Mom's mental state and stubbornness make it hard for me to arrange for her long-term care.

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I moved my mother in with me about five months ago. I deal with her hoarding, "shopping" through my papers and belongings, refusing to go to scheduled doctor's visits, and showing paranoid and delusional behavior. She's actually had the same habits before, but her mental state seems to have worsened. Dealing with her, work, and graduate classes put me on the verge of a nervous breakdown.

Today, she refused to go to an appointment. She has cataracts and doesn't want anyone "cutting on" her eyes. She believes she can get glasses and make the problem go away.

She is also having problems understanding documentation. I'm not sure if it is vision problems, cognitive problems, or a combination. She misunderstood a document about Extra Help for prescriptions and thought that it was a notification that her Medicaid was being discontinued.

Her poor eyesight hinders her from doing what she wants and needs to do. It also puts more of a burden on me as I attend to things that she can't see and try to work around her vision problems. To make things worse, I can't ask her to stop keeping dirty dishes and trash in her room without her making a nasty comment about my housekeeping habits. I told her that I was under a lot of stress with working, going to school, taking care of myself, and being a caregiver. Her response? "You could have finished college a long time ago while you were out running around."

I would like for her to stay so that I can keep an eye on her and make sure she gets the medical care and assistance she needs. However, I'm dreading approaching the topic of money with her--I haven't asked for any money for rent or utilities, and I usually buy her food myself. (She gets lunch from Meals on Wheels on the days that I'm at work.)

I'll have to start asking for and documenting her contributions in order to keep her assets below the maximum for Medicaid. When she gets upset, she'll mention how she doesn't like staying here and plans to move out on her own. She doesn't want to stay in assisted living, and I took her into my house because she was not able to take care of herself properly.

I'm worried that she will see my request for rent as being "bossy", and that she will move out and not keep up with what she needs to do to maintain her health and finances. I was concerned for her welfare earlier because she had lost weight and had been hoarding extensively. Now that she is in a more normal state, I don't think I could prevent her moving out based on my concerns. I'm frustrated and worried that she will wind up in the situation she was in before. I'm in Florida; she has an Elder Care caseworker. Any suggestions on how to proceed would be greatly appreciated. Thanks in advance!

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Annnie,

I didn't know that the surgery was so short. When we went to get her eyes checked before, the doctor explained that she had cataracts, told her what needed to be done to remove them, and they even talked about which lenses she wanted. That was about 4 months ago; it took about that long for her Medicaid application to get approved. Somewhere in between she changed her mind.

One of the services that Elder Care provides is a companion. My mother will get a visit in a few days; hopefully the companion would be willing to discuss cataract surgery with my mother. It would be great if the companion winds up being someone who has personal knowledge about the surgery; she might be more inclined to listen.

I agree that the surgery would add to her quality of life. I was hoping that the pre-surgery consultation would give the doctor the opportunity to explain what cataracts are again and give her additional information about the surgery. I was also hoping that they'd be able to explain to her that glasses won't be able to provide the vision correction she needs.

Thanks for your comment. I joined this site a couple of months ago and I'm really impressed by the support and information that members provide.
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jeannegibbs,

I had to laugh at myself after reading your comment, because you're spot on. As of today, my mother is receiving the same medical care that she would have received without all my planning and worrying. I will definitely call her caseworker; I honestly hadn't thought of asking her about my mother's other housing options.

Good advice! Much appreciated.
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Hi JessieBelle,

She's offered to contribute before, but I didn't want her to for two reasons:
1. I wanted her to be able to have money for emergencies. When she first moved in, she only had Medicare A, and she didn't have a lot of money in her bank account, so I wanted her to have money for medical care as well.
2. My mother is literally paranoid and delusional. She has been involuntarily committed twice, but refuses to take any medication. She'll accuse family members of doing various things, from saying negative things about her to following her around in a van. I didn't want her saying or thinking that I was taking money from her. But due to the lack of expenses, her current assets could disqualify her from Medicaid.

You're right about the blackmail.Thanks for the observation! I agree that she would be cutting off her nose to spite her face if she tried to live on her own at this point. However, I'd feel guilty if I "let" her move out on her own. If the discussion comes up again, I'll try listing the ways she would benefit by staying. Thank you again.
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My mothers cataracts were so advanced that she could not see when she moved from a room outdoor light to a room with indoor light. Then she FINALLY agreed to have the cataract surgery done and she is sooo happy with the results. One of her issues about it was she beleived that the surgery was long and difficult as it was when she was young (my mother is in her 80s). With the new procedures, about 15 minutes total surgery time, done on an out patient basis and the results have really added to her quality of life. Perhaps if her eye doctor explained all this to her then she may agree to it?
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It may be your mother is showing signs of dementia, or perhaps this is business as usual for her, with her basic personality traits just intensified with age. Either way I think JessieBelle is spot on with her advice to stop letting her blackmail you.

YOU are doing HER a favor by having her in your home. Keep that in mind in your dealings with her.

You say, "I would like for her to stay so that I can keep an eye on her and make sure she gets the medical care and assistance she needs." That was the intention and your plan, but it isn't exactly working out that way, is it? What difference does it make if she refuses to go to the doctor while she is living on her own or she refuses to go while she is living with you?

The reversal of roles is very hard for some of us to adjust to. Yes, she is your mother, but you are the caregiver and the home owner. Your house, your rules. Be gentle but firm about this. If that causes her to leave, so be it. If you can't set some rules then you can't achieve your objective of keeping her healthy in any case.

1) For room and board you are charging $x. She will think you are being bossy? Fine. Because when it comes to allowing someone to live in your house, you are the boss. When my mother moved in with my sister she charged her the same amount she was paying for subsidized housing. Seems fair to me. Check with her case worker to find out what your mother could expect to pay if she moves out. And put this agreement in writing, so that Medicaid will not look at it as a gift.

2) If she lives with you, she will get her vision problems fixed. You would gladly take care of her if she were totally blind, if nothing could be done. But since in this case something very routine can be done you insist on her keeping her appointments and following the doctor's recommendations.

If she wants to move out, have the caseworker get involved, to either talk some sense into her or assist her with finding a suitable place.

As much as you love her, and much as you'd like to make her life all better, you cannot control your mother's life. You can offer assistance, as you are doing, but ultimately she can accept or reject it.

What she is getting from you is extremely valuable, but right now neither one of you is acting like it is. She "threatens" to move out, as if that would be a bad thing for you. You back down, as if keeping her with you was worth any cost. You ladies have this reversed. Living with you is a privilege. To maintain that privilege she needs to abide by certain minimum rules. She thinks she'd be better off on her own? That decision is her right to make.
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I think the easiest way would just be to let her know you run low on money and need her to help pay the expenses for living. I would ask for half on everything. I'm surprised that she hasn't offered. I would not be blackmailed by her threat to move out. It sounds like it is a perfect way for her to get you to do everything her way. If she is not incompetent, you won't be able to legally keep her from moving out, but you can't be held hostage to the threat. If she were to move, it would be biting off her nose to spite her own face. Maybe you can remind her of that.

I don't think our parents ever really want to live with their children, but sometimes it is the best option for them. I hope that you and your mother can come to a good agreement.
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