Family ... Relationships
You Look Like My Mother - But What Have You Done With Her? A Journey into Advanced Aging
By Maureen Hildebrand
If asked for the most universal issue I've encountered during my career as a Case Manager, I would have to say that it's the difficulty families have in accepting the physical and mental changes in their aging loved ones. In some cases, the non-acceptance translates into downright denial, which makes breaking through that mind set one of the most challenging (and important) roles for the Case Manager.
Here are some phrases you may relate to or that may sound familiar to you and your family:
- "My mother is very independent", or "She does everything herself."
- "You don't need the walker/cane anymore."
- "My mother is still totally with it."
When families are separated by long distances from their loved ones, this theme of unrealistic expectations is common.
I dealt with a man living in Arizona whose 83 year old Mom was in a nursing home in New York for rehab following a fall and subsequent broken hip. His mother had been living with, and was the primary caregiver for, his 50 year old sister, who suffered from a serious mental illness.
In my phone conversations with him, he presented as angry, demanding and unrealistic. "My mother has to go home and take care of my sister," he would say - or he'd give instructions to the Social Worker at the nursing home, such as, "Send her home in a van with a staff member to accompany her just for a day, so she can pay the bills."
My involvement in this situation was primarily for the man's sister. There were concerns about her ability to manage living alone. Could she handle the finances? Would she stay on her medication? Was she able to keep the apartment clean?
The first time I met her, she was guarded and almost didn't allow me in to speak to her. In subsequent visits, I would come to learn that her allowing me in was out of a strong sense of not wanting to be rude and that culture may have played a part in it. The second time I went to see her, there was no answer to my knocking and I noticed the door lock had been broken.
Upon returning to my office and making a few phone calls, I found out that the psychiatrist's office called the crisis team because she didn't show up at the clinic for her medication injection and she was now hospitalized. To me, it was a relief that she was safe, but her brother was not happy about it, to say the least. He told me that he didn't trust anyone in the mental health profession - not psychiatrists, social workers, or case workers. He thought that if his mother would just go home, everything would be back to "normal". His mother was nowhere near ready for discharge, according to reports from the nursing home, nor would she ever be able to resume her previous caregiving role, with her disability and advanced age.
After numerous unsuccessful attempts of the hospital, nursing home, clinic and myself to get this man to realize the gravity of the situation, I came straight out and said, "I think it's time you take a trip to New York and make a plan for your mother and sister." There was silence at the other end of the phone. I wondered if I'd pushed him too far and lost him for good. I don't remember how that call ended, but I didn't hear from him until several days later. When I called the nursing home for an update on his mother, I discovered that he had been to New York with his own son. The nursing home Administrator said that he was surprised by how much his mother had aged and that he finally realized she needed people taking care of her.
His hostility toward me was gone, since he faced his family in person and concluded that I wasn't the enemy. He was faced with finding a nursing home for his mother that was located near him. He wanted his sister to either move in with him and his family or try to find a housemate to share expenses with her. Neither choice sounded ideal for his sister, but having him on board was decidedly better. There was improvement - I wasn't asking for perfection. This was progress and it was good.
It makes me pause and think about a difficult time I lived through with my own son while he was in high school. He needed several calls to get out of bed in the morning and on one occasion, I was short of patience and yelled his name until he jumped up and got ready. As we were getting into the car, he looked at me and said, "See, you only had to call me four times today - that's progress!" I was stunned. After dropping him off at school, the defenses I didn't know were up, went down as I drove away, and I burst into tears. I cried all the way to work. What was going on within me?
First off, I indentified the guilt - how could I have lost my cool with him, when he's doing the best he can? Then it dawned on me - this is his best right now. I was expecting more, and therein lay the sadness - a mother's hope and prayer for total health and wholeness in her child was torn apart. It was too painful to accept the reality of the present, so I guarded against it. But in my non-acceptance, I was coming from a place of reaction rather than response and making matters worse.
I learned the hard way that denial leads to frustration. It leads to trying to get a person to do things they're not capable of and having unreasonable expectations. Attempting to control another's behavior is a lesson in futility.
Maureen Hildebrand has 10 years experience as a Case Manager delivering services to the adult care population in both public and private sectors. She has a Master's in Public Administration with a specialization in government. Maureen is currently working as an Elder Care Consultant based in Putnam Valley, NY and her contact information is seniorservicesspecialist@gmail.com.