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My mom went into assisted living in December after years of not properly caring for herself (mostly hygiene). She has never been a caring, loving mother. She has always told us she wishes we were never born,etc. So her living with one of us is not an option. Ever since finding out she has aUTI she is meaner than usual. She refuses the meds (she currently is on no medication at all). She has always had some mental health issues but has never been formally diagnosed (she hates doctors). Anyway is there anyway to make her take the meds? AL says they can't make her.

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my MIL has repeated UTI’s. It is only when she becomes “her evil twin” do we realize the severity of the situation. Most times it progresses to the point of hospitalization. She is in a small AL facility that also will not force medication. It becomes a struggle as the urologist wants her on a daily low dose antibiotic. I really understand your frustration. Someone mentioned putting the meds in pudding. That sounds like a very clever solution.
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Cherry,

Just wondering how things are going. Is Mom still refusing antibiotics. If so, how is she doing?
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There is liquid form, spread it on toast. Use peanut butter and liquid antibiotic along with honey the liquid is a little sweet. Or you can add it to yogurt too.
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Does the facility allow you to bring in food that you prepared? Is her antibiotic in capsule form, like Doxycycline? If so, try this because it is what I did with Mom, even though she still lives with me. My Mom loves her chocolate, Loves it. I bi=ought a pack of Glad 1/2 cup *4 oz) storage containers, they come in an 8-pack, and made Jell-O instant chocolate pudding. Once I made the box; doesn't matter if it's the 4 or 6 serving size, I portioned it off in each container and put it in the fridge. Since she took the med 2X daily, she got a pudding cup after lunch and dinner. Before I gave it to her, I opened the pill and mixed it into the pudding; the med is bitter but is masked by the pudding. Never had an issue and still make the pudding everyday regardless. Do not premix the meds into the pudding since it breaks down the lactose and turns the pudding into goop within a few days; learned that by accident. If you visit Mom daily, then I'm pretty sure that the facility would give it to her at least after lunch in the pudding. They might also put it in apple sauce and give it to her. They tried that w/Mom whan she was in rehab recently. That went over like a lead balloon. She hates apple sauce with a passion on top of the fact they tried to feed it to her. I saw that the 2nd day I went to see her. I about died laughing. She started acting like a baby, then told them to shove "somewhere". I went to the store and bought some pudding cups until I made some at home to bring her. She said the homemade tasted much better. Just like when Mom cooked for us, being made w/Love, it makes it taste better.
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Bear in mind, my dad is not in AL.

My dad was told to lay off his aspirin while they treated him with an antibiotic for I can’t remember whether it was an uti or bladder infection (he had blood in his urine). Well, he got confused and refused to take any of his other medications (sugar pill, lung pill, prostate pill, etc).  No amount of me pleading worked as he only allowed me to give him the antibiotic. The only thing that worked was calling the doctor and begging him to call and get dad back on track. That was the only solution. What made it so bad was that sister did not notify me that while I was off dad had gone days without his medications.
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Cranberry juice has sugar. Not the best thing for UTIs. Its more of a preventative than a cure. Cranberry tablets would be better but again, more of a preventative. UTIs in older people does not cause pain. Thats why they go unnoticed. They really don't do away on their own. Mom could become septic and that is serious. Then its a hospital stay and rehab. Not where I would want to be if all I needed was an antibiotic.
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Cheryl lots of people come on the forum and don't bother to reply, IMO it's only frustrating when their question needs clarification, and even then I just assume the OP has gotten what they needed and moved on, so I do too. Not everyone who comes here wants a back and forth conversation, and that's perfectly OK.
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Cherylcheryl124 Apr 2019
Thank you. She is still refusing she will continue to refuse. She thinks antibiotic are poisonous and there is nothing I or the AL can do to convince her. Unfortunately she was like this when my dad had cancer. She refused to believe he really had it and this was over 15 years ago. It's unreal to think someone can think this way, but this is how she is, how she's always been and will continue to be. Right now I'm at the fine, you just wait and see and end up in the hospital stage. That is the only way she will think something needs to be done. I'm tired of fighting with her about it and she gets hateful toward me anyway. I have POA so I've been managing her bills and such and an stepping away from the situation right now.
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Sorry I have not responded, but I am here still just listening to the replies. My mom did end up refusing the meds because she says she feels fine. I have told her and the assisted living has told her that if it would get worse she most likely will end up in the hospital. She doesn't believe us. She has drank cranberry juice and doesn't seem any worse. She refuses to go back to the doctor to even get checked to see if the UTI is still there. I don't think she'll do anything until she thinks something is really wrong with her, for example physical pain. I think the antibiotics have her diarrhea. I even was going to get them to switch antibiotics, but she refuses still. She has always been like this. She is 78 and takes no meds and does well physically.I am in the process of getting her in with the doctor that comes to the assisted living she is in. She's just very frustrating. Sorry I won't post if I can't answer your replies sooner.
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Again, no responses from OP
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As this is a medical emergency (think septic shock), she should be taken to the ER stat!
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I agree with Barb. Does this woman know she will get septic and probably die? The elderly do not have the symtoms of a UTI as younger people do, the burning and itching. They just tend to get combative and Dementia seems to worsen.
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My father decided he had had enough and requested no more medical care. He had been in a NH for about 5 yrs after a fall and head injury but basically was up and around. Personally, I felt that was his right, he had had enough. His life, his choice. I thought of this when I took my mother(92) to a neurologist Monday. She’s had a number of strokes, Dr felt since she’s been on eliquis it kept them from killing her but she’s miserable and hateful and is getting worse mentally but physically not that bad. She’s afraid of death so doesn’t want to die but had she not been on the eliquis would be dead. I can’t really say which I think is the better result. Sometimes meds may keep us alive but for what?
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Isthisrealyreal Apr 2019
To be Guinea pigs for meds to keep us alive longer to be guinea pigs longer. Doctors and big pharma don't care about quality of life, only quantity of money they can get.
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As others have suggested, you could assert yourself into the situation, consult with an attorney and try to get appointed to be her Guardian, so you could make medical decisions for her, but, it's quite an ordeal, especially for a person that you have a poor history with. I'm not sure how you would feel doing that considering you have never been on good terms with her. I might ask the AL what their procedure is for situations like this. She can't be the only case they've had like it.

As long as she is competent, I would respect her health care decisions. And, if she's competent, perhaps she needs to sign an Advance Healthcare Directive that says exactly what she does not want in writing. Such as no antibiotics. This is not unusual for someone with a terminal illness. Is she terminally ill?
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Cherylcheryl124 Apr 2019
She is not terminally ill. Physically she's in good health, besides being diagnosed with the UTI. She receives minimal care. She is in AL because she was not taking care is herself... She never really has been good with hygiene/cleaning. It's just worse now that she's older.
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There is also a supplement called D-Mannose that has proven successful in treating and prevention of UTI’s. It comes in a powder form with probiotics that can be mixed in her water/drink and might help. Otherwise you might see if a shot could help? I’m sorry she has been so abusive to you and your family. The fact that she has shows me she has some mental health issues that will only be exacerbated by the increasing dementia. You very well may want to get an independent guardian appointed so that you don’t get dragged down the rabbit hole. It will only get worse.
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Pepita48 Apr 2019
Yes, I agree with you, D-Mannose is a simple sugar related to glucose which is brilliant at getting rid of certain UTIs, I always keep some at hand and take it as soon as I notice any symptoms. However, I believe from the literature that it only works on e-coli bacteria, which are responsible for around 90% of UTIs. Infections caused by other bacteria would unfortunately require antibiotics, which can cause unpleasant side-effects - perhaps this lady has experienced such things in the past which might make her reluctant to take them? Just a thought...
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Under Federal Law a long-term care community can not "force" a resident to take their medication.

That being said there are some things they can try. One of the problems with a UTI is that it can cause a senior to become confused. I would ask the home to try and crush her medication and mix it with something she likes, applesauce, ice cream, pudding. Another thing they can do is request a liquid medication that can be mixed with something she likes to drink.
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Dunno if this will help but there is a liquid med for UTI; maybe for other things too; Cephalexin. Taste is pleasant. Have used it. Did the job.
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She is a consenting adult and thereby can make her own decisions, even bad ones.

If she continues to refuse the antibiotics her bad attitude will get worse, this is a symptom of UTI in seniors. Then her system will become septic, full of toxin, and she could very well die without intervention and if it gets bad enough, she could very well die with intervention.

I would tell her that and see if it shifts her willingness to comply.

I am surprised that no one has mentioned this to her or you before, doctors and nurses, even CNAs know how serious this is.

You may be better served letting the state take over as her guardian, it is hard enough dealing with a senior without all the baggage she packed for you all.

Hugs, it is okay to not be her advocate, just make sure and get her one. She should be paying her own way also, you children should not be paying anything for her.
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Cherylcheryl124 Apr 2019
Thank you. We are not paying anything for her. As unpleasant as she can be, I still try to make sure she is cared for as best as I can even if she doesn't appreciate it.
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I guess my question would be, does this lady understand that she could die from an untreated UTI?

If she does, and she understands that she may end up dead from the infection going septic, then it's her decision.
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Cherylcheryl124 Apr 2019
I've told her SEVERAL times as have the people at the assisted living. She doesn't believe any of us. When my dad was dying of cancer she didn't believe he really had cancer. She's not totally right mentally, never has been.
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Aside from the ethical considerations "tricking" those mentally competent isn't easy, at least not the second time.
On the other hand a little sleight of hand is sometimes all it takes - I watched an encounter where the nurse asked someone if she would taste her pudding as it was a new recipe and she wanted her opinion, of course the meds were mixed in the spoonful. After accepting the lady replied "well you sure as h** can't cook"!
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This lady has never been formally diagnosed with any mental health issues. She is therefore, for the AL's purposes, a consenting adult. She cannot be forced to take medication, neither can she be tricked into it - giving her the antibiotics surreptitiously is out.

It's up to the attending doctor to talk her round. If the doctor won't or can't, and mother really does have an aggressive u.t.i., mother will eventually become so ill that consent will cease to be an issue temporarily (because she'll be incapacitated) and her next of kin or her representative will get to make the decision. If mother hasn't created any standing directive, it will then be possible to treat the infection.

I can understand that none of you would be exactly eager to take on the role of advocate for your mother. It's hard to fight for someone who has made her own feelings about you so painfully clear. Does anyone have power of attorney for her? Would it be possible to ask the ALF about finding somebody independent to do this?
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Cherylcheryl124 Apr 2019
I have POA over her.
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Only if it’s administered intravenously & you have to insist if ALF not allowed to do that, then take her to ER. If she is there for at least 3 days you can have her transferred to SNF & then they will continue to administer the antibiotics intravenous. She needs more care than an ALF can provide at this point. Don’t wait because it will get worse & travels to kidneys.
Hugs 🤗
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JoAnn29 Apr 2019
I doubt if an AL will do anything intravenously. There is usually one RN, who MAYBE trained, the rest of the staff are CNAs not trained nor are they allowed to set up intravenous. So, like said, take her to the ER.
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Cherylcheryl124, if the antibiotic comes in pill form, maybe that pill can be crushed and mixed into ice cream or pudding. It all depends on the pill and what one can do to the pill.

I remember the nursing home crushing pills for my Mom and placed into her favorite chocolate ice cream. What was interesting afterwards Mom wouldn't eat regular non-pill ice cream, she would say that it didn't taste good :)
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CaregiverL Apr 2019
Freqflyer, the SNF will go out of their way to crush & put into pudding or ice cream, but ALF not required to. They will not do anything they don’t have to. & what if she don’t finish ice cream?
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If she has not been diagnosed / declared as incompetent then you can not force her to take her medication.
If this is important to you you could try to have her declared incompetent and become her guardian at that point you can force her to take her medications. (Or she would be appointed a Guardian by the court) She would probably have to be moved from Assisted Living to Memory Care. (Or at least be admitted to the hospital so her medications can be administered.)
Another option would be to let her do as she wishes for as long as she can. You could encourage her to take the medications or if she will not do that at least increase fluid intake, drink cranberry juice and or cranberry supplements. The infection will run its course and get better or get worse.
Sorry I'm not much help here but you can not force someone to do what you want them to do. You can try to motivate them, you can try to change their mind about something but you can not force someone. (short of restraining them). It also depends on the policy of the Assisted Living facility where she is do they administer medication? and if they do so will she be then charged for a higher level of care? (You might want to mention this to your mom if she is concerned about cost)
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When my mom was in the nursing home I watched the daily dance between the nurses and a woman who was resistant to taking her insulin. While it's true they can't "force" someone to take medication a good nurse can certainly reason with, trick, cajole, or do whatever it takes to get compliance. Ask them to try harder.
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