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My mother is 92, probably in the end stages of dementia, living in an excellent nursing home which is 1,600 miles away from where I live (this was her choice when she was selecting her retirement home). Her physical condition is rather good but her mental status, not so much. Because of her history of being strong and active but extremely confused, agitated, trying to escape the facility, violent/hitting, combative, etc. we had to bring on 12 hours/day, 7 days/week private sitters. She spent 2 weeks in a psych hospital last summer to adjust her meds but everyone agrees that only made a minimal change. I also pay a geriatric care management agency who sends various people to check in on her physical, emotional and social well-being 3 or 4 times weekly; depending on whose day it is to visit, it's either a nursing check, a social visit, or music therapy.


My brother lives a couple of hours away and goes to see her once a month, as long as his health permits; he's not well either.


Around the beginning of 2023 she began losing weight over a period of several months. As it turns out, it's because her dementia has progressed to the point where she can no longer feed herself. So, we added to the care plan that the sitters are now to assist with feeding and her weight loss has stabilized; she may even start re-gaining. During that time period she was accepted by hospice due to the weight loss which gives her yet another level of care.


So, I have no worries over whether she's being well-cared for. My guilt arises because every visit I make is one that I increasingly dread. My mother and I have never had a warm relationship; she was hyper-critical, demanding, and self-absorbed. She was a difficult person to like, although I felt that as her daughter, I should love her. She was difficult in her younger years and is still a difficult person now; even though of course now it's the dementia that gives rise to a lot of these behaviors.


I'm not sure if she knows who I am. People tell her, "Look, your daughter is here," and she smiles but I don't know if it's because she recognizes/remembers me, or if it's because she's evidently got a daughter and that daughter is visiting. Her verbal ability is fairly low now; she hasn't addressed me by name for over a year. Asking even yes or no questions stumps her. Sometimes she'll answer with a vague generality of "we should do whatever it is we should do" or "I don't know" or sometimes she just strings a garbled word salad together which makes no sense.


Her "good" days are when she's active but confused, pacing the halls, trying to escape the unit, shushing me if I attempt to speak to her or to passers-by. Or she'll sit staring out the window for hours without any interest in interacting with anyone. Her "bad" days consist of sleeping pretty much all day and then striking out at the nurses and aides when they approach her with food or meds.


In the past I've visited quarterly; Every 3 months. When I visit, because of the 3,200 mile round-trip distance I have to fly, which I despise; it takes all day due to layovers. I usually stay 3 nights and spend the entire days, from 8 AM till 5 PM with her. Just like a job, which it is.


With her condition deteriorating - she's sleeping more, eating less; and hospice has accepted her even though she's got no terminal condition other than old age and dementia - I'm hopeful that this journey may be drawing to a close.


My dilemma is, how often should I continue visiting when they're such unpleasant visits? They do nothing for me, but if they do something for her, then that's a reason to continue.


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You've managed her care so well, and if she doesn't know who you are, why go? It's too much at this time to travel thousands of miles only to have her give you that puzzled look, close her eyes and go to sleep.

To me, it doesn't make much sense to keep traveling back and forth, especially since these are perilous times for air travel and disease. Don't put yourself at risk.

And you have no reason to feel guilty. Her mind is gone. That's what tied you to her, not her aging and sick body. If your minds can't engage, it's over.

My deepest condolences on the loss of your mother. And BTW, I went through something very similar with my mother. I spent my "visits" doing the backbreaking work it took to clean out her attic, closets, and storage units and haul it away. She had no idea who I was or what I was doing there.
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Your mother made the choice to find a facility 1600 miles away. Visit when you want. Once a year, every 6 months. Your choice. Just like her choice didnt take into account family visits. Sounds to me like family wasn't her priority anyway. Take care of your own health first.
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You are so lucky she is in a facility and you have the luxury of deciding how often to visit. My parents are 94 and I go back every other month for a month long stint to fulfill my obligations. My dad has been in a NH since January and my mom is still at home. I hate going back so frequently. Can’t wait until this slog is over. Because that’s what it has become. I’ve been doing this for the last three years and there is no end in sight. I know this is crappy attitude but it is the truth.
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sp19690 May 2023
Then stop doing it. Just because your sister wants to continue this charade doesnt mean you have to continue to participate.
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Air travel has become unpleasant and exhausting, and it doesn't sound worth it when her "good" days and "bad" days are as you describe. Your mother forgets your visit quickly after it's over. On the other hand, you remember the unpleasantness. I'm not one for the bedside death vigils, so I would be content knowing that she's in good care, has hospice, and one day you'll get "the call" that her journey has come to an end.
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You could ask Hospice to call you when they think the end is near and go visit her then. You are doing a lot for her by getting her the care she needs. She may or may not know who you are. That's hard to tell. I'm sure your visits help her either way. My mom knew me because I saw her almost every day, as during almost all of her illness she was minutes away from me. However, it is extremely hard on you to make the trip to be with her. It was hard enough on me to see my mom, who was not combative. I had a good relationship with her, so it's difficult to imagine your situation. You do have to take care of yourself. That's the most important thing here. Be at peace with your decision.
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You're certainly managing her care in an excellent way, so you should have no guilt from that. She won't remember your visits, but it doesn't her to see her person to check on her actual condition. How many times? There is no right or wrong answer to this. You need to ask yourself if, when she is gone will you regret that you didn't visit her more often? Regret, not guilt. Also ask yourself, if you were in her place, what would you hope that your LO would do? I don't think visiting out of guilt is the right criteria. Everything about dementia is hard, every little decision is second-guessed. Work on gaining wisdom and peace in your heart about the situation. You're doing the best you can do, so do not feel guilty about this.
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I dread the nursing home visits, too, and have anxiety and stress over each one. It is hard on me in so many ways. BUT, in my case, they bring my mother joy and that's why I do it. It isn't really about me but about what she needs, which is family contact and connection. So I provide that for her. We both feel better when each visit is over. I am the only one that visits her, though (and she is very aware of this and mentions it every time I see her), so if I didn't, nobody would. So I put her needs before my comfort and do that for her. It's also good for me to check in regularly with staff and see what she needs and how her care is going.

I'm not saying that's what you should do. It all really depends on how meaningful the visits are for her, and what positives these visits bring to you both, if any. If there are enough positives, then it's worth it. I have relatives that experience so much discomfort over visiting her that they avoid it altogether, and use those negatives as further excuses not to go. It makes me (and my mother) sad.
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I think these kinds of questions always come down to:
if it were you, what would you want? If you were a mother, what would you want your daughter to do?

If I were a mother, I'd appreciate it very much that my daughter visits. Let's say I'm 60, I have a daughter. I'd tell her, "If ever I get dementia and I'm in a NH, I'd appreciate it very much if you visited me. Since we don't know what the future holds, like maybe I'll have dementia, and be very difficult and show no appreciation, I want you to know now already, that I'd appreciate your visits. You must do what's good for you, you have your life too. If, when, you have time, yes please continue visiting me."

OP, there's also the factor that your Mom was difficult towards you your whole life. You'll have to weigh all the factors.

You decide, so that you have no regrets later.
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sp19690 May 2023
But the mother intentionally chose a place 1600 miles from daughter. What about OP doesnt she matter? Why didnt mom take her daughter into consideration when selecting a facility? Not to mention the trips drain OP physically and mentally and she is a senior citizen herself.
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(((((judy))))) I was a distance caregiver of a mentally ill mother - not 1600 miles but about 350 miles. Over the 20 years my mother was at this location (she moved from across the country to be closer to family) I visited 2-4 times a year. stayed a few days and did not spend the whole day with her -ever! Latterly I would visit for up to an hour and only with a friend who was supportive of me which reduced the verbal abuse.

I was POA and then executrix and looked after all her affairs, arranged for her cremation and burial service (across the country where she used to live as according to her wishes) but did not fly there to the funeral. -not that that made any difference to her, but it did to me.

In my view, you have gone the extra mile and then some. When I got the word that mother was dying I flew down and saw her but due to extreme weather conditions (yes even in the city) was not able to be there a day later when she died. I was OK with that.

It sounds like, understandably, these trips are hard on you and I know they are expensive. I understand the increasing dread. My view - give yourself a break. You have looked after your mother's needs enough. She is being well cared for (mine was too) . Soon enough she will pass and you will have additional duties. Let your next trip to see her be the last one. Just my two cents worth.
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JudyM283 May 2023
Thank you, that helps a lot!
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I would add, I guess in my own defense and that of others who do not visit often, you don't necessarily have to be there to see that your loved one is well cared for. It may be ideal to do so - in the best of all possible worlds.

I made good contact with staff when mother first moved into a facility, and kept close contact with the staff who cared for mother by phone mainly, and some texting, and they kept me informed as to how she was. Family/friends visited occasionally as well. They never found anything out of order.

The most important thing to me was to be sure she was in a facility that was well run and offered a very good quality of care. That combined with making my presence known worked well for us. I don't think for a minute that mother would have been better cared for if I visited more often.

That is not to say I disagree with frequent visits if they work for you - of course not. More power to you.

I had to count the cost to me vs the benefit to her.
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