Priya*, a 64-year-old shares her struggles of supporting her 91-year-old mother-in-law’s needs while keeping her safe and cared for as well as finding time for her own interests and priorities. She shares some tips on what worked for her.
My mother-in-law, who is in her early nineties, is a strong personality who has gone through a lot in life, caring for a disabled son for 55 years, and dealing with bereavement loss of children and spouse. She has the joie de vivre to live a full life on her terms. She is very up to date with world news, sports, via television and newspapers, and very involved with overall happenings in life. She is an avid knitter and churns out sweaters by the hour even at this age.
Health
Overall, my mother-in-law is in reasonably good physical and mental health, with hypertension and has been diagnosed with COPD. She has mild COPD flare ups at times. She remains healthy most days and carries on with her daily activities by herself. She takes medication for hypertension once a day at the same dosage for a long time, and an anti-allergic/COPD medication at night.
Daily Life
She was living with her husband and managed daily chores and life with regular support from my husband and me. We visited them regularly. After her husband’s passing, she insisted on living by herself. Unfortunately, she had a fall and had to undergo a hip replacement surgery (hemi-arthroplasty). After this, my husband and I ensured she had a 24-hour live-in help.
Settling her in with full time support was a tough challenge to handle for all parties involved – for her, the live-in help, my husband and me. After 2 years of remote management, a decision was made with her reluctant consent to move her to live along with us into our home.
The transition was not an easy one. It meant losing her independence, her own space, control of her chores, shopping, visiting temples and her friends, missing the group she met daily in the evening. The challenge was to slowly create a similar environment for her in our home -one that would be as close as possible to her own home and surroundings.
The biggest challenge in caring for her is achieving the right balance between her mental alertness plus interests and her physical ability; along with her willingness to accept the importance of balancing her strengths and weaknesses versus making her impulsive needs happen, weighing pros and cons of each activity and following instructions we provide for her safety and security.
With a strong will power to want to be up and about and doing activities beyond her capability, like opening a heavy door with strong wind pull, traveling to places by herself, for example, 5 hours to Shirdi, long haul international flights with long layovers, just to be outside home and of course meet her grand and great grandchildren. It is tough for her to accept safety as being a very important consideration at this age and she will often prioritize her desire to do things herself, rather than ask for help.
She does have fear of slipping over spilt water, but at the same time will not hesitate to pick a bucket full of water and carry it herself from the bathroom to the balcony just to fulfil her interest on keeping busy and watering the plants. She seldom seeks help for activities she thinks she wants to do herself and she likes to feel in control all the time. It is truly a crazy balance of how she can amaze and cause worry and frustration one after the other. And this is a constant dilemma
As a Carer, I struggle with coping up with my mother-in-law’s ever demanding needs of constant attention, keeping up with what she wants to do and her subtle stubbornness. Her health is not a major aspect needing attention as she is fairly independent physically and manages her chores- bathing, eating, medication on her own. I have a 24 hour help to manage my mother-in-law’s daily needs – to accompany her in her outings, evening walks, serving her meals, even tasks like combing her hair. There is the added challenge of managing her poor hearing and her dietary needs (she refuses to use a hearing aid or dentures), though her choice of food is never an issue to manage. Explaining to her is sapping, as everything needs to be repeated multiple times. Communication via writing may not always be the easiest choice as her patience to read and understand is limited.
Learnings from my experience as a caregiver to a reasonably healthy and mentally alert older person.
- Recognize their existing disabilities and specific wants/priorities upfront and clearly. Ask them what they want, discuss that with the medical team and allow them certain flexibility in enhancing their quality of life.
- Ensure they have hobbies/activities they love doing and provide support/ materials for the same – for example, wool for knitting, plants they can safely water and care for if gardening is an interest.
- If social contact is a major need, create an environment that can foster that need – evening walks and meeting with friends, arrange a day to be spent with a relative.
- Support visits to their places of interest – places of worship if religiously inclined and manage safe travel arrangements with someone accompanying them.
- Use music, entertainment, religious chants, reading, exercise, television - sports and news, whatever works to lighten the situation.
- If there is a task or activity that is unsafe, establish what about it makes them want to do it, be around or possibly assist them in the activity as needed.
- Ensure all unwanted belongings and junk are disposed (with their permission if that is easy and possible) and retain only essential items, to avoid confusion and help their memory in early dementia
- Organize all finances and bank accounts upfront so it is easy to manage. Also keep enough funds that are accessible and available in an emergency.
- Organize wholesome nutritious light food with a good balance of fruits and vegetables that comfort, to feel active and do not cause discomfort.
- Balancing aspects on safety and living healthy and longer vs their priorities and interests in life. It is important to get the sweet spot here. Providing some support to help them kindle their interests. Most importantly it is key to make some clear choices and lists of things and activities that are of interest them and are practically possible from your own previous experiences. Setting expectations and drawing up a clear schedule enables to create a smooth and hassle-free environment.
What worked for me as the Carer
For the Carer, it may appear manageable if there is full time home care, all the physical effort and activities are taken care of. However mental well-being is also key for overall energy and health of the carer. Hence it is important to consider the following aspects:
- Proper communication and understanding between family members are needed and they need to place their trust in the primary care giver.
- The carer should be able to make decisions without interference. Otherwise, it will result in friction. In fact, if the carer is managing the full-time care, he/she should be the one making decisions.
- The carer needs support from as many people as possible to take care of the elderly. If near and dear ones can take turns or be around at the same time the situation is better. This can be decided based on availability and the situation and health condition of the elderly person. Taking turns works well when the situation is under control and maintenance involves routine tasks. However, if you have an emergency and multiple tasks need to be managed, having more than one person around makes it easier to manage the situation.
- The carer needs to have the freedom to move around, create the time to step out and meet friends, pursue interests, manage some amount of personal and professional work, etc. It is extremely important for the carer too to get good sleep, exercise, sunshine and good air and quiet/relaxation time.
- Organize wholesome, nutritious, light food with loads of fruits and vegetables that comfort, to make the carer feel active and alert and stay healthy.
* Name changed on request
