How to convince siblings that a parent should not be left alone?

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Three siblings living in the same town care for and see their mother with Alzheimer's regularly. A fourth sibling visits several times a year from out of town. The fourth sibling sees the decline more than the ones that see her regularly. How can the fourth convince the three that the mother should not be alone. The stove and counter top appliances are functional presenting a danger.

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Whether out-town or in-town, siblings can have very differing options about parents remaining in home driven by differing experiences and personal agendas.

My mother was primary care giver for her husband with paranoid personality disorder and vascular dementia for more than 20 years when she first showed some short term memory issues. Her PCP administered a quick cognitive test (which Mom passed with 100% correct responses) and stated the cause was likely (1) care giving stress, (2) sleep interruptions (my dad took at least one stroll around the house nightly, and (3) side effect of a stomach medication. One sibling stated Mom obviously had Alzheimer's and the doctor was incompetent not to recognize it. He felt Mom's "mental problems" gave him the right to take over and tell my mother what she was allowed to do in her own home. Understand that my mom was still doing all the housework, yard work, shopping, cooking, and ADLs to her same decades long standard while coping with my father.

Her short term memory problems did get worse over the years as my sibling decided to add his bullying to my mother's load. Sibling started mowing the yard with a riding lawnmower and told Mom she didn't need all those flower beds and bushes around the house, shouldn't be driving, shouldn't be shopping (just give him the money and he would take care of it), but otherwise did nothing helpful. The PCP continued to see Mom's problems as minor and most probably stress related.

Mom had no accidents driving and I rode with her every couple of months so I know her driving skills didn't diminish. I eventually (8 years from onset of memory issues and after a MCI diagnosis with 26 of 30 cognitive score) asked her to stop driving not because her driving was off, but because I was concerned that if she were involved in an accident (even one that wasn't her fault) she might not remember enough to be able to tell her side for the accident report. She complied and I started driving Mom around. When the grocery store reorganized Mom had problems adjusting to the new arrangement so sometimes we had to make a couple of passes down an isle to get everything she wanted. She was still maintaining herself, her house, and my dad (as much as he would let her) in good shape. She learned how to operate a safe to secure some items from my father's and brother's access (did I mention my brother decided since mom "obviously had Alzheimer's" he had the right to secretly search her home anytime he wanted for any reason). She also learned to operate the security system I had installed with panic buttons and smoke detectors.

Ultimately, my mother's exhaustion from dealing with my father and my sibling's bullying forced her from her home. Younger siblings felt our father needed a move to MC, Mom planned to move in with me when that happened because she didn't want to live in the house alone. Younger siblings and Mom wanted to sell the house to provide funds for Dad's care. Older sibling resisted dad going to MC - we should just put him in control and everything would be fine. My sibling resorted to physically intimidating my mother when she would not "mind" and sign some papers for him. Cornered her in the kitchen and told her she couldn't go to the bathroom until she signed papers for him - she signed "my son is an ass", locked herself in the bath and called me on her cell to come "handle your brother". She moved into my home shortly afterwards when my brother filed to become her guardian. She no longer felt safe in her home and I couldn't continue to drop everything and head to her house whenever my brother started something (he didn't have a job and liked to strike during my working hours). On the other hand, she improved dramatically after getting away from all the stress. Brother's guardianship attempt failed and he couldn't believe how hard taking care of our father could be.

Some siblings see parent's decline as an opportunity to gain/take control. I believe my oldest sibling felt he should be in charge because he was the oldest. He exploded when he found out my mother had long standing POA documents that excluded him in favor of his younger siblings. He also wanted to preserve assets while the younger siblings wanted to spend them on our parents care.

Some siblings will see parent's decline as an opportunity to assist their parents to continue living the life they choose for as long as it is practical. To only reluctantly make decisions as conditions force issues.

Feuding siblings just make a very difficult situation much worse!

Just because our parents are having some problems doesn't mean they should be pushed out of their homes. First we need to consider what adjustments/supports can be provided to reduce risks. Then we start talking about what they want to do when they can't keep the house going anymore.
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Reply to TNtechie
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Linda22 - "start your dialogue based on the assumption they do know this and do much more listening than talking." This was exactly my point, and you said it quite succinctly.

If I were the out of towner, I would start with a question or two, rather than conclusions or assumptions. I would ask "Does Mom seem extremely frail to you? Are you comfortable with her living alone? Have there been any discussions about moving her to a residential facility?"

We (local sibs) know full well that my mother should have been in assisted living years ago, and really should be in a nursing home now. But combining a fiercely independent parent with a dire lack of funds and you end up with a piecework of care that everyone agrees is really not enough. If one of us (meaning me) had moved in with her, that siblings (me) would have been stuck fulfilling every little wish and whim, as well as every genuine need, of my debilitated mother, and everybody else would have breathed as sigh of relief and moved on with their lives, unhindered. That's why I moved in and back out again within about one year. We're thinking, now, that the next time Mom is hospitalized would be a good time to move her into a nursing home "Medicaid pending." That's how this will probably end up. But it will have taken many years and much effort, discussion, and stop-gap measures to arrive at this point.
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Reply to CarlaCB
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An out of town family member used to tell us that our LO wasn't safe living at home and we needed to do something. We didn't need to be told this, as we saw the changes. Telling us the obvious didn't address that we'd had countless discussions with LO, each resulting in him saying he wanted to stay home. He also didn't think he needed in home caregivers. It was his call. To the out of towner, we weren't doing what needed to be done. To us, we were helping the best we could with the limits set for us. I finally told him as we couldn't hog tie the man and take him over in the back of a pickup, I was open to suggestions. Testy, I admit. But my point is start your dialogue based on the assumption they do know this and do much more listening than talking.
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I have three out-of-town brothers. A few years back, one didn't want our mother driving any longer, one thought she did okay driving, and one didn't care. Of course, none of those brothers was going to have to be the one to haul her around -- THAT privilege (ha!) fell to me, the Dummy Daughter Driver.

My mother even said she didn't want to drive anymore, but I did nothing until she refused to drive anymore. I had to become her taxi driver (I have set strict boundaries about this, and she wasn't happy).

My mother should be in assisted living. I think my brothers are concerned when they think about it, but since I'm local, they are happy to keep it all in my wheelhouse.

My mother needs someone to monitor her showers, and could use help dressing. Several times now, she's burned stuff in the microwave. She has now said she won't cook spaghetti anymore, as the pot is too heavy. I'm not sure how she gets her big cups of coffee and tea to the table safely.

She has money to hire help, and refuses. Not even housecleaning help.

While I'm sure my brothers (well, 2 of the 3; 1 doesn't care at all) would LOVE it if I would help her by monitoring her showers, fixing her meals, helping her get dressed, etc., they wouldn't DARE mention it to me.

My mother, at almost 92, has no vision in one eye, very poor balance, poor hearing, atrial fibrillation (on blood thinners), neuropathy in her feet and lots of anxieties. She lives alone, housebound except for Mass, chair yoga/grocery trip afterwards. This is her choice. I've done plenty for her. And she tells me I don't do much at all for her.
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Even if the out of towners do call, there is the whole "showtimers" issue. There is another out of town sib and he often says "she sounds fine." And we don't see her often but I promise you...fine she is not.

I have a lot of sympathy for the in town sibs. This is scary stuff. They are angry and scared and they resent the out of towners for not being there. I get it. My advice to RedRoses is to get professionals to assess the situation and come up with some possible solutions. You might be surprised at what services are available to people with no money! Then have a family meeting (a mediator is a great idea) and let everyone offer what they have to offer...and demand nothing from anyone. And take as little as possible personally. People who are grieving are not usually at their best.
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Concerning the issue of keeping out of town siblings apprised of the parent's condition, I don't feel obligated to do that when they don't feel obligated to even call my mother, or me. The incident I described above happened almost 7 years ago, and little has changed except my mother has declined even further (and now has a housemate who helps her out in exchange for free rent) and my elder sister has been deceased for two years. The absent siblings (there are 4 of them) know perfectly well that my mother is elderly and frail, that she requires a lot of assistance and can't manage independently, that she is frequently hospitalized with one crisis or another. Still, no phone calls, no emails, nothing. We let them know when there's a potentially serious event but that's it. They don't concern themselves with her, so I don't concern myself with them. Of course, she could call them too, but she doesn't. She never did, really. She only calls people (like me) who do things for her.

Everybody has their own perspective based on personal experience. You might think the out of town siblings would be more invested in their elderly parent based on your experience, but in my experience, that hasn't been the case.
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Reply to CarlaCB
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Dear RedRoses,

Its really tough in a family. I'm sure there is resentment about the fourth sibling given they are not around as much. If at all possible, I would try and call a family meeting and hopefully have an independent third party there as well to help mediate.

With my own siblings I did the day to day care. But when things got tough there was arguments and silent treatments among the siblings. Hard to get everyone on the same page.

I hope the siblings can have an honest conversation with each other.
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In our experience, the in town sibs were not providing any care. They were all in a state of deep denial. "Everyone forgets things sometimes." Other relatives who would see our LO infrequently at gatherings such as weddings or showers would call or email and say "Something's wrong. What is being done for her?" My point is that it's hard to see something that is happening so slowly and right in front of your face. I have read posts from people who are aghast that things got so bad and they never saw it. I don't think they should beat themselves up. I think people who see them infrequently sometimes see decline more clearly.

In your case, I think your out of town sib should have been kept up to date on your mom's condition by someone. She might have reacted with denial. You very well might have heard "Well, she sounds okay on the phone." from her. But when she came to visit you wouldn't have heard "She can't live alone." like this was brand new news for you. You might have heard "Oh my goodness, you were right." And maybe, "What are WE going to do?"
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But Marcia, the local siblings aren't just seeing the mom more often than the out-of-towners. They're taking care of her. So they know whether and how often she falls, whether there have been 911 calls, whether the Mom can walk to the car or needs a wheelchair, whether she makes strange purchases or falls for scams, whether she's screwing up her meds, what the doctor's saying at each visit, all of it. They know Mom's financial situation and her feelings about going into care or staying in her home. They know because every little issue has to be dealt with, by them.

I was one of the three local siblings. On the occasion of my mother's 80th birthday, several out-state-siblings came down for the party. One such sibling took my eldest sister aside and said "Mom has really declined. She shouldn't be living alone anymore." To which my sister replied "Oh, we totally agree. Are you taking her home with you?"

What I'm say is, it's easy to recognize that a parent may not be safe living alone. What's hard is to find a solution to the problem, especially when the parent has no funds, is unwilling to move, and nobody can or is willing to take on the 24/7 live-in caregiver role. Been there, done that, got the T-shirt.
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We arranged for a service to come to the house and do a Home Safety Assessment. It was an occupational therapist and a social worker. It was covered by insurance with a doctor's prescription. The social worker noted that the LO was vulnerable because she couldn't call for help if it were needed and let anyone who knocked on the door in- without asking who they were. Adaptations such as improved lighting and bath rails were suggested. I think there are adaptations that can be made to the stove and faucets that would keep them from being left on, too.

I have to say I disagree that someone who only sees someone once a year can't see decline more than those who visit regularly. There are loads of people on this board who are beating themselves up because they didn't see the dementia sooner. You get used to something that happens little by little. It's not that they aren't doing a good job as caretakers. It's that the change was so incremental that it is hard to really see.
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