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Married for 20 years my stepfather (88) and mother (82) lived on a rural property about 35 min from me. He was the primary cook and general caregiver for my mother.


Last fall he became ill and was hospitalized. Subsequently went to rehab to gain his strength back. Was released from rehab but still needed care. Tried a home visit, but clearly wasn't going to be enough, needed more help so we went to ALF. Since mother wanted to be with him she moved there also. He moved into the ALF and within 24 hours was told he needed hospitalization and died a week later on Christmas Day. With the help of my siblings and her siblings she agreed that she shouldn’t move back to the rural address. We sold the property.


So now mom was in the ALF but living as an independent. I had her briefly evaluated by her doctor who said she had mild cognitive impairment. In addition mom has multiple chronic issues (among them instability, high blood pressure, diabetes (uncontrolled), glaucoma, macular degeneration ) takes lots of medication and needs a walker. I look at her medication boxes regularly, there is usually a couple of days missed, but she fills them on odd days. I planned to get her medications administered to her by the ALF in the next few weeks, but didn’t know how to approach her with this.


I’m afraid of making my mother feel like an invalid.


In the middle of this last few months after losing her husband, her home, and her dog (run over in the middle of this) there was another death in the immediate family.


Mom’s outlet has always been a sewing club at a church where she used to live. I’ve taken her there a few times and she knows it’s too far away. We’ve attended a different places locally but she couldn’t see the screen and it was a modern type service which she couldn’t follow. She hasn’t wanted to go back.


One day she says she’s been enjoying the ALF and has started to make new friends. They have tons of activities at the ALF, but she doesn't always want to participate. She stays in her apartment a lot. Then on another day she has talked about missing her friends, that the ladies she eats with at the ALF aren’t really her friends.


Just recently she got invited to a bday party with friends from old church. Upon getting there she asks if there’s any ALF nearby. They all say yes and they decide to go and look at the place. Two hours later Mom promptly calls me and says she is thinking of moving there to be by her friends. She misses them. The friends she has made at the ALF aren't her real friends she's had for over 15 years. I’ve tried to get her connected and we've been to another church she didn't like. I also contacted another church and they are reaching out to her. But it will take awhile.


The place she wants is over an hour away from me. I don’t have children but I am a school administrator and can’t take off of work all of the time. I’ve taken more time off in the last several months. I can't be running up there all the time.


Am I being selfish?


When we spoke on the phone mom said my husband and I had our own lives to live. This has always been the case, my mom has always been independent and gave me the courage to do the same thing….but she needs help! I have tried to preserve her independence and respect her wishes as long as possible. She doesn't realize how much help she needs.


I am torn because I want her to have quality of life, however long that may be, and I want to preserve her independence. Yet I have to be near her and be able to work with the facility where she is living while she's still "independent" as she says. She's really not all that independent.


Any advice out there for how to talk her off the idea of this? Or am I wrong? Do we all have the right to live where we want as long as we can?

Youre NOT being mean. You're being practical.

It sounds like mom is beyond the " mild cognitive impairment" stage.

I wouldn't lift a finger to move her. " we'll see." "Let me look into that" and " we need to ask the doctor about that" are all good responses.

Another thing. I'd be curious to see if those friends step up to help. We kept my mom in an Independent Living place near her old address so her friends could visit. Didn't happen. My mom, not a social butterfly at all, eventually made friends in IL.
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TaylorUK Apr 23, 2019
I don't hear anything in OP that suggests mom is beyond mild cognitive impairment and in need of regular medication / food intake monitoring. Which are probably best served by a once a month or every couple of months appointments with her general physician. Your experience with your mom's friends is not a given general situation - my mother (90) is a social butterfly (you use that term, I tend to say she needs superficial socialisation - i.e. she would like to see 4 people a day for 10 minutes rather than two people a week for two hours or even all day!!) It is horses for courses - and one has to give one's elderly relative the choice if they are able to make one mentally. Its their life not ours.
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This jumped out at me: your mom has uncontrolled diabetes, dosen't take her meds properly, is visually impaired and has some cognitive impairment, unspecified. You're not the one making her into an invalid. Old age is doing that. You're trying to get her proper care.

Is she private pay at these ALFs? How long will her money last? Do they accept Medicaid after a certain period of private pay? Are either of these facilities campus-type arrangements with Memory care and NH facilities?

How often has mom been hospitalized in the past year?

Does your mom understand that if she moves back to her town, you will be unable to take her to doctors, show up in the ER and can only visit twice a month?

Can mom manage this move on her own?

I don't think you're being selfish. I think that you are looking realistically at the future and your mom is not.

There is no easy answer here. But lay the situation out for your mother and see if she seems to understand the subtleties of the situation.
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Scubaqn Apr 19, 2019
Thank you for the response.

Yes private pay. Has resources for some time but are all in my name which she does not have access. Also when diagnosed properly has a good long term care policy I will activate. All total more than 10 years.

Yes ALF are part of a large well known corporate entity. The one she lives in has memory care, the one she wants does not. This is part of the reason I chose it.

Mom not hospitalized in last year. 1.5 years ago had a fall, only went to the ER.

I plan to tell her all of this about the drs and can't visit as often. I don't know that

Mom can't move on her own. It was a huge endeavor to move her there over the last few months. Kept wanting things from the property we sold then a week later would ask me to get rid of them. I seriously don't plan on helping her if she insists. She would have to do it all herself. That sounds mean but its just such a bad idea.
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The way I see it is: as long as a person wants to live a certain way, place, etc., AND they do not need other people to enable that choice, then they can do as they like. But if a person needs help, then they must consider the needs of the person who is helping them.   It is simply fairness. How competent to decide is your mom? Have you talked frankly to her about her health issues and the need for you to help her? Would the new nursing home have services to monitor medication?   And of course, just how old are her friends? Seen situations where the friends are on the edge of no more independent living themselves.
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Scubaqn Apr 24, 2019
My mom is very capable but then has times where she's not to some degree but how much is yet to be determined. Don't have a neurology appt until the end of the month. We talked about me helping her and yes the other facility is full ALF but no memory care should she get worse. Yes all of her friends are 80's and not much better. They wouldn't have come there often either, but would see her at church and her sewing group. She has chosen not to move, and so it's ok.
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There are problems either way, and some of them have no solution.

One thing that jumps out at me is how fast this has all been. If I'm understanding the story correctly, a year ago she was happily living in a rural home with a husband who took care of her. Last fall he got sick and by Christmas he had died. After just a week in the ALF selected for his situation, she agreed to sell her home.

Four months later she realizes she wants to be near her friends and has actually found an ALF that would make that possible.

This sounds like a person with MILD cognitive impairment, recognizing her limitations as far as making new friends or getting involved with a new church, and trying to make the best of it.

As to medications ... if she's taking "a lot" of meds at age 82, it might be smart to ask her doctor to re-evaluate and see which can be dropped. Many medications that make sense for someone in their 60s to prevent longterm problems may make less sense for someone in their 80s. Sometimes taking too many meds can be the cause of cognitive impairment, and reducing the pill burden can be a noticeable, even measurable improvement.

She's grieving a lot of losses right now -- her husband, her home, her notions about her own mortality -- why should she have to lose her friendships on top of that?

You're not going to stand by her every day to make sure she takes her meds on time (that would drive both of you crazy). The ALF can make sure she takes the important ones on schedule. You might both be happier if she has her friendships instead of having to rely on you for everything.

And then there's the question of self-determination. Even a person who has mild cognitive impairment at 82 is entitled to make their own choices. She's not going to live forever no matter what you do, which sometimes we 'children' forget.
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Don't. Just don't. Trying to convince her to stay near you is being selfish on your part. She needs that empowerment to keep living her life on her terms. I think she'd want you to do the same when you get to be her age. Phones were invented for a reason, I suggest you use one daily with the AL she wants to live in. Hope this helps you gain some perspective.
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Scubaqn Apr 24, 2019
She has made the decision that she doesn't want to move after all, but thanks for your consideration.
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I think if you have a look at the ALF near her friends and are satisfied with the standard of care and attitudes of staff, then you need to sit down with her and make a pros and cons list for each facility and let her choose - she may well be much happier back within easy access of her old friends. Whilst I don't think you are selfish wanting her near you, I do think that your priorities may be wrong as far as your mother's needs and happiness are concerned. I am sure she is very happy to have you close, but you still both have your own lives, let her choose hers as you will one day want to choose yours.
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Scubaqn Apr 24, 2019
This was sound advice. thanks so much for your consideration and mode of operation. I would probably have done this. She has chosen not to move, and so it's ok.
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I think you should go and have a look at the facility she's interested in, before you rule it out. See what you think of it.

You already know your mother is in favour. She has the right to make this decision, so the least you can do is take the idea seriously.

Then, it has the advantage of being within practical visiting difference of a much wider social circle.

Then, there are other pros and cons to weigh up and compare with her current ALF. Do a check list, perhaps - continuing care, range of activities, customer reviews, cost, quality of environment, food, etc. etc.

Then, just supposing you are really impressed and agree it's a good idea, it's an hour away. That is actually the ideal distance when you are engaged and involved in your mother's care, but don't want her to become her emotional and physical life support system. You're near enough for regular visits and emergencies, but not so near you'd feel guilty for not going every day.

Anyway - you're a long way off being stuck with a decision you can't work with. But yes I think you must explore this idea, not just shoot it down.
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Scubaqn Apr 24, 2019
Thanks for your kind words. I actually considered this facility when choosing the one she is in. It was ruled out due to availability of 2 beds needed at the time, and my stepdad said he didn't want to be that far away. It did not have memory care should she need it so that was another reason. She has chosen not to move, and so it's ok.
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I think many of us would want your “problem” - loved one wants to be in an ALF. Many of us have the opposite problem. Consider yourself lucky!

If you want to preserve her independence, let her have this cake and eat it too. She will have friends to socialize and safety in a secure environment. Imagine your mom being in her own apartment in your neighborhood and she fell or got sick, you’d spend a lot more time with her - a luxury you do not have. At ALF, she will have some kind of help from staff.

So, no, you are not being selfish. You are a very loving daughter who cares about her mom. How many parents can say that? Let her have this last wish.
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Scubaqn Apr 24, 2019
Yes I realize that not everyone will go along with ALF. She's still together enough to know she needs help but since she lives there as an "independent" (basic services fee only ) she is OK with it. As she needs more services I will employ those but for now..well... She has made the decision that she doesn't want to move after all, but thanks for your kind words.
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I will add that having friends is very important to some of the elderly and can enhance quality of life. My father who had to move from AL to LTC grieves losing his friends and I think it had a major impact on his decline. Think of yourself in a similar situation. Whichever facility she ends up living in should definitely be administering her meds. This is one of the reasons for being in AL and I’m surprised a facility would allow her to do it on her own. You mention uncontrolled diabetes which is a risk factor in dementia. You might use this as a weapon to get her to comply with them giving her meds. If nothing else tell her this is the policy of the facility.
So you are an hour away but she is in a place being taken care of which is the reason for being in AL. Write down what you are doing that can be managed either at a distance or done by the facility. They should be offering outings for shopping. I often would have Amazon ship things to dad even though I was 7 miles away so it would be there when he wanted it. There are ways around this. Don’t make any hasty decisions as I realize what a chore it is to move someone having done this 4 times with dad. If you do move her, use a Senior moving company to handle it. It totally is worth it.
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Scubaqn Apr 24, 2019
She has made the decision that she doesn't want to move after all, but thanks for your kind words.
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In our church we have several older people that their family lives far away. These older members know that they can contact another member if there is an emergency. Then notify their family immediately. But people must be willing to share the tasks.
Example: One member (has since passed) lived here and her son lives in the next state. The member had one of those medical alert necklaces and when she would fall the first person (one of our members) on the list would be contacted, that person would go over and see what was happening and call the son.
Perhaps if you could work out a system with a few friends it could work.
Blessings
hgnhgn
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Scubaqn Apr 24, 2019
She has made the decision that she doesn't want to move after all, but thanks for your kind words. The friends aren't much better off than her, but had they been maybe it would have worked.
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