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My 87 year old mother is a live in caretaker of my disabled 97 year old aunt. My Mom has medical power of attorney and statutory power of attorney over her sister. I have secondary poa. My Mom lives at my aunts house but is ill and no longer able to lift her sister. My Aunt is in denial about her declining mobility and ability to live at home without assistance.  Her doctor is recommending the nursing home and signing paperwork but the physical act of getting her to go is the problem. Any suggestions?

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Dear Juliet,

I'm so sorry to hear what is happening. What an amazing mother you have to been so loyal and devoted to her sister's care. I know change is hard. I think your 97 year old aunt must be so scared. Are you able to have independent third party talk to her? Maybe a social worker, family therapist, family doctor or counselor could help her with the transition. Hopefully they can allay her fears and help her cope with this change of care.
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What does your mother want to do?

I hesitate to jump to any conclusions because I've been wrong before: my great aunt, then in her eighties, nursed her sister at home through cancer of the jaw to the end of life. If I'd been more clearly aware of what was going on I dare say I'd have wanted to intervene, but as it was the two of them were very much a self-contained unit; and somehow, goodness knows where she found the strength, she coped.

So I can't assume that your mother, in spite of illness, wants your aunt to be removed to the NH - does she, has she said?

Meanwhile, what support is available to them at home?
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My Mother feels trapped. She is a cancer survivor in remission. We want my Aunt to have the best care and we can no longer provide it for her in her own home. My Aunt is terrified to leave her house. I am terrified of losing my Mother. The plans are made but you cannot force a person to go unless you have guardianship. I am hoping we get a social worker that takes the time to understand the situation.
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Juliet, not to nag you but that is quite a "politician's answer" to the question of what your mother wants :)

If you don't mind humouring me: does your mother agree that your aunt needs to be placed in the Nursing Home? I am getting a vibe that you think she does but... just short of saying so. Especially to your aunt.

Whose house is it, by the way?
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My Mother wants her to be with her sister in the nursing home. Everyone but my Aunt agrees she needs to be in a nursing home. Two doctors. Getting hospice to assist.

I really just wanted advice on how to emotionally prepare my Aunt.

Thank you country mouse for your concern.
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There's another sister already there?
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Would a little bit of trickery help? If she was told that it was only temporary until your mother can get back on her feet?
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My Mother is ill, 87 years old and not capable. I believe we are going in with the caregivers respite then hoping she adjusts and stays to be with her sister.
My thanks for all the suggestions. Hope I can pay it forward.
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Is there a possibility that you Mom would agree to move into an Assisted Living facility so she can still "help" with her sister but she will get help as well to do the things she can not do with ease. It also sounds like your Mom could use some help as well.
This might be a Win-Win for both of them and maybe even you, if your Mom is comfortable and gets help herself she may decide to stay which would take a care-giving role from your shoulders.
If that is not necessary your Mom could move out after her sister passes.
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Based on personal experience, be firm and tell her she has to go and why. If she refuses, try this tactic - it worked when my husband was very ill and refused to go to the doctor in Philadelphia who discovered he had cancer. I told him he could go with me willingly. He refused. So I asked him would he prefer I have two men who I (I pretended about that) hired take him to the doctor. He finally gave in and went with me. You may have to consider getting help in physically getting her to the nursing home. Or an ambulance may be the solution. I don't know anyone who willingly will go to a nursing home because I am sure they realize it is the beginning of the end and a death sentence. It would be that for me,.
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What I would suggest is first find out if she's competent, and if she is there's really not much you can do. If she wants to die at home, that's her right.

Decreased mobility:

Get her a wheelchair if she needs one. You can also have in-home healthcare come in to help her. An elderly friend of mine who long since died had a power chair and was able to get around very well with it except he had macular degeneration and should've never been on one. He should've instead been in a manual chair. Those with decreased mobility often find wheelchairs very useful because they are very helpful to get people around. They are very helpful to arthritics for starters. If you have arthritis in your lower extremities or very low lumbar spine, standing and walking can be painful and can limit your ability to stand and walk for very long.

I don't know if the doctor ever thought to get her something to help her to get around better, but if not, you may mention this to him instead of forcing her out of her home, especially if she happens to be competent. Home is where all of your comfort's are, and it also contains all of your valuables. No one wants to leave all of that behind and have it ripped away from them, I don't blame them. Furthermore, no one wants to lose their freedom, I don't blame them, neither would I! If she happens to be competent and doesn't want to go to a nursing home, you can't force her when there are other alternatives available, think about it and think long and hard. Put yourself in her spot and ask yourself if you want to be ripped away from everything you know and like and the answer will probably be no. Try anything and everything before bringing up the work nursing home because too many people don't want to hear it. Too many times people give up right after being forced into one when they really would've otherwise done better to have stayed home. Good for her for being determined to stay home as long as she wants. Good for her if she may physically fight you, so would I and given her situation, I would probably hurt you far worse than she would if you ever laid a hand on me to force me out of my home! I personally would go to great lengths to keep you away and even lock you out and change the locks. Given her situation if I happened to be competent but just couldn't get around, I would never ever go willingly to a nursing home when there are other ways for a person to get around such as something as simple as a wheelchair or even a power chair. There are certain organizations that can even build handicap ramps for those with steps who must depend on a wheelchair. I know someone who had one made when her doctor prescribed her a wheelchair. I remember when that ramp and deck were built, I was there and watched the progress but I didn't stay there all the time. When it was done, I got to take my own chair up this ramp and it was very nice. Providing handicap accessibility is the law when someone depends on a chair or other mobility aid. Perhaps a call to the right channels will help get the ball rolling in the right direction if you get her something as simple as a wheelchair or a power chair. Even a mobility scooter would really help her if she has no car and needs groceries. You can put a box or basket on the floorboard and put your groceries in there and carry them home. I use one myself and they are very helpful and useful. You just plug them in and keep them charged as needed, and when the tires need attention, you tend to them. Solids are actually better, but you must periodically replace them or add rubber. Many mobility scooters these days are low maintenance, but they do require proper care. I would seriously consider getting her a scooter or power chair to help get her around. Don't just throw someone away just because they can't get around
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Have your mother tell her sister that they are both going to the facility on a "trial basis". Assuming that your mother also wants to live in the assisted living facility. If you call it anything but a nursing home, it might work out better for you in getting her to accept the idea. Call it a senior apartment, assisted living facility, whatever it takes. Have her go there for lunch (most offer a free lunch with a tour), and ask for her input.

My mother was not happy about having to move from my house to the ALF, but I stuck to my guns, told her she was not safe alone in my house, I had to work, and that the stress of worrying about her on a daily basis was going to lead to my untimely demise. All of which were true.

She has been there only three months, and is thriving, gaining weight (she was dangerously underweight), and the staff tells me she is interacting well with most of the other residents (although my mother calls them inmates when she talks to me).

Good luck.
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Try to keep your mind open. The Administrator at Mother's Senior Facility agreed that I could stay with her. That all changed and the new administrator took his place. She is a nightmare. I am POA of Health Care and against my Mother's "NO," my disagreement and the Dr.'s orders they set upon a forced "Care Program" and injured her. It was a year ago on March 17, 22016. They did not stop and made me into the scapegoat for all their negligence and mismanagement and made up lies. Mother was forced into their Personal Care Unit in July 2016. She went from independence to an invalid under there imposed care. I was not permitted to stay overnight in PC. The staff took her to breakfast and brought her back and set her in front of the TV in her wheel Chair. They didn't know she couldn't get out of the wheel chair to bed or bathroom. She had several falls, a real set back. They did not know better than a loved one attending to their elderly needs. They triangulated the family. My brother and cousin supported them. In PC I started out staying with her from 7:00 am until 11 PM at night. We had a private duty Nurses Aid with her from 11 PM until 7:00 AM. My brother came around to supporting me. My Mother was improving. They started cutting my hours back, much to my Mother's dislike, after I discovered the Nurse messing up Mother's eye drops. They manufactured stories against me with just an inkling of truth as a backdrop to cut my hours to 4 hours a day 5 days a week. My son filled in. He told them this was just an interim stay as we were moving mother. We got her out alive. She is in a wonderful facility. I would have had her at home with her there with me and had looked into a Home Health Care Program to meet her needs. She is thriving where she is so I am not going to argue with success. Myself or my son is with her all the time. We will cut back if she regains more independence. The point I am trying to make is don't break up the bond between your Mother and your Aunt. If she goes to a Nursing Home, inspect it and ask residents/ residents families how they like it there. Ask around in the community, better yet, a church nearby. Ask them if your Mother can stay with her there. Also be sure to check out a Home Care program that could help your Mother care for your Aunt. They can recommend care and a price. Check out part time help from someone the family knows well to help out at home. Listen to your Mother and Aunt. Make them part of the decision. Good Luck.
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You really can't prepare her emotionally, unfortunately. You likely will succeed with using a respite plan then leaving her there by continually telling her that your mom is not well enough to take her back yet but that you are working hard towards that end. They will likely tell you and your mom to stay away for a while, but you do what you feel is right for her. If you think she's better with one of you visiting, ignore the facility and go as often as you see appropriate. Good luck!
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The aunt doesn't get to make decisions, else they be incomprehensible.
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