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My father in law is a great man. He has been unquestionably the leader of the family, a warm, loving, and generous person whose decisions have led to a prosperous life for him and his children. He is now 90, and his great mind, the true person that he is, is only around a quarter to a third of the time. It is impossible to gauge when the real person will show up, although when he is around more than a couple of people he seems to try harder. The rest of the time, he can be confused, angry, combative and abusive. He lives with my mother in law, who has taken on almost all of his care. Both of their children live in different cities than they do. A few years ago, my wife started regularly flying down to help out every couple of months. Her brother goes down a few times a year as well. My mother in law is a dozen years younger than her husband, but his needs are taking a toll. Everyone agrees she needs help, but my father in law refuses. He doesn’t even want the cleaning person to come for more than once a week. I am very concerned about her health. If she catches the flu, she will likely be down for a minimum of two weeks, which would be a disaster. If something worse happens to her then all choice goes out the window. Either he will need a full time nurse or they will both have to move to an assisted living facility. Because of my father in law’s success in life, money is not an issue. My mother in law realizes there is probably not much time left so she wants to keep him happy and comfortable. She cannot say ‘No’ to him. He will be around longer, and the quality of the time remaining will be better if we can just convince him to let her have some help. Do we fight him and hope he tires of the battle? Do we lie to him (tell him he already agreed to having someone come in for a few hours a day)? Do we try to have his doctor be the one who tells him that he has needs that are beyond his wife’s abilities? I would appreciate hearing from others with similar situations. What can work? What is unlikely to help?

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I think you do what ever works.. it usually takes a combination of fibbing, tricking, fighting, using the doc and so on.

Your FIL sounds like classic dementia. He has no idea anything is wrong and you will not convince him. Just save your energy.

As my dad developed dementia mom and I had to work around it. The carpet cleaning guy was an old buddy of mine. “It’s free dad!”
The home care nurse after mom’s hip surgery was my old girlfriend and so on. I would tell Dad anything to get basic stuff done. Trust me, there is no shame in this. Do what ya gotta do.

And pick your battles. I gave up on the nasty sofa and dinette set but had a new dryer sent in even though Dad was screwing around trying to fix the 30 year old one. “It’s a birthday present for mom”. He was miffed for a little bit but finally admitted the new one worked much better.

Dad and mom just went into assisted living about 3 weeks ago. Mom went first after a bad fall then a few days later I took Dad to have lunch with mom and checked him in. He had fallen off the dementia cliff. Six weeks ago he was mowing the lawn and driving to the store. Now he’s pretty much in the moment.  It’s rough, a huge adjustment for them, but they are finally safe and cared for.

Good luck to you. You will hear from many others with very similar experiences.
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At a minimum, make sure all of the paperwork has been completed for a respite care facility of choice. That way, if Mom gets sick, there will be someone to take care of Dad.
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You sound like a respectful and appreciative SonIL
Pick up the book Atul Gawande wrote called ‘Being Mortal’ subtitled ‘Medicine and What Matters in the End.’
Your MIL has the right idea to spend as much time with her husband as he has left. That quarter to a third of his time where her husband shows up is obviously worth it to her.
You are also right. The other personality is wearing her out. She needs help and may be so mentally fatigued to not realize how badly.
I’m not sure why you think she should have to go into an ALF with him at a healthty 78??
But, she’s in the drivers seat here. Read the book and you’ll understand the options better. Then get her to read the book.
She needs to understand that she needs to be rested enough to make good decisions for the both of them.
So the siblings need to have their ducks in a row and offer her respite so she can have time to absorb the decisions needed to be made ahead.
And if MIL gets the flu or any other health issue hopefully your wife and/or her brother get there ASAP.
Before that time you find out what care taker companies are in the area and get them started upon arrival.
If FIL acts out more than can be handled you ask his dr for a psych evaluation to have his meds adjusted.
I agree with you that they both could have better lives with more in home help. At some point MIL has to understand that she is allowing her husband to run them both off into the ditch by not hiring the help she needs now.
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Does Mom want help? If she's open to it, she would be a great ally. Work with their primary care physician. Their generation seems to take everything their doctors say without much argument. It might only take a "prescription" for extra help to persuade Dad, especially if it's explained that SHE is the one who needs help, not him.
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So respect your family's respectful attitude toward your father-in-law! Completely understand your challenge. My mom lived with us for over 13 years, and toward the end, we definitely needed help because she had Alzheimer's.

About six months before her passing, during one of her lucid moments, I said,
"Mom, your doctor is very concerned about you." She was very surprised and wanted to know why.

"He is worried that during the day while Joe is at work, you are home alone with me. If something happened to me, there would be no one to care for you until Joe returned from work. He says that for your safety, either you need to move to assisted living (where there are lots of people to help) or we need to hire someone to be here with us during the day while Joe is at work."

She immediately saw the logic of this and was very cooperative when caregivers started coming to help. That may have been the last meaningful conversation that I ever had with her. Within three months, her Alzheimer's had progressed so far, she had to go to a memory care facility (and she was a challenge to them).

I had read on agingcare.com that when reasoning with a dementia patient, make it all about them. That strategy definitely worked for us! Hope it will work for you.

Many blessings to you and your family as you care for your aging relatives!
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In certain types of marriages (and not just old-fashioned ones) it can take the wife quite a while to realise that there are certain things it is better not to bother with one's husband's explicit agreement to. For example, in just my own experience: calling a glazier, getting a decorator, fitting kitchen shelves (so what *was* all that mystery about how the electric drill works..?), comparing tradesmen's estimates. And so on.

You have to draw the line at issues which are properly your spouse's to decide on. E.g. not taking his old blazers to the Red Cross shop without his consent, and especially not if one of them contains his i.d. and contact number and the stupid shop rings up and leaves a voicemail and drops you face-first in it. Or, more importantly, committing him to unusual expenditure or active participation - that would be just rude and he would have every right to object strenuously.

So. In the case of your MIL, she doesn't need your FIL's permission to hire help for herself; and in fact having some of the more irksome chores done for her would free her to be better company. And if FIL says "we" don't need this extra help, she would be well within her rights to respond "maybe we don't, but *I* do" and stick the bill on the housekeeping budget.

With luck and persistence, she will thus have inserted the thin end of the wedge, setting the important precedent that if something is too tiring or difficult for her to manage then the *sensible* thing to do is hire help.
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Has he appointed a Durable Power of Attorney or Healthcare POA? If so, perhaps they can discuss the matter with his doctor. Do you think that he is still competent? If so, it's up to him to make his own decisions.

But, if he is not competent and no one is appointed to be his Durable POA and Healthcare POA, then, I'd seek advice from an Elder Law attorney in his jurisdiction and inquire about Guardianship. They can explain the process, proof needed for court, costs, etc. If his health, safety and welfare are suffering, then, I'd find out ways to protect him. I'd inquire about self-neglect. Do you think that is the case? If his wife is too timid to be an advocate for him, that would concern me. When people have dementia, they don't always use good judgment, do the safe thing, consider what is feasible under the circumstances. Sometimes people with dementia may believe they can do things for themselves, when in fact, they can't even get out of the bed. It's called magical thinking. Eventually, a person with dementia can't drive the train, if their health is at risk. They may need someone with sound judgment to take control, for their own protection.
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As a former caregiver, I believe all these suggestions are very valuable, and I hope they will be put into action.
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If MIL wants help say YES to her. The sick person does not get to decide that. Now if she doesn't want help, and the situation is overwhelming, you will find out soon enough. Someone will have to help them make decisions.
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When the day comes when Dad needs to be hustled off to a Memory Care unit for respite or permanently, how about packing a bag and telling him he's won a mini staycation at a hotel? Perhaps that will get him out the door. I agree with the others about his behaviors.
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