I think I have a perspective many of you probably don't have. My brother in law (DH older brother) is SMO, and does not leave the house. He also lives with my MIL. He is still ambulatory, but it is getting to the point he will lose his mobility soon and seems like he will be bedbound. My MIL is an enabler. He has more issues than just health problems, he was a raging alcoholic for many years, prone to angry outbursts, etc., if she did not get him is bottle of liquor every week. She justified it by saying it was just a bottle a week and it kept peace in her house. Or her nerves could not take the confrontation. she knew he needed help, but was too (fill in the excuse here-- too poor to afford help, etc., etc.) She herself has only an 8th grade education, and sadly, will not do anything to improve her own life or her situation, despite repeated attempts by us to help her. It's a no win situation. So, they feed off each other. He has cut back on the drinking, but upped the food intake. He smoked for a while (and yes, she bought him cigarettes), but when he quit smoking, he ate even more. My husband and I have repeatedly tried to get him to go see a doctor for depression, agoraphobia, or whatever it is that keeps him from leaving the house. He won't go. We have also tried to help them all out by getting him to apply for disability. He won't even do that. So, he lives off what income my MIL makes. We are willing to help them by taking them where they need to go, helping them fill out forms, etc. They won't even try.
At one point, he was very ill with leg ulcers that bled and got infected. He finally relented and went to a doctor with my husband for the first time in 20 years. He had not been out of the house in probably 7 years or so before that. He had to get some treatment for his leg every week for about 5 weeks, bandage changed etc. We were encouraged that this might be a turning point for him, he decided to quit smoking and cut back on the drinking at that point. We were hopeful that maybe he'd get the motivation to start walking more and get out. He has not been out of the house since the last doctor visit, and that was about a year ago.
It is really sort of a pervasive mentality that is hard to understand unless you've been there. My MIL is very anti social herself, refuses to drive outside of the tiny town she lives in. When the one grocery store in town closed down, she still refused to drive to the next town over (10 minute drive) to buy groceries, instead she bought canned and boxed goods from the town's only Dollar Store. We finally decided to stop enabling her. She is in good health, has perfect vision and works a full-time job that is physically demanding. So it is not a health or frailty issue. If it were, we'd be more accomodating. As it is, we offer once a month to take her grocery shopping with us when we go to SAM's club or do our big grocery shopping for the month. (we have 5 kids). She wouldn't go with us. I finally got fed up with my husband running to do her errands for her when she was perfectly able, and basically told him his own family came first, and she could either go when it was convenient for us, or do it on her own. She chose not to go with us to get healthier fare at the grocery store, and stocked up on Dollar Stores snacks, hamburger helpers, chips, etc. Again, not making decisions based on health or welfare, just what is easiest and cheapest for her. It is not strictly a monetary issue either. She owns her own home and works full time, recieves a pension check from her late husband, and her car is paid for and she has no credit card bills or other bills other than utilities and groceries.
So, at least in this case, it is a multi-layered problem. Not just the SMO person who is home bound, but the foundation for this was probably set in place by parents who had their own issues. My brother in law did not get to be 600+ lbs over night. He was a MO child, SMO teenager, etc. In his elementary pictures, you can see a child who is very unhappy. My DH tells me of his childhood days when his mom would bake 10-12 pies at a time and have him and his friends over to eat whatever they wanted. She fixed fried pork chops, gravy, biscuits, green beans with bacon or lard added, and chocolate pie for dessert, with a big 'ole glass of sugar sweetened iced tea.
Now, the health problems are so apparent, and we all know that the weight is killing my bil. My DH is also MO, but active, and that helps. My MIL continues to order pizza, buy fried chicken, and uses her "fry daddy" just about every week. It is sad, sad, sad. We all know that one day he is going to die in that house, or have to have a wall cut out to extract him from the house.
sorry this was so long. My DH and I have had to face some hard realities with this situation. It has been a sore point for us during our marriage, how the dysfunction in his family affects who and what he has become today. A few years ago, DH made the decision that he had to save himself. He would be so depressed for days after visiting his family. He basically told his brother that if he wanted to get help, he'd be there, take him, etc. But he was not going to get sucked into the whole thing. If my MIL passes away before BIL, basically we will not take on the role of his nurse. He will go to a nursing home.
and yes, the expense of feeding and taking care of someone who doesn't leave the house keeps her emotionally and financially poor. She knows it will kill him, but says she can't make him do anything he doesn't want to do.