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I am one of 5 siblings. We live 1 1/2 hours to 8 hours away from parents except for youngest 53 yr. old sis who is unemployed and lives with parents. Dad diagnosed with Dementia 3years ago and is mid-stage while Mom, 85, we strongly suspect has had mini stroke. Struggles to put sentences together, forgetful and easily confused. Sister is dual diagnosed bipolar alcoholic who denies this and is untreated. My other siblings and I feel Sis is doing the minimum she can. We want her to take a stronger stand and get on a schedule where they take their meds daily, shower a couple of times a week, get medical care even when they refuse (Sis gives up and Mom just had bronchitis and pneumonia because she would not go. Another sib went to visit and MADE her go see doc) fix at least one decent meal a day, clean a bit. I live 8 hours away and drove to see them last week but only gave them 1 hour notice to see what conditions were like. Had to scrub potty before I would use it, etcetera. Sharing our concerns with Sis is met with defense and pronounced paranoia. She lies and has tried to start trouble between each of us to deflect her problems. Parents did not plan at all for retirement and very little money. The sibs can do a little but not much. We are checking into caregivers but money is an issue for us. We are also concerned about Sis when parents are gone as none of us will take her in. She has 3 degrees but cannot hold down a job. How can we get help for parents and make, force or require Sis to get treatment? Our pleading does no good and Mom backs Sis and thinks she does a great job. Refuses to see lack of care and finds excuses for everything. Dad's dementia diagnosed 3 years ago and neither have read anything on disease, joined support groups or sought help from social agencies despite our giving them many resources.

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And finally don't dare tell me what we can and can't comment on it aint your thread - it is a thread that in the future others may want to refer back to or gain knowledge from and as you seem to have it all sown up - goody for you....... I wish your sister the very best of luck for she is the one who needs it.
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If you want your sister to get better so that she can be the daughter you want her to be (mind you that is your call not necessarily hers) then what your parents want is irrelevant. I am fairly certain if was endangering their health something would have been done about it assuming you have ensured that parents are registered and reviewed regularly and that their meds are checked annually following that review. If they cannot afford help there are agencies that can help but dissing your sister wont do you a lot of favours on here - a lot of us have been dissed for doing our level best - even when we know it is not good enough. Your best and her best are different and her best is never going to be good enough.

Im out of here. Anyone who can't understand that bipolarity affects different people in different ways is not someone I am going to waste my breath on.
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Please do not comment further on this thread. Our course of action has been decided on and I appreciate everyone taking the time to try to help us.
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Tacy, I did not put my sister in charge of my parents. She had already lived there 7 years when my stepdad (her father) was diagnosed three years ago. As a trained healthcare provider herself, she took on the role herself. She could have told any of us four siblings at any time she couldn't do it or didn't want the responsibility but she has always said she wanted to do it as her contribution to the household. We have all asked her if she needed more help and she has said no. We have helped as much as we can as well as some of the adult grandchildren who live close by. I have not thought of myself as being "outraged" with my sister as much as desperately concerned for her well-being and that of my parents and hence, my asking for help. You seem quite judgmental of me personally as I ask for HELP. It is ridiculous to accuse me of neglect and negates your credibility. I am one of four siblings (two of us are stepchildren and the other two are not) and not one of us "put her in charge". The geriatric case managers will handle this for us. I didn't know there was one until I talked with a social worker about it last week and she hooked me up with her and the Eldercare attorney. Neglectful of me, right? SMH
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You are holding an incident that happened 15 years ago over her head. Are you serious? In college 15 years ago, I was at a party, drank too much and had my stomach pumped...do you think anyone in my family would bring that up now to justify making themselves feel better about themselves or to put me down. You need to examine your own life. I will not apologize for being harsh because it is completely unacceptable how condescending your attitude is to someone who needs help.
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Oh, and another little memory bell: "Dad's dementia diagnosed 3 years ago and neither have read anything on disease, joined support groups or sought help from social agencies despite our giving them many resources."

Our mother has had dementia at least 5 years. Of her seven kids, I am the ONLY one who has read extensively about dementia, attended seminars, belongs to a caregiver support group, participates actively on AgingCare. (I started this when my husband was diagnosed, a few years before my mother.) Does this make me the hero and authority in my family? Ha! It makes me a bit of a suspect, if you want the truth. The fact that Mother and Sis haven't educated themselves is sad, but not at all uncommon and not grounds for assuming they are bad caregivers.

When my brother was in crisis mode and us sisters finally "got it" about his mental illness we asked him what we could do to help. He begged us to read about his disease. What an eye-opener. I wish I'd known more about bipolar disorder much earlier!

It sounds like there are three people in that household who deserve understanding. Yes, it would be nice if they all learned about each other's maladies. But the person whose education you can control is you. I hope you'll be mindful of your poor sister's handicaps, too.
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This post thread rings some personal memory bells with me. You had to clean the toilet before using it. I remember having a volunteer stay with my husband a couple of hours a week. I said to her, apologetically, at the first visit: "I certainly don't expect you to do any cleaning whatsoever. You are here to keep Coy company. But there are Lysol wipes in the bathroom that you may want to use before you use the toilet yourself. Coy isn't as neat as he once was." Having a dirty toilet in a household where someone has dementia is necessarily a sign of slovenly housekeeping. It can happen suddenly, any time of the day!

My bipolar formerly alcoholic brother is being treated, and that helps a lot. Still, he is subject to outbursts and inappropriate behavior where our mother (whom he adores) is concerned. For example, when Mom fell in the nursing home he went off on a tirade against the staff, blaming them, talking about suing, etc. Us sisters went to the staff involved and to their bosses and explained Bro's mental illness and assured them that he didn't speak for the rest of the family and that he was very good with Mother. We did not want him banned from the NH! We also talked to him when he was calmer. He now visits on Sundays and plays cards with Ma. She loves his visits. He would not be the right person to be in charge of decisions for her, but he is a loving son and we try to support him in that role.

If Bipolar Sis can't be relied on to provide meals regularly, how about something like Meals on Wheels for all three of them?

If she is not a dependable homemaker, why not bring in a cleaner once a week or twice a month, as needed?

It seems to me like these three people have made their bed and are lying in it more or less comfortably. Captain's tone is a little harsh, but I tend to agree with his observation.

Help make their situation better, or stay out of the picture.
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If you read the thread, you will see we have done several things for this sister.we tried to Baker Act two years ago and our parents had an absolute fit about it. The NyQuil incident was 15 years ago. She knows how to cook, clean and stay on a schedule (she has 3 college degrees-the heart catheterization one completed since moving back in with parents) but she is unmotivated to do anything unless she knows someone will be watching. That is why we only gave an hour's notice for our visit two weeks ago. It was obvious things were not being done but she was a whirlwind while we were there..I am one of four others that have seen the same thing. I know a good bit about bipolar as another sister lived with me and my family for 4 months after she was diagnosed and we had several 3;00am visits from Crisis Management. She continues to have her meds adjusted the last 25 years but she is an excellent patient and has talked extensively with other Sis. It just has not worked to convince her to accept her diagnosis or to get treatment. I have offered to have my parents come live with me but they have steadfastly refused to move from their home of 45 years and move to an area they are not familiar with. My house is 3 stories and it would be very difficult for them to get up and down the stairs at this point as well. I KNOW she is not responsible and I KNOW all of these problems or I would not have been asking for HELP which, obviously, has been a waste of time.
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Well, I have to agree with Phoenix. In actuality, you are abusing both your sister and your parents. You are putting a person with mental illness in charge of not one but two people and then you have the audacity to act outraged that someone who cannot hold a job cannot handle the pressure of taking care of your parents. What delusions are running through your head? Not to mention, your condescending attitude towards her is just wrong...how dare you? You full well know that she cannot care for them but you are putting your parents in her care and that is neglect...by you.
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Kathy, people are jumping all over you. You must feel attacked. I'm sorry about that. I just want to point out one word you used. This may be the bit some of us want you to understand.

Your words: "I do not think it it unrealistic to expect my sister, who has lived with them for 10 years and has never held down a job for longer than 3 months (and nothing at all the last 7 years) to cook one meal a day, make sure they take their meds, " etc.

It is not unreasonable to expect that an average or below average person could do that. It is UNrealistic to expect that your sister will be able to do this. Why? Because she never ever has, and probably won't start now.

I think you are trying very hard to be a good daughter and sister. Your family is in a terrible situation, and you are trying to make things work out. You need a lot of help. and I hope you can find it.
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Actually I have read the thread - I am British so we have slightly different rules over here but over here your sister could be detained if she was a danger to herself or others and clearly if she was so drunk that she downed NyQuil and she is also responsible (????I query responsible) for your Mum then I would certainly consider the Baker Act if she still wont hear. Harsh as it sounds people with bipolar disorder do find it incredibly difficult to manage their issues and sometimes need a different kind of support when all else has failed. Good luck with the GCM.
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Obviously you have not read the entire thread. I cannot MAKE OR FORCE her to get help. She has been there 10 years and only has had to assume a caregiver role in the last year and a half. None of us can pay her and my parents are barely able to pay their mortgage. Thank you for your kind words but I am turning to Geriatric Case Manager and Eldercare attorney to help us with this situation. We need a professional, unbiased person who will help the entire family with this. We are hopeful Sis will hear and accept any help that is offered if it comes from that person rather than one of us. Short of Baker Act, I have tried everything I know to get her to get help.
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Can I just SCREAM here please?

You have a sister that you KNOW is bipolar and an alcoholic AND doesn't take her meds, and has no income and is totally reliant on parents for anything and you wonder what is so wrong that she can't do the bear minimum in terms of care? Its not by accident that bipolarity used to be called manic depression. The mood swings in a relatively 'normal' situation can be bad enough to cause some BP sufferers to commit suicide and your sister is by no means living in a normal situation. In fact she needs to be cared for too which I know is not something you want to hear but it is fact.

You write We have to focus on Sis as she is their full time caregiver. She stays in her bedroom 80% of the time watching TV or sleeping. She does not get "paid" but she has free room and board, use of their car anytime she wants and does not contribute for gas or insurance. Respite care? I cannot go stay for two weeks with them and where would Sis go anyway? She has no income and no friends whatsoever. .......Just untreated mental illness and no discipline results in an unstable environment for the entire household.

It actually isn't a wonder that your sister's bipolarity is deteriorating. She isn't LIVING at all she is existing, she will know she is dependant on them and that wont improve the situation and she wont be able to see any light at the end of the tunnel.

In my truly honest opinion you need a family meeting. You need to all be there and all be as honest and as open as you can about the needs of each of you and of your sister and of your parents. An absolutely open discussion about who can do what and when and how and how much you are each prepared to take on. AT NO POINT should your sister feel positioned somewhere with an insistence that she take on the role of caregiver - she really isn't capable of so doing. Caregivers have to be 100% reliable - hell I have written books on dementia and I wasn't remotely prepared for the road ahead of me and I bloody hate it. Would I tolerate criticism in any form - however mild? not if you want to keep your head !! If anything your sister is really being badly abused (not deliberately but situationally) and it is SHE who needs to be in a secure environment...then worry about Mum and Dad.

If she is going to do the caring and the level of that will need to be reviewed then she has a RIGHT to be paid for that. Would you take on a role that has the potential to become 24/7 for just room and board? Even if her role only takes up 20% of her life that is still over 30 hours a week and she should be paid for goodness sake.

However if she is going to care then she needs guidelines some of which MUST include regular treatment and adherence to medical regiment that the doctors prescribe.

Meanwhile APS MUST be able to address you concerns and could possibly offer guidance and help and if not does your social services not offer something along those lines? What would be really helpful would be for a member of the social services team to be there for the meeting to sleep you all on the straight and narrow.

If your Dad was a Vet could he not access VA benefit?
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A geriatric care manager is an excellent idea! We had one for my mom and another for her hubby. They did a great job of assessing the care that they were receiving and found home care much better than any facility would be. It is kind of funny now but twisteds agreed to the GCM thinking they would have their way and get the folks moved to what they thought was more appropriate care. I was so relieved to have someone impartial look at the situation! Professionals are necessary for many reasons, and dysfunction in the family, which my family has plenty of, is just one. Their job is to try to work with the siblings to bet them to work together. Our GCM tried but failed because sibs did not expect or accept the conclusion and resolution. The primary job of the GCM is to determine what is working for the parents, that is who they are responsible for.

I hope the GCM is able to offer your parents assistance, Kathy.
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This is apples and oranges. I am not criticizing from afar. I asked in my original post how I can get help for my parents and get help for my sister. Without telling about her bipolar and alcoholism, how could anyone understand any portion of the problem? I have yet to have a solid answer. My sister is up all hours of the night and sleeps until 11 in the morning,, sneaks alcohol into the house, hoards Dad's Ativan in her room and has admitted to taking it from time to time, spends about 80% of her time in her bedroom watching TV or sleeping, is delusional on occasion and refuses to get help with alcoholism or bipolar disorder which is well known, if left untreated, only gets worse. She got violent with another sister last summer and my mother had to pull them apart. NOW I will admit to being critical. This is not a safe or healthy atmosphere for any of them and it is only going to continue to deteriorate. We want our parents to have better care than what they are receiving. I am in my 60's and have been disabled for 12 years. I do as much as I possibly can living 8 hours away and have appointments with a geriatric case manager this week as well as in-home caregivers in the area my parents live .My parents are not bad enough to need to go to AL and, to date, can continue to live in their home of 45 years with some help. I do not think it it unrealistic to expect my sister, who has lived with them for 10 years and has never held down a job for longer than 3 months (and nothing at all the last 7 years) to cook one meal a day, make sure they take their meds, encourage the occasional shower and clean the kitchen and bathroom that she also uses as you have stated that I am in your post. .I have been in a support group since Dad was diagnosed, read books, tried to get Medicaid, food stamps,Meals on Wheels, spoken with social worker and an eldercare attorney for them so I am hardly sitting back and criticizing from afar and doing nothing to try to help. I bought them a new vacuum cleaner and washing machine in the last 6 months because they have no money. Another sister has been involved with the Senior Connection Center and she has spent hours talking with them. Parents are on a waiting list to be assessed but we do not know how long that list is. It has already been 2 months and we have yet to hear from them. I understand very well about the hot button issue as I have seen it first hand but I am not sitting back and criticizing while lounging on a sofa eating bonbons 400 miles away. .As it is now, they eat poorly, hit or miss with the meds, seldom shower and I had to clean the potty before I would even use it when I was there two weeks ago. It is very obvious this is not the right forum for me to ask for help. Memory people for emotional support and geriatric pros is the best way to go for me. Thank you for your comments.
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Your sister is in no condition to be a caregiver to your parents. By your own words "When I did not answer phone, she called my brother and told him my husband had drugged me and tied me up to keep me from talking to her. This stuff happens periodically from her". A person who is bipolar with paranoia and delusions and drinks excessively should not be a caregiver to anyone. I am glad you are seeking the services of a geriatric case manager.
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Kathy, we all tend to base our responses on our own life experiences, many here are the hands on caregivers with siblings who criticize from afar so you have pushed a hot button for some of us!
I'm not sure what kind of advice you are hoping for, it seems you won't consider AL for your parents, they can't afford paid help and in my opinion it is unrealistic to expect your sister to do more than she is willing or able to do. As I said before, you can't legally force any of them to change things if they are not willing.
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I was there two weeks ago. They ate every healthy meal my husband and I prepared, took their medicine when we gave it to them, showered when I said get a shower and I will fix your hair, gave mom a mani/pedi, cleaned both bathrooms. None of this was hard and took very little time. I walked to the Medicaid office at the corner of the street (literally) to apply for that and other social services for them. Apparently you only see me as sitting back and criticizing from afar. Sis needs help now and not too long from now, my parents are going to be in very bad shape as dementia progresses. I am asking for help but apparently it is seen as criticism of my poor untreated bipolar, alcoholic, unmotivated, and occasionally violent sister. Obviously, I have not expressed my concern for her well-being as well as the well-being of my parents. Rick Phelps says if you can say yes to these three questions
Are they safe?
Are they comfortable?
Are they content?
you are doing a good job as a caregiver. My three other siblings and I do not feel they are. I am not alone. The social worker I spoke with here said last week I have described elder abuse through neglect. My grandmother had Alzheimer's and I know how it is there now is a cakewalk compared to what is going to be. I have an appointment with a geriatric case manager this week. Perhaps I should just leave it to the pros. Thank you for taking the time to post your thoughts.
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Kathy, I am not trying to rake you over the coals. Unless you are the person providing care you really are not able to understand how difficult it is. Find ways to support your sister rather than rake her over the coals. Call for a pizza delivery once a week. Offer to pay for a cleaner. Elderly are often not cooperative about taking showers. If a decent meal is prepared, it is often not eaten. I resorted to Subway, Chick-Fil-A, hot dogs, McDonald's hamburgers, those were the things that they wanted and would eat. I could prepare salmon and veggies, they would not eat it.

There really is plenty that you could do to help. I think there are suggestions even in the 36 Hour Day. Once folks see you and your siblings working together, things will be easier for them and everybody. It is easy to watch from a distance and be critical, it is harder to watch from a distance and be supportive. There must be something your sister is doing right.

I had these discussions with the twisteds numerous times, they still would not get it or understand. They thought the care was easy and they would be ok by themselves. At least until the move, just about a year ago. My mom with late middle stage Alzheimer's went off the deep end. Kicking and hitting other residents, screaming, trying to climb eight foot security fences to get out. You name it mom did it. Yes, with mom at home it was relatively easy care, only because she had somebody familiar caring for her.

Just find a way to be supportive of your sister. You may be surprised what just a bit of kindness and appreciation will do.
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Yes, I have read 36 Hour Day, Things Unsaid, Alice, Caregiver Support books and pamphlets ad nauseum. I have talked with my neurologist about dementia. Memory people support group and read the founder of this group's book, While I Still Can. I have another sister who is a treated bipolar patient who did talk to her doctor about her bipolar and I have been the one who checked her into Alcohol Abuse at Medical University of SC as well as took her to hospital and spent entire 3 days with her there when she drank a bottle of NyQuil while too drunk to realize it. I feel like I am being raked over the coals here for asking for help. If I sound like I am complaining, I am sorry. I do not know how to explain the situation without it sounding like I am complaining. Ii is not healthy and getting worse. I do not think it is too much to expect Sis to make sure they take their medication daily. Fix one nutritious meal for all of them a day. Putting a frozen cheeseburger in the micro for 20 seconds is not cooking for them. Remind them to shower a couple of times a week. Clean a little (she lives there too!) and do her own laundry. The car? She goes to tanning salon, buys cigarettes and a regular shopper at Dollar General down the street. I don't know where she gets the money. Yes, she usually goes with Mom to get groceries and the doctor but not every time which is also a concern because Mom gets confused easily and not good about remembering what was said. Sis does frequently call the office if she did not go to find out what was said if she did not go. An exampl if something Sis did recently: she called me twice while I was in shower and blow drying my hair. When I did not answer phone, she called my brother and told him my husband had drugged me and tied me up to keep me from talking to her. This stuff happens periodically from her. We want help for her also but I am concerned about the "care" my parents are receiving.
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Kathy, have you read the 36 Hour Day? There is some very good information about families and the difficulties that arise.

How do you know sis's ailments? Did you talk with her doctor? One of my twisteds is a therapist and has diagnosed many family members including me. Not at all appropriate since she uses this information and diagnose while pitting family members against each other.
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Kathy, you sound like the twisteds. The cost for 24/7 care for two elderly people in their own home is in the area of $12,000.00 a month. Compare what your sis is recieving, room, board and the use of a car? The car is used for household errands I imagine. Sis doesn't have friends? So what else would she use the car for other than something related to your folks? Your focus needs to be your folks. If they are not receiving adequate care then move them closer or even in with you. Sounds like your folks are content where they are. Stop causing your sis additional problems. You cannot go help or stay witth folks? If you want to help you would figure out a way.

It is very sad but family dysfunction that has long been gone once children marry and have their own families, sure rears its ugly head as parents age and need their children to get along and cooperate with one another.
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If sis is unreliable when the other siblings are not around, then alternate plans for your parents care needs to be arranged. Expecting her to care for your parents based on your standards is unfair to her. Mental health issues and caregiving is an inhealthy mix when also included is expectations from others siblings.
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gladimhere, We have to focus on Sis as she is their full time caregiver. She stays in her bedroom 80% of the time watching TV or sleeping. She does not get "paid" but she has free room and board, use of their car anytime she wants and does not contribute for gas or insurance. Respite care? I cannot go stay for two weeks with them and where would Sis go anyway? She has no income and no friends whatsoever. Two of her degrees are in healthcare, radiological tech and heart catheterization and is very intelligent. Just untreated mental illness and no discipline results in an unstable environment for the entire household. We want help for her as well as my parents. I recognize it is extremely hard to be a full time caregiver but ad Fad's dementia progresses, the situation is only going to get worse. We want her to read 36 Hour Day she was given or anything at all about this disease, go to a support meeting once in a while. When I asked why she and Mom have not tried to do more to educate themselves about it, I was told "because he's not that bad yet."
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cwillie, I am not trying to diminish anything that Sis does and, when anyone is there, she is pretty good at doing things but it is when no one is there that concerns us. Not complaining or nagging from a distance but the other sibs and I are not close enough to check in physically weekly. At least one decent meal daily, meds given on schedule, showers twice weekly or so, clean bathrooms and kitchen and help them get finances in order to pay bills. We are contacting Caregiver Agencies and will see if we can afford to pay someone to do these things a couple of days a week. It is frustrating as Sis lives there and is perfectly capable of doing these things. They are not at the point they need assisted living and both parents are not going to leave their home willingly. Money is a huge concern. They make too much on SS for Meals on Wheels and Medicaid but are struggling. No POA. They refuse to even talk about it.
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Kathy, call and make the appointment to get your folks in. What can you do to help your parents? Sis should not be the focus. She is the one providing care. Fine a way to give her some respite time. Plan on staying with your folks for a couple ow weeks. Stop criticizing your sis, caring for aging parents is not an easy task. Is she being paid? I cared my my elderly parents for nearly four years, I am not diagnosed with bipolar or alcoholism. I have a Master's degree and was accused by my two twisted sisters of financial exploitation, even investigated by Adult Protective Services due to vindictiveness of sibs and one of them had complete access to Mom's accounts. APS closed the case very quickly. I stopped caring for the folks because I just was tired of the nonsense from sibs. They wore me out with their constant criticism while doing nothing constructive to help. Caring for the folks was easy compared to dealing with the twisteds.

Find a way to help on a regular basis. How about one weekend a month? Take a walk in your sister's shoes.
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You are absolutely right about the TIA, Pam. Until I read up on it, I did not realize they go back to "normal" so quickly. It could be a small, real stroke or even something else. I will be going down for another visit in 3 weeks and will see if I can go with her to see her doctor, express my concerns and the changes we've seen and ask what can be done. Thank you for pointing this out. I wish I could go sooner but it is an 8 hour trip which I have to make with my husband as Sis is a handful one on one and he can only take so much time off at a time from work.
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if your mom and dad are satisfied with your sisters efforts , that should be the end of the story .
sorry but ive been in the carer situation with jealous sibs negging from a distance .
helping your sister and the parents out in a real way would be a lot more constructive .
mom is 3 yrs gone . im still a maniacal boozer -- my two sisters are still intellectually disadvantaged , or whatever the current term for half witted is ..
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Well, sis is mentally ill, so no amount of pleading is likely to cause her to change. In fact, since you say she is in complete denial it is more apt to have the opposite effect as she will look upon your interventions as meddling. And she also may be doing a lot more behind the scenes than you give her credit for.
I would suggest you gather as much information as you can about which assistive living facility you would choose for your parents and how they can afford it. Look into subsidized housing options for your sister. Have a plan in place for when it all hits the fan and then stand back and wait. You can't force any of them to change or see reason.
Oh, I do hope someone responsible has poa and not sis, because then you will be powerless when the time comes.
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Kathy let me adress one issue here, If Mom had a "mini stroke" she would be back to normal.. they are TIA's, and last from a few minutes to half an hour, and they snap back pretty quickly. But they are a warning sign of a larger stroke looming on the horizon. My mother has had several, and while they are scary they resolve (but still call the Dr!! or the Ambu) Sound like she may have a small "real" stroke if she is confused and has speech problems this far out. There is a very small window of time for medical help in resolving a real stroke,,, so call 911 right away if you suspect one.
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