for those who love me & are trying to help.

I'd like to think so.

But my DF said the same after dealing with his own elderly, somewhat challenging and spirited, relatives. And he insisted on setting up POA, inheritance tax mitigations etc very early. Then he developed dementia, tried his best, and succeeded in some cases, to undo all his planning, convinced himself I was stealing and plotting against him, and steadfastly refused to accept he needed any help.

I hope I manage to remember to clear the house - started but hampered by DF's unsorted things still- , downsize, accept help, submit to care etc. but judging from our long family history of being stubborn independent old people, I think I'm doomed

I didn't find the posts offensive, to be clear. I thought they were unnecessarily snarky. For the first couple of posts, I gave the benefit of the doubt to the poster hoping they were trying to be helpful. But. When you have said you managed to get your father moved to a safe place (Care Home) as a result of a Fire Risk Assessment (meaning to be helpful to others in case that would help them as it helped my father and was suggested by Social Work) and someone sees fit to be judgy about it by mentioning it three different posts in quite a non supportive way (such as calling people out for "expecting Social Work, GP's, Fire services instead of themselves to step up for parents ") this undermines middle aged people juggling a job, grandchildren, personal ill health, an obstinate elderly parent. In my mind, it doesn't matter how you get help for your obstinate parent to keep them safe even if it is a Fire Risk Assessment. Btw, I've had family issues I've had to sort since early childhood and I have managed. I just don't appreciate snarkiness

I was in no way shape or form intending to be snarky, if I was too blunt I apologise. I am a middle-aged person with ill health and obstinate elderly parents as it happens.. and elderly patients too. (Not a doctor though).

I’m glad it worked out for your dad, my point was simply that it not really practical to manage all elderly people’s fire risk using the fire brigade, and anyway some won’t listen to fireman either or forget they’ve even been.

@Mirabai everyone is fraught. 🥰

Thank you, sincerely appreciated. My very obstinate father got taken in as an emergency on Xmas Eve to Care Home because not only did he present as a danger to himself (he said he would jump out his window if there was a fire - due to the height of his flat, he would have been dead on impact), his neighbours were deemed to be at risk from him. Hence, the Fire Risk Assessment got him a placement, helped his neighbours and me because I was at wit's end trying to keep him safe and not a risk to his neighbours. I could write a book about the issues he caused but I won't. I suppose all I was trying to say was that sometimes something you don't expect to help like a Fire Risk Assessment is the very thing that does help. I ended up very ill on the back of my father's dementia and actually have never properly recovered. I do not dismiss your own experience in any way. It was my father's Social Worker that suggested a Fire Risk Assessment. I agreed and she was right to do so because my dad got an emergency placement, the neighbours were safe and I got a sleep for the first time in months knowing he was safe. Best regards

My experience of working with the fire brigade (in hoarding situations which are presenting a fire risk, amongst others) is that as a service and as individuals they are held in such high regard by the public that suggestions from them will often carry more weight with an individual that I could do as their usual HCP. It also puts the person on their radar. Always been a positive experience all round.