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Bscales610 Asked January 2022

At what point is someone considered as not being able to take care of themselves?

My husband had a stroke 16yrs ago, he can do a lot of things for himself but won't. I have to tell him he needs to brush teeth, shower, pick up his messes. I stopped him from driving after he had an accident. He rear ended a car that he did not notice car was stopped.


I was diagnosed with stage 4 lung cancer 5yrs ago and given 21 months, immuno therapy has helped get rid of cancer in lungs. However, it has started to pop up in other places and I have started chemo. He expects me to continue to still do for him all he needs, cooking, cleaning, laundry, Dr's visits. Every time I think I have communicated to him what things I need him to do to help out, it's like I'm saying it for the first time even though he says ok I will do. I think because he has not seen me get really sick he thinks nothing is wrong. His family, who all live out of this state call often and ask how he is doing. When I express my frustration to them they just say we are glad he has you and we will talk to him about it. They are like him in the thinking, they seem to think I'm fine.


I don't think he could take care of himself if I die before him and I don't know when I should get into that with his relatives.

BurntCaregiver Feb 2022
You should get into that with his relatives now. You are a very sick woman and cannot continue to be a nanny for a grown man who can do many things for himself but instead chooses to assume the role of helpless toddler.
Stop indulging him and enabling this toddler behavior by continuing to serve and do everything for him. You need outside help. If he's going to be in denial about you being sick tell him and his family that the end result will be he goes into a care facility because you cannot fight cancer and still take care of him. The next time the family calls they make it clear that you need their help.
For your sake please hire some caregiving. At least to help out with housekeeping, errands, and meals to give you a break.

PeggySue2020 Jan 2022
Once MIL was diagnosed with S4 lymphoma and FIL followed soon after with a stroke, they hired 24/7 for the both of them plus housekeepers. They no longer have to worry about messes or cooking or the process of getting to their appointments.

You may not need 24/7, but at least consider 12/24 while undergoing treatment. That way you can focus on chemo and evaluating what's going on neurologically with him.

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lealonnie1 Jan 2022
Your DH rear ended a car he 'did not notice was stopped.' That was your first red flag that he has cognitive impairment issues. " Every time I think I have communicated to him what things I need him to do to help out, it's like I'm saying it for the first time even though he says ok I will do." There is your second red flag; he has no short term memory where he's able to remember he promised you he'd do the things you've asked him to do.

He's not fine & you're not fine. Get DH into the doctor for a full cognitive work up; he's had a stroke and dementia/cognitive impairment is something that often follows. Once you know what you're dealing with, you'll know what he is and is not capable of doing. Then you hire the help you need or you both go into Assisted Living. I'm not sure what you expect from 'the relatives' in terms of care or what they can do for you. I'd expect nothing, if it were me. Because when others, even family members, ask us how we're doing, all they want to hear is "Oh we're fine, thanks, and you?" All the rest of the reality goes in one ear & out the other as they tend to their OWN issues.

By all means DO let them know that your cancer has returned, that your husband has X diagnosis from his doctor, and that you do not feel him capable of living alone were you to pass before he does. But again, expecting them to stand up and care for him may be a bit of a long shot.

Have you thought of selling the house & both of you moving into an ALF where mostly everything is done for you? Meals are served, housekeeping is included, and YOU can get help with whatever issues YOU face, w/o relying on DH for much of anything but companionship. Something to think about.

I'm so sorry that you're in such a situation. May God give you the strength and courage you need to face all that lies ahead. Sending you a big hug.
MaddieMae Jan 2022
This is excellent advice. A person with cognitive impairment is able to understand what you’re telling them, but they are unable to act on what you are telling them. Your husband does not mean to not follow through--he is unable to follow through. Strokes can be a cause of dementia, but there are other factors that can also cause dementia, so a visit to neurologist who specializes in dementia would be in you and your husband’s best interest. Your PCP can give you the referral. That way you will have a better understanding of what’s happening with him and will have an idea of how to proceed.

If you do not already have in place power of attorney, medical power of attorney and other directives, such as Medicare, now is the time to find a relative or friend or attorney who will take these responsibilities on for your husband. and you. You also probably want to place your assets in a trust to protect both you and your husband. You will need an estate attorney for all of these matters. I would also talk to the attorney about the spend down of your assets to qualify for Medicaid. You don’t want to leave yourself or your husband financially vulnerable while dealing with your husband’s challenges and your cancer. Your local Area Agency on Aging and Alzheimer’s Association‘s can help you find these resources as well as give you guidance on living opportunities for you. Bringing in outside help can get very expensive very quickly, which is why assisted-living residences are found everywhere. ALs are typically much more cost-effective, especially with a couple sharing a room than living at home with hired help. Depending on the stage of your husband‘s dementia, you may need to place him in a memory care residence. Make sure to check out campuses with both assisted living and memory care in case his dementia advances and the two of you can’t live in the same unit. This way he will be proximate to you and you will be able to visit him as you go through your chemo and other medical treatments. Also consider adult foster care homes. These are residences that are set up for six or less residents. These homes specialize in elder care and can even specialize in memory care. Some states even have AFCs with nursing licenses.

Now is the time to be candid with your relatives and find out if anyone is interested in helping you out and to what capabilities.. This is a big ask. Let me repeat that – this is a big ask. I would speak with your estate attorney first and with the Alzheimer’s Association before asking your family how they can help. You want to have a good understanding of the kind of request you are making of your family members and you want to convey to them that you realize what you are asking for and need a lot of help. Work together with your family to get some plans in place. Again, let me emphasize, that you need a lot of help. This is not something you can do on your own.

This is a very tough situation and my heart goes out to you. I would also find a support group for yourself if you can. I took care of both of my parents with dementia and went through a life-threatening medical condition simultaneously, so I do have a deep understanding of your situation. Best of luck to you.
Taarna Jan 2022
You both need help now. You will not have the energy to do your usual chores as well as the chores you remind your husband to attend to. Please talk to your insurance company about home health aides to assist you and your husband. You may also qualify for local and federal government assistance. Another option is to consider moving both of you to assisted living and share an apartment. Find a place that can transition each of you to higher levels of care as you or your husband's needs change.

Llamalover47 Jan 2022
Bscales610: It is IMPERATIVE that you inform his family members that your cancer has INDEED returned and that you will require help sooner than later. Chemotherapy can be very physically draining for a patient. His family, who live out of state, have been informed of your illness and seem to be unable to grasp the fact that you have cancer. When they state that they're "glad he has you," that is a very ill-considered remark. Your husband needs to see his physician. Also, you will have to hire help if husband is unable to follow through with your prompts.

Meauxg12 Jan 2022
You need to take care of yourself starting now. Do the minimum for him and don’t feel guilty. Just do it because the chances are you will not be caring for him one day. Is it better that he be hit all at once or a bit over time? Only God knows our future, but yours will be shorter if you continue to do everything for him and do not care for your own well being. You need your reat.
I would make him a list in big type, what he needs to do daily for himself. Laminate it or put it in Plastic of some kind that you can tape to the bathroom or bedroom mirror. Everyday tell him to go and do what it says.
Meantime, tell the relatives that you have to deal with your own health and to please call your husband if they want to see how he’s doing because you’re not doing well. Leave it at that. Stop letting them placate themselves through you. Just bow out graciously. Tell them you’re too tired to talk and give him the phone or have him answer it. Just do what needs to be done for him and tell him you love him but you can no longer do the things on the list for him. He has to do them himself. Somehow you need to set a new normal, one that at least puts you on equal footing with him.
I’m not saying to abandon him in any way, but don’t complain if you are choosing to do what he himself can do. Nothing will change if you do that and only time will tell how this will all play out. I’m sure you are aware that your life is a miracle in that you are still able to manage day to day care of yourself and your husband. But don’t ignore the fact that it can all change quickly. Take time for you. Enjoy the simple things in life and let go of anything that doesn’t really matter. My thoughts and prayers are with you.

WendyElaine Jan 2022
I am sorry you are carrying so much on your shoulders.
As for your husband’s failure to do things, I suspect it could be cognitive problems. It sounds much like my mom who can no longer do simple things like dressing without step by step direction as she’s doing it. She simply does not know. Tho I find this very hard to understand and do get frustrated with her.
In your case, you just don’t have the energy to do everything for him while you are facing serious health issues. If you were to die before him, something would have to change for him. Look for those solutions now.
Wishing you some help and peace.
Beatty Jan 2022
Yes, problems with initiation tasks. Can happen post stroke.
Riley2166 Jan 2022
I think this is a sad, intolerable situation. You are ill and this should NOT fall on you to take care of him. You have your own problems and need to put you first. He obviously is showing signs of aging and onset of dementia and it will get worse. His family may appreciate knowing but they have NO intention of helping as he has YOU who is now the martyr. I don't know what good a caretaker would do - it would be 24 hours and what about being "there" and affecting your privacy. No one will help. I feel he needs to be placed where can be "watched" and helped. And as to you, possibly you need to consider the same so someone can help you. Somehow YOU need HELP and you have to come first. Good luck.

ConnieCaretaker Jan 2022
Perhaps you can get assistance from a "Visiting Angel?" That way, you get to choose what you will and won't do.

Santalynn Jan 2022
Sounds like the inlaws are in some degree of denial, sort of 'out of sight, out of mind.' And Stage 4 lung cancer should have been a 'wakeup call' to them, but such illness is 'invisible' in a sense, not like a broken leg where you're on crutches, etc. And you are very likely a highly capable person who shoulders a lot so folks just figure you're fine, no matter what. You'll need to spell it all out for the family, in person if possible; have them visit and see the situation. Even tho your lung cancer is resolved, the spread does spell a tough road ahead and the family must be made/helped to understand coming issues. Your husband 'agreeing' to do things is perhaps him being 'polite', 'agreeable', 'yes, dear' but may in fact lack the capacity to follow through because of stroke damage that is also not obvious either, until now manifested in not helping out, you or himself. He needs evaluation and you need stress relief so your immune system can handle your current challenges; I agree with other posters to engage every possible support in your area for everyday help and making a plan, for both of you. My dad had a stroke at only age 41 (military stress related, after he retired from service) seemed to recover relatively well but died very young, at 65 but he looked 80. He suffered from headaches constantly, likely brain/vascular dysfunction and he gradually down-regulated from a capable, engaged, active guy to a couch potato, without motivation for much of anything. And of course depression often plays a part in these conditions. All the best.

Daughterof1930 Jan 2022
You should get into that with husband’s relatives now. Let them know clearly that you are sick and he’s not capable of being on his own. Also let them know you’re not as capable since you’re receiving rigorous treatments. If they don’t offer help, accept that and call your local Area Agency on Aging and find out what help is available in your area. Get in home help now, give husband no choice in accepting help from others. Above all look out for your own well being. It’s sad that you husband isn’t capable of improving, but that’s not fixable. Time to prioritize yourself. I wish you the best

NancyIS Jan 2022
Get connected with a local social worker who can advise you on what services are available for you and your husband. You need to take care of yourself at this time in your life, while you are dealing with your own illness. Are you able to hire an aide to clean, do laundry, help him bathe and dress, take him to doctor appointments, etc.? The social worker should be able to advise. Talk to his doctor about whether your husband is showing signs of dementia. One sign is a disability to remember instructions, and also forgetfulness about taking medications, etc. If he has dementia, don't expect him to empathize or understand what you are going through. Just do what you need to do to make sure he has the care he needs, whether it's with an aide or in an assisted living facility, and take care of yourself. All the best to you, and best wishes for a full recovery.

cxmoody Jan 2022
If there is any kind of dementia going on, that could explain why your husband does not take initiative to do what needs to be done for himself.

The part of the brain that tells us the steps to take care of a problem, or a basic activity of daily living (ADL), is GONE in dementia.

We can ask, beg, cajole, shame, stand on our heads, but the person with a dementia will NOT be able to do these things.

Best wishes to you in this next phase of care-giving.

AlvaDeer Jan 2022
I agree with grandma1954 that you need a clear diagnosis and staging with a good neuro-pysch MD. Meanwhile, yes, do spend down by just hiring in some help. I also agree you need to evaluate for yourself realistically how well your hubby can function. That means not to enable him but to give him a list and SEE how well he can function. I don't know how much you are discussing with him your illness, your prognosis, what treatments will/may mean in future, nor can I guess how much of that he can absorb and understand.
Who is there in your own area to help, to act as POA for you, as second POA for your husband? Is all paperwork in place?
I am so happy for the good treatment you are clearly getting. But it can get like whack-a-mole where you are treating one thing, it comes into control and another pops up. It will all get exhausting.
Have you ever thought, while you have the strength to address this, of selling all assets and moving in WITH you husband to ALF????? There were several couples where my brother was, and they had two rooms, did very well, with some to activities and others in room, with help for doctor appointments, and etc. Much of this depends upon whether you have assets enough in a home to make the money to support you in a decent facility, but it is worth considering I think.

bowgirl Jan 2022
Stop doing for him what he can do for himself and help him when he helps you. YOUR goal right now is getting yourself well and having others take care of you!

RedVanAnnie Jan 2022
I like againx's100's suggestion to get some hired help as well as ideas from all about options for future care for either or both of you.

Erikka Jan 2022
What happens if you write out a schedule and stop doing for him? If you’re his safety net, he doesn’t have to change because there’s no pain when you save him from consequences.

Knew a man who couldn’t adult and didn’t trust his trustworthy relatives. His wife died. He got suckered by con artists. Lost his house and $1/2M. Called the relatives he didn’t trust for “just $10,000.” They called 2-1-1.

Grandma1954 Jan 2022
Has your husband been evaluated?
It is very possible that with the stroke he may have Vascular Dementia. This is a series of mini strokes that often go unnoticed.
the decline with Vascular Dementia is different than other dementia's. The person will often be very stable for a while then have a rather sharp decline almost overnight.
If you and your husband have not seen an attorney to draw up papers for both of your protection I would do so sooner rather than later.
If you are in a single family home, apartment, condo you might want to think about moving to a Continuing Care Community where you can go from Independent Living to Assisted to Memory Care if that is needed or Skilled Nursing if that is necessary. Yes that can be expensive but if you have the means it might be the best option.
Much of this is more for you than him. It will take a lot of the stress from your shoulders.
The best think you can do for your entire family is PLAN now for tomorrow.

Geaton777 Jan 2022
To help your health you need to lessen your stress, including off-loading providing and even managing care for him. I would call his family and tell them in no uncertain words that either they come and provide care for XX weeks/months or you will need to find a different alternative that will be expensive. In my opinion hiring one person to do x and another to do Y just adds to your daily burden of managing him and your own treatment.

His family isn't obligated to step up so you will need to have a plan B, which may be transitioning him into AL. This doesn't need to be permanent but you have no idea what your coming cancer battle will entail. You will need help for YOU and you shouldn't/can't be spending energy worrying about the aid who didn't show up that day. Or you contract an agency who will worry about scheduling. Perhaps the threat of a diminishing inheritance may motivate his children. If none of this is affordable you should contact social services for your county to get an in-home assessment to see what services they can provide. May you receive the help you need and have a full recovery!

againx100 Jan 2022
I would definitely hire some help at home. I'd start with a cleaning lady. Then maybe someone to drive him to appointments. Someone who can help him with his shower, etc.

So sorry you have cancer. Could he have some dementia going on? And that's why he can't remember to do things?

Good luck.

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