Friday, May 24, 2013

Wednesday, August 22, 2012 CJ asks

Q: How do I tell her grandchildren that my mother (for whom I've been providing care in my home for 5 years) is not up to a family reunion?

Without contacting me about it in advance, my niece has recently sent an email to everyone in her immediate (nuclear) family that she would like to have a family reunion that includes my mother, who lives in our home.  My niece lives several hours away, so the "reunion" essentially will involve my having the reunion here, because my mother only rarely leaves the home and mostly leaves in order to receive medical treatment. 

 

My niece has not seen her grandmother in about two years, and my mother is now fully into stage 5 of alzheimer's. 

 

I suppose the question I really should be asking is how do I tell my extended family that my mother is no longer really interested in them?  I actually have asked this question, in a way, before. 

 

My mother has taken to telling rambling stories about her past, putting things together that did not happen in the way she "remembers" them, and mixing whole decades of information up to the extent that it is difficult for me (who was, in a sense, the "family historian" among us) to decipher what she is saying.  Though I live with her and usually can figure out where she is in her thinking, even I have difficulty sometimes. 

 

I don't think my mother, if she had her complete senses, would want to be seen in this way by her grandchildren and great grandchildren.  No one would want to be seen this way, if they had a choice. 

 

As her primary caregiver (though we now have assistance in the home on a nearly daily basis), I have to deal with the fallout from visits from my sisters and their families.  The fallout is sometimes mild (needing to stay in bed for two days) and sometimes severe (delusions and disorientation for a week or so). 

 

If there is a large family gathering here, it will exhaust my mother, and the fallout (the events that will occur in succeeding days) is quite unpredictable, but it will mean more careful supervision of my mother's health (blood pressure taking, vigil while she sleeps, etc.) than would normally occur.

 

I feel it's too late for a "family reunion" to have any meaning for my mother, and I guess, to preserve her dignity and the good memories of her that her grandchildren and great grands might have, I think such events are best left undone, so the next generations can remember my mother as the vibrant, ebullient, vivacious woman my mother once was.  

 

I should add that my mother herself this evening said she was not up to such an event when I floated it past her and my husband.

 

How do I tell the family that it might be past the time to have such things that would involve their parent, grandparent, great grandparent?  She doesn't care about them and their stories about their lives.  Her needs and her life are what matter to her.  She led a long, good life, was a giving mother and grandmother, and she is tired now and wants it all to be about her now.  My family doesn't seem to get it.  And I feel in the middle of it all, as her primary caregiver.

 

Any suggestions as to how to deal with this?

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Answers (3)
Carol Bradley Bursack, Health Guide
8/23/12 8:27am

Hi CJ,

Good to hear from you again. You've mentioned your family and their denial about your mom's health problems. From what you've said in the past and also here, I don't see any "tactful" way other than just telling them that she is past the time where a family reunion will have any meaning to her, and that she would be utterly exhausted by any attempt to attend one or to have one at your home. 

I've seen this often, where extended families who don't/won't understand dementia, or for that matter any late stage disease, think it's kind and thoughtful to have a big event and include this person. In effect, it is too late. You'll have to stick up for your mom and in the end you'll have some family members mad at you. We can't win, can we? I just discussed this with a woman at the grocery store was trying to convince her family that their grandmother was in no condition to travel a long distance and attend a wedding, about which she'd understand nothing. 

 I really haven't given you much advice except follow what you know to be true and be ready for fallout. I'm sorry you have to cope with this. You've been through so much already.

Blessings,

Carol

Reply
8/24/12 3:29am

Hi, Carol, and thanks for your reply.  Your message came in, it seems, just as I was composing my email message this morning.  After receiving my message, my niece evidently got the point.  This is not a young woman, and I learned yesterday that one of my sisters *had* tried to dissuade the niece from attempting a "reunion" that included my mother.  The most positive spin I can make of the situation is that my mother's grandchildren must have good memories of family gatherings long ago.  But this recent suggestion came out of the blue from someone who has not been in touch with us here for two years. 

 

My mother is way past wanting to take part in such events.  Though we keep photos of her family right next to her chair, she really would rather just talk about her own life and some of the events that she (now, misremembering) thinks took place.  Her sense of chronology is so different from the way that the events she describes actually occurred, but this is the world she lives in now, a very special world that anything like a family gathering could seriously negatively impact. 

 

My mother no longer can reliably remember the names of the few assistants we have here in the home to work with her, and these are people she sees every day.  Two of my three sisters are finally getting it, these last 4-5 weeks, because they have seen my mother.  The other one, the mother of this niece, is only occasionally in touch with us. 

 

Thank you again for the support!  The issue of visiting is still on the table, but that of "reunion" has now been better understood as inappropriate.

Reply
Carol Bradley Bursack, Health Guide
8/24/12 5:16am

I'm glad to hear this, CJ. Progress!

Take care,

Carol

Reply
8/23/12 10:19am

CJ,

 

So sorry that you have to deal with this. From what you wrote about your sisters when they came to see Mom, I can tell that it is so much work for you to deal with them all.

 

This reunion has many different issues. First of all, a family reunion does not mean the member can force other people to attend at the same time for sure. Second, your Mom probably cannot travel with ease, so you can easily tell her sorry Mom cannot travel and you need to help Mom so you cannot visit her. Please come to see us sometimes!

 

Frankly I still think the person with dementia needs company or friends or peers. Even if she does not know the family, it is still some comfort to know she is with people. I don't know about your Mom - she may not like to be with people or she may like to. The only problem is the family may not know how to cope and may end up blaming you for something fishy to them. The right thing to do is for them to see her at times in small group or in one or two persons. But if they cannot visit her, so be it. Mom does not need to visit the grandkid. If the family know that Mom is very sick with AD, they should understand. If they don't, you probably just have to show a letter from her doctor (one last thing to do.)

If the family can accept that they can see her but know that Mom cannot react normally, they may get used to it. Mom does not have to know the family, you know, but she may still need to be around people at times if they come to see her. She may feel they are familiar. But Mom does not have to know them. The other thing you can do is to update the family periodically about her state of mind. Quote some example and etc. If you are busy, your husband could post it for you. Like a quarterly note or so.

I mean, if the familly members have the issue dealing with Mom, it is their problem. You can also suggest that they buy a book about Alzheimer's and learn about it.

 

Hugs,

Nina

Reply
8/23/12 10:47am

I just read about the part that you want the kids to remember her best part.

I think it also helps the kids if they know how to take care of grandmom or at least understand what caregiving means. My husband wants his late Dad's friends to see the normal photos while his Dad was not sick for memorial service. I understand that people want to see the "normal" part of a person. Sometimes the family try to shield her from strangers and etc.

But what about family caregiving? A family do take care of their own people. It is a right thing to do so why is that the kids cannot know what is wrong with grandma or try to help her out? Maybe the kids can read her a story if they do visit her?

 

There is this thing about visiting the elders with dementia. In the NH I saw, many young kids did come to see the elders although the elders are not normal.

Young kids from the school nearby visitied the elderly often. I think it is a learning curve for the kids to know that the elders can get dementia and this is the way it is. What if the kids or family get sick like this one day? It is a lesson for the family to learn. A family is not just for success or being normal, it is also for helping one another. Of course, if the kids are too distant, it is another matter and you can very well keep them at a distance for a good impression.

 

Regards,

Nina

Reply
8/24/12 3:55am

Hi, Nina.  Many thanks for your concerns and suggestions here.  I haven't been on here in awhile, so the backstory to some of our current situation is something you haven't heard much of. 

 

Beginning in March, we began hiring assistants who come almost daily to work with my mother, not just on the days I am at work, but at all times, so that she can have the companionship she deserves.  They watch old movies, talk about days gone by, do jigsaw puzzles (the special ones offered by the Alzheimer's store), do the Daily Jumble (every day--a happy ritual for my mother, who can still do this with assistance), read Dear Abby, read their horoscopes, talk about recent local and national news, and do my mother's daily personal needs together.  At first I wanted it to be the same assistant each day, but I find that because the job can grow old quickly for some people, actually having a few different people here has really been good stimulation for my mother and enables her to make a story of her life that she can tell again and again.

 

My sisters all know - well - about my mother's progress, because I write them messages, perhaps too long messages!, every time my mother has a new kind of "event," or when she has been to the doctor (she goes to several doctors), or has a new assistant, or whatever.  I write emails to all three sisters at least 3 times a week, on average. Even with these emails, my sisters were ending up in total denial.  But over the summer, two of the three sisters came here, so these two do understand - now - what I have been saying for months and months.  They look a bit shell-shocked when they leave my mother's vicinity to report to me that my mother's capacities are now limited.  Sometimes they cry, even with my mother in the room, over our loss of our mother.  Because I am the one caring for her, I know how to carry on past the tears I feel inside, though when I see my sisters' crestfallen faces, it's sometimes hard.  

 

I try to keep them informed as best I can, but it is really a situation that one has to witness.  I feel sorry for them sometimes when I see my sisters' faces as they are coming to terms with my mother's "new normal," but it's important for them to see how things are here. 

 

So if my sisters communicate with their children, there can be no way that the extended family is uninformed about my mother's current condition.  That this niece persisted in wanting to make this plan, despite another sister's attempt to dissuade her, suggests to me that something else (perhaps anxiety about her own middle age) is going on for this niece. I'm just guessing.  This niece's mother is the one who is much less frequently in touch with us. There is a long backstory to this particular sister and her relationship with my mother that I won't discuss here.

 

As for letting young ones see the person with dementia, in general I guess this is a good idea, but if you knew my mother in her heyday, you'd understand that she would want to be remembered as the vivacious, laughing, happy, sensitive, and dignified person she was. 

 

Speaking for myself, I am not sure what good is served by having young children (two of my nieces and nephews have *very* young children) see my mother.  In general, yes, young people need to know about how life ends for some.  But in this case in particular, for my mother's sake and in behalf of her memory, I'd much rather the children heard the stories about her while seeing pictures of her in her youth.  And this is what my mother wants - what she has actually said to me.  

 

It's a tough call, but even this particular niece is now getting it that if she is going to bring her children here, she should first, herself alone, see what she would be bringing them to see.  Her children are grown children; this niece is not all that young, as she was the daughter of a sister who is significantly older than I, the late-life child.  The niece is only about 10 years younger than I am.  She needs to see for herself, though, to see how unfair it would have been to force my mother into something that would be quite overwhelming.

 

Thank you again for your interest and suggestions, Nina.  You are such a great help to us here on this site!

 

Best wishes,

CJ

 

 

Reply
8/24/12 11:38am

CJ,

 

Thanks for the update. It is a long one! :)

Indeed sometimes the family do have some hard ones and you need to deal with them! Like I said, you probably just have to tell the niece that your Mom cannot visit her, that is all. It is good that your 2 sisters are on the same page now. Yes it is hard to see if they are not there daily. It is like a shock when they see her. It is sad. But I think family caregiving is not about mourning the loss? Not yet. Now they should cherish their best moments with Mom. Yes she wants the best impression and no kids,  that is fine. But the sisters should cherish the moments instead of being so sad. One can all recall the fond moments in the future and feel comfort.

What I meant by seeing kids, it is not that she has to hug them. In the NH, the older kids came to play violins and sings. They came for a short time once in a long while to perform. It is like entertainment. I am not saying the elders have to hugs them and etc. In fact, some sick elderly holds a doll like it is a real baby. That is all I am saying. Proper existence by kids can bring them joy.

I was also referring to grandkids. My own folks have at least 3 grandkids who are willing to help my parents and sisters. They are pretty adult now (in the 30s or late 20s.) I am just saying adult grandkids, if available, can help a lot. I know some family even have only grandkids to help out.

 

Hugs,
Nina

Reply
8/24/12 1:07pm

The other point I would like to make is:

I perfectly understand the elders would have said they don't want to be like this. They don't want to have bad impression and etc. However at some point, it is about caregiving. Your family probably want Mom to be the same but she is not anymore. It is not just caregivers' jobs to take care of her. She still needs company and family to be around her in the right way. Yes, I would have said "Don't look at me like this - I am in bad shape." Yet I would need caregiving and love from  the loved ones. I remember I saw one post pictureL the husband continued to feed his wife who forgot him. People asked him why. He said even though she does not know me, I know her. That one way street is enough in terms of family caregiving.

That is all. Sometimes it is not just about good impression. I mean you all know her good impression. Now she is sick so she is in bad shape. But you will always remember her good impression. This does not mean that one denies her existing state that needs care and love.

 

Regards,
Nina

Reply
8/24/12 2:41pm

Hi, Nina,

 

I *think* I understand what you are saying here, but maybe not.  The short version of a reply would be that the sad truth is that two of my three sisters do not *want* to be involved in caregiving of any kind with my mother.  They don't touch her, hold her hand, or, sometimes, even look her in her eyes when they talk with her.  When these two sisters visit, they leave the caregiving still to me to handle.  One will at least offer to take my mother her meal plate, but she will not sit next to her on the little couch nor touch her, walk with her, anything.  The other one who now comes once a week to help me *does* touch her and relate to her personally. 

 

Each family is different, and each existing family dynamic tends to construct what *and* what *not* the children will do for their parents/loved ones.  The sister who now comes once a week to help with the caregiving was closest in age to me, and we all four sisters agree that she and I had a more easy life with our mother than the two elder ones do.  As for the grandchildren, they don't offer to visit much -- all live at least 3 hours away by car, one way -- and so that is not an option. 

 

Each family is different, and some circumstances are not ideal, whether for caregivers or for their loved ones.  In my mother's case, I am fulfilling on a promise I made to my father long before he died in 1993 - that I would always take care of my mother to the best of my ability, whatever her and my circumstances were.  Being the last child, I was the only one who had a chance to be with my parents by myself, as if an only child, so I developed a different kind of relationship with them, I guess.

 

Thanks again for your input!

CJ

Reply
8/24/12 3:15pm

CJ,

 

I am so sorry that your sisters don't touch her? It is so sad. Indeed it is true that your Mom should stay put without being bothered by them. You made a right decision not to see the grandkids since they are far away anyway.

The parents' attitude affect the kids. I cannot imagine why the sisters cannot touch her or look at her at all? I guess my opinion apply to them, not you.

It is so sad. My husband would have touched his late Dad and kissed him. I guess my husband will miss this part for a long time.

 

I am glad you have a good relationship with your Mom and that you are doing a good job to fulfill the promise to your Dad. Kudos to you!

It is true if the family members reject her this way, your Mom is better off with you and the hired help!

 

Take care,

Nina

Reply
8/25/12 8:10am

Hi, Nina.  Yes, it's very sad, but I hear from caregiving services that the situation of my family is actually very, very common.  The WW II years were very hard on young women who were mothers (my mother had two of her children before she was 24).  When the men went away, there were no support services, whether military support services or social services (the way there are now) and few charities to assist these young mothers who had to fend for themselves and take care of the household. My mother probably didn't want to be a mother at that young age, but it was the way of the world she knew, so there she was.  By the time she had the sister closest in age to me and certainly by the time she had me, the war was over, and the family was ready to be a family again.  My two older sisters sort of raised me, for which I have remained grateful.  *They* didn't have any of the same advantages as I.  So it's understandable. 

 

Our situation is also sort of based on a personal philosophy of mine: I believe that most people will always do their best, whatever their circumstances, and so even if they didn't do something the way I might have or might have liked, they were doing the best they could and ought not to be judged against any standard than the question, "Did they do their best, given their circumstances?"

 

You sound like you have a phenomenal family, lucky you!  Thanks again for your input.

 

CJ

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By CJ— Last Modified: 08/25/12, First Published: 08/22/12