Mom is declining rapidly at ALF and I'm finding I don't want to visit. Any advice?

Is Medicare paying for Skilled Nursing? If not, it's very expensive out of pocket and requires a 3 day acute care admission for eligibility. So check it out before she gets moved and then you find out you're on the line for payment. (My dad was in a SNF and his Medicare supplement didn't have a co-pay. We got an informational notice that looked like a bill. Which claimed we owed $7500. I got a person from the Medicare supplement company Anthem and we did a conference call in which the facility was assured that my dad had coverage and no copay. The next month we got a similar notice but it wasn't called a bill, but Notice of Potential Liability for Care.)

Venting:I suggest you find a support group, I found that very helpful. Try several groups to find the right mix of people for you. If you can afford it, check your health insurance, go to a mental health counselor.
Three hour visits: I think this is way too long. Give yourself permission to have shorter and also less frequent visits. Try visiting at different times if possible. The visit may be better if Mom is doing an activity when you visit. You can interact with in the activity.
I figured out that the best time to visit my mom was just after she got into bed. I got in the bed with her to cuddle and talk. She was very calm and relaxed at that time.
Your interaction: You are probably trying to interact with your mom in the same way as you have before. This will not work, she is different now. Accept this. Here is an example. I brought children's books from the library with me and read them to her. We looked at the pictures and talked about them. I would not be appropriate when she was 60, but at 90 with dementia she loved it. I also made up simple stories about her assorted stuffed animals. She would pick up an animal and say "tell me!" so cearly she enjoyed this. It may help to try distracting your mom with something else when she is upset. This works with kids and it worked with my mom and the other residents of her facility.

Try pushing your mom in her wheel chair around the facility or outside when she gets restless. Maybe she wants to get up because the chair is uncomfortable. Look into Medicare paid for physical therapy to evaluate the chair and recommend proper cushion. I found that you have to ask for the physical therapy your mom is entitled to. My point is to try different things. Try a lot of different things until you find what may work.
It is not surprising that your mom had a decline after a broken pelvis.
Please taken care of yourself.

My way of visiting a person with dementia is to play soft music (I used old hymns and sometimes Gaither music) and take photo albums or power point presentations of their life to share. I also try not to visit in the late afternoon or early evening when Sundowners Syndrome may interfere. I also often shared lunch. People with dementia often have a beautiful smile and it is worthwhile to try to get them to smile.

I was so reassured to read the responses posted here to your question, jclscc, and to read what you and so many of us are going through.  Sometimes it's such a lonely place.  I could easily have written at least portions of almost every response I read. 
I concur with those who responded that maybe it's best you reduce at least the lengths of your visits.  I have found with my mother that she tires so easily these days, and you may be doing yourself, and her, a favor, especially if the care she is getting there is satisfactory.
My mother will be 94 next month, and has been in an ALF since December 2014. The original issue was primarily safety - she has severe osteoarthritis in her knee, and she was falling a lot at home - and there was some evidence of cognitive decline.  I had taken over all her affairs about 2 years prior to that and kept her at home, with some in home care, for as long as I could.  But she was no longer safe living alone in the house, no matter what we did to modify it.
Last November I had to move her into memory care there.  She is depressed, increasingly incontinent, and never happy.  She has hallucinations at times, and her cognitive decline is accelerating.  She complains (too much help, not enough help) constantly. When she's not complaining she's not making any sense. Visits with her are exhausting.  Her communication skills are on good days difficult, on bad days incomprehensible at times.  I have learned not to contradict her, which just upsets her and upsets me...and again, as long as I know she is well cared for and safe, I don't push it. A lot of  "oh, I understand Mom" when I really don't.  I try to remind myself that I have a right to have a life too, but the guilt and remorse is just horrible to deal with sometimes.  There are no easy answers.  But knowing what so many of us are going through really helps.  We need to support each other. 
Last week I was out for the first time on a Saturday night, for the first time in months, celebrating my own daughter's birthday.  Mom fell (not for the first time) and was taken to the hospital - while I was in the middle of enjoying my first night out in a long time.  I know it wasn't her fault but all I could think about for the rest of the evening is, should I go to the hospital? (I didn't).  And at the same time, with resentment, Why did this have to happen tonight of all nights? They released her at 2 am without anything serious having happened but I didn't sleep all night, and my festive mood was pretty much ruined.  I felt guilty and angry at the same time.  Looking back, I don't think that was such an abnormal reaction to what happened.  But I also think often  that I don't want my own children to go through this with me (and yet wrestling with guilt about whether I was being selfish for resenting her for falling on that night of all nights.)  So many conflicting emotions with this experience.
I've never navigated anything like this before and I really don't have all the answers.  I can only say that you need to care for yourself too, and remind yourself of that need constantly.  And don't feel bad about those conflicting emotions that crop up because they are REAL, and they are VALID.  We are here for you...talking and sharing really help.

Urinary tract infections are a common occurrence in Parkinson disease. Older people don't experience the symptoms that we usually associate with UTIs. The usual symptoms for seniors are being tired, shaky, weak, muscle aches and abdominal pain. Mental confusion is also common. So, a simple Urine analysis might be very helpful for your mother.

Doublefire I am sorry for the loss of your mom. You did great, the best you could do, nobody could ask for more.

Now I can answer this question from the experience of my mother passing away. I did not spend very much time with my mother physically over the past 2 years since her dementia and full loss of any memory of me or her past. I spoke with her on the phone from time to time and I wrote her letters and sent little gifts and flowers. My mother turned 103 June 12 and passed away June 14. I was able tell her happy birthday the other day and tell her I loved her. Contrary to others I do not have any regrets for not physically being with her these past 2 years. I think this is a very personal decision and their is no right or wrong answer. She was extremely well cared for and passed with dignity, quietly and peacefully. Since her passing over the past 2 days I have been filled with a sense of peace, relief, and freedom for myself and her. She is no longer locked in a confused and memory-less mind. She is free, in the arms of God's angels and her husband. This is what worked for me.

I know how you feel. My husband always tells me to go less often and shorten the visiting time. I also will not stay if I can not get her mood to change. That is why she lives there so I don't have to endure the abuse. The pros can deal with it. I am just glad she can't remember how she treats me. She has her goods days though , but I always get anxious when I am on my way to see her. Hang in there.

I don't agree that you will regret it later. I cared for mom for four years. When she went to memory care I just could not bring myself to visit frequently. She had done so well at home and once moved She declined rapidly. Dysfunctional dibs thought she would do fine a,d adjust over a few weeks. It did not happen,. Mom's behaviors were always difficult. Sibs had no freaking clue. It was their turn.

Bless you too jcslcc!  Also my dad takes buspirone and it is helpful. When he gets in a really anxious worked up state they’d give him Xanax. But he’s doing better since he’s accepting his new accommodations. Best to you as you make this move of her's to the NH. Come back and vent anytime!

Hello my friends!

I was so blown away when I saw how many people had responded to this. I had tears running down my face as I read these responses. I read each and every one and took something from all of them. I just couldn't believe so many people had taken the time out of their busy and stressful lives to answer my post. Thank all of you. You are all incredible people, and I wish you the best in your journeys with your families.

I was so overwhelmed in the amount of posts and questions that I would have to write a novel to answer them all! But I appreciate all of your interest and care- oh my gosh, I can feel the love! I'll just write a short update and comment on a few of the questions that stood out.

I had a bit of a stressful week- I had a meeting with the care team, and they are suggesting that mom might be ready for a skilled nursing facility. I was expecting this might come at some point, but it was just sooner than I had expected. They said she is requiring one-on-one care constantly through the day, and of course it is more than an ALF, even memory care, can provide. The doctor visited mom yesterday and is fiddling with her meds a little bit. Meds have come up a lot in the posts- my mom had been on a lot of meds in rehab, but has been off of them now and is all bare minimums, what she was on before she broke her pelvis- Sinemet (Parkinson's med for tremors), Metoprolol (for heart), and Aricept (for the noggin). Those are the only scripts she takes. The rest are just multivitamins. The doctor is going to try buspirone before they decide on the move. Her behavior is bad enough that the care team suggested a sitter or that I come for long daily visits (!) because the staff just can't handle her. I spoke with them about my personal health issues (which I didn't get into much on here, but as some of you had mentioned or warned me about my health- I do have several health issues going on at once. My health has gone in the crapper these past few months). I told her staying all day I just couldn't do. I know they are not staffed for one-on-one care but we'd have to find alternatives. Thankfully she has the most amazing care team and we are working together to find a solution. At least my mom doesn't hit (that I know of). Just up, down, up, down, sweater on, sweater off, up, down... you get the idea. That has been the trouble in her visits too, like yesterday I was pushing her in the wheelchair and we were just going in circles! I tried to take her to her room and she said "No, let's turn around!" So we did, didn't get five feet, and she said, "Let's turn around!" She digs her feet into the ground if I don't comply! Oh boy I relate to the posts about them being like kids. Little naughty kids!

I also related to the posts about the manicures and hair care- I actually bring a little pink tote with me, every time I come, with nail polish, files, and personal care stuff in it! I used to do her nails a lot more, paint them, fix her hair and braid it... but now she can't sit still long enough for me to finish. She really is fond of the little cafe in the ALF- you've given me an idea to take her there and try to do her nails. Maybe if I give her one of those free muffins and coffee she can't say "I want to get moving!"

A few people asked what happened with the fall- it's kind of a funny story in a way so I'll share. She was SUPER active before the fall. She danced when they had musicians, she'd walk the halls, even help the aides make beds and fold clothes. She was a real joy for the staff. Well, they were having activities, and playing noodle ball (a balloon flying through the air while the residents try to swat at it with pool noodles- seated). My mom was not participating in activities and was wandering by the couch area and the balloon went flying over the couch, so my mom tried to run and swat it. She stumbled and hit the entertainment unit, then fell on the ground. So the staff was not ignoring her and it was an accident- just that, an accident. I don't blame the staff or my mom. It just happens. It had a funny element to it though at the start, because when I got to the ER the way my mom told the story was that she "jumped through the air to hit the volleyball-" her words! So as we had to answer repeatedly what happened, it was "mom was playing a game of extreme volleyball at her memory care facility." Now of course it's not funny at all. We thought she'd recover fully, and I could have never imagined this would unfold this way. This is our journey though. And as I've read in your comments, I'm certainly not alone. One day they are fine, the next they are not.

Instead of going one day a week to visit, I think I will continue with two days a week for now but for shorter times. I do not live very close to the facility. I live 35 minutes away from the facility (I live in the country so there are no other facilities nearby, and hubby and I had planned to move out that way since he works in that direction anyway). I will adjust the time as I see how this new medicine works or if she is moved to a skilled nursing facility. It's just one day at a time now, and I will do what I can handle, physically or mentally.

Thank you everyone. We really are all in this together. What a terrible disease that robs of us our loved ones. They were all beautiful people and this is all so hard to process and cope with. I am truly grateful to all of you for responding and sharing your personal stories. Bless all of you.

You all are sooooo compassionate and brave and know that your Moms do know you're there but they're just unable to make you know they know you're there. May the Lord give you all comfort and peace in these sad trying times. Hugs to all.

When we are born, we do not come with life and death instructions. Unless you have been specifically trained for patient care, you may continue to feel useless, when you visit your Mom. Even trained and experienced nurses, commonly struggle with the care of their own. It may be convenient for staff, if Mom responds to a familiar face. However, staff know that Mom's dementia will advance over time, and your reasons for the visits, will change as well. Safety and comfort are the main focus. Mom's cognitive decline may cause undesirable behaviors, and Mom has no control over them. Nobody is policing you, on how often, nor for how long, your visits are. Even if it's just for a moment, Mom may feel comfort from seeing a familiar face. Know that Mom may feel warmth in her heart, just from hearing a familiar voice. Focus on the quality, rather than the quantity. You are just as important, as Mom is important to you.

I am so glad you brought up ALF visits as I have been struggling with the same issue, specifically feeling guilty if I don't visit mom every other day. I am her only caregiver and visitor. Sibling lives across the country.

There are lots of excellent suggestions here, but what it comes down to is what is right for you. Personalities and relationships with the LO need to be taken into consideration. Short visits of under an hour have helped ease my guilt. I also do a mini-manicure, clip off the chin hairs, straighten out her closet, find the hidden items she claims were stolen (curlers, toothbrush, nail files), change her beads or bracelets, puff up her hair. I bring cookies, which she loves, and we share a few together. I bring a photo album even though she is legally blind, I think she enjoys hearing me talk through the pages. Wheel her around the facility. Visit lost and found. There's usually enough to fill an hour. I too go right before meal time so she has something to do after I leave.

Besides her vision, she is also extremely hard of hearing, is wheelchair bound, has neuropathy and a nasty diabetic ulcer on her foot that's been there for about 5 years. She's suffered a series of strokes along with sepsis the last year. Bounced around 4 times with home, hospital rehab. Now has late-stage vascular dementia.

She's been in ALF for about 6 months and for the first few months, I was going every other day as she adjusted. It's 30 minutes from my home. Then cut it to twice weekly, which is ok for now. At some point I may reduce to weekly as I still work full time and I find the visits unfulfilling but do ease the guilt somewhat. Although she knows me, I don't think she understands the relationship. There's no conversation but I can make out her jumbled words about her delusions.

I know others have suggested you monitor UTIs, meds etc, but I found the more "involved" I became, the more her care became all-consuming for me and my own health began to suffer. At certain points in this process, mom's care was ALL I thought about. Always top of mind and that was not healthy for me. Cutting back on trying to solve her problems and play medical professional has freed me up to enjoy being her daughter. I want whatever time she and I have left together to be pleasant and not me being frustrated because I can't fix her problems.

Well, it sure feels good to vent and hear others have similar issues.

I hear your frustration, I always try to be understanding about mom. She is 90 and realizes what is going on to her (dementia) and I would also feel everything that she feels at 90. I can see it in her eyes that she is so called losing her mind and she has a very hard time dealing with the things that she could do "back in the day". It is not fun to watch and you want to talk to her like like before, but just keep in mind that a parent doesn't get to sign an application for this to happen, no choice what so ever, they are upset, nervous, not in their own home, strangers taken care of them, losing their dignity and scared. Please keep visiting your parent (I know it can be very trying at times, but just remember that it is just as hard for her.

In the same boat too. My mom will be 103 in 7 days, has advanced stage dementia, is blind, deaf, and has lost her language ability. She no longer remembers any of her family for the past year and half. I used to struggle over this same thing. I live a distance from her so going to visit is not an easy task. I finally realized that my guilt in not visiting was not guild but deep sorrow at the loss of my mother. I write her now. The nurses read the letters to her. If I lived closer I would visit but probably just for maybe 10 or 15 minutes. It is heartbreaking to watch this process and you have to take care of yourself also. I have made peace with my decision because I know I have provided for mom's dignity, comfort, and care. Sometimes that is all there is left to do.

Hello, jclscc -

Almost everyone has their comfort level for accepting abuse from a sick parent. Find yours because when Mom is gone, she's gone forever.
My Mom fainted while waiting to go into lunch. She was taken to the hospital and never returned to her apartment at the ALF. It took three months for the cancer to take her. Many times I've questioned whether or not I should have visited her more than every Sunday or call her three times a day. It's three years since she's passed away and there are days when I am still so guilty because I wasn't there every day. But, then I remember we had so much fun together to the very last because she did know me and knew and appreciated the fact that my sister and I had done the very best for her all of her life not just when she was so sick.
Find your comfort level for visits and if you have to change because Mom is getting worse, then change but don't stop going. Try to find something good about every visit. May God continue to bless you and give you strength and patience.

Don't know if this helps. I used to visit my Father every 2nd day for an hour in care facility.
His depression nd dementia have deteriorated him so much in the last 4 or 5 months.
He is nasty to me and blamed me for being in care.
I had a blow out 2 weeks ago about how he treats me
He could not care less how I feel. It's all about him. All he says are negative statements and complaints. I took a break for over a week. First visit after that when I went in he says " Yes . As if what do you want.He then proceeded to tell me a lady ,who also has dementia , is going to take him home and that they had a party for him the night before as he is leaving to go home. Badly behaved child comes to mind
I have decided i am going to go once a week and just before meal times so visit is short.
I am going to stop feeling guilty because he certainly does not.

I can't imagine what you're going through. My Mother turns 89 in July and kicking us all in our graves! She lives with my daughter in the country and helps with the great grands after school and loves it! I'm in my 60's and on Judge ordered SS Disab. and barely able to look after myself!
I have a dear friend who is caring AT HER HOME for her father in the last stages of ALZ simply because the 3 places she tried to place him, he got violent with them, they ignored his med orders and all hell broke loose and she AMA'd him out to her home where she is his total caregiver, driver, physical handler, you name it. She has turned him around with homeopathic treatments and the last I heard he is actually improving. Eating better, talking more coherently. Whatever she's doing is working. Her Mother passed years ago. So it's pretty much him and her. She's a champ!

As for your situation, God love you for being as patient as you are, I will pray for you more patience because really all you can do at this point is hold their hand, sing to them, show them pictures of their family, childhood if you have those available, take her for walks which I know is very difficult at this point as you stated and just try to be there. Just know that one day she won't be and that's what's going to kill you and I totally get it. My Mother's mother however had to go into a NH and after we went down to visit we had to AMA her out to a calmer, much better one in North Ga. this was in the 70's. They didn't know then what they know now about Alz. Have you talked w your mother's Drs. about the new Prevagin treatment that helps to arrest and reverse Alz dementia, sounds like that would help if you could maybe get them to write the script for it. If it's a matter of cost, the Part D, which I have, can help and she can maybe qualify for TROOP or Extra Help cost reduction or 0 copays for her drugs. I would certainly hate for them to have to restrain her, perhaps her Dr. can help with a sedative. If necessary.
Prayers, I know it's hard. Hugs. heart symbol.

I know it is difficult to see our loved ones decline in health . You may want to still visit the memories you are creating though difficult can be bittersweet. I saw my mother decline after her diagnosis of small cell lung cancer terminal cause it had spread to her lymph nodes and spine. But I wouldn't have changed the bittersweet memories I had in carrying for her she was a hospice patient but I was her primary care giver as well as her advocate I did the same thing for my grandmother my mother's mom who had deminitia . She wasn't with hospice.

I think guilt just comes with the territory- Whether she is in a home or at your home. Whether you visit or don't spend time. Whatever you do, the guilt is there. Mine is with me 24/7 and I still feel guilty? (What is that???!!) I don't even know what to suggest. How about shorter/brief visits, maybe try different times and see if there is a time when she does a little better? best to you

Most/all of this is just reiterating what others have said, but there are a few suggestions:

1) do the visits more for YOU than her, so you will have no regrets later.

2) shorten those visits!
- 3 hours is a bit much. It can be overwhelming for them AND you.
- if it is a long drive, limit it to say no more than 1 hour (less is okay too.)
- ask staff what time of day is her "best" and try visiting at those times.
- if possible, more visits during the week, but keep them short!

3) if she had surgery/anesthesia for the break, that can contribute to behavioral
issues. It can take MANY months to work out (you indicated 2 months ago, but
I've read it can take 3 or more - the only caveat is that often they get better, but
most never get back to where they were before.)

4) absolutely check for UTI - I suspected our mother had one, had an appointment
coming up anyway on a Monday, but starting Friday she was fit to be tied every
night, insisting she had to get out, go home, had guests coming, etc. Setting off
the door alarms, extremely agitated. It still took the full 7-10 days before she was
back to "normal", meanwhile I had to insist the doc give us anti-anxiety meds for
only occasional use (usually she is easily distracted/redirected, but not with the UTI!)
Along with this, yes, check any/all medications (a pharmacist is the BEST source to
inquire about side effects/complications with mixing meds). If she currently does
not take any anti-anxiety meds, consider trying them. Many will work right away,
no need to take them for extended periods to see the results (mom got one in the
evening if she seemed agitated during the UTI treatment - none since then (just
keeping them on hand/available if we get another UTI during doc off-hours!)

5) never argue or try to correct/contradict anything that is said. Smile and agree! It is
a battle that will NEVER be won! Since she has trouble with speaking, keep your
statements simple, questions limited to a yes/no type. A woman who started in MC
just after our mother was about the same level, but she is now in a wheelchair (and
often tries to get up/walk!) and most of her communication is unintelligible. If she
addresses me while I am there, I often just agree, or give a "really?" response and
then make excuses to move along... Although this can be brought on/exacerbated
by surgery/anesthesia/hospital stays, sometimes it is just part of the progression. I
don't recall this woman leaving for any treatments, and within a year or less she
was in this state. There is no 'one-size-fits-all' in the dementia world!

6) for those times that you just cannot get motivated to go visit, NO GUILT. We can
only do so much and it is not worth your health to force yourself to go! Go another
day when you are more "up to it!"

7) I cannot agree more with those who said bless those who are in the trenches with
them every day! I go at various times/days and see what they go through. Given
that they are likely among the lowest paid staff but are the ones who do the "REAL"
work, we cannot say enough nice things to/about them! Not every place has good
staff, but if you go often enough and vary your visit routine, you can get a good
sense of what they do or don't do. If they work well with the residents, make sure
you thank them at the least! I know mom's "staff" appreciates my kudos to them!

8) find out what treats/things she likes and try to bring something each time to make
her happy for a moment or two - ice cream, candy, trinkets, flowers, cards, etc. The
staff might be able to suggest things that seem to please her or you can dig into
your memories for what she used to like.

9) try various simple games or puzzles. I love jigsaws, and work with another resident
(100 years young she is!) - mom joins us, which surprised me as she was NEVER one
to do these! Now sometimes when I stop by I find the two of them working together
on them!
Remember that the mind is slipping further and further into the past, so some kids
games/puzzles/card games might be just the thing! Dollar stores are good for
trying out some things without breaking the bank (you can always pass these items
on to younger family members if she doesn't want them!)

10) Bring a scrapbook/photo album and pictures of the "good old days" and work with
her 'organizing' it (just beware, let her do it HER way!) She may take it all apart
later, but then you can do it again during another visit!

11) this is our own personal vent station! Vent away!!

Many posts have warned that a urinary tract infection UTI shows up as confusion. For about $ 10 these is a kit that shows UTI's. The brand is AZO in any drug store. In the box there are three dipsticks. A UTI shows when the urine sicks turn colors. Just hold the stick in the stream of urine or dip it in fresh bedside commode urine. within 1-2 minutes the sticks turn dark if a UTI is detected.
There are some other AZO items, a pain reliever and an antibacterial. I would avoid them for the elderly. Meds are very tricky for the elderly. I would contact your primary MD for treatment. I myself just used all three and now feeling healed but my plan B is to go to the local immed med site for an antibiotic. One of the meds causes very orange urine so use your old panties and discard them because the stain is permanent.
Some UTIs are common in women. Due to a woman's short uretha tube secretions from intercourse is one cause. Wiping backwards can cause them. Often no cause is found. The bladder irritation can be extremely strong so something has to be done ASAP.

I was getting this way and as result, left the NH earlier in the day one day, only to hear that he passed later. I wish I would have stayed. On the other hand, I am trying not to beat myself up on that. I spent so much time with my dad. But it was getting so difficult. Do I wish I would have overcome that discomfort to stay and be there when he died. You bet I do, and if I had to do it over again I would But I was making decisions based on what was going on at the time

Just a suggestion. If they do not have a system to play music, invest in a CD player and some of her favorite music cd's to play while you visit. Then make up photo albums to share with her. Include photos of her life and friends.

been there. mama would cuss and one time even tried to hit me, and had dementia and other issues, but i did it for me, she wouldn`t remember, but i would.. now that she is gone , even though i did all i could for her, i still beat myself up mentally about shoulda, coulda, woulda.... so i suggest you put your big your big girl panties on and your game face and go visit all that you can now while you can. she can`t improve her situation, she has lost her independence, and she`s lost in her world, so yes she may be angry, lost and confused. talk to the nurses there to help you deal with the situation, they have a lot of experience without emotional attachment to the patient and are trained to work with her. don`t get angry with her, she has alot of emotions and physical issues to deal with. there is plenty of time for you to sort things out in your mind later. these are her last days and yours with her........xoxoxoxox

My dad has been in a memory care facility for about 15 months. He's at a pretty advanced stage now. I visit twice a week. The visits are usually no more than an hour and a half. Up until about two weeks ago I was able to take him for walks outside or for a car ride or even out for a quick lunch. But he has declined and hospitalized for pneumonia so now I don't know how well he will bounce back. I also sometimes eat lunch there with him in their dining room with the other residents which I think helps "normalize" his experience of being there.

I was always happy to be with my Mother regardless of her disposition. I just did not want to be "there" when she passed, and I was not there when it happened. We previously agreed to a direct burial, but I could not attend it, and I still have not seen the grave after several years. I do not want to remember her that way.

Speaking as a person who visited the folks often, took all the calls and made a lot of phone calls when I couldn’t be there, my advice is to do what feels right to you. I would advise letting go of what others think you should do and you do what your gut says. When your mind and body are getting physically taxed trying to do “what’s right” , you risk damaging your own health. Spoken from someone who has paid heavily from trying to do it all.....

Everyone has made great suggestions. Consider your visits a challenge to find out what soothes her or breaks the frustration/power struggle. Don't fight her on issues, instead validate and distract. I liked the idea that someone made of the manicure. (I used to do that for mom; she loved it.) Does she have any favorite music? (my mom enjoyed musicals and perry como) Would she enjoy you pushing her wheelchair for a walk around the facility or outdoors? (Dad loved this, especially drives in the car. I'd bring a snack or go through drive-through. We even did errands together just so he could get out.) Does she enjoy any particular tv shows or golden Hollywood actors? Put your thinking cap on. She is frustrated and bored and possibly confused so happiness and distraction is key. Just do your best and you won't regret it.