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Author Topic: Elderly BPD MIL broke her ankle  (Read 307 times)
pursuingJoy
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« on: November 12, 2021, 10:05:25 AM »

BPD MIL has serious balance issues. H has been trying to get his mom to use a cane for months. Three weeks ago, she fell face-first onto the sidewalk and an ambulance was called. (This was the day before H was going to take a whole day to himself to prep his hunting ground by putting out corn, cutting back trees, and fixing the deer stands, one of his fav activities. Coincidence?) Last Friday, her little dog pulled her over and she broke her ankle. (The eve of opening day of hunting season, H's favorite day of the year. Coincidence? Thankfully he made sure his mom was ok and still did what he loved to do, even though he was party miserable and worried about her.)

H became very anxious and for two days, I was bracing to enforce the 'she's not moving in' boundary because he was dropping comments like leaves in fall. Thankfully the intense level of care she needed became quickly evident and he became accepting of the help from her local family (2 brothers, a sister, two cousins, and H's oldest daughter). The very good news about all of this:

1. For the first time, H expressed frustration with her choices and refusal to take care of herself. He said last night that it makes him sad, it affects him, but he cannot force her to do anything. Takes me back to advice that I think GaGrl gave me - step away and let him handle her, he will experience the frustration firsthand and this will allow him to reset expectations.

2. For the first time, H expressed appreciation for her living arrangements. Family has stepped in to help her use the bathroom, take care of the dog, make medical arrangements - things he and I would have been hard pressed to handle on our own. If she moved here, she would ONLY have the two of us. The gravity of that is setting in.

3. H is hopeful that she will realize how important it is to take care of herself and she'll start taking her health more seriously. I verbally expressed support for his hope. I didn't say that the way she is soaking up all the attention indicates the opposite, that she'll repeat this behavior. Her irresponsibility is being rewarded with lavished attention and fussing. Maybe I'm wrong. I hope I am.

He's spent the last few days with her getting her ready for surgery today. She will be in a rehab facility for 3-4 weeks - this is a HUGE step for H to accept. He was always insistent that she would NEVER be in extended care, he wouldn't allow it, it was his obligation to help her. 

He calls me for 5 minutes at night to say goodnight, and each time she has found a way to desperately need something immediately that cuts our call short. Last night she need the end of her bed lifted slightly. (insert eye roll) I plan to ask him to call only if he has time alone.
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« Reply #1 on: November 12, 2021, 10:44:52 AM »

Oh, dear...not a good turn of events! I'm so sorry.

If it helps your H get his head around it better, surgery and rehab is NOT the same as long-term nursing care. Many people in their 40s and 50s have surgeries that require rehab (knee replacements, etc.). It is very, very important that your MIL receive the aftercare and physical therapy that will build her strength and allow her to be home and independent again.

Here's the sticker...if MIL doesn't work hard enough at physical therapy, her core muscles will weaken and hinder her recovery. The PTs at the rehab facility won't be easy on her, and she may chafe at that. Your H may bear the brunt of the complaints. Again, let him do this.

Under no circumstances can she move in with you with the level of oversight and care she will need going forward. Your H needs to come to that realization himself.

Assisted living?
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« Reply #2 on: November 12, 2021, 11:11:55 AM »

Here's the sticker...if MIL doesn't work hard enough at physical therapy, her core muscles will weaken and hinder her recovery. The PTs at the rehab facility won't be easy on her, and she may chafe at that. Your H may bear the brunt of the complaints. Again, let him do this.

Great insight. When she complains, H blames me as the reason he can't do or be more for his mom. The situation plus the work I've done to remove myself from the triangle is exposing reality for what it is. I just need to brace myself for all the feelings they'll experience in the weeks to come. I am dreading Thanksgiving.

Assisted living?

Some days he himself brings this up as a viable option. Other days it's like he forgets it's an option and he passionately states that he would never 'place his mom in a home.' Reasoning that assisted living isn't a nursing home doesn't go anywhere. I think what he really fears is his mom's emotions in response to any next move.
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« Reply #3 on: November 12, 2021, 11:23:44 AM »

Can you remind me of your MIL's age?

My mom was SO independent for so long -- I have to remind myself that some parents reach aging issues earlier than she did. She drove til she was 91, went to water aerobics weekly til age 92, never missed Sunday School and church services.

But the brutal truth is that once she broke her ankle and had pneumonia at 94, the physical care required when she came home from rehab facility was more than I could do by myself. If her caregiver, a CNA, had not been available five days a week for bathing and personal care, I could not have had Mom at home. And while Mom could be demanding, she was very appreciative -- her few BPD traits did not arise in her later months.

Just stay realistic about the level of care required...rehab is medical, independent apartment living in a senior community can be a bridge, assisted living provides help as needed, then the level of care can reach long-term nursing care or home hospice (which we did).
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« Reply #4 on: November 12, 2021, 11:31:34 AM »

And so it begins.
Here's the sticker...if MIL doesn't work hard enough at physical therapy, her core muscles will weaken and hinder her recovery. The PTs at the rehab facility won't be easy on her, and she may chafe at that.
This is the truth.  This is exactly what happened to my mom.  She had four surgeries for knee, hips, and back, and NEVER did her physio exercises.  Now she is 85 and weak, and can't walk, and refuses assisted living offerings.

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« Reply #5 on: November 12, 2021, 12:02:10 PM »

M, do you have any advice to encourage MIL to take PT seriously? Anything work for you?

MIL is 73 but I'd put her health at late 80's. She has smoked heavily most of her life. Drinking was a vice for a good while, I think she's cut back some.

Thanks for sharing your experiences. I agree this is just the beginning. She wasn't doing well before this. She has been hospitalized for one thing or another about 5 times over the past 6 months. It seems like the issues are often attached to bad choices, but with a touch of plausible deniability. Eg, supposedly her Dr. prescribed an alternative antidepressant and never told her to stop taking the first one, so she was taking both at the same time and she got really sick. (I was surprised she was actually taking her prescribed antidepressants, because to date, she had refused.)

So true that people age at different rates. My grandma died at 92 and was living independently and successfully until she died. My mom is 69, works full time, is physically active, walks, cooks, and looks about 30 years younger than MIL.

Aging is not for the faint of heart and I get that. It's hard to accept you can't do what you used to do. Your body fails you and may be in pain. You've lost independence, friends and family. But watching this unfold, I don't want to age like MIL. I hope I make choices that will offer me the option not to.
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« Reply #6 on: November 12, 2021, 01:01:09 PM »

I am 69, my husband is 72, and we are nowhere near appearing as aged. I want to keep it that way! Although I admitted this morning that I just can't paint the master bedroom with 9' ceilings -- I'll just have to pay someone.

My husband is very aware of life decisions and genetics that affect health. Both his parents were heavy smokers and each died in their mid-sixties. As soon as H got a Type II diagnosis, he modified his diet, started meds, and upped his exercise.

Seeing the elderly struggle is a difficult way of preparing ourselves for what is ahead.
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« Reply #7 on: November 12, 2021, 02:39:38 PM »

M, do you have any advice to encourage MIL to take PT seriously? Anything work for you?

I really wish I had something to offer PJ.  H and I have both religiously done physio, not just as rehab, but as strengthening as part of aging (I'm 59, H is 65).  Like others here have said, I am determined not to age the way my mother has.  I know that strong people stay younger longer, so I have a strengthening and cardio routine I do when life doesn't get in the way.  Our D was a talented athlete whose soccer career ended early because of injury, and surgery that was unsuccessful.  But before her soccer career ended from the injury, she did physio religiously (sometimes two hours a day starting from the age of 16). Now she's a physiotherapist just beginning her career (just got her first job out of physio school! Way to go! (click to insert in post))  My point being, that my mom was living in a family culture of injury, pain and PHYSIO, and still CHOSE not to do hers.  We bought her weights.  Took her to physio appointments.  Helped her practice the exercises.  She never did them on her own.  If someone had babysat her and done them with her, she probably would have, but who can do that every day?  She had H and D and I around her all doing physio, so there were lots of role models, and a culture of belief in physio, but she still never did hers.  Why?  I'm speculating, but I believe whole heartedly that it was because it wasn't "fun" and she didn't "feel" like doing it.  My mom only did what she wanted.  If it wasn't going to give her instant gratification, she wasn't going to do it.  Full stop.  Furthermore, if someone (her surgeon, physiotherapist, family member) told her something would be good for her (i.e. physio to strengthen the muscles around all those surgical incisions), then she would rebel and not do it.  Especially if it wasn't fun.  Some people call her rebellious.  My elderly services consultant calls it "Pathalogical Demand Avoidance".  Perhaps everyone should have used reverse psychology and suggested physio would make no difference.  BPD is such a wretched disease.  You can lead a horse to water but you cannot make them drink.  I frustrated myself all of my life believing I could make a difference for my uBPD mom.  I have tried so hard. I couldn't, and I failed.  When I look at her now, it feels like it was a waste of energy and my time, which I could have better spent looking after myself instead.  I would have less of my own health problems if I had lived a more active lifestyle, and had more fun, and spent less time being the perfect _______(career) and perfect daughter.  I've just accepted now that mom's gonna make the decisions she's gonna make (because of her distorted thinking or feelings) and there's nothing I can do to change that.  All I can do is watch it unfold in front of me, and manage myself as best I can.  Sometimes I manage well.  Other times (like recently with her eye emergency) I don't manage well at all, because she completely hijacks my life with all her medical emergencies.  Like you said in your first post, these medical emergencies bring lots of attention.  I believe that BPD's also need to be in crisis.  If there isn't one, they create one.  It's their normal, where they feel the most comfortable.  Having no emotional skin, crises come easily.

Does your H have siblings?  Do they help with H's mom?  Is your H an "only" (or a functioning only if the other sibling(s) don't help)?  It sucks to be alone and yet feel so responsible.  At least I am not in denial about my mother's BPD.  I am still hopeful that your H might eventually come around to seeing that he needs to change how he reacts to his mom.  But if he doesn't, it's going to be rough.  At least you can see it years in advance, and prepare yourself and him in whatever ways you can.  I didn't see all this (or get educated about BPD) until two years ago.  I wish I had learned all this a few decades ago.  Honestly, I may have considered moving away before my mom got old, if I knew then what I know now.  That's just my truth.  Hopefully things will work out differently for your H and MIL.  I'm kinda beaten down by it all, and know that its only going to continue to progress and get worse as my mom ages further (she's 85).  Yesterday in a text she spelled "boat" as "bote" (we're all in the same bote).  That's her dementia.  She used to be a good writer.

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pursuingJoy
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« Reply #8 on: November 12, 2021, 03:39:11 PM »

I've just accepted now that mom's gonna make the decisions she's gonna make (because of her distorted thinking or feelings) and there's nothing I can do to change that.  All I can do is watch it unfold in front of me, and manage myself as best I can.  

The progress you've made is just astounding to me. You're doing great, M, even when it doesn't 'feel' good. I think the hardest part about watching things unfold is allowing BPD loved ones to navigate the consequences without jumping in to rescue or alleviate, and with aging, it's constant questioning of what's BPD and what's normal aging...and then questioning whether that matters. It's brain-draining.

I believe that BPD's also need to be in crisis.  If there isn't one, they create one.  It's their normal, where they feel the most comfortable.  

I believe this is why MIL doesn't do anything proactive about her health. My counselor once explained to me that it takes a great deal of courage to heal and stand on your own. Healing would mean less attention and that would be the worst thing for MIL. I absolutely believe she would rather fall and break her ankle than avoid harm and risk losing attention.


Does your H have siblings?  Do they help with H's mom?  Is your H an "only" (or a functioning only if the other sibling(s) don't help)?  It sucks to be alone and yet feel so responsible.  At least I am not in denial about my mother's BPD.  I am still hopeful that your H might eventually come around to seeing that he needs to change how he reacts to his mom.  

H is alone. From what I can gather from H and family, his only brother was the scapegoat child, and potentially had BPD himself. He committed suicide at 24. About 10 years later H's dad died. This is a lot of loss and essentially a bottomless pit of glue to keep H attached to her. She draws from the well frequently. It takes so much courage for a child of a parent with BPD to face reality, but the loss H and MIL makes me think it's impossible. I've pretty much given up that he will ever really see clearly.

 Yesterday in a text she spelled "boat" as "bote" (we're all in the same bote).  That's her dementia.  She used to be a good writer.

It would be hard for me to watch my mom decline and lose the ability to write. I'm sorry, M. I'm so sorry that you don't have the mom you deserve. I'm sorry she can't appreciate all of your hard work and love and time and care and thoughtfulness. I wish she could appreciate your amazing courage in setting boundaries with her, the things you've accomplished in your career, and your success as a wife and a great mom. You deserve that appreciation.
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« Reply #9 on: November 12, 2021, 03:44:05 PM »

One suggestion...

The rehab facility will schedule and monitor progress, and then you probably can arrange for home health assistance when she goes home. Mom got three PT visits a week for several weeks, then 2x, then once a week for a total of 12 weeks. The physical therapists gave her a set of exercises to do every day between PT sessions.

So since her caregiver was a CNA who had worked in a rehab facility, we arranged for the caregiver to work on the exercises every morning after Mom had her bath.

Maybe arranging for a caregiver to focus on PT exercises will help keep her strength so that she can maintain independence, plus have someone who sees her every day outside family.
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« Reply #10 on: November 12, 2021, 05:49:46 PM »

Oh PJ.  You have so much empathy.  

Thank you.  It doesn't feel like I'm doing great.  I don't see it probably because I'm living it day to day. But I SOO appreciate hearing it objectively from someone else.  So, just thank you.  You brought tears to my eyes, but this time the emotion was from validation and an intense feeling of appreciation, instead of the despair I so often feel over my mother.

I believe this is why MIL doesn't do anything proactive about her health. My counselor once explained to me that it takes a great deal of courage to heal and stand on your own. Healing would mean less attention and that would be the worst thing for MIL. I absolutely believe she would rather fall and break her ankle than avoid harm and risk losing attention.
 Absolutely.  This describes my mom too, perfectly.  All those medical issues and falls resulting in fractures or broken bones bring a ton of care and attention, not to mention another crisis, which they seem to need to exist.  No crisis?  Gotta create one...

H is alone. From what I can gather from H and family, his only brother was the scapegoat child, and potentially had BPD himself. He committed suicide at 24. About 10 years later H's dad died. This is a lot of loss and essentially a bottomless pit of glue to keep H attached to her. She draws from the well frequently. It takes so much courage for a child of a parent with BPD to face reality, but the loss H and MIL makes me think it's impossible. I've pretty much given up that he will ever really see clearly.
I hear you about giving up he will see clearly.  You know your man and the dynamic.  I am so sorry for all the losses.  Man are there a lot of them - the brother, the father, and the loss of not having an emotionally available healthy relationship with a healthy "normal" mother (even if he isn't fully aware of the latter).  And the losses have rippled out to you, and the next generation too.  

I hope your H can continue to let her other "family" help, and not himself feel like he isn't doing enough.  To be honest this has been a journey for me.  I have had much help "growing" along the way with this problem.  For example, recently I was telling the elderly services consultant from our local health authority about how much mom's friends are doing to assist her.  Mom has enlisted them, and FOGs them too.  This I know.  I was expressing how guilty I feel that they do so much (they take turns).  The consultant came back with "that's fantastic! Let them!"  Hearing that was shocking for me. It was like being woke up with a bucket full of ice water splashed in my face.  I would predict that your H could come to a time when he struggles with the guilt of letting other people (even if they are her family) help her.  He will feel like it should be all him, because he has been conditioned by her to feel that.  Anything less will mean he's not a good son.  I've struggled with trying to be the daughter she wants me to be.  But, I've come to the stage where I have accepted I cannot do all she wants (and what she wants isn't reasonable). Now I am desperate, so it's easier to let other people help.  But I don't get the feeling your H is quite there yet.  I just wouldn't be surprised if he struggles with this feeling of needing to do more, and not letting other's do what he feels like he should be doing.  FOG. My advice would be to expect this, and plan for it.  You are a good planner PJ.  Since your H is alone like I am (an "only"), it could be helpful if a T or some other person he will listen to, gives him the same message the elderly services consultant gave me.  I really needed to hear that message.  It was another piece of the puzzle for me.

Excerpt
She will be in a rehab facility for 3-4 weeks
.  I'm curious about this.  Does she visit this facility on an outpatient basis, or is it a residential facility?

My mom has had multiple broken bones from multiple falls and been in a wheelchair for months as the fractures healed.  Where I live there is a hospital, and medical and physio clinics, but no "rehab facility".  Different jurisdictions (states, provinces, countries) will provide differing levels of care for the same injury, but I'm just floored that she gets a rehab facility for an ankle break.  Just, wow.  That's fantastic Doing the right thing (click to insert in post) and should help a LOT.
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« Reply #11 on: November 12, 2021, 10:14:34 PM »

When my mom was in her late 50s, she tripped on her property (the hill she wanted to die upon). I was living in Oregon at the time, she in Cali. She got care and help.

Many years later, as her hoard house fell into more decrepitude, she had other issues. I was back by that time and supported her through a mastectomy and overian removal. I was only a little over 100 miles away by that point, with a baby and still with my later ex. Fast forward...

Into her mid 70s, she was still trying to die on the hill, though not on purpose. This was after she came to live with us the winter and then returned in the spring. It was the better part of a year after APS got involved, that repeated calls to EMS was enough for Adult Protective Services to remove her from "the hill" and the horrible Hoard Home, to place her in basically a strip motel in town nearby Services. It was actually a decent little community of people, and creek side.

That was both the natural (she was no longer able to take care of herself on the 5 acres in the woods) and logical (authorities had legal means to force her into a safer environment) consequences of her actions.

I had done what I could, but as my T said, "you have a home, not a hospital, and your mom needs professional care."

Over much guilt, and with support of the Good people here, I realized that in a way I had been enabling my mother (financially as well). By doing what I thought was my Sonly Duty, I had been shielding her from the consequences of her actions and inactions.

The "talk to truth" may not go over well. I had tried it with my mom when on her early to mid 60s, out of frustration: "I should take you to court to see you're taken care of!" Not my best moment, and it blew over quickly. She smirked and replied, "I'd like to see you try!" She always thought that I was trying to steal her property... *sigh*

sometimes it's better to hand it over to the professionals and support as best you can without losing yourself. That doesn't mean that that's no implicit explicit guilt. The first is what we tell ourselves; the second is what may be said by others.
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« Reply #12 on: November 13, 2021, 06:30:18 AM »

Watching my father age and get weaker was hard. I wanted to do more for him but BPD mom's verbal and emotional abuse escalated at that time. I realize it was stressful for her but I had my own family to care for and had to have some boundaries.

I like the idea of letting your H experience his relationship with his mother. If you intervene, you become the persecutor in the Karpman triangle. Your boundary is to do something else with your time, let him deal with it as much as possible.

Let him miss his hunting trips. If he becomes overwhelmed- let him decide what do do about that. He seems to be learning through experience what his limits are. I think we all have an idea of what we think we need to be doing, but the reality is sometimes different.

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« Reply #13 on: November 15, 2021, 02:07:38 PM »

The rehab facility will schedule and monitor progress, and then you probably can arrange for home health assistance when she goes home. Mom got three PT visits a week for several weeks, then 2x, then once a week for a total of 12 weeks. The physical therapists gave her a set of exercises to do every day between PT sessions.

Thanks GaGrl. This is a great example of the many options that might be possible.

H came home after her surgery saying how proud he was of his mom, that she seemed really motivated to get better. The next day she called and all I heard was his side of the conversation, he said "You failed? Failed what?" She told him she wasn't eligible to be transferred to the rehab facility because she was in a cast. It seemed really odd to me that the day before, H was told by the surgeon and staff that she could/would be transferred to the rehab facility. Once H got back home, MIL called with a different story, saying they were telling her she'd have to be transferred to a skilled nursing facility until she was well enough to get into a rehab program.

Long story short, H's oldest, an occupational therapist that works for that hospital system, made some phone calls and we are back to plan A. MIL is  going into a rehab facility starting today or tomorrow. H admitted today that his mom may have been avoiding the work.

I'm fascinated by all of this. At the moment, I'm not being blamed for his perceived inability to care for her. MIL is in excellent spirits, high on the doting from everyone. MIL being in good spirits means H feels at peace. He's accepting help from family. He is taking the entire week to hunt. Thankfully I've had the distraction of unexpectedly hosting my brother, his wife, their 3 kids and two dogs for the week so I don't look completely like the uncaring daughter in law.

This is the top of the cycle. She'll crash, likely when she goes home. Her anguish will make him feel guilty, which he'll turn on me. I am hoping that he sees how unrealistic it would be to move her to our city, where she would only know the two of us. The family that lives around her has been an incredible support. Many hands make light work.

Notwendy I can't imagine how hard it was to watch your father get weaker with age, and deal with your mom's outbursts. You're right - the ideal is one thing, reality can be another.

sometimes it's better to hand it over to the professionals and support as best you can without losing yourself. That doesn't mean that that's no implicit explicit guilt. The first is what we tell ourselves; the second is what may be said by others.

I've enabled too. We're all doing the best we can with what we have. We were conditioned to enable, given enormous burdens by our families of origin. And people do say the darndest things at the worst times and heap the guilt on. I'm glad you were able to listen the professionals and take their advice.

If she's not careful, H's daughter is going to get caught up in their triangulation - she is pushing pretty hard for PT, and once MIL starts to cry, H will come to mommy's rescue.

He will feel like it should be all him, because he has been conditioned by her to feel that.  Anything less will mean he's not a good son.

 I just wouldn't be surprised if he struggles with this feeling of needing to do more, and not letting other's do what he feels like he should be doing.  

EXACTLY how he feels. He couches it in terms of right and wrong. Being a good son and taking care of all of your mom's needs in her old age is the 'right' thing to do. My perspective was that there are many scenarios and ways this could work out, but he only saw the black and white, all or nothing. The in-between scenarios are starting to expose themselves now and I hope he realizes that there isn't one way to do this.

I'm curious about this.  Does she visit this facility on an outpatient basis, or is it a residential facility?

That's fantastic Doing the right thing (click to insert in post) and should help a LOT.

Given her condition and the fact that she lives alone, this is a residential rehab facility. I know I was surprised too.  I didn't know such things existed. I wish you had this option near you!

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« Reply #14 on: November 15, 2021, 07:40:32 PM »

Residential rehab and long-term care are often housed in the same facility, so it's difficult to know they have separate guidelines. Mom's facility also had lovely Assisted Living apartments, all on the same grounds.

I found I had to follow up on what Mom told me. She was too optimistic -- she would brag that she took ten steps in physical therapy, the the therapist would say, no, she shuffled a few steps.

She may crash when the PT gets hard.
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« Reply #15 on: November 18, 2021, 08:21:59 AM »

She was too optimistic -- she would brag that she took ten steps in physical therapy, the the therapist would say, no, she shuffled a few steps.

She may crash when the PT gets hard.

Thanks for the heads up. H came home from visiting his mom yesterday. After days of insisting she couldn't put any weight on her cast, yesterday he bragged that she had walked 40 ft (?) unassisted with a walker that morning before he arrived. My first thought was, "Did SHE tell you that, or did the staff?" Laugh out loud (click to insert in post) time will tell.

Since I'm not even close to caretaking her, I don't necessarily point out all that I see. I ask a few intentional questions here and there but mostly try to offer support. He keeps expressing hope that she'll work hard, but puts it on her to do the work. I asked him last night if he had thought about options in case she doesn't put the work in, and he mentioned an assisted living option where she lives. We'll see. She loves her dog and if they don't let her have her dog there she'll become very sad and lay on the guilt. H doesn't manage that well yet.

H has been hunting most of this week, though he did take a day to go see her yesterday. I'm really proud of his measured emotions and the way he's balancing his priorities. This isn't something he's done before. The jury is still out, though...I wonder if he feels at peace at the moment because she is happy and thriving on the attention. Everything could change the moment she starts to dysregulate again.
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« Reply #16 on: November 18, 2021, 10:54:58 AM »

Mom's rehab facility had a social worker who conducted team conference calls (during Covid lockdowns) once a week -- the SW, me, the physical therapist, and the occupational therapist. That's how I found out Mom was not being realistic. Your H can probably set that up.
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« Reply #17 on: November 19, 2021, 11:50:47 AM »

What a great solution! I'll tuck that away and mention it at an opportune time! Thanks GaGrl.
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