MIL with mental illness lives with us

julie_vaAugust 6, 2011

I have many questions that, if I have time, I would like to come back later and ask about, but have one pressing question that hubby and I have right now.

Ma lives with us but has been visiting her daughter for an extended stay for the past 4.5 months. She is 85 and has diagnosis of paranoia and schzophrania along with manic depression. She usually does well under her meds, but occassionally life gets too much for her and her chemicals go haywire and she has a breakdown. It takes about 4 months to come to a head, and it's horrible on us because she hears voices and the paranoia takes over. I am fairly new to the family and we live away from the 2 sisters, so I didn't know what to look for when she had the 3 breakdowns while living with us. They each had different symptoms also and I didn't know enough to recognize them and my husband is just clueless.

My sis in law has been calling me recently with some "complaints" (I hate to use that word, she really isn't complaining, just telling me things ma is doing) and I suddenly put it together that these are behaviors that she did early on the last time she had a breakdown. One of them is being a dead weight and not having function of her legs. She has fallen 2 times in past 2 weeks. She also loses bladder control. This, among other things sis is telling me is making me wonder. Now it could just be that she has a lot on her mind, or it could be that maybe she is having mini strokes or something. Last night after the 2nd fall the ER said she was just dehydrated, gave her fluids and sent her home.

She will be back here with us on Tuesday, hopefully, and I will be able to get her to her psychiatrist for an evaluation.

But... I am really concerned for her safety here. My husband and I both have disabilities. When she is like this she becomes totally dependant. She leans on us going up and down the stairs, have to walk with her now I am afraid when she gets up to potty at night, etc. If this is a breakdown, once her meds are adjusted she will come out of it and be dependant again...until then...

That is a bit of background in a nutshell.

Now on to my question for now.... if she is beginning to have a breakdown, this may sound selfish, last time she heard voices that told her to pee all over. In the bed, on our couch, all over the rug. The bathroom gets "both" all over it and she tries to clean it and smears all over.

I am not too concerned about during the day, I can clean what I can see. At night she gets up a few times. Sis has told me that she puddles all the way to the bathroom and she has gotten up to bathe and change her. We have a fairly new carpet and will be selling our house in a couple years. We would like to keep it as nice as possible. Again, I know this sounds selfish and is the least of our worries. This is why I am addressing it with strangers and not family.

Hubby and I have been going back and forth on how to prepare the house for when she comes back. She refuses to allow anyone but family help her and I don't know how medicare does that anyway. I bought a tub handle and will help her that way if she will allow me. We have cleared spaces so she can walk clearly since she won't pick up her feet.

But how can we protect the carpet, or should we just let her pee on them? I really don't want to sound heartless here, this is why I am asking. I feel like a really bad person for asking about this. This isn't the main concern, her safety is. Hubby has this thick plastic that he was thinking of putting down from her bed to the bathroom. it isn't slippery. But then would it insult her? I don't want to take away her dignity. But we need to protect our home and during her breakdowns she has destroyed a lot.

I am sorry that this is so long. I am just so confused here on how to do this. Thank you so much in advance for any advice.

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OK, I'm going to be a little blunt about this. She's 85 with a lot of mental problems. Also, I suspect, that there may be some sort of senile dementia going on.

Things are going to get worse. It may be time to look into custodial care in a nursing home type place. They will be more able to insist that she be under proper medication. It also would mean that she would be in a place where going up and down stairs would not be a problem. She may do better in a wheel chair.

Start looking for a suitable place and put her on a waiting list. It's hard to choose a suitable place when you have plenty of time, it's worse when you have to do it suddenly. If finances would be a problem, it's time to think about getting her qualified for Medicaid (NOT MEDICARE)

Get your husband to put down the plastic. I doubt if she would be insulted. Even if she were...what difference would it make? She is not in full control, so you and your husband must be the ones to arrange things.

    Bookmark   August 6, 2011 at 2:35PM
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I agree with Agnespuffin. She has been thru with similar problems She needs to be into some type of nursing home where they will watch her meds, and control the situation. You stated you both have disabilities and who is going to take care of YOU if you both fall down stairs? Be firm, discuss it with your husband, and tell the family that you can no longer take her into your home.

    Bookmark   August 6, 2011 at 5:09PM
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I also agree with Agnespuffin. This is a serious situation that will not get better. Helping someone who can only shuffle their feet get up and down stairs is hard enough when you are strong and healthy. If you and your husband have disabilities, it's a recipe for disaster (just as Marie pointed out). You really do need to start looking for other living arrangements before things get any worse.

Regarding keeping the carpet clean, is there any reason why your MIL does not wear Depends or a similar product? They are not a perfect solution, but they would help a lot to contain the worst of the damage. Having "drippy" elders in the house is not an unusual situation. Take advantage of the many products available to make things easier to control the messes.

I'm assuming you are talking about the thick plastic runners with a toothed underside to grip the carpet. Anything less stable could be a tripping hazard, especially for someone who can't pick up her feet.

Finally, you need to stop worrying about insulting her dignity. Protecting your home from urine and feces stains is not heartless. There is nothing dignified about someone losing bladder and bowel control. Helping that person by having them wear Depends, keeping their living area clean, keeping their clothes and bedding clean, watching out for their safety, keeping unpleasant odors at bay -- all those things are preserving her dignity.

On a practical note, could you put a commode in her bedroom for night night use? I know I had to use one when my mom was with us. It needs to be emptied and cleaned each morning, but it was sure a lot easier than cleaning a trail of urine or feces drippings.

One other thought: many of the big box stores sell almost room-size cheap carpets. Could you invest in some of those to lay over your nice wall-to-wall carpeting? Of course, you wouldn't want them to get disgustingly soiled, but they would protect your nicer carpet underneath.

And finally: She's 85. Her mental problems problem aside, if her general health is fairly good, she could live another 10 years. Think seriously about that. Both her physical and mental health will deteriorate. How long can you keep caring for her? Just remember, as she is aging, so are you. That's why it's would be wise to start looking into other living arrangements for her.

Here is a link that might be useful: Carpet runners

    Bookmark   August 6, 2011 at 6:54PM
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Your health is just as important as hers is, more so because you are younger than she is. She needs to be in a care home where they can care for her properly. I took care of my husband for 4 years and my health was declining rapidly. I was having vascular problem in the brain from the stress of it all. I almost back to normal, but I would have died if I had not put him in a home.

    Bookmark   August 6, 2011 at 10:23PM
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MIL may decide to start hitting you if she can't remember you are trying to help her, voices may tell her to. I would try getting her on medicaid & I think medical dr. would have to evaluate her. I tried a large plastic under desk thing beside the bed when dad came home after the stroke last year. I spilled a little water on it & stepped on it barefoot & nearly broke my neck. It was super slippery so if you get any plastic try it out with someone right there ready to catch you if you start slipping. They work great under a desk but useless for medical purpose. Very thick too so chair for computer doesn't slip. So some things just don't work. Cover mattress completely with couple of zip on mattress protectors so it doesn't start smelling. I'm not disabled(no cane,walker or wheelchair)69 yr old & I could not be cleaning up messes of either pee or feces daily. That is really hard & smelly & soon your whole house will smell bad. Your carpet will be ruined as lot of meds make permanent stain. Dad just dropped a pill out of his mouth, orange colored vitamin & cotton baby blanket I had put on wheelchair with waterproof plastic & foam pad under that to protect the wheelchair & it did! The baby blanket I rubbed until my fingers hurt & bleached after trying several stain removers.I couldn't deal with worse very day, I've cleaned dad up few times when he had another small stroke but daily couldn't deal with it. So between the stress & the messes your MIL really needs more help than you can give. She could get outside & lost. 3 breakdowns should qualify her for nursing home help if you enlist her drs. You also have a marriage & your sanity to protect! Good Luck!

    Bookmark   August 7, 2011 at 2:37AM
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Sunnyca, brings up a good point about using plastic to protect the floor. Any liquid on plastic can make it horribly slippery and even more dangerous.

    Bookmark   August 7, 2011 at 5:09PM
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I had not thought about the plastic being slippery when wet. Something to think about.

Maybe cheap carpets from a Thrift Store would be better.
you could even cut a big one to work as a strip down the hallway.

Good Luck!

    Bookmark   August 7, 2011 at 5:19PM
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OP has described a situation requiring 100% observation/attendance. Patient is peeing, crapping, falling, telling what else and/or what comes next. Such a state of affairs cannot be accommodated in the home without HUGE expenditures on professional outside help. If OP has money enough and expertise enough to evaluate and hire a staff like that, OK. Otherwise, it's time for the big NH. The situation described cannot be allowed to continue.

    Bookmark   August 7, 2011 at 8:26PM
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Thank you all for your wonderful responses. You have educated me and hopefully I can take this and educate the family.

I have written responses 3 times today and gotten 3 different calls from the sisters so I had to delete them as things changed. It seems she is now in a full breakdown. I am not sure what is going to happen and if she will be in the hospital or not. Her dr has been contacted and meds adjusted.

She doesn't qualify for medicaid as she has some money from her house which isn't much, but enough to keep her from getting it. I think we will be talking with a social worker soon if she ends up in the hospital. The younger sister is really fighting everything.

I think I am dealing with the 3 stooges regarding the 3 siblings, and my husband is becoming the head stooge. They are not presenting a united front. And all he and the younger sister seem to want to do is yell and scream. It's like a competition of who has done more and who has it worse. And older sis just wants to only now worry about her own hubby and her grandchildren now that she has put in her 4 months. I have never seen such an unproductive bunch of people in my life. I told them they all win, now can we concentrate on ma? If anyone has a right to complain is us, the in-laws, and the 3 of us are the calm ones.

I have put a nice piece of non-skid plastic down by her bed. Thank you for "giving me permission". I also put a blanket over it to absorb the wet so that she wont slip. I just hope she picks up her feet enough to not fall over that.

A hint for anyone ... we had an elderly dog who had many pee pee accidents. I found a wonderful product at the pet store called "Nature's Miracle". It is a neutralizer and takes out the odor perfectly. Dab up the wet spot then saturate the area and let it dry naturally. It's easier with a dog because they tend to go in one spot, not all over. It can also be put in a carpet washer. It has a very fresh scent. The key is to let it dry by itself over a period of days. Another product is "Spot Shot", it is wonderful for stains that won't come out. I have pulled these out and they are ready for her return. sigh...

We learned in the past to keep doors locked and hide the keys so that she can't get out. The keys are near by in case of fire, but she doesn't know where. We will need to see where the week leads.

The mattress is already covered. I looked and I must have covered it the last time. We almost bought a new couch while she was gone. I am glad now that we didn't. I will make sure she takes all of her pills in the kitchen where there is no carpet, thanks for that warning, sunnyca.

She usually comes out of these breakdowns and then goes back to being normal, well as normal as can be for her. I am hoping she will pull out of it quicker this time hoping she started med adjustment early enough. And then she can be coherent enough that we can get her to sign papers that need to be signed that should have been signed.

Going tomorrow to get a baby monitor, or I guess I should call it an intercom, so if she does come back and not in the hospital, I can hear her calls at night.

through all of this I keep thinking, I don't want to be a widow in all of this.

Thank You.

    Bookmark   August 8, 2011 at 12:40AM
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I feel for you! It's going to be difficult! When dad was in rehab I asked why his roommate was in there. He had been transferred from another NH. They kick clients out 1st time they fall. Wow! I thought they were all equipped to handle falls. Found out that that is NH's biggest worry! They had a man that they had the bed less than foot off floor & a 1 in thick pad 72 in x about 30 in. on the floor. Well he managed to fall out of bed & break his hip. His wife came back to get his things but don't think he did very well & couldn't go back there. So if anyone has to put relative in NH BE SURE TO ASK ABOUT FALLS-before you sign anything, don't want to have to move them yet again as that is hard on them. I would suggest that you get someone to come in for 4 hrs twice a week to give you a break. With her "accidents" that might be hard to find someone. Mom got an agency to come & help out & mainly she walks dad & exercises him & gives him shower. She had never made a bed before so mom showed her how, she does few dishes,dusts & vaccums a little. Mom can leave the house to run up to her dr or grocery store. It gives us a little break but is expensive. $20 hr x 4=$80 a day x 5 days $480 week. We don't have them on holidays as double pay & his dr. is quite a distance so I do the shower & get him in car &load wheelchair, we got a super light weight 1-20 lbs so I can lift it. Julie, you are lucky MIL can still walk,will be harder when wheelchair becomes necessary. Hope all goes well with her return. Hope you have a good friend to talk to or that can come over. I have couple of friends from way back in HS that helped me get through(e-mail) 1st 4 mos & then after he got home. It does make a big difference having someone to talk to. You can always come back here & learn from what works for us. Oh, I got some Prevail Belted Shields at thrift shop, they suddenly had about 50 pkgs of various "nightwear" well, we had struggled trying to get those huge diapers on him, We would lay it on the bed but of course getting him on top of it about did us in so I tried it standing up(him---Ha!)well, with mom on 1 side & me on other would get tapes on but then some brands they would come undone while he was getting into bed. We did this as he had 3-5 mild strokes 1st couple of mos & would have problem getting up fast enough in morning. Well, finally we opened Prevail pkg & we love it. It is possible to put briefs that are padded some over it while he is standing. It has 2 tapes that go through slits so the buttons hold. Each pkg comes with 2 sets of these elastic button things. 30 shields to a pkg. 1 size fits all so never get wrong size unless you were probably over 300 lbs or so. I went on line yesterday as we were running low & Walgreen's doesn't have any in stores out here in So. Ca.(what else is new) but you can order them on line & deliver to your house. $14.99 for 30.(I pd $2.98 at TS) So we may have to do that. However since monday's are 25% off for seniors at TS I got another pkg similar & they are from Kroger(Ralph's grocery store) So I have to check on that soon as mom said they worked well also. For 50cents each we found they don't show under his clothes when we go out & he has never had an accident but don't want him to have 1 & be embarrassed. He says they are very comfortable & he likes not getting red skin as some brands of diaper do when tape moves. His circulation at 95 isn't good bad but doesn't take much to get a bedsore so we are really happy about finding these. I also use Dr. Sheffield's Diaper Rash cream in tube-U.S. made at $1 store, 40% zinc oxide on his feet if he looks red or like he is getting a sore from rubbing feet in bed & then put socks on so it doesn't get all over. Stuff is great & saved my behind, morning I knocked my very hot tea over & took all the skin off my backside on 1 side even tho I caught the mug. I slapped that zinc all over it after I had sat for hr. with wet washcloth & another 1 with crushed ice behind that 1. Once I took the washcloths away it was pure pain & no way was I going to hospital-last tetanus shot I had nearly killed me. So I figured diaper cream was working well on dad, why not, even tho all the medical books say don't put any creams,butter etc on raw hide. It stayed on, whereas antibiotic salve slid off & once it was completely covered- pain gone! I paid $1. So you don't have to use expensive stuff. Enough already, bedtime!

    Bookmark   August 8, 2011 at 2:57AM
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A word about the possible hospital admission. If she does have to go, and IF she goes directly to a nursing home, Medicare will pay for it. I don't know how much or for how long. But it's something to think about.

Now, about Medicaid. So, she has some money from her house. See about using that money for nursing home care. Then, when she has used it all up, she may be entitled to Medicaid. If the sisters don't want to use her money to pay for NH care, then remind them that it is HER money.

Many of us could tell you stories about what our un-stable kinfolk did. It would curl your hair!! It's a risk.

    Bookmark   August 8, 2011 at 1:49PM
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"She usually comes out of these breakdowns and then goes back to being normal, well as normal as can be for her. I am hoping she will pull out of it quicker this time hoping she started med adjustment early enough. And then she can be coherent enough that we can get her to sign papers that need to be signed that should have been signed."

A couple of extra thoughts. Please be aware that there really is no going back to being normal. As the elderly age and their health deteriorates, things inevitably get worse. It's just a simple fact. So you must prepare for the decline.

Getting papers signed is really important. If she's your dependent, then you need to have power of attorney for finances and also for health care decisions.

Also, regarding what Agnespuffin said about medicaid: You should confer with someone who is familiar with both Medicare & Medicaid. Just because she has a house doesn't mean she can't qualify for aid. If the house needs to be sold to pay her expenses, then so be it. It's her house and it will be her care. You need some good solid information. And you need to get the power of attorney papers taken care of.

Yes, siblings can be unhelpful and even obstructive. In a sense, you need to work with the premise that they will not be supportive and go from there. Expecting them to do much more may be simply a fantasy.

    Bookmark   August 8, 2011 at 2:28PM
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"I have put a nice piece of non-skid plastic down by her bed. Thank you for "giving me permission". I also put a blanket over it to absorb the wet so that she wont slip. I just hope she picks up her feet enough to not fall over that."

I haven't seen the arrangement but it sounds like a first-class falling hazard to me. You've already described how she sometimes loses control of her legs and feet. How is she going to keep from tangling up in this thing?

Depends are wonderful things. Been using them with mom for almost four years, now.

From what you've written, this person is going to require more structure -- and restriction -- than anybody seems willing to provide. If you're OK with living in the poo/pee finger-painting you've described, well, go ahead. Can't imagine why you would, though.

    Bookmark   August 8, 2011 at 3:47PM
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"I have put a nice piece of non-skid plastic down by her bed. Thank you for "giving me permission". I also put a blanket over it to absorb the wet so that she wont slip. I just hope she picks up her feet enough to not fall over that."

Asolo brings up a concern I had when I read the above paragraph. Plastic topped with a blanket, combined with an elderly woman who does not pick up her feet when walking sounds like an invitation to disaster.

Also, I don't believe anyone suggested on this forum that plastic was the only or even the best solution. I know I suggested cheap area rugs and Agnespuffin suggested cheap thrift store rugs. We've all cautioned about the slippery tendencies of plastic. And now we're warning of the combination of plastic topped with a blanket. A couple of us have also recommended Depends.

All that to say that no one on this forum "gave permission" to use plastic as the solution to the bladder and bowel dribbles.

    Bookmark   August 8, 2011 at 8:06PM
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I have about 30 minutes before the in-laws arrive with ma in tow and the "excitement" begins. I have read all of your responses and reread my posts. I need to take the time to reread what I write. I probably won't have the time today either and hope things come out better. It seems what I mean and what I write don't always mesh. Am shaking my head at what I wrote. I see what I did write, but what was in my mind was more meaning getting permission of going with my gut feeling of doing things, and not over thinking things. When I trust myself, I tend to make better decisions. Originally, I was concerned about being selfish and worrying about her dignity. My gut was to not worry and I was told here to not worry. I was also told to not put the plastic down, which we won't be doing.

She doesn't want the depends because of her dignity, this was discussed with her daughter a couple days ago. She has been ok with not having accidents. Daughter bought them and told her if she has any accidents she will wear them. She won't accept that talk from me, but I will be telling her the same thing, I will be sweet but firm. Like someone said, it's my house, and cleanliness IS preserving dignity.

I am so happy I found this section of the forum a few days before her return so that I can begin to put things in perspective and get my mind in order.

She has 3 days of increased meds in her now. At the first sign of a problem, she will either be going to the hospital or 911 will be called if needed. I am prepared and am not going to play around this breakdown. I have notes and names in a notebook. I have the "go bag" ready, except her pills. I have protein bars, puzzles and a book in it for me in case I spend the night in the ER. Now to smile when she comes walking in the door.

They are here. Thank you so much.

    Bookmark   August 9, 2011 at 6:01PM
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From what you've written, I must tell you your (her) "days of dignity" are over. Do what is required to manage the reality of the situation. You have my "permission". : )

    Bookmark   August 9, 2011 at 7:39PM
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When she's living in your home, YOU are she who decides how things are going to be done.

Gird your loins. Other family members are going to give you grief. However, sounds to me as if you may be the only one with their head screwed on straight.

I commend you for your willingness to undertake this challenge. Please remember that your own well-being is a consideration also. Don't hesitate to assert yourself in that regard if pressed.

    Bookmark   August 9, 2011 at 7:51PM
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I think the idea of Depends taking away dignity is all wrong. It's backwoods, in fact. Wearing Depends PRESERVES dignity. By using a product like Depends, the loved one is spared the embarrassment of making a mess. No trail of urine dribbles and no feces stains.

My mom was happy to use Depends because she didn't want an accident. It kept her incontinence a secret -- not really public knowledge. Even when she was in a memory care unit, the only ones who knew for sure that she wore Depends and had occasional accidents were the staff. And they took care of the accidents privately.

Depends allow someone dealing with incontinence to still function. They can go to a restaurant without worrying about embarrassing themselves. They can join their family on the couch to watch TV. They know they haven't made their family spend hours cleaning up their urine & feces. That's preserving dignity, not taking it away.

By the way, I bought a couple of really pretty protective pads that I kept in the house and in my car just for extra protection. When I'd drive my mother to doctor, I'd put one on the seat. I'd tell her that the seat seemed uncomfortable and the pad was some cushioning to make it softer. Instead of being embarrassed or ashamed, she felt like I was giving her special consideration. A lot of times, it all boils down to how you present something.

    Bookmark   August 9, 2011 at 11:59PM
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Wish I could write like shambo. She said it best. Agree with all.

    Bookmark   August 10, 2011 at 12:42AM
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I have no idea how the word "backwards" in my first paragraph got changed to "backwoods." Sometimes spell-checker isn't all that helpful.

Hope you got the idea of what I was trying to say.

    Bookmark   August 10, 2011 at 2:08AM
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Maybe you explain to her that if she wears depends no one knows it. If she wets herself everyone around her will know it and dignity goes out the window.

    Bookmark   August 11, 2011 at 2:52PM
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