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Absolutely SIL is in denial. Get her to SIL's home even for a little while and put MIL's house on the market. Downsize.
A lot of good advice here but too many variables that no one has a plan for.
Not looking promising. No one is dealing with the elephant in the room.
MIL will have to show humility here in doing something (go to SIL house to give you & fam a break) or staying selfish.
What will she choose?
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With deeper background info on MIL, she sounds like a person who has lived a life of all show, no substance or planning.

Which is why she's hoping to just "fade away".

Very sad, but not Dorker's fault.

MIL's adult children are terrified of her tantrums and continue to try to " fix" what is wrong with mom.

Planning would have involved selling the house when FIL lost his job, or when they " retired". (Possibly it was underwater, which would have stymied that plan)

But you don't go into retirement with a mortgage unless you KNOW you have the pension to pay for it .

My point is that MIL'S lack of a plan for her old age should NOT become the "emergency" that either Dorker OR SIL should have to personally take on.

There are housing and care programs for elderly folks on fixed incomes. MIL needs to access those.

A serious conversation needs to happen among SIL, DH and MIL. It's not going to be pleasant, but it needs to happen.
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As Shane1124 says...why the continuing dialog with SIL. How about "I will forward your comments to DH". Copy, forward to DH. Don't engage, don't comment, disengage.
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Bring brother and sister together, remove yourself from the conversation, and the continued loop.
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Shane, I don't think that MIL has the ability to be humble, or to consider the impact that her behavior is having upon others.

Consider her treatment SIL's husband (when she was younger and supposedly had no cognitive issues). Or comments to son about his choice of wife.

This is a gold-plated, self-entitled, self-important narcissist. She "won't hear of it" and "don't you dare".

My goodness. How rude she is!
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Hasn't it been said that part of what one sees in a patient that has dementia, is inappropriate social behaviors, exhibited in, "no concern for others' POV and feelings".

In other words, that can be ( at least to my knowledge), in and of itself, .. one of the markers of dementia, that the person would act in saying things in front of people that they should know will be hurtful or insulting.

MIL certainly does that.

I know recently, within the last couple of months, we'd all gone out to lunch, all of us gals. That included my 4 yo g'daughter. Absolutely gorgeous little girl, .. with blue eyes and blond hair. The 4 yo little girl has a wonderful appetite, unlike others her age, and will try almost anything, at least once. She really is astounding in her palate that she will eat a lot of things that most 4 yo's would turn their noses up to.

Here we were sitting at a restaurant, .. all of us. And the 4 yo was eating whatever it is that was ordered for her (I guess .. generally speaking a 4 yo .. you might see them picking at their food and not eating it, not so with this 4 yo). She was eating.

MIL looked across the table at the almost empty plate in front of the 4 yo and said the following:

"Whoa, .. she has a good appetite .. you guys better watch that, she's gonna end up being the little fat lady at the circus that everybody comes to gawk at".

Yes, she said that!

The 4 yo didn't hear her, thankfully .. went right past her .. if she had heard it, and it hurt her feelings, .. it would've been horrible. The 4 yo missed it, entirely.

But the other adults at the table, myself, dd .. my youngest daughter, we all heard it, .. and the gasp of "WHAT DID YOU SAY?, ... YOU CAN'T SAY THAT!!!!!!!!!!!! MIL THAT WAS AWFUL, YOU .. WHAT ...?!?!?!?... CAN'T BELIEVE YOU JUST SAID THAT .. THAT WAS MEAN!".

The recrimination was swift and harsh for her having said that.

Lost on MIL though. She giggled, and a follow up of "Well it's true, .. if she keeps eating like that, she's gonna be a little fat girl".

At that, dd .. said to her g'mother (MIL) "Don't ever say that again in her presence, you have your opinions but keep them to yourself".

MIL then did seem to understand the brevity of what she'd done, and said: "I'm sorry I guess I shouldn't of said that".

The rest of the meal had a real pall cast over it. We have not included her in any outing since, ... that includes the 4 yo.

She does compliment the 4 yo. The 4 yo is absolutely gorgeous . and she is smart as a whip, and a vocabulary not seen generally in that age group. MIL will say things of her: "I could just watch her all day .. just watch her play and chatter .. it's like watching a kitten play".

She does say nice things. But the above .. so uncalled for. And if the little girl eats til she has a weight problem, that is NOT MIL'S to judge and/or reprimand about .. that is the 4 yo's mother.

That incident was within the last several months.

We purposely made the decision, most recently to exclude MIL from two baby showers held on dd's behalf. Why?

When dd had the first child, the now 4 yo, MIL was included. Her behavior at said event, was socially inappropriate and a distraction. Child-like almost.

That baby shower, 4 years ago. (this isn't new) .. it's obviously been going on quiet a while. That specific baby shower, just things like .. time to gather to play the games that the hostess has put together, and so she calls everyone to the room set aside for those games.... everyone one does as instructed, and begins to gather .. and listen to instruction .. not MIL. MIL in the kitchen (we had all been dispersed ... mingling..but now was time to stop mingling and go sit down and play word scrabble or whatever of those games that are played at showers). Not MIL. She was in the kitchen chatting it up with whoever would give her an ear. Not only did she not join .. in the games, she was (she talks loudly anyway . .as if what she has to say is the only thing being said) .. talking and a distraction to those who were trying to partake of what was going on at the moment.

Calling her away from that scene, to try to engage her, .. "MIL we're going to sit over here now and play these games a bit, if you'd like to come on over". Answer from MIL: "Oh I don't care about all that, you guys go on without me". Well the poor soul that was trapped by her motor-mouth .. had no choice.

Fast forward a little later (remember she has mobility struggles). She was seated the whole time, .. while others are up and mingling and fixing plates of food, etc.

So I go to make a plate of food, and at the same time, make my own .. and am moving thru the food line. People begin seating themselves around with their little plates of food. I was working my way through the line .. I just hadn't finished yet. When I hear a loud, "Well am I going to get anything at all to eat?!?!?!". Just rude!

Time to cut the cake, .. I go to get a piece of cake for her, and one for myself. I come back with a piece for her, one I guess she deemed to small, and her loud voice, .. (she never says anything quietly), .. "Well is that all I get?, ... why is my piece of cake so small".

Dd found that she had to apologize to some of her friends that attended, for her g'mother's behavior. All understood, old people will be odd and say things they shouldn't.

But fast forward to now, there were two baby showers in the offing. Decision made, to purposely exclude her, and exclude her we did.

There's no cognitive impairment here. No, she's fine.

RIGHT!
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But Dorker, hasn't she always been socially inappropriate? Are the awful comments to SIL'S husband, to her own son, etc., only made in the past few years, since the stroke, say, or do they go back to when she was younger?
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The way MIL behaves when she's home alone is also indicative of dementia. Cannot execute her pill-taking. Has all the time in the world to assemble a proper meal, yet she cannot. The defeatist/defensive attitude about compression socks -- and many other self-care no-brainers.

For some, it's the executive thinking that goes to pot first. These oldsters always know what day it is and who is president; they recognize everyone and always call people by the correct name. But they can't reason their way out of a paper bag. They flub routine tasks (and eventually stop attempting them) because they cannot do the steps on the correct sequence.

Apathy is a biggie, too.

And another dementia marker: they become terrible conversationalists. One word answers. Or strings of excuses about why they can't do _______ like a normal person. Delivered with the attitude that you are the one who is abnormal.

I spent 5 years wondering why my mother turned into such an azz. So did a lot of other people.

I thought Mom was just being willfull. She seemed to love that her world was shrinking. Totally reveled in it. Which made me nuts; I am SO not like that.

Because I am a mere mortal and not a neuroscientist, I thought Mom was deliberately taking her lifelong odd priorities and self-centered (lack of) time management to a new level.

Boy was I wrong. Turns out Mom had mixed dementia. Alzheimer's and a non-Alz dementia. A new level alright.
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Oh, I agree that Dorker's MIL is showing signs of cognitive decline. Look, she had a stroke some years back. That often causes vascular dementia. Neuro should be asking questions about processing, ability to manage. But MIL bluffs and lies.

But it also sounds like prior to the stroke, mil had this no filter thing going on. Just trying to separate the two.
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Comments made to BIL about "now look what you're married to", that was eons ago, long before a stroke. Comments about BIL "is he being inappropriate with his niece", .. that too eons ago. In more recent years, .. within probably the past 3 or 4 years, is when she made the cruel comments about SIL's husband (he suffers from pretty severe bipolar disorder) .. her words to him as he gazed upon the b'yard standing at the door to the b'yard .. no particular reason .. he just was standing there, .. he'd been manic w/their stay at MIL's. She said to him, (this after telling her daughter, don't come back if you have to bring him with you), .. her words, "yea, that's right, take a good look around there bud ... you won't see this again". So cruel.

Says numerous other things about this SIL's husband .. that SIL constantly has to correct her, "Mother you can't talk like that about him, that's mean", that kinda thing.

She seems almost fixated on his shortcomings (mental illness/one he can't help), harping on it, all the time, (another marker for dementia, .. at least in my opinion, obsessing/fixating on something). She is most definitely fixated on his shortcomings.

Anytime she can get your ear, she will circle to that topic. And she will talk incessantly about him. "You know he's nothing more than a bump on a log, he stands there .. blank .. just stands there, right behind SIL ... her working all the time, .. you know, he's the reason she's the way she is .. she used to be so carefree and a lot of fun, but she's not anymore, she hasn't been for a long long time (that is true), she's had to take the reigns in that household, and that marriage .. and be his caretaker, .. he stands there, blank .. just stands there .. waiting for her to bark out what she wants him to do next, just stands there, .. and you know, he will eat anything not nailed down, I'm surprised he's not 400 lbs ... I don't know what would become of him were it not for my daughter, .. she should've long ago turned him over to one of his siblings .. and washed her hands of it all, .. but no . now she's about half crazy too, you know he doesn't even have enough sense to come in out of the rain, .. this guy, . he just waits .. just stands there, .. like a bump on a d*mn log, just useless".

On and on it goes .. (all of that, not generally in front of him, just in conversation with myself, with our daughters, .. with DH).

Each of us will try to redirect (we've all talked about her fixation with the whole thing), . you try to redirect, "Oh now he's not that bad .. he really is a great guy .. ya know, if you talk to him, .. he will talk to you, he does have a lot of sense ... ".

That gets countered with: "You don't live here, you don't see it, .. you're not the one here with him, that's me .. I'm the one here seeing all of this, all the time, .. ".

On and on it goes, anytime the conversation drifts in that direction, all of the above will be said over and over.

I don't know what SIL will do, .. to be bringing that into her household. If it goes that way. But maybe that's what it's going to take, for SIL to see that her mother does indeed have some cognitive issues, and get it addressed.

Probably a whole lot easier to come this way .. and hop on that hamster wheel of managing her life for her, then scoot on out back to her own life .. with the proclamation that continues endlessly, "she's fine, .. so and so ck'd out fine .. she is doing great", .. justifies her being able to hop on that plane and go on back to her life (which, incidentally, she doesn't mind at all, her life).
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............and the isolating ... she is so very isolated. Her ONLY social outlet, is myself or our daughters (who have their own lives and are generally speaking, pretty busy living those lives), . .or DH. That is absolutely positively 10000% it. That's it. Us.

Isolation. Another marker as to dementia ..

They isolate finding themselves unable to interact socially appropriate to the situation. Very very much the case here.

I have told her countless times, there is a lady in our church, brought there by her daughter, in a wheelchair, on oxygen, .. I think the woman probably is in and out of any real ability to be in the here and now .. but she's a life long member of our church, and she is there, every Sunday, in her wheelchair and her oxygen attached.

Now that woman, if ever there was an impediment to getting out and into life out there, it's her and her health limitations. But MIL .. (yes we've offered to go get her, if she'd like to come), .. "Oh that's just too much, I'm not able to do that".

Won't any longer come over here for gatherings .. even though we offer to go get her, and bring her here and then take her home.

Won't go to any senior center and engage with peers of her age and activities there. Won't go to any social gatherings in her neighborhood.

SO ISOLATED.

I can sit here and armchair QB all day long ... and I think I'm pretty on target with it all, but it doesn't matter. I'm not an MD. And if her daughter wishes to continually wash her hands of the whole thing and look at any depth at what's going on with her mother, .. (denial???), then not much that armchair QB'in will do.
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And one last thought, .. I'm up early early .. going to help dd with babies as they ready for their first day out, to church this morning for their dedication (her request, too had to get up and get herself, and the 4 yo and two babies ready to do much of anything).

It makes me feel like a cruel mean person when I do have this over-riding thought in my brain of the poetic justice ongoing at this moment.

This all started a couple of months back with my dd and her complicated/troubled pregnancy with twins and my need to be on that front, helping out with g'daughter, as well as my daughter. I said at that time, and well before it, .. "My priorities are going to be my dd and g'children upcoming, you guys .. your mother's needs are increasing and I will be unavailable to be on that front, we need to take additional measures to get this addressed".

I said that! Over and over and over!

My suggestion, if anyone remembers the original theme of the whole thing, was that SIL take MIL to where she lives .. while we weather this event with upcoming newborn twins and so forth.

That got dashed, .. MIL .. always firmly entrenched she's not going anywhere, and "she will manage, she knows what to do, and she will manage". As well as SIL . the fact that her son was coming from around the other side of the globe .. he and his kids.

When they come, .. she's on the hamster wheel there like none other.

She was worn out, past the point of exhaustion, when they left. But that coincided with MIL's hospitalization, so here .. she had to be, on a plane getting here, to care for her mother.

Absent the ability to have MIL go stay with SIL .. I suggested numerous times, "then we need to involve some 3rd parties here, folks from our church who've been so kind to offer to help, let's get that in action here, .. neighbors". That too, MIL dug in firmly .. "don't you send any of those people here to my door!, I will manage, I know what I need to do and I will do it!".

I can't help but find a slice of poetic justice here. SIL .. who had every intention of regrouping ..and resting subsequent to her sons' family and their visit to her home .. did not get the chance to do that, at all. She had to hop on a plane and get here, post haste .. and she has been on the hamster wheel here .. running faster and faster, since she got here.

Maybe .. maybe just maybe ... if she'd of gone with SIL and SIL do as I had suggested, tell her son .. tell him .. "I know you love to come here, but mother's health is really poor and I'm having to look after her .. and she has to stay here with me, so you guys .. you can certainly come .. I want to see you, but it might be best if you guys rent a condo for your stay .. at least this time ... and that way I can kind of enjoy you guys .. as well as look after my mother". Maybe, just maybe .. her mother wouldn't be in the shape she got to, .. and her having to hop on a plane to get here right after her son left, and she so exhausted.

Or maybe .. maybe maybe .. if she hadn't been so strident in her refusal to allow 3rd party assistance on this end (always has been, that's not new). Maybe her UTI that brought all this confusion on (but there are a LOT of numerous other issues with this woman) .. maybe she wouldn't of even gotten a UTI .. she'd of been hydrating appropriately .. and not having to wear Depends as she doubles up on her diuretic .. who knows.

I do find a bit of poetic justice in it all. But that makes me feel cruel .. like I'm a cruel vindictive person and I am not.
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Your MIL is selfish.

You are simply experiencing the results of her children not acting like adults and standing up to their mother's probable dementia, self absorption and refusal to acknowledge reality.

There is some satisfaction in being right, Dorker, but it would be better in the long run for you, if you could simply turn your attention to your daughter and the babies.
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Barb's right, Dorker. Your MIL was exhibiting narcissistic behaviors well before the stroke occured. She's been training the family to put up with her antics for years and years. Now is the time to realize **she's** the cruel vindictive person and stop beating yourself up. It is as if you can't bring yourself to admit your MIL has always had issues.

My mthr had a personality disorder and was equally cruel and inappropriate to innocent bystanders. It was difficult to know when she started slipping into dementia because the behaviors were the same as dementia symptoms. Decades before dementia set in, she isolated herself from social contact, and dressed it up with being too good to be around those other people. She refused to follow normal rules for behavior at my house, and chose to isolate herself from us rather than visit us under our house rules. 8 years later, we rescued her when APS found her unable to care for herself.

It's not us, the people who have boundaries, who are the problem. It's the people like my mthr and your MIL who run over everyone else. Therapists help normal people like us deal with those who demand obedience. I'm not sure our narcissists can be helped.

Practical advice from my therapist that helped me, rewritten for the problem at hand:
Have you tried putting your ringer on silent for MIL and SIL, and also setting the ringtone for their texts and emails to silent? If you want to disengage and focus on the babies, deal with MIL -her issues, texts about her, and her family - one day a week. If anyone fusses, say, "with the twins I knew I'd be busy. I'm simply not able to respond to your messages about your mother. If you need to talk to your brother, go ahead, but I'm not available even to read your messages for days at a time." No bargaining, no waffling, just one day a week you even look at your phone to read those messages or answer the phone. One day. Pick the day and put it on the calendar if you want. One day. Nothing the rest of the week but YOUR Grandbabies!!

Dorker, get mad again and stop making excuses for these people! They are trying to suck you back in!
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Surprise, you said it SOOO much better!
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Here's the current discussion of narcississtic mothers on this site: https://www.agingcare.com/questions/narcissistic-senior-with-alzheimers-155285.htm
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I'm so sorry to hear what you are going through Dorker. Life is so hard sometimes. I often wonder if my mother is a narcissist as well. Thank you for the links and all the information my friends.
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Maybe it's a process ... to get to where you "detach" from it all. I don't know.

They came to church today (because the twin babies were dedicated today). MIL and SIL have probably only been to the church there, maybe 2 or 3 x's in the several years we've gone, so they aren't regular attendees, by any stretch. MIL, we've offered countless times to go get her, if she'd like to go, but it's always "Oh no, that's too much for me to do". (BTW, she was a regular church attender back in her younger years, not this church, but her own).

It's just .. the first thing that struck me, (and why ... I don't like having to feel as though I'm so cynical and so jaded and so uncaring). They pulled into the parking lot at the precise moment I did.

SIL driving (but remember, it's said now that MIL can drive .. even though that's not what was indicated at the hospital). But now, it's been said she's safe to drive.

Well into the parking lot comes SIL behind the wheel, of MIL's car. I'm so "not detached", that my first thought was, "why in the world isn't MIL driving ....?!??!!.... she's been cleared, ...why not, . by all means .. let's let her drive, better yet you SIL .. you ride, and let her drive ... and let's see what her capabilities really are .. but no .. no no no. SIL driving.

Then, .. SIL gets out and is instructing her mother, "now wait mother, wait .. let me get your walker out of the trunk, hold on mother".

Again, my cynical *not detached* anger .. and just in general, fed up demeanor with the whole thing. My thoughts were, "well that's just grand .. she's been instructed she can drive now (contrary to what was said in the hospital) and not only is she not the one driving (never does when SIL comes, it's always SIL driving her around, when she comes here), .. not only is she not driving, she's now dependent upon someone to get out of the car and get the walker out of the trunk. A set up that is not going to be a viable one for MIL.

I wanted to ask SIL (being much of a smart azz), ... "so how's that gonna work, let's see, she can drive now .. but you're choosing to not have her be the one to drive, and not only that .. the walker she'll need to utilize one day when she is yet again behind the wheel, it's in the trunk .. that's good .. haha .. yea .. oookay .... and she'll get to it how, .. recipe for a fall for sure, okay got it".

I didn't say a thing. I greeted them, and then saw someone that I needed to speak with .. and walked away, just in general frustrated with what I saw.

Bottom line, I've said it and said it, .. and I won't be the one here dealing with it .. so .. if they fail to listen .. they will soon find out that I find all this charade of propping her up, something I won't do any longer. And I can be the SOB that is the unreasonable b*tch I guess.

I just don't get it. (throwing hands up in the air in disgust)
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I'm going to refrain for you, Dorker.

You're not the SOB. You're the First Alert alarm who brought MIL'S true deficits to light. And now, you're going to be the truth teller who stops enabling her self destruction.

She needs full time care. It's going to be either her living with one of you, medicaid applied for so that care givers can be hired ( which means you can't leave most of the time, because she'll only be eligible for a few times a week), or she goes to a nice income based AL.

You're just seeing the facts on the ground, Dorker. I still think some talk therapy for you right now might be a good support for you.
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Dorker, you are suffering from an overwhelming urge to say "I told you so."

There is nothing obviously misguided or alarming about your SIL doing the driving and helping her elderly mother out of the car. Just because she's not always going to be there to do it? But she is there. So why not do it? It's only polite. It does not inevitably imply that once SIL has gone home you or DH will be "forced" to take on the job.

Detach and enjoy the peace - and your new grand babies. How was the dedication?
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"Reframe", Dorker, not refrain.
Yes, how was the dedication?
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Yes I have a counselor that I saw at one time for problems with a daughter, . and how to navigate that. I am going to hunt him down this week and see if we can't resume some sessions to help navigate this situation.

The dedication for the babies was absolutely precious and such a blessing to get to witness and be a part of. Made even more special by the fact that DH works in leadership in the church and was the one to stand at the podium and do the dedication. It was all very sweet.

We all went to b'fast at a restaurant nearby, after the service, which was also such a joy, to get to be together. My mom and her b'friend in attendance at both service and b'fast, as was youngest daughter (oldest daughter not present, she is Buddhist and as such chooses not to participate in things that are of a Christian display, that's fine .. we all live in a country where we are free to worship as we choose, that includes her).

MIL and SIL begged off the b'fast out portion of events, saying that just getting to church was more than enough for the stamina level there.

I'd gone over to help dd to get ready for the big event. Too much for her, .. to get twins ready, a 4 yo, and herself. Got there about 6 AM, which meant that I'd gotten up here, at 4:30 AM. If I don't have a minute to open my eyes over some coffee and engage the brain, I'm worthless to myself or anyone else. Was very much appreciated by dd, as she sat in peace to put on her makeup, having taken a shower and gotten dressed while I dealt with kids.

Believe me, I count my blessings that I am in a position to help and be on the front lines of a good relationship with a daughter that would seek out my help, and put me in a position to enjoy those precious babies.

Dd had husband yesterday after the day's events, so that then freed me up to not need to be on that front. I came home yesterday and ran into a brick wall of fatigue. Slept so hard, on the sofa. One of those kinds of sleeps where you wake up .. almost disoriented, as to where you've been for the last couple of hours. It was nice.

Got a text from SIL late in the afternoon (had seen them earlier at church). She said she was sitting a the doc in the box, .. that she feels she may have a UTI in the works herself. Also, feeling so lethargic.

I responded, "sorry to hear that, hope they can help you".

She then texted again, sometime later, "results inconclusive, they did rx an antibiotic just in case, ... I wonder if it's just that I am run down. I went from geriatric duty, the month of May that I spent here, then went home in June to prepare for our son's visit with his family and they came mid June and stayed for 3 weeks as you know .. and that wore me out, .. and I'd intended to stay home and rest and regroup before returning to geriatric duty, but that didn't happen. I am so worn out, .. I can feel it".

I wanted to say "welcome to my world, when you aren't here ... on the scene for your mom. That's my world. I help manage a biz, am not retired, try to spend time with my grand-daughter, .. now .. of course, on the front with dd and new twins . but prior to that, trying to spend time with my g'daughter .. and of course, manage my own household. Yes I hear ya, worn out".

But because I care about this person (SIL) in spite of her *head stuck her backside on this whole thing* ... I simply responded: "Get some rest".

Didn't hear another thing.

DH ran by there to visit briefly .. (he'd seen them at church, but all going in different directions, and he hadn't had time to visit with them). He wasn't gone long, returned back home.

Didn't even ask him if he approached with his mother/sister ... "so what are the plans going forward here, some things we need to talk about".

I didn't even go there, in discussion with him. Would be pointless. Just kick the can down the road .. that's what the approach is going to be, obviously.
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Dorker - i really feel for you and i think you are upset and anxious because you see what is going to happen next in this movie and know that the s$it is likely to hit the fan at that point. I think somehow deep down you might feel guilty about your intention to step back. Don't.

Your MIL is choosing to make bad decisions. She is an adult & as long as a she has not been declared incompetent, she legally can continue to make these bad decisions. (not allow help in, risk falling, mismanaging her medicine -etc.)

You, too, are an adult and can make your own decisions. MIL's bad decisions do not need to result in you being responsible for fixing this. As you have seen, MIL's needs are beyond your and SIL's ability to help and her needs will increase. You have every right to step back and tell SIL and DH - if MIL insists on her way - fine - but i will no longer participate, i am worn out and do not have time. You yourself are aging, your DD and grandchildren need you, your business and church need you, and you need some time for yourself. Do not feel guilty about this. I think we women have a tendency to take on guilt whenever we say "NO".

I think you are afraid that the "same ole" will happen. SIL will go home, MIL will remain in her home. SIL will be micromanaging from afar with urgent text and calls to you, neighbors, and DH. Your attempts to deflect and disengage will mean DH has to deal with this more than he has up to this point. He will get impatient and angry and wonder why you won't help more. He will think you are unreasonable and "don't you care about my mother?". You do, but you cannot do it all and you are exhausted as it is with all of the other responsibilities in your life.

Then, what we all know will happen, will. MIL will fall or mismanage her medicine and she will end up in the hospital - and everyone will finger point at you - since you didn't step in. Question - why is this your responsibility? It is not. YOU HAVE been the one stepping up, YOU SEE the upcoming needs, these needs are beyond your strength. YOU HAVE NOTIFIED her children who are choosing no to listen. That is fine, but that doesn't mean that you have to step back in because they chose not to listen. Not your zoo, not your monkey!

So now what? Make clear (as you have been) that DH and SIL need to sit down and discuss (without you) MIL's needs and what will be done before SIL leaves. As much as you would "like" to help with MIL - her needs are now beyond your ability, time and strength. If they DON'T take action - and MIL ends up in the hospital, or worse, THEY need to accept the responsibility. You are exhausted and cannot do this anymore. I don't know what it will take for DH and SIL to sit down and talk but if they don't, it will be on them.

Stay strong and every time SIL and DH want you to do step and fetch - remind them that you no longer can. Unfortunately - i feel that only MIL having a medical crisis will force those two to talk. By the way, it often happens that way due to the insistence of our elders that they can live on their own, and manage their lives, they too "know what they need to do and how to do it" so let them.
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Dorker, good job with SIL. Yes it is exhausting to manage all those things. This is what you have been trying to communicate to your husband and SIL. In the past, I'm sure that the doc in the box and exhaustion comments would have been a trigger for you to go into "fixer mode" and come help. This time you kept to your word. "Hope they can help you". "Get some rest". The bland responses that don't involve you helping but are not snarky to elicit a response. HOW PROUD OF YOU WE ALL ARE! I understand the deliberate not asking husband. My husband drops little "hints" about his calls to his parents now that I am disengaged. I used to question him about the calls and status of folks. Now if he doesn't volunteer it, I don't ask. I don't offer advice. His mother, my MIL, is now safe in assisted living/skilled nursing for her Parkinson's with a supra pubic catheter that she can't self-care. Not happy, but taken care of. His father's games with Medicaid and money and lawyer that are done WITHOUT involvement of sons. Dysfunctional. Your husband is still dancing to narc tune with his SIL right next to him. Glad the babies dedication was such a success and involved with your family and community. The efforts you make should be directed at the truly helpless babies and 4 year old and exhausted daughter. MIL and SIL and hubs can figure it out on their own. I do think you need to be at any meeting with hubs and SIL only to make sure you are not obligated or included as labor in any future endeavor. If you are not included and don't agree, then Call 911 and No are perfectly reasonable responses.
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Hmmm...while ideally the "what to do about Mom" conversation would occur without Dorker, the danger in her not being there is that her H can promise that HE will do all sorts of things for his mother. And then turn around and expect Dorker to do them. There's already some tension in regards to his expectation of her doing things for Queen Narcissa. (And the Yellow Room.) 

If Dorker is at the meeting, she can be the voice of reason. 
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I'm hoping SIL, now thoroughly worn out, now sees what is going on with her mom.

She shouldn't have to take mom home with her. Mom should be in a facility where she can get consistent monitoring and care. SIL has her hands full with her husband.
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I think it would be rotten of SIL to take her mother home with her, considering how nasty her mother is to SIL's husband.

Neither SIL nor Dorker's H want to risk the wrath of Queen Narcissa, though. And then there is the issue that there has been no planning on their parts as to how the facility would be paid for.

It will be interesting to see what happens before SIL heads back home.

Perhaps we should place bets...?
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Dorker' s daughter works at an income based AL. MIL still has her SS and a small pension. Possibly some RM monies left after sale of house.
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Dorker, Dorker's husband, and Dorker's SIL all need to get on the same page. The three of them must agree on what each will and will not do. No one can promise that someone else will do something for someone else. Dorker's husband cannot volunteer his wife to be his mother's caregiver unless Dorker accepts it and goes through with being volunteered. Dorker is far from helpless. The three of them need to make a plan that works for all of them and not just for the mother.
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As to Kimber's point, the suspicion there is a bit of "guilt" on my part, for stepping back. Interesting point to ponder. There is "Guilt" but only from the respect that I have always been a helpmate to DH. And will continue to be. As I would expect he do for me, .. if necessary. Having said that, .. the guilt felt there, has been reasoned, within me, .. and weighed. It has come down to the point that I have always maintained .. with all involved, that I will happily assist wherever I can to help her to remain independent, UNTIL .. such time .. as her needs become greater than what I can see to. We are there. That juncture is upon us. Has been for quite some time, and I've been saying so, but have been ignored.

I recall very vividly in the last several months, . as I worked to try to be all things to all people, my household, my duties at the church (which btw, are pleasurable to me, I enjoy what I do there), my obligations and responsibilities to our small biz, my g'daughter, and my daughter .. and to MY OWN PARENTS .....

As I ran on that hamster wheel of trying to be all things to all people, and found myself continually down rabbit holes and wild goose chases, . and worse yet .. in the ER outpatient unit, and/or doc visits, on MIL's behalf for things completely preventable, as she wasn't seeing to her needs "on her own, and she will manage".

This was in no way a knee jerk reaction on my part. It was a self-examination of why am I so stressed all the time, and can't keep a lid on the things that are my responsibility to see to, and I don't mind seeing to them, it's why I'm here, ..

It became pretty evident where the gap was. It was in the fact that I was constantly being called to the front lines of the MIL situation .. and the need on that front, which has increased .. measurably over the last several months if not years.

I'm pretty sure any "guilt" felt there, has been measured and reasoned within myself, that yes, I feel guilty in that I know how hard DH works, . and how he is for the most part, truly, spoken for as to work hours and isn't free to run and see about his mother. That's been my job . and happily doing it, all these umpteen years. UNTIL .. it got to the point the need was increasing so that I found I wasn't able to manage the rest of my life, "FOR MANAGING HER'S". I feel "guilty" in that .. it does indeed put the onus on DH (where it should've been all along) to figure the way forward here, he and his sister. They have failed to do that, and that angers/frustrates me. There is absolutely 0 dialogue between the two, or with the mother .. in fact, very little with me, .. as I assert, repeatedly that I'm out .. what will you guys do. That frustrates me.

Yes, SIL, when point blank asked the other day, by me, .. she did respond that MIL seems willing to try it (going to her home, SIL's home) .. for a little bit.

I didn't ask, .. don't care, have asked, it's never been answered, I'm beating a dead horse to keep asking it.

"How do you propose that she will agree to all this?".

That's the $64k question no one is answering or even attempting to. The other obvious questions, what to do long term? No one is addressing it.

That, I know, is because all "assume" (Incorrectly I might add) that status quo will continue . that ole daughter in law here, will continue living her life living on the edge of all the stress created in MIL's lack of ability to manage any further. I know it .. in my knower, I know it!

Was very telling when SIL responded, "She's willing to try it for a little while".

A "little while"? So . somehow in all of this, you are deluding yourself into thinking a "little while" is going to find her somehow miraculously able to manage her life and afford that you can then deposit her back into her home, and all is well?

AMAZING!!!!!!!! The stupidity and denial that is ongoing. Just Amazing.

I can't drag either of them by the shirt collars, into a room and knock their noggins together and tell em, "NOW SIT DOWN AND FIGURE THIS OUT". I've done everything short of that, .. I've told SIL SEVERAL TIMES that I want some of her time, to have her ear .. thus far, there has been no .. not one iota .. not a single attempt .. at even acknowledging that fact, much less an attempt to try to make it happen.

Yes, SIL is worn out, I get that. She .. it was her choice. .. I get it ... she wanted to see her son and enjoy he and his family on their visit to the states. That always, always, always .. entails she pretty much become a nanny for their stay here in the states. And so she would be worn out beyond exhaustion when they leave. She knows this .. she's always known this .. it's what she prefers . it's how she prefers to operate.

But I've been over her raising the flag up and down and screaming it, as much as I possibly can . her mother's needs are increasing and it needs to be addressed, even suggesting some stopgap measures .. measures that were summarily declined or flat out refused.

So SIL, poor poor SIL .. she sends her son and his family on their way after completely wearing herself down .. and her mother once again, on the fringe here and needing supervision/help.

Kinda find it hard to find it in my heart to say and feel, "you poor thing, let me hop right on in here, .. and you get on that plane and run on back to your life .. run along now, I've got this".

That's what I"ve been saying!

SHE NEEDS MORE HELP. Your failure to listen/hear/wear it/live it/breath it/address it, .. doesn't then make it incumbent upon me to take the lead on all this and run with it.

Not happening.

So I get it, she's tired .. I do .. and for that I'm truly sorry .. but that doesn't somehow fall upon me to wear it.

Look, there have been discussions in passing, between myself and DH .. even more fleeting, mentioned a few times in the years as they've worn on, .. "what will become of the situation with MIL .. she will, if she lives long enough .. she will become more needy, how will that need be met".

That discussion has come up .. a few times with DH . thru the years .. and even less with SIL.

It has never been adequately addressed. Easier to kick the can down the road, as it continues to be, to this day.

I just find it awfully frustrating, .. if I were to get their ear .. either one of them, and ask them point blank, "look take me out of the equation and any emotion, .. can you answer me honestly ...that you think it's best for your mother's well being .. can you honestly say that is the best scenario .. that she be left alone, to manage on her own .. is that what you think is best suited for this situation .. take the emotion of her not wanting to leave her home .. look at it as if it were a friend asking you, a friend with upclose personal view of it all, would you advise that friend, .. yes your mom so vehemently wants to be left in her own home, even though she can't manage .. by all means do it .. is that what either of you would advise?".

But .. can't get either of their ear's .. not for long enough to make a valid case ..

So frustration yes, most definitely. Guilt . perhaps .. only from the respect that .. it's like my job description has changed at this point .. and I have the choice to step up to the plate and take on the additional assignments .. or I can say "nope" that wasn't part of what I bargained for when I took on this role, .. not doing it any longer. Guilt in that .. I won't be helping DH who I truly know, does not have time for this. I know it, I live with him .. I see it, daily.

But .. getting he or his sister to address it .. it just doesn't seem possible.
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