I’ve spent father’s day weekend looking at assisted living facilities in Austin for my mother. Currently, she lives in Houston, 150 miles from me, and 3 miles from my sister. Last Friday, her AL called me to let me know they were sending her to the emergency room due to mental confusion and high blood sugar. I was in San Antonio for work when I got the call. My sister didn’t answer her cell phone. I had to track her down through her daughter. Meanwhile, I drove back to Austin from San Antonio. Mom was stable, but had a nasty urinary tract infection that required IV antibiotics. The emergency room nurse also said mom had skin breakdown on her bottom, reportedly from not being changed out of wet diapers often enough.
The following morning, last Saturday, I drove to Houston and visited my mom in the hospital. She seemed to be doing well and was in good spirits. She was coherent and didn’t appear too depleted physically by the UTI. My sister popped into the hospital while I was there. During my visit, my sister and I discussed hiring a caregiver for my mom to keep a closer eye on things. (My sister is not interested in keeping closer tabs. Once-a-week pop-ins appear to be her limit, despite being only 3 miles away.) And then my sister, who is 58, said:
“We have to do something. Especially since I’m retiring next year and moving to Galveston with [husband.]”
Galveston is 85 miles and over an hour and a half away from my mom (and my sister’s current primary residence). Galveston is a 4-hour drive from my home.
“She can move,” I said.
“Yes, she can move,” she answered.
My mother needs to be near one of us. In addition to her plans to move to her beach house in Galveston, my sister advised she plans to spend her summers at my mom’s cabin on Lake Superior, six months of the year. I told her she’ll be splitting those summer with me, as I’ll be retiring within the next couple of years, myself. That caught her by surprise. I found some satisfaction in that.
So, my sister essentially advised me that she’s largely removing herself from our mother’s life beginning next September. Which means my mother will need to move from the neighborhood she has lived in for nearly 40 years. The neighborhood where her friends and grandchildren live. I, being her only living child other than my sister, am prepared to pick up the slack. Doing so, however, means my mother will need to move to Austin. Seeing as my sister plans to absent herself from the country for many months of the year, Galveston is not an option. It’s a 4-hour drive from my home.
Which is how I found myself touring AL facilities in Austin this weekend. The first one I visited greeted me with this sight:
The baby deer on the left was romping about as I approached, with mama standing nearby keeping watch. There are two baby deer in this photo. Can you spot the second?
Take a look at the next two photos for a hint on where he’s hiding.
At the end of the day, I got on a waiting list for one of the ALs I visited. It’s similar to the one my mom’s living in now, but the room is a bit smaller and the cost is quite a bit higher. The selling point is that they offer a higher level of care, and that my mother can “age in place” and not have to be moved again. They can also handle her insulin injections, something new that recently arose.
I don’t know if her need for insulin injections is a permanent thing, or if her blood sugar will settle down once the stress of the infection subsides. It’s been a cycle for the past year and a half, and it seems to be worsening. The UTIs cause the blood sugar to spike. The high blood sugar causes UTIs. And UTIs cause mental confusion, which is often the only symptom of a UTI in the elderly. On Wednesday, the mental confusion looked like this:
Mom: “What are you having for dinner?”
Me: “Fish.”
Mom: “Where did you get it.”
Me: “At the grocery store.”
Mom: “Oh, you didn’t catch it?”
Me: “No, no time for fishing this week.”
Mom: “Well, you could have gotten it at dad’s.”
Me: “What do you mean, at dad’s?”
Mom: “At dad’s house.”
Me: “Where is dad’s house?”
Mom: “You know where it is.”
Me: “Oh, OK, but I just got it at the store this time.”
I assumed it was caused by her blood sugar since they’d zapped the UTI with antibiotics while she was in the hospital. But by last night, the mental confusion looked like this:
Mom: “I’m going to tell you about my bed.”
Me: “OK.”
Mom: “It has metal rails. And I have blankets. And there are four animals. And they are warm.”
Me: “What kind of animals?”
Mom: “I’m telling you about my bed.”
Me: “How are you doing mom? Are you feeling OK?”
Mom: “I called to tell you about my bed. I have blankets and the animals are warm.”
Me: “I’m going to hang up and call the nurse mom. I’ll call you back in a few minutes.”
Mom: “OK.”
She said this while breathing in little puffs. I hung up and tracked down the nurse, who assured me she was fine. I explained to the nurse that the mental confusion was not normal for my mother, and insisted they recheck to be certain the UTI had not returned. The nurse said they’d already ordered a urine culture for the following morning.
I hung up with the nurse and noticed my mother had called and left a voice mail. It lasted over five minutes. This is what she said. Just one word. Repeated slowly, over long intervals, for five minutes:
“Steve?
Steve?
Steve?
Steve?
Steve?
Steve?
Steve?”
Steve is my brother who died in March 2013.
As this is happening, my sister is in Galveston celebrating father’s day with her husband. She has promised to visit my mother Sunday evening when she returns.
So here is my current conundrum: Do I move my mother to Austin when we are reached on the waiting list? (Assuming she is stable.) Or do I wait until we are closer to my sister’s move to Galveston? If I move her now to unfamiliar surroundings, it will be very disruptive. And being completely pragmatic, she may not live until my sister moves, so moving mom to Austin may turn out to be unnecessary. Also, her 80th birthday is in March, and I hesitate to move her before her birthday as all her friends and family (save me) who will attend the celebration are in Houston. On the other hand, if I wait to move her, and she declines further, then the move (assuming she lives that long) will be even harder on her, and perhaps, impossible.
I’d like to be closer to my mother. I’d like to spend more time with her. I’d like to spend more time with her while she still has her faculties. And I’d like to be able to keep closer tabs on her. (And her cat.) But is moving her here the best thing for her? Will she still be with us when it’s time for my sister to move to Galveston?
Does anyone have access to a crystal ball?
As I sort through the variables, I remain booze-free. Although it has occurred to me it might be nice to blot everything out with extreme inebriation, I haven’t. I also gave up sugar last week. I’m at Day 170 on the booze. Day 8 on the sugar. I’m fumbling around for an adequate coping mechanism, but I’m having trouble finding one. Other than writing. And soft, fluffy, purring cats. Those will have to do.
unConfirmed Bachelorette 
Wow. Lots to deal with.
Maybe now is not the time to give up sugar? Or, if it is, make sure you still have some treats that you like. Cheese and crackers is my go to. On a nice plate, so I don’t eat the whole block of cheese!
Think about what works best for your life. It sounds like it would be nice to get your mom close sooner. And less stressful for you.
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Lots of fresh berries. And Texas peaches. But I’m dreaming of topping them with fresh whipped cream.
We’ll figure it out. I’m sure it’s as stressful on my sister as it is on me. I’m probably not giving her enough credit.
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You definitely did not come across as critical of your sister. It sounds like the two of you both love your mom.
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It sounds like you are weighing all the options and will do the best thing for your Mother. Hard decisions are definitely still hard with or without booze, but at least this way you have a clear head! Sending good thoughts to you and your Mother.
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Thanks, Jen. Clear head is nearly a crystal ball.
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I don’t have a crystal ball. My best advice to you would be to trust your gut. The last weeks I spent with my mom will forever be precious to me.
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My gut says to leave her where she is–familiar and comfortable surroundings. And to tell my employers I’ll be cutting back on my hours for the time being. My crystal ball says some audio books are in my future for the trips to Houston. When my sister is ready to move, we’ll work together on a new plan. I have a feeling she’ll make adjustments if need be. As will I.
I’ve had some time to reflect since I wrote this. Simply the act of writing helped clear my head. Writing. And a clear, booze-free head. Who needs a crystal ball?
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Or who needs booze …
You will be coping better without – as this way you get things done that need to be done.
Mover her now or move her later? Well, since she is not able to make the decision herself you have to make it. One way or the other – you will always wonder what it would have been like if you had decided differently. So once you have made a decision (with your sister) don’t look back. You are not deciding that by a coin-throw but give it some reasoning, you decide with empathy – you cannot make a wrong decision.
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You’re right: I will wonder about the decision either way. I want what’s best for my mom. Which may not align completely with my interests. I do know that I like her current assisted living better than any of the ones I visited here.
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There’s a lot to work on but I think you are doing just fine with it all. Clearing your head/mind is a ‘crystal ball’. Go with what feels right. Good luck!
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Thank you, Gert. I think trusting one’s gut is great advice.
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I’m so glad that writing it out gave you your crystal ball. I wish you fortitude in your difficult time. Trusting your gut is the only way, alongside being gentle on yourself. Hugs from me to you x
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Thank you, Bea. The reminder about self is a good one. I’ve been neglectful.
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A huge conundrum. Does your mother have friends who visit her where she is now? If not then it might be better to move her closer to you.
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She has one friend who visits at least once a week, my sister who visits once during the week, and sometimes on the weekend. She sometimes has her over for Sunday dinner, which often includes a long-time family friend and a granddaughter. And then there are the rest of the grandchildren: they visit, but not often. She also has visits at least once a week from a long-term employee/family friend. Once my sister moves farther away, the dynamic will shift so far as visitors. But there would still be quite a few. If she moved close to me, there would be just me, and whoever made the trek to visit her up here. Yes, a huge conundrum.
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Hoo-boy, what a dilemma. I vote for moving her now to Austin. By the time her 80th arrives, she may not even know who’s in the room. Your sister sounds utterly useless. My mother lived to 90, though she was totally lucid. Her body was in very bad shape. Situations are different.
I spotted the second deer in the first photo immediately.
Hang in there with the booze-free life, though I would want chocolate now and then.
I wish you well, truly.
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She’s pretty good cognitively when she’s not in the throes of an infection or other acute medical issue. So unless something major happens, she ought to be OK cognitively in eight months. But it is possible things will shift. It’s possible she won’t make it that long.
Great job spotting the first deer. I watched the other baby romping around while the mother watched over her and did not see the one in the corner until her sibling stood next to her.
After I dry out from the sweets, I’ll definitely add back chocolate. In moderation.
Thank you, Felipe.
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Wow, so many conundrums! Wishing you the best… It sounds like all of your introspective questions regarding the situation and its many options are solid and pragmatic. The thoughtfulness you are approaching this whole thing with will keep you grounded. And your heart is definitely in the right place.
As for the sugar detox – good for you! The hubs and I did a cleanse a couple of years ago, and I found the smoothies in the morning and evenings really helped staunch my sugar cravings during that time. If you just want to use the recipes to help you, and not necessarily jump into the whole cleanse, I think you might find them helpful. The book is called ‘Clean’ by Alejandro Junger.
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I have had the same smoothie for breakfast for quite some time: whole milk, kale, and a banana. I was adding honey. Now that I’ve stopped, I see it was totally unnecessary. I’m going to have a look at the book. It would not hurt to vary my selection. 😉
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Oh, yay! Let me know if you discover any you love. My favorite is the one with lots of almond butter… Have fun experimenting!
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Whew, that’s a lot to take in (to say nothing of having to go through it). Stay strong, and the answers will come. Sadly, I’m fresh out of crystal balls. I had one once, but I’m pretty sure it was defective. It kept showing me how wonderful life would be if I kept drinking, so I smashed the f*$%! out of it.
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I’d say your defect assessment was correct. Smashing your crystal ball must have been quite satisfying. Staying strong! Thanks.
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My mother is 85 years old. Now she lives together with me. My mother cannot live alone at her home (which is 220 Km. from my home) all year because sometimes she has not all her faculties, has heart problems and each month must do her checkup at the hospital. So we decided together that her house will be her holidays’ accommodation. Now she is there until the middle of July: happy with her friends and all her things. We phone every evening. My brother? 😕 No comment!
Ciao
Sid
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That sounds like a really nice solution. Your mother gets the best of both worlds. My mother would have liked to stay in her home, but once she got to assisted living and started making friends, she preferred AL. It had gotten pretty lonely for her in her house after my dad died.
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Yikes… lot of tough decisions here, and it sounds like you’re really stepping up to the plate despite all the chaos. I don’t have access to a crystal ball, and I don’t have any answers for you, but I can imagine how stressful and frustrating all this must be and wish I could give you a giant hug :(.
Watching a parent decline like that can be pretty scary, and I’m wondering if you ever received any kind of firm diagnosis as to the underlying cause for her altered mental status? Blood sugar sounds like it could be a candidate, but such a sudden change as you described would, I’d guess, warrant a head CT scan to rule out stroke? Did the urine culture come back negative?
Either way, you’re doing a great job of being an advocate for her. My thoughts are with you, and I hope this gets sorted out soon :).
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Cyber-hugs help. Thank you! As it turns out, the UTI they were treating her for in the hospital returned within a week of being in the rehab hospital, which was the cause of her rapid shift in cognition. On Monday, before the culture even came back, they hooked her back up to the IV antibiotic (a different kind of antibiotic), and by week’s end this week, she was doing much better. UTIs in the elderly can cause rapid-onset mental confusion, and we’ve seen this in my mother before, so I was fairly certain that’s what we were dealing with. But it is no less scary and upsetting. I fear that one of these UTIs will evolve into sepsis, and that will be the end. Thinking rationally, there are worse things that could happen (for my mother and for us). Like living with late-stage Alzheimer’s.
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So glad to hear she’s doing much better! And I agree, Alzheimer’s is just about the worst thing that could happen to a parent. I don’t know what I’d do if my mother or father was diagnosed. Hunker down for hell, I suppose. Sending out positive vibes for your mom :).
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I can answer your questions from personal experience.
#1. Nursing home patients always get better care if they have someone who visits them on a regular basis. Facility staff are far more busy than you can imagine, and they will leave a wet diaper on a patient if they know that no-one will be coming to check on her. I cannot over-emphasize how important it is to move your mother nearer to someone who will check up on her, and in this case, it appears that that person is you.
#2. I took care of my gramma’s diabetes for 6 years. Going on insulin was the best thing for her and I wish we had done it earlier. It made her blood glucose so much easier to control and high blood glucose is directly responsible for dementia. The nurses must control her sugar levels.
#3. Don’t delay your mom’s care for a birthday party or other social event that you think will be important to her. She has dementia. I know how hard it is to accept that she is no longer the strong woman that you used to depend on. You can repay her for all her love by moving her close to you and seeing that she gets better care. Do it quickly and quietly.
My prayers are with you, Ella. You can handle this.
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Thank you, Rivka. All very good advice. Currently my mom is in assisted living, which should be providing more attention than a nursing home. We pay them a lot of money to stay on top of her care. With that said, she does need someone visiting often, preferably every day. My sister is not doing that. Although I do like to bash her for it, I’m sure there are many good reasons, including her own self-care. My sister does seem to be stepping up to the plate now that I have made serious noises about moving my mom. We have also decided to find a care-giver/companion to visit with her daily to provide company, help her with various tasks, and make sure the AL nurses and staff are staying on top of things. As much as I’d like to have her closer to me and be able to visit with her more frequently, I am worried about the disorientation of a move, and about moving her away from her other visitors. With those two changes, perhaps she can stay where things feel safe and familiar.
My mom’s been on and off insulin for years. Sometimes her levels are fine, and she doesn’t need it. Sometimes they spike (usually when she has an infection), and she does. We have now added insulin to her care for as long as she needs it. Since she’s been living in AL (and not in her home), her blood sugar has been much better, generally. Regular nutritious meals and a home not crammed with sweets has been helpful.
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Having experienced some of what you describe for several years, I think that Rivka has worded things quite eloquently. You will never regret giving her the best care and attention possible. Best wishes to you.
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Thank you, OBJ. Caring for an elderly parent isn’t easy.
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The best thing I ever did was move my mom closer to me. Time spent, though difficult at times, was incredibly important.
I agree with Rivka. She has wise advice. Having just gone through this, I’m willing to help. If you’re in MN on Lake Superior, let me know! 🙂
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We’ve settled on the solution, at least in the interim, of keeping her near my sister (friends, and grandkids) in familiar surroundings, adding a caregiver, and I will drive down and visit more often. If my sister isn’t able to keep closer tabs on things with the help of a caregiver, I’ll have to insist on moving her close to me. I may regret this, but as someone suggested in an earlier comment, I could also regret moving her.
I wish I was on Lake Superior! I will be in a couple of months, but in North Ontario. 🙂
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Very interesting, Ella. What if you did have that crystal ball and could see into the future? What if what you saw didn’t appeal to you? Then what? Would you take measure to change the outcome? All’s any of us can do is “deal” on a day-to-day basis, change what we have power to change, and accept what we don’t have power over to change. You are doing great. I am beyond proud of you. Xo
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Tahira, you are so wise. You have (perhaps unintentionally) pointed out that, once again, I am attempting to control things, as I am wont to do. And often at the expense of self. I need to go walk in the woods. Meditate. Do some yoga. A bit of letting go is in order. Thank you, friend. xo
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I feel your pain. I’m in a similar position except my father is still alive. They keep asking me to move my family closer to them to help. Guilt is a horrible feeling. Sorry you are going through this.
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I think there has to be a line somewhere. Between supporting the elderly parent and self-care. Picking up and moving our lives is a big sacrifice. I think there are lots of us struggling with these issues. With no clear answers.
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No crystal ball here. My brother and I are going through a similar struggle with our mom, but fortunately we get along extremely well and communicate every day about what’s best for her. Decision has been to put her in a lovely facility that is 4 minutes from where she’s lived for 30 years, so she still has friends/church/ near her. My brother lives hours away, I live 8 hours away, but somehow, we’ll do it.
But I’ll need sugar, for sure!!! Best of luck.
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You are lucky you and your brother get along well. My sister and I had been estranged for years, and have been forced into a truce. I suppose that’s a good thing, but I’m very uncomfortable around her husband. So I expect this is only a temporary cessation of hostilities. Being close to friends and familiar surroundings has made things much easier for my mom. But as her medical condition declines, it gets harder to keep on top of things from afar. Once we find a caregiver/companion, that will help. It’s just tough finding the right person. I’ll be back on the sugar, in moderation, in the not too distant future. Best wishes to you!
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I agree with your decision to have her stay in familiar surroundings. Moving is very stressful, and especially so for someone her age who is in fragile health.
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Thanks for your support. I’m feeling better about the decision. She’s already had to move out of her home for many years. And then the multiple trips to the hospital on top of that. Going back to her AL next week should help her feel grounded amidst all the chaos of the past few years.
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