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She has been staying indoors, only going out to the mailbox about once a week. All her meals and meds are mailed or delivered to her. She can do for herself the major things: use the dishwasher, washer and dryer (but not fold or hang up the clothes), and warm up meals in the microwave. But, lately, it has gotten very hard for her to do even that. When she has a bathroom accident, and poop gets on the floor, it is nearly impossible for her to have the energy to wash it off. She has a cousin who comes once a month, so sometimes, it has to solidify on the floor and wait until the cousin can come to help. She has a son who will take out her garbage, but not come in to do any chores as he is tired after his work and needs to do things for his own family on the weekends. The price for a housekeeper is $20 an hour with a four hour minimum. She doesn't qualify for Medicaid and Medicare doesn't pay for that. Lately, she has expressed that she doesn't think she can live much longer. She is a fighter and has fought many horrible things in her life to survive. I hate to see her giving up. How can I motivate her? Psych said she doesn't qualify because she is not actually suicidal. She refused psych meds because of all the other pills she has to take for her heart and diabetes and pain. She does not abuse her narcotic pain meds. In fact, she often screams in pain and won't take them. How can I help or advise her? She can't do things she used to love: paint, draw, crochet, garden, because of pains in her fingers and joints, and with the Covid restrictions and her fear of getting it (she is vaccinated), she does not want to socialize any more. She used to be very friendly and gregarious. Now, she is afraid of people. Afraid of going out. Afraid to go to the store, and even, as I said, afraid to go out daily to get the mail.

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If I had all her medical issues I certainly wouldn't be afraid of getting covid. She's so afraid if dying that she doesnt even realize she has stopped living. My advice to her would be to get out and live her life. If she gets covid so be it because the alternative sounds like a living hell.
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She's sick and dying. "Motivating" her to not be that way isn't a thing. Her heart doesn't pump enough, and her COPD prevents her from breathing well. Those are two must-haves for good health, and both are incurable.

I suggest you arrange for in-home care somehow and look into hospice or palliative care for her as well.

Her issues are not a state of mind, so don't treat her as though a change of attitude will fix everything. Respect her issues and work to help her live with them.
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I'm not sure that what she needs is motivation. She needs more help.

Is she using adult incontinence garments? Does she have access to flushable wipes?

Can she afford for a house leaner to come for 4 hours every other week?

Is she on Medicaid for her health insurance? If not, what funds does she have? Can she spend a bit on her care?
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I just read the profile. Is this the person mentioned in the post? If so, please do not write in 3rd party. It confuses things. If not, I am writing this like a friend is asking.

First, CHF means her heart does not pump enough to move the blood thru anymore. Just having this makes it hard to do anything.

Second, she has COPD meaning her lungs no longer can get the oxygen moving thru her body.

Third, arthritis is very painful and debilitating. It takes my husband's Aunt all morning just to get moving.Then top all that with diabetes.

Her body is not able to get oxygen thru her system. I'd not be surprised if she is not showing signs of memory loss. Have you checked her pause ox? Does she get her hemoglobin checked. I am surprised this woman can do anything. She needs help not someone trying to get her to be more active.

Why doesn't she qualify for Medicaid help? And there are people who will work for less than $20 an hour.
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