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My mother in law is in a nursing home in another state. She has MS and is wheelchair-bound (and has been for quite some time), but until recently had been in otherwise decent health. Over the past couple of years, she has had a series of UTI infections that have required treatment.

Most recently, she's had a UTI for several months (!!). At this point, she needs hospitalization and a blood transfusion. The UTI is presenting cognitive symptoms and she's a bit mentally mixed up. She was never a particularly religious person, but she's started telling us to just "pray for her."

She's been refusing to go to the hospital and refusing all treatment, and has refused to eat for the last three days. Her home won't give her treatment or food without her consent, and we're pretty far away. We've tried reasoning with her, but it doesn't seem to be working.

What do we do? Should we try to pursue legal guardianship (and if we do, do we need to get a lawyer in her state or ours)? Is there anything more we could do if we drop everything and fly out there? Any suggestions on reasoning to use to try to talk her into going to the hospital like she should?

Links/resources/advice all very much appreciated.

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Went through this recently with my MIL, who died early in December. She'd had open heart surgery and the rehab was too arduous for her, she decided. She stopped eating, insisted that she be given palliative care only. She was a strong minded, perhaps stubborn lady all her life and decided that enough was enough. There was no reasoning with her; my husband, who disagreed with her decision vehemently, withdrew from the situation; her other two sons faciliatated the transfer to palliative care. You need to have a mental health assessment done (perhaps the nursing home can help identifying a resource for this) to show that she is of sound mind and is making this decision rationally. Might she accept anti depressant therapy if this is suggested? Best and hugs, Barbara
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I am not a lawyer and only know what we experienced when dealing with out of state elderly parents. In our case, the parents and their proposed guardian had to live in the same state. We had to move his parents to Texas where we live before my husband could apply for guardianship.

My ILs siblings were in the same state but all declined the responsibility.

Is someone living near your MIL that is currently overseeing her care? If so, what do they say?

Sometimes older people begin to do what my grandmother called "cramming for finals". She was referring to people being concerned that religion might be important after all as they deliberate their own possible deaths.
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There will always be something that can be done to prolong the inevitable. And, doctors will be right there to offer it. But, your mother in law should be in charge of when all of that stops.Only she can decide whether she has a life worth living. Try to be grateful that she's able to express her desires and make the decision. This is hard, but it would be harder if she continued to decline without making her wishes known one way or the other and it was up to her loved ones to determine if she'd want to linger or go.
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hospice, hospice, hospice. Please consider it
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No it is noteasy to accept the inevitable. Unfortunately many do not realized the importance of DNR and medical end of life choice documentation. I agree with you and am sure many others do, though I have talked with some that do not and will try to circumvent wishes. I see this often when I vist my assigned NHs.
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And what would you do if you had legal guardianship? Force-feed her? Require her to undergo treatment against her wishes?

How old is MIL? How long has she been in the NH? How often is she visited by family members? Friends?

I think the bottom line question is whether she is in her right mind. (And if she is, I'm not sure you could obtain guardianship.) Do her doctors think she is incompetent to make her own decisions?

My heart goes out to you. You are in a very difficult situation. Competent adults are allowed to make their own decisions, even against family wishes.
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Father (95 and 11 months) passed away last week- alz problems and body giving out. DNR and ready to move on- combination of him not wanting to eat and maybe the mind/body was causing problems in desire to eat. Couldn't even swallow a sip of water (even if he wanted to) without choking near the end. About two years ago he tried to stop eating but it wasn't his time- now the mind/body said it was time to go. Difficult for the family but nature/God is the way. Hospice is great support- please call them for their help.
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FBG, I am so sorry to hear your father passed away. I know age doesnt matter but wow he lived a long life and thats great. Take care and hang in there :o(
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Hi FriendlyBedGuy..I'm sorry about your father passing away. I may not comment on the threads that you have commented on. but, I just wanted to let you know that I have enjoyed some of your comments. Some were helpful on how we can improve with our caregiving patients. HUGS!!! to you. Sincerely, Book
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I'm sorry for her. Why does she not have a choice in this? Maybe she's ready to move on and, I'm sorry, but why are you so determined to stop her? Death is difficult to accept, but at some point it's going to happen no matter what we do. What's wrong with just being supportive and allowing hospice to step in and help everyone? You don't say how old she is or give any reasons for why you think she needs to keep going, against her wishes.
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From my experience with my mother and bladder infections, confusion was the predominant symptom. You have to be proactive and step in to help, they are not in the right mind to make decisions like not eating when they are confused. The unfortunate thing is that bladder infections can be more serious with people in poorer health (needing blood transfusions etc). She may not be well enough to be moved to your state. If there is anyway you can get guardianship where she lives or persuade another family member to take on that responsibility, do that now. Her time will come when it is supposed to but in the meantime I feel we need to be their advocates and help them when they are confused. My Mom got through episodes of severe bladder infections to enjoy a few more months of quality life. Yesterday she signed up with Hospice and we are all in agreement that this is the right decision, there are no more procedures or operations which can help "cure" her.
Hospice will prescribe antibiotics if needed.
Listen to your instincts.
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My mother did the same. Stopped eating and drinking. The hospice said this is usually an end of life thing that happens and that they see this alot. Apparently when the time is near people no longer want to eat or drink. I would ask that the doctor in charge of her care to call in a hospice to make her more comfortable. My mother was not scared of dying and was hoping to see her sister in Heaven.
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Oh I forgot to say a few days later she passed away holding my hand, after I told her I loved her, and that it was okay to go.
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redsage...This is what I would do...if you can afford it and work it out, you and your spouse, and perhaps any other children of your MIL should fly there and make an appearance at the NH and visit with her, ask questions of the NH, her doctor or doctor's assistant and anyone else you can find in the city (Agency on Aging, Senior Care etc) about what rights you have and the laws in that state, as well as their suggestions on what to do. You need to see and hear face-to-face what's going on yourself instead of relying on someone explaining it to you, especially if the info is coming from your MIL. She maybe painting the picture unobjectively.

I experienced what I think you are going through; A) The feeling {responsibility) of wanting to do the right thing...that you can't just let this family member decline in a harsh manner without some sort of a response and...B) the uncertainty of whether these decisions she's making are her genuine, competent wishes or perhaps the result of unclear thinking ("mentally mixed up") caused by a treatable and what could be a temporary illness.

You are searching for answers. The best way to get them is face-to-face from your MIL, the NH, and her doctor or other medical pros at the NH. As to what to say to your MIL to perhaps change her mind and accept food & medical treatment; considering logic will probably not be helpful, I would fight fire with fire, if she says again to pray for her, remind her that most religions find it sinful to kill yourself, which she's doing by not eating or allowing treatment for an illness. Some religions also find it worse than sinful (murderous) to deny food and nourishment to God's creation.
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After experiencing a recent incident with my own mother who ended up in the ER and ICU due to a urinary tract infection, I learned via the ER doctors and the ICU nurse that when an elderly person comes down with a UTI that lasts for several months it does affect their cognitive abilities BIG TIME. I learned that UTI infections are likely caused by either not drinking enough fluids OR not getting cleaned up well after a bowel movement or BOTH. If the E.Coli bacteria stays in the urinary tract long enough, like one or tow months, it can cause obvious behavioral changes AND it can cause sepsis which if not caught in time, can cause organ failure and death. Nursing homes are famous for spreading infections. My mom is currently in a Skilled Nursing facility but sometimes she has to wait for a half hour before the CNA can transfer her from the wheel chair to the potty to take a dump which means the chances of her pooping in her pants is great and the chances of her getting another UTI is great if they don't clean her up promptly and thoroughly. Although her white blood cell count is back to normal and she is done with her 14 days of antibiotics and still healing from the infection, she has now caught a nasty cold and cough from being in the Skilled Nursing facility. Plus I learned that most of these nursing facilities are not into providing vitamin supplements like cranberry extract to keep the E.Coli from re-infecting the urinary tract. If you are ready to give your MIL the care that she needs at home, then I would definitely make the necessary legal arrangements to get her out of the Nursing facility ASAP. I plan to yank my own mom out of the SNF and take care of her on my own as soon as she has completed her physical therapy which is one of the few Pros about a SNF. There are more Cons than Pros about being in a Skilled Nursing Facility in my opinion.
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It is a natural part of the dying process to lose appetite and thirst. In fact, some consider it cruel to force food and drink on a person who is actively dying. There is debate in the hospice profession about whether giving hydration to a dying person is actually uncomfortable for them.
"Waddle1": Please don't heap guilt on anyone by suggesting that letting God (or nature) take control is somehow sinful. Many would argue that modern medicine has increasingly been 'playing God' with the elderly. The many "temporary illnesses" that arise when a person's body begins to fail are inevitable at the end of life and, in my view, shouldn't be treated as crises or even "illnesses."
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This whole issue is fraught...my MIL came out of surgery to repair a dissected aorta, real surgical emergency, so not a lot of time, brain space to make decisions. Since she was already suffering from COPD and mild dementia, had a DNR and DNI (which of course were suspended for the surgery), the children who were making the decisions should probably have agreed to let her go at that point. For whatever reason, they consented to the surgery...and she never really recovered. Had a small stroke either during or right after surgery, never really regained her ability to swallow, had a UTI that was stubborn. She decided one day that she was not going to eat anymore and declined from there on out. Was she in her right mind? Did she make this decision rationally? Maybe, maybe not. She convinced the psychiatrists that she was compis mentis and that she was not depressed. In any event, she got what she wanted and is now at peace. She would have been 81 years old today. With some people, there is no convincing them that there is something to live for. In her case, maybe there wasn't. Sorry for the pain that you are going through. Hope all the information you are getting here is helping a bit.
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IsntEasy...I hesitated before bringing religion into my recent post. I went ahead and did it because...A) redsage and the MIL raised the issue and B) redsage asked for advice on how to respond to MIL refusing care and treatment.

What I wrote about various religious beliefs concerning food & nourishment is not my personal belief, but it is factual and reality for some religions and people. There are religious and secular people who believe it is cruel to not provide/offer nourishment to someone who is dying, just as there are those who believe the opposite, as you noted. Secondly, my intention was not to "heap guilt" on anyone but to point out, as others have done here, that there could very well be other things going on here besides "the natural part of the dying process" and redsage, for the family's peace should explore the situation. I'm not suggesting that redsage thwart MIL's wishes to die if she's ready to go. I'm suggesting that redsage get some clarity on the situation by evaluating it first hand. At the least, a visit at the NH could bring a chance to see MIL for what could be the last time, and say good-byes.

Redsage is obviously wanting to be involved or desires to respond in some fashion to the MIL's situation...and should. I applaud the interest. I think the "guilt" could arrive later if he/she does nothing but wait for a phone call from the NH saying it's over.
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