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My mom is in year 3 after being diagnosed with dementia. She and my stepdad have been married for 25 years. We see my mom once a year when they come to visit in Wisconsin.

The change in my mom from last year is dramatic. The loss of memory, physical functions, disposition, hygiene etc. My stepdad, who is 80, has been the only caregiver with them living hundreds of miles away.

During the first week back my mom had a stroke. After hospitalization my brother took them into his home. My mom is no longer able to support her weight so he has had a hospital bed and a hoist brought in. He and his wife have become my mom's full-time caregiver, with my stepdad helping as he can.

Discussion is beginning on what to do with my mom. My stepdad is under the illusion that he will be able to take her back to TX with him. My brother and I do not think that is possible ever. My mom needs full time care at this point. There was some talk about a nursing home.

The finances are blurry and only my stepdad knows their financial situation. He said that they had signed a prenup when they got married, his stuff is his and hers is hers. I don't know anything about their finances, as I said, but after 25 years of marriage there is not much mine and yours anymore. They have a joint account which checks are written from so I am assuming that all money to pay for anything was pooled.

My brother has committed to taking my mother in and providing care for her. He describes my stepdad as "frugal" and I am translating this to mean he is still in visitor mode. He has not come to terms with the reality of my mom's condition and the expense of providing care for her at this point.

We have not been included in any of their healthcare discussions for the years they have been married we do not know what my mom's wishes are. At this point she is not able to communicate those wishes.

We are in over our head at this point. Where do we go for help in sorting this out?

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Start the background legal necessary for you to help mom. POA.
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Because he probably should not be driving by then. Allow for the independence, keep making sure they feel welcome. It took years before my aunt's husband would allow my aunt to shower or spend one overnight in my home when they visited once a year. This could have been because they were fiercly independent and would never say they had any needs. Excuse me if this doesn't quite match your circumstances, but it is my understanding of 'Snowbird'.
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Snowbirds can live anywhere and come with their own R.V. to visit? Hook them up outside, invite them to stay. Tell the 80 year old Stepdad it is temporary, and allow him to be in charge of her bills, but that Mom shouldn't leave until she is recovered.
Then later, if he has family in Texas, call them up to come and get him
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Don't assume because they pool their money to pay bills that each doesn't have completely separate investment or bank accounts. I think that assumption would be a mistake. And what a shame it is that neither one, apparently, got their financial house in order long before now.

As I read your post here, I'm so discouraged for your mom and stepdad. Mom's life has spiraled and stepdad's right along with her.

Honestly, if it were me, I would pray that I had a good enough relationship with stepdad that he'd let me into their lives to sort out their finances. I would want to make it abundantly clear that I was looking out for both of them. If you lose stepdad's confidence, you could have a real hornet's nest to deal with.

I don't envy you this task, but I honestly think Step #1 is figuring out the finances. Sigh.
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My parents spent winters in Texas, as well, for 19 years. Ten years in my Mom was diagnosed with dementia. I'm an only child so it was up to me to make suggestions about stopping the trips to Texas and staying in Nebraska. The trips back & forth every six months were horrible & exhausting for Mom even before the diagnosis. But, Dad wouldn't listen. We had knock down arguments about this. Mom told everyone she didn't want to keep going down there, but he just wouldn't consider what she was going through. Then this year in May my husband had to fly down to Texas to bring them home because Dad was in congestive heart failure and Mom isn't capable of doing anything such as sorting and packing. Now, instead of being together in assisted living, as I've begged of them since 2008, she's in memory care and he insists he wants to "die at home". The trips and change of environment forced on her for the past 8 yrs has brought her down fast! If you can keep them from returning to Texas by explaining every time your Mom's environment is changed she sinks further down into the black hole of dementia, she will be much better off. I warned Dad years ago if he waited too long Mom wouldn't qualify for assisted living then memory care would cost a fortune...well, that's where we are now & he still won't admit that he's been wrong. This has caused a big separation between Dad & me that I have to just live with because guess who is at his beck & call now? Fight for your Mom! Be her advocate, because she can't fight for herself any longer. There are many resources available, including Medicaid, for memory care. God bless and be with you as you travel this hard and painful road.
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This is a complicated situation. First of all you have to talk with her spouse about his plans for your mom, an their financial condition. If his cognitive functions are impaired, you need to talk with his support system (if he has one) to determine what their influence is with him, an maybe what help he needs. After these discussions at least you will know what steps to take next (attorney, nursing home, etc), an what resources are available. If he is the spouse you can't put your mom in a nursing facility without his consent or legal help. Good luck.
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Maybe, hopefully they have long term care policies? But if they are like my folks, they thought they would be able too care for each other. Happens all the time.

And stepdad's cognition may or may not be the cause of you not knowing what was going on with mom. In my case, nobody had any idea how ill my mom had become, as her hubby was in denial about how ill she was. He thought the forgetfulness and behaviors was her trying to be funny or cute or anything other than dementia. And men of this generation are of the belief that they do what they have to do to take care of their spouses, and do not complain when things get tough! What an eyeopener it was to start caring for mom! Sibs and I had absolutely no idea. And if you only see your mom occasionally, it is really much worse than what you see as problems in a short period of time. Multiply your time with her by 24/7/365.
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Was rehab recommended after the hospital? That's the usual "path" by which many stroke patients make the transition to a skilled nursing facility.

Are stepdad's cognitive skills impaired? I'm inferring that perhaps they are since he'd taken no action with regard to you mom's worsening condition.

It seems like your brother may need to get stepdad to an eldercare attorney to sort out financials and allow him to see that he won't end up in the poor house as a "community spouse" if mom goes into care and she wnds up on medicaid.

Your poor sister in law and brother! Are they at least able to hire caregivers to come to their home to assist with mom?

Worse case scenario i think is that one of yiu ends up having to get guardianship for mom. Does stepdad have any family that can be your allies in caring for HIM?
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Barbs, I am sorry you are going through this. Many of us find ouselves completely unprepared for an emergency related to our folks. When I started caring for my mom, my sibs thought it was completely unnecessary as her hubby had been providing all her care up to the point he required hospitalization and rehab for a hip replacement.

Who has your mom's POA's? I can certainly understand your stepdad wanting her to return home. But, he will also, possibly soon be over his head. Where does your brother live? Would you really want to separate your mom and her hubby?

As far as the finances go, my mom and her hubby also have a prenup that states they will each pay for their own medical expenses. Does your mom have resources of her own? If not her hubby needs to see an elder law attorney that specializes in Medicaid planning. This will provide him some protection from expenses related to your mom. Medicaid was not a party to the prenup, and they expect spouses to care for one another up to a certain point. Rules vary from state to state, but spouse is normally able to keep the home, one of them, and a car and 120k in other assets. Not much at all in the whole scheme of things, is it.

Stepdad needs to see an attorney now! You wouldn't want him impoverished as a result of your mom's health. It sounds as if he has taken very good care of her for quite some time.
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