Dear Mary,

My Mother-in-law moved in with us over a year and a half ago and turned 84 in November. The toughest challenge for us is her stubbornness - she will not listen to our advice and expects us to change our ways to suit her. She also has some poor hygiene practices: she consistently uses the kitchen dishrag and towel to wipe her hands and face. My husband is her only surviving child therefore we almost never get any relief. We have managed to get her to go to the local senior center twice a week, which she loves. Our friend's mother also attends and they enjoy each other's company. However, when we suggest inviting her to visit, Mother comes up with excuses as to why the friend might not be able to come over.

My husband suffers from cluster headaches, and his patience for her is very limited. Having his mother here has changed our family life, and has limited our ability to lead a normal life, if there is such a thing. Another complicating factor is that we are still raising our second child, a nine-year-old son. Because of his lack of patience my husband is shouting at him more than he ever did. If you can provide some resources, tools, or guidance on how to cope with what we are going through we would really appreciate it. Our relationship is taking a toll, and that is very frightening to both of us. We are looking for some advice on how to handle this situation.

"Re-living" with a parent is no easy task. Anyway you cut it she is still the parent and expects her son and his family to be mindful children. Her stubbornness is a way of maintaining control in a situation she has little control over. The first priorities for you and your husband are your son and your marriage so examine the situation and make changes. You say she loves going to the Senior Center (which is open five days a week by the way), is it possible to take her the other three days, too? As for her friend visiting, just keep the offer on the table. If she never invites her over, so what? Give the local Area Agency on Aging a call and ask about volunteer visitor programs. A volunteer could come once a week for an hour or so and spend time with her.

Regarding the kitchen dishrag and towel, you are not going to change old habits so how about replacing cloth with paper? Yes, paper towels will be more costly, but more sanitary and less aggravating in the long run.

Many times caregivers try to change the behaviors of the loved one. But the reality is caregivers must change their own behaviors in order to effect change in a troublesome situation. Anxiety and frustration are contagious in close quarters and tempers flare. If you cannot make positive changes that create a more peaceful coexistence, it may be time to consider other housing options. Again, the Area Agency on Aging can help you.

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Dear Mary,

How do you get rid of pressure sores?

Dear Reader,

Pressure sores occur from staying in one position too long, poor nutrition or hydration coupled with immobility, and incontinence. Once they form infection with sepsis, a serious systemic response to infection, can occur. They need to be managed with a rigorous repositioning schedule of at least every two hours, good nutrition and hydration, by keeping the skin clean and dry, and proper treatment. It's important that the person be evaluated by a health care professional to determine optimum nutritional level and type of treatment needed. If the care-receiver is at home and can't get to a physician, the health care provider can order Home Health nursing. Medicare and some private insurance policies cover this cost if the service is medically necessary. I urge you to call the physician as soon as possible.

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Dear Mary,

The trauma of relocation from home to a facility is difficult for the caregiver and the loved one. The tearing away from home has traumatic effects. With increased age the average person does not want such disruption in their lives. In the married state it is the commitment to a human being that over shadows all other aspects. If the $50,000.00 a year nursing home has been decided against, then it is home you stay.

Dear Reader,

Forgive me for only printing a small portion of your letter. You have made some valid points. One being that relocation is a traumatic event for all involved parties and is not to be taken lightly. The other is that commitment to a marriage is a strong emotional factor. It is the reason why spousal caregivers do not readily reach out for help. But commitment only goes as far as the health of the loved one and caregiver permits. I respect and encourage the decision to keep a loved one home if at all possible. But sometimes it's not and a long-term care facility is the only option. In this scenario placement is a sign of a strong loving commitment to care for him or her the best way possible.

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