How do I set limits on caregiving with a family member?

jadelpn, LPN, EMT-B · May 14, 2012

You and your husband need to make a plan. And that plan would involve your brother in law accepting VNA and whatever other services he may need. If he is put into the hospital again, talk to the case manager that he needs a viable dishcharge plan--and any other services the case manager can put into place for your BIL. I am assuming that you are a nurse. If so, The LAST thing you want is the brother in law to up the anty--ie: My sis in law the REGISTERED NURSE KNOWSSS all ABOUT my issues, and blah, blah, blah......then you are left holding the bag, as a licensed professional who knows that a person (in this case your BIL) is neglectful to himself, and seemingly can not take care of himself at home.

Do you believe him to be mentally ill, or does he have a diagnosis? If he wants you to be involved in his care, he needs to sign a medical release at his MD's office so that you can. Speak to his MD about getting him involved in the Department of Mental Illness in your state. Is he older? Then Elder Services. I know that he may not want to accept anything, however, that is where perhaps your husband comes in to have a heart to heart with him. It is not right that he is putting your professional license on the line to gain attention, and should you not be a licensed nurse, there are services that are available. And he does have some major health issues that need attention. Perhaps even a stint in a skilled care facility for rehab and discharge with services.

I think at this point it should be made clear to your BIL that enough is enough, and I would be clear with the fact that your house is no longer an option, as he declines when he leaves, and the need to start at square one is not fair to anyone.

SuesquatchRN, BSN, RN · May 14, 2012

He wants to move in with youse.

deftonez188 · May 14, 2012

He is family - but don't let cliches about blood being thicker than water hold you back from ending this behavior. It isn't fair to you that you are in this situation - and you are not responsible for him. If he refuses to care for himself, he needs more help than you can give - the best you can do is offer referrals, but otherwise, live your own life.

I've given care for an ill parent on hospice - he needed me for a reason, he couldn't take care of himself - what you describe is an adult who, although potentially depressed, has full capability for self care. Do not let him place a saddle on you to ride.

We have to accept that our patients, and people in our lives, are going to make choices - they also have the responsibility to face the consequences of them.

Anna Flaxis, BSN, RN · May 14, 2012

Sounds like he might be a candidate for an adult foster home.

beachmom · May 14, 2012

I am an RN. He has never been diagnosed with a mental illness, but he probably should be. He doesn't fall into any typical category. He would never cooperate with a psychological evaluation.

He is disabled enough to get SSI, but he has too much money in the bank. He won't spend it on medical care. We've told him countless times to put his money in a small house or mobile home, then apply for SSI. His typical decision making process goes like this: I'll do this. No, I won't. Yes, I will. No, I won't. I didn't do it. I should have done it.

My biggest fear is he will come to our town with a bad foot and have it removed. I couldn't drop him off at the foot of his stairs and tell him we'll see him later. He can't get into rehab without money. He's 51 YO. Although if he goes to rehab, that would use up of the money in the bank, and then he could get SSI. I hadn't thought of that. We need to insist he goes to rehab.

I need to have a heart to heart and emphasize I am NOT going to keep helping him. He NEEDS to take responsibility for himself or accept the consequences himself. I'm not very good at confrontational stuff. My husband's "heart to heart's" end up being arguments.

Thank you all for your comments. You're helping me work up the courage.

OhioCCRN, MSN, NP · May 14, 2012

if he has too much money in the bank, why is he applying for SSI/disability? Im just curious...not really familiar with SSI and how it works. thanks.

deftonez188 · May 14, 2012

Arguments are a fact of life - no one enjoys the emotional 'spin-up' of one, but they are necessary. People argue all the time when threatened with facing realities about themselves. It can be very uncomfortable and confrontational to put out flaws, but it is necessary, because the individual in question is allowed to continue as things stand if you slide backward into the fear of facing them.

I've had to cut off my own mother from contact - and it wasn't pleasant. Growing up abused by an alcoholic who then spends the rest of their life living like a teenager and seeing you merely as a bank account and retirement check later led to a blow out, and I've never been happier since.

It's like bullies - they see what they can get away with, what you don't stop, then they repeatedly abuse you in the same manner. Bullies don't have to be the biggest kid on the playground, they take new shapes in adulthood.

RNsRWe, ASN, RN · May 14, 2012

I'm with Jade on this one: next time he's hospitalized (which he will be, of course), you need to make case management aware that you will NOT be taking responsibility for him or his care, and that you are NOT going to be involved in decision making on his behalf. They need to treat him as if he has no family, because frankly, if they don't and keep assuming you're going to be his guardian angel, they won't do much to help you with that.

Long-term, he probably should be placed in a SNF, and have a psych eval next time he's brought to the hospital (by ambulance, I'd imagine).

You have to lay this out for him now, before the next emergency arises. For when that does, it can't be "but I was counting on her to help, how was I to know she'd desert me", etc etc. Can't be a surprise, nor a desertion: it's going to be the plan, period.

kids · May 14, 2012

If there is one thing I've learned from being manipulated into being a caregiver to a family member is that YOU can not care more for their welfare than they do. He's a competent adult and as heartless as it sounds, for your own wellbeing you need to let him experience the natural consequences of his actions.

Next time he's hospitalized leave it for him and the hospital social workers to deal with. As long as you keep rescuing him he has no motivation to help himself.

leslie :-D · May 14, 2012

next time he's hospitalized, tell the attending that your brother needs a psych eval and have it done inpatient.

once he's officially dx'd (and he will be), he will have other resources than you.

your soft heart is enabling his debility and dependence on you.

please take a stand, for the sake of you, your husband and your brother.

this is a lose/lose situation all around.

leslie

beachmom · May 14, 2012

I emailed him today (he has no minutes on his phone) and nicely told him I was not his caregiver. He needs to accept responsibility for his health or accept the consequences. I'm kinda proud of myself.

In answer to why he needs SSI. He can't get a regular job. His only income is going door to door selling honey (hence the bad foot). It's hard for him to pay medical care with that small income. His dad died awhile back and left him about $60,000. He's never had any kind of money before, and he doesn't want to spend it. Yes, he SHOULD spend it on medical care, but he WON'T, so he just doesn't get medical care. He only needs SSI for the health insurance. Although if he loses a foot, he won't have any income. If he puts the money into a house, he won't have rent, and he can get health insurance. Or if he spends it all on medical care then he could get SSI after that. Kinda complicated. He's got a fine IQ, but he has little common sense.