My mom turned 90 last year. Without going into too much detail, she has been living on her own until last June when she fell in her home, and was on the floor overnight by herself as she couldn’t get up to call for help. (Since then, we’ve gotten her a first alert button, which took a while for her to want to wear, but she is now.).
Anyway, she was taken to the hospital and then rehab for 2 months.
She has congestive heart failure plus more heart conditions, on warfarin for blood clots, cannot hear, cannot walk without a walker, etc. (she also had many UTI’s, with us thinking dementia, but that finally got cleared up.)
When she came home from rehab, we were told she could then not be left alone anymore.
The siblings set up a schedule to rotate her daily and overnight care. Some doing a bit more than others as some are retired, have spouses to help at home, daughters to help out, too, etc. Each sib is doing what they can to help out, and all are dedicated to helping where they can. BUT, it will be getting close to a year of this and everyone is or has already burned out, fighting going on between siblings, and some of their families are now suffering because taking care of mom has been the number one priority.
When this first happened, some sibs were not willing to move her to ASL, and also Covid had taken over, so the best option was in her home caregiving.
Not to mention, as mom has been getting much better under all this care, she has become at times a bit obstinate, controlling and at times just mean. She is mentally quite with it.
She doesn’t like people being in her house, moving her things around, taking her car away (as she put it, even though she had agreed to it and understood at the time), complains about each of us to the other after we leave. I won’t go into more details.
At one point we were able to get some help for a ‘break” as everyone was exhausted/ burned out, etc. we were able to have a full time caregiver there for 2 weeks out of the month for 4 months, bit the funds have run out for this. We each also cannot afford to pay for her care.
The caregiver help gave everyone a bit of a break and a chance to step back, get some rest, and reassess the situation.
Now the siblings (most of them) are ready to look at ASL’s for mom.
She has already fallen 3 times in her home, so is a fall risk. Her OT, PT through Medicare has run out, and they have released her. Someone has to give her showers, and only her one daughter is willing, but mom refuses.
Mom is convinced she is going to get better and will take care of herself and be on her own in her home. That obviously cannot happen. She has become more obstinate at times, yet demanding that we be there and take care of her needs she we are trying through OT and PT instructions to have her get up some and move around more and do some things for herself. She can do a little at a time, but gets worn out, winded, or sore, so she says no, she won’t do it, at times.
She has no intention of leaving her home. AL is not discussed.
We all know that is the best option, but Medicaid is what she would have to go in an AL on after the funds run out from the sale of her home, and paying her bills first.
1.) How do you convince someone who doesn’t want to lose control, is in denial about her care issues, athough knows and has told us we cannot continue to take care of her 24/7, that an AL facility would be the best option for her needed care, etc? Things will only get worse as time goes on health wise for her, and one fall by herself would do her in.
2.) Also, is it better to move her into an assisted living now when she has her mental faculties, or wait until later when she doesn’t know what’s happening as much?
It is quite a dilemma the sibs are trying to figure out, and very difficult and painful also, to say the least.
It would be so much easier if she was more open and willing to work with us. Some parents are not.
1. Mom accepts that the family can not continue as is and a caregiver is necessary. And mom pays for the caregiver.
2. Mom goes into Assisted Living if she will not accept a caregiver.
And mom pays for AL.
the third option and one that no one would want is you all cut back the amount of time you are caring for mom and she WILL fall again then she would have no option but to enter rehab again and THEN you say that she is not safe at home.
The problem with this is her next fall may be fatal. She may not do well with rehab and maybe wheelchair bound after then next fall.
If she has not been declared incompetent you can not "make" her do what she does not want to do.
You can present options.
she can refuse options presented.,
If she has been diagnosed with dementia you can place her in Memory Care. AL is not a great place for persons with dementia. Does someone have POA?
If she has been diagnosed with dementia and no one has POA someone will have to become her Guardian.
1. Review her paperwork or establish paperwork for Power of Attorney, Medical Power of Attorney (they aren't the same and don't need to be the same person). Also review her finances.
2. Start looking at Assisted Living facilities without her and determine what she can afford and if they will accept Medicaid once she qualifies (Medicare doesn't pay for assisted living).
3. Establish your boundaries - no overnights, one check-in or visit per day, someone will grocery shop for her but no meal prep, This is HARD but she has to understand that this is how living independently works, she has to be independent or she has to go to assisted living. EVERYONE in the family has to buy into this.
4. Wait for the disaster - another fall or hospital trip which will probably end with her needing a nursing home - or if you're lucky she'll soon realize that moving to assisted living is necessary.
Most of us have gone through this process. It's not easy and our mom/dad/love one is angry and spiteful, but just like with a toddler or a teenager they have to learn the natural consequences of their decisions. You say your mom is mentally sharp so she can see the results of her stubbornness and decide how she wants to live. I had to do this with my father. I cut off all help except grocery shopping and trips to the doctor. After years of asking him to move to assisted living he finally relented when he realized that I was out of town and he needed someone to apply an ointment to his itchy, itchy back and there was no one to do it. Not a life-threatening situation (it was an allergic reaction), but it was scary for him to realize that he was actually all alone with no help. He begrudgingly agreed to assisted living at age 97. Both of our lives are much better and he now says he should have moved earlier when he was more able to make friends and participate in activities.
In a similar situation, my LO did rethink her situation, and after a fairly rocky start ultimately entered a very good Memory Care.
In her situation the assumption that she was cognitively intact was not the case and your description seems to suggest that your mother may be the same.
Bottom line, your ultimate goal MUST start with SAFETY. Will she accept challenges to her perception of herself if they are offered by people outside the family?
Would your sibling group attempt an intervention? Has she tantrumed through life to get her way?
She says she cannot understand this new dr. as she reads lips, since she can't hear and he has an accent, of sort. I don't think she would listen to him if she could hear him, as she hasn't built up enough of a rapport for him to tell her the truth and she agree... Unfortunately.
I hope my siblings will be open to an intervention. Some are not all on the same page, but as time moves on and they each take their turns 'taking care of her', they are beginning to see the witing on the wall.
She has always thrown tantrums, or such. There is a streak of narcissism there and always has been. I have learned to keep my distance and not give in to her whims. She can be very nasty at times, too.
She has had a few 'battles' with a couple of my sisters. One time she threw a tantrum because an area rug was removed so she wouldn't fall. My sister refused (also per the OT) to put it back due to falling, and my mother would not talk to my sister for 2 days because of it. Very difficult at best to handle her at times, as you can see. Thank you for your advice.
The answer to your Q. 2), I think, is that the move would be better now, while she has her mental faculties, but obviously that will be up to her. If she's able to give someone her POA, then she can also take it away and you also won't be able to gain guardianship.
After my mom died and I could see that my dad living on his own wasn't going to last for too many years, even with several of us helping him, I began researching and taking him to assisted living facilities just to "look around," as I told him. I didn't pressure him at all to make any decisions and he seemed to enjoy the outings and once in awhile would actually make a comment about something he liked or didn't like. As it turned out, my wife and I first moved him into our home for a few years before I became completely exhausted and had to move him into a memory care facility.
This is a hard time for your mom, you and your siblings. As my wife's aunt used to say "Old age isn't for sissies." Like many or most of us, she was adamant about staying in her home, but my wife also had to eventually move her to a memory care facility. Best wishes for you and your mom.
My brother is the POA, but he also waffles as to what to do with her, and often just washes his hands of everything, not wanting to be involved. It's too much stress for him, he says. He would prefer for it to just go away. His poor wife has had to take on lot's of it, to 'help him out', as she says.
Not the best choice for POA, but mom appointed him, because he is the 'only male' in the family. Ugh
Mom will have to face reality, whether it be her being on her own and having something happen to her, or hopefully the sibs will agree to pull back and let her find out for herself what kind of care she needs that her children cannot continue to provide. Thank you for your advice.
Very elderly parents still view us as still being in our 20's or 30's with a lot of energy, not realizing that their grown children are senior citizens themselves or close to being seniors. Even showing my parents my Medicare card and AARP membership didn't phase them.
Regarding assisted living.... your Mom is at the age where she probably remember that aged friends and loved ones went to the county home for care, most of these places were asylums at the time. Your Mom may have no idea that today's assisting living facilities are more like hotels. My Dad loved his senior facility because he was around people of his own generation. He never felt alone.
So you know, she's already thought about us taking care of her.
And yes, she experienced many, many years ago her mom going into a "nursing home", because she and her siblings could not take her in. She came home everyday after visiting her and cried with seeing how awful they were back then. She told us to 'never put her in a nursing home!' So, the guilt was started back then... lol
A vein of narcissism has always run through mom, so that makes it more difficult. thank you for your advice!
Do you think this is a possibility?
ALL the sibs need to tell the mother that they won't be providing care for her anymore, and then back out of the picture.
Do you think this could happen?
We've already had one sib back out out due to burn-out, but came back with geting some help to back her up.
I don't know if we can get all sibs to provide united front with mom and have the 'meeting' with her. We are scheduled to have a family meeting with just the sibs next weekend where my eldest is going to present to everyone what info. she found with ASL and medicaid coverage. I'm hoping we can come to some much needed decisions then... thank you for your suggestions.
If there is a "next time" she falls at home and is then taken to the ER, this is the opportunity to intercede and make sure she is not returned home. This would be an "unsafe discharge". No one in the family should go to retrieve her to take her back to her house. Sometimes the hospitals will work very hard at guilting family to come get her and even take her into their own home. Never do this. At the hospital arrangements might be able to be made for her in LTC. Your mom's reticence might be a sign of her cognitive impairment, as judgment often erodes first, along with short-term memory. It is like standing by and watching a train wreck in slow motion. I wish you success in getting her somewhere she will be safe and your family can breath a sigh of relief.
It's possible her reticence could be a sign of cognitive impairment, but she has always been a very stubborn person and a vein of narcissism is also there. (in my opinion...)
Yes, it is like standing there watching a train wreck in slow motion! I completely agree. I told my eldest sister back in Oct. last year that we needed a plan B to put in place (i.e. ASL). She and none of the other sisters would listen to me or even entertain the idea. It is very frustrating to just wait and watch this all unfold. I have tried numerous times to get them to do something about. Now, she has finally starting looking at ASL's, as you will see in my other reply comments. She's finding not much out there with medicaid. We'll know more when we meet for our family meeting next weekend. prayers and fingers crossed we can find a solution that will work for everyone. As of right now, she asked each of us to contribute funds to pay for mom to stay in her home at least another month. None of us can afford to do this on a regular basis. We'll all end up in the poor house and have no one to take care of us! Ugh I hope this is a wake up call for all of us! Thank you for your reply
Currently you are enabling a Mom you describe as currently quite "with it". Meaning capable of understanding. I think the fact you ALL now recognize that your Mom needs 24/7 care means you should get together and speak about withdrawing what support is not absolutely crucial, and about ALL OF YOU going together to tell your Mom the facts.
If she will not agree then nature will take its course. We have a member named Elaine I hope will speak with you if she sees your post. Her own mother refused care over and over and over and eventually did end up having an incident, and dying in her own home. It can and it does happen. And it may happen in your Mom's case. I think otherwise, given your Mom is basically with it, you cannot force the issue. The time will come when something else will break and the issue will then be forced.
I sure wish you all luck with this. It is impossibly difficult to know how not to enable a senior you recognize does need more care, but who refuses said care.
Maybe the dr. will have to intervene, or one of the 'favorite' children that she listens to more. I dont' know We will see what happens when the sibs meet next week for a family meeting, finally our first one in person, to discuss this entire situation.
I am going to mention many of these comments that were sent to me here on this forum as a way to help us come to some decision.
thank you for all your replys. Sooo very difficult.