I need advice on what, if anything, I can do about my mom's lack of care for my dad.

Your last line is sexism at its worst - why because you are female is it assumed that you will be the caretaker by both parents & brothers? - there are 3 children of your parents so each does 1/3 of work - even if you are stay at home mom that is still a 24/7 job - you are too far away to be 'on call' however you can do some help but not regularly -

Look at mom for some issues too - your dad should not be flying all over the place - does he want to go or is it mom's not too brilliant idea?

Mom seems like a narcissist to me. I don't think she is in denial. I think, without being judgmental, that it's all about her and she really doesn't want to make your dad her problem. So I think you and your brother should step in in whatever way you see fit to address the situation. It sounds as if your mom has already washed her hands of everything by making you guys clean up her messes, so to speak, so you might as well try to address care issues as you see fit.

AS I read these responses , I am moving in sympathy towards your mother. We all have seen the daily ads of retired people who are traveling and having a great time. We dream that will be for us--but it is not truth for most people. And when It does not happen that way we become resentful and wonder what we did wrong after a lifetime of hard work. I am touched by the fact that she s making travel plans--God Bless Her.
That is the life force in her and it is still a powerful energy. For that all her children should be grateful. I suggest a kindly, no-blame meeting to discuss what is possible to help both parents have what they would like to see happen come true in their retirement years.

I've seen it suggested here that some in your situation have managed to get parents to accept in-home care by telling parents the caregiver is a friend--maybe from church--who needs the extra income, so maybe it would be nice for them to help your friend by hiring him or her to help look after your dad, freeing up your mom to do her thing.
This didn't work for my in-laws because Mom wouldn't relinquish any of the care-giving--she just paid the care-giver to sit around--but it sounds like your mom might be accepting if you presented it as getting his care off her back so she could have her own fun.

Perhaps you could suggest a doctor visit for your dad before the next trip, "just to make sure he's up in shape to travel, since he got so sick the last time," and tip off the doc in advance so he can address your dad's needs, including driving competence as well as the freedom it would give Mom to hire some help.

As others have mentioned, it's a good idea to visit an Estate Planning or Elder Care attorney NOW. You may find that your dad could qualify for Medicaid in the future while preserving the family farm, if that's what they hope to do; but if you wait, opportunities may be lost.

Dear Gardengurl, like you I live in a rural area where ‘everyone knows everyone’. If you are sure that your rellies are going to be telling everyone what a ‘rotten horrible person’ you are, it might be good for you – and even for your parents – if you get in first. Talk to other people you know about your concerns, making it worries rather than complaints. You say it ‘will be nothing new’, so your neighbours will probably fill in the blanks. Then if your rellies complain to the neighbours, they are not likely to get sympathy about how horrible you are, and they might even get told some home truths that stick. It could make more impact than what you are saying, because they are not respecting your views. And it should at least mean that you can still live there with your own reputation intact. I know first hand that it’s difficult to live in an area where your reputation has been trashed, even if people know they have only heard one side of the story. Get your side on the page first, if you can see it coming. This doesn’t solve the bigger problem, but it could help with one part of it.

Thank goodness that you cannot be their caregiver. I am ABSOLUTELY APPALLED that they are traveling when dad is so ill. Remove mother from the caregiver duty  and find someone else immediately. Perhaps your mother has experienced burnout. Idk. But that 18-hour flight speaks volumes about the entire situation. So very sad.

As a former flight attendant, your dad is who we were trained to help medically - KEEP HIM OFF THOSE PLANES! - you can't phone 911 from 40 thousand feet so you'll get the FA or whoever answers the page for help - by the way we were told to even accept the help of a veternarian who offers to help ... is that who you want helping your dad? - it doesn't seem like he is with it enough to travel but your mom doesn't know what else to do - tell her to go on her own for both their sakes

Wow, thanks for all the replies. It’s great to read from various viewpoints. Here is some more info and an update. It has been a rough week but I now have peace about the hard decision I had to make which I will hopefully remember to add at the end.

First I should have probably started with the fact that they aren’t telling anyone my dad has Alzheimer’s. They just say he is slow.

As for my parents finances they have over 1.5 million in a retirement account. They receive over $5000 a month from Social Security (which than what my husband makes). In addition to that they receive around $70,000 a year in land rent from the farm. Their house, car and land are all paid off. The farm pays their electric and water bill. So they have a lot of disposable income. Which is awesome that they were able to pay everything off several years ago.

The farm itself (buildings equipment etc.) is a separate entity that my brother, uncle and cousin own as they are the ones who farm. Plus my parents sold a business they had shares in 6 or so years ago and received around $100,000 a year for 5 years from that. This is their first year not getting that influx I think, and that money has been spent, none was saved for future possible care needs. So I feel they have had the means and ability to save very well for their care needs.

My dad was diagnosed before this sale so they had the ability to plan. They have an estate planner and a financial planner so seem to have that all taken care of.

They would never let me go to a doctor appointment or have any access to doctors.

I am all for my mom sleeping in another room to get a good nights sleep. What bothers me is she has literally no plan for having any sort of set up to alert her when my dad gets out of bed. The rooms are on separate ends of the house. She has had to call my brother to help my dad get up multiple times in the past year, so he has already established a pattern of falling.

This week has been eye opening because she asked guess who.....me if she could hire me to watch Dad. I said I could if I was available but she needed to have some sort of back up plan because I can’t do it all the time. I was hoping this would help he transition to finding and hiring caregivers. She got pissed that I asked her that and told me she wanted to be in charge and didn’t want to talk about it any more.

My mom is definitely narcissistic and my oldest brother is the golden child along with his wife (who is definitely narcissistic, I have witnessed the narc rage although I called it an adult temper tantrum) and their 2 children. I am definitely the family scapegoat.

I finally went and talked to someone about all of the anxiety and issues I was having and they recommended the book called Boundaries. I read it and oh my word was it eye opening and freeing. I have spent my whole life thinking it needed to make my mom happy. Knowing I am not responsible for her feelings and especially for fixing her irresponsible choices lifted a huge weight off my chest. It’s sad it took me this long to find out how normal relationships should work.

Anywhoo, she admitted she had not back up caregiver plan other than me and had no interest in making one. Then tried to guilt/shame me into complying and just being the family work horse again.

So, I realized her pattern of behavior wasn’t going to change and set some boundaries. She got pissed and decided my dad would be going with her because the housekeeper would be there that day and he didn’t want to stay there. Which is not true she has left him with her before and she’s the sweetest lady ever and he has no problem with her. I realized I dodged a bullet and told her that I needed to take a break from things to work on my own emotional/mental/physical health problems and I loved her and would still be part of family get together and would respect her wish to not talk about anything and only engage in small talk. So I will be low
contact from now on with my family.

My brother and his wife would never want to travel with my parents because they have no interest in doing any actual hands on caregiving. They went to the Cayman Islands with my parents and would leave my parents at the condo and go out and go snorkeling and do stuff. So they would not be helpful. There are no friends to go with them because my moms terrible behavior has driven them all away.

What do you guys think about this idea? My dads brother who is a retired Dr. lives a few miles away and does visit my dad regularly. Should I talk to him and tell him what is really going on and see what his advice is? My brother said he would watch the situation over the next couple of weeks and see how things are going, but he really thinks that just talking to my mom about her behavior will make it change, it won’t, I have tried for 2 years in every way possible. But maybe if he sees she won’t change then he will be on board with paid caregivers. Or maybe I’m just sticking my head in the sand too.

Thanks again for reading and any advice. I’m so thankful for this group!

By all means talk to your uncle. But if he visits your father regularly I doubt if you will be telling him anything he isn't already aware of. So have the conversation as just that, a conversation. Ask questions and listen to his point of view.

Sticking your head in the sand is a strategy, you know. Particularly when, as in your case, you have been deliberately excluded from decisions by the people you aim to help.

Read 'Being Mortal' by Atul Gawande. Given your parents' living situation, the fact that they have the resources to support considerable freedom of choice, this book is a particularly relevant discussion about what really is in their best interests. You, like most of us caregivers, want your parents to be safe, well cared-for and happy, in that order probably, with their autonomy and dignity as nice-to-have icing on the cake. What Dr Gawande points out persuasively is that your parents' order of priorities is likely to be quite different - ranking autonomy, freedom of action, happiness and continuity much higher than you do, and accepting a much greater risk of harm.

The question that remains is at what point do you become a) entitled to intervene; b) morally obliged to intervene; and c) legally required to intervene.

As things are, the answer your mother is giving you is "never!"

Let's say, okay, never. What happens next?

If your mother had managed your father in the way that she did during those trips, if they had not been in public with other people around, your father would have died. She was "wilfully blind" to his physical needs.

Bear with me, and think the unthinkable here. Supposing he hadn't received treatment, and he had died. And?

The thing is, what we family caregivers are really aiming for, when you strip everything away, is a soft landing. We know that our elders are going to die, probably before us (though watch out - caregiving is bad for your health). We don't literally believe they can live for ever (may they live forever!). So what do we want to happen? We want them to be supported through their last years and the end of life so that they do not experience pain, fear, loneliness or neglect; that they die at their proper time, loved, in comfortable surroundings, and at peace.

I'm not saying that your mother wants your father to die. But her feelings about it must be complicated. He is suffering. He is not the man he was. His difficulties intrude on her. Even getting help for him would disrupt the environment she likes to have around her. She wants none of this to be happening. Well, would you?

The trouble we still have is that your father is a vulnerable adult. How he is cared for and protected is no longer solely your mother's business - actually, it's now a societal problem. He is not in a position to make decisions on his own behalf, so we can't ask him what he wants. But we can refer back to any statements or directives or preferences from earlier on, when he was fit and well, and see if that gives any guidance about what his choices might be now if he were still able to voice them. And it may be that no, he chose your mother, he never expected her to turn into Florence Nightingale, and he would still rather be with her, in the place that is home, than better cared for somewhere else.

Okay, next, what can be done for him if he isn't to be "rescued"? Your mother doesn't want a team of caregivers coming in and tramping round her house and needing supervision and BOTHERING her. She doesn't mind if you do it because she can control you - never mind that you're not a trained nurse or personal care aide, that there's only one of you, that you have your own life. Well! - you can't force her to compromise there. You can only find out what services are available, and keep prompting her to consider them.

The other thing you can do, and I would loudly, is insist on objective assessment of your father's condition and needs. You are free to tell whomever you like about your concerns and about what you have witnessed. You can tell your uncle, your parents' doctor, their local social services, anyone you like. Most families get pretty shirty if one member talks about family business to outsiders. Yeah? And? Bite me. There is an expression: "tell the truth and shame the devil."

Consider the difference between these statements, just for example:

"Mother won't help dad with washing or dressing, she just leaves him in his soiled clothes."

versus

"Dad needs more help with washing and dressing."

One is an accusation - mother is being a bad wife, callously indifferent to her husband's suffering.

Two is a statement of your father's needs.

What you want is not condemnation of your mother's shortcomings, it's improved support for your father. So keep your opinion of your mother to yourself, and just keep plugging away to get your dad what he needs.

WOW! Well said, Countrymouse!!!!
Thanks for the excellent synopsis for all of us!

Yes, well done Countrymouse!

What CountryMouse suggested is spot on....except for you talking to your father's doctor. It is my experience because of HIPPA that your father must allow (in writing) you to talk with his doctor or they receive a copy of a document stating that you are his healthcare proxy.

In terms of your father falling at night scenario, there are Lifeline type products that register falls and automatically summon help. If your dad requires multiple visits by EMTs to assess him after each fall, then the authorities are aware of his situation and his events are documented. Also, a baby monitor could alert your mom if she cares to try that.

Lynina, HIPPA prevents the Dr from giving out info without patient's consent. It does not prevent someone else from giving info to the Dr.
So, while Dr can't answer your questions about the patient, Dr should be informed of problems that Dr might not be aware of from just an office visit--unsafe driving, for example.

Aging myself, that is correct. No chance of a discussion is what I meant:)

I had a friend in a similar situation. Parents with plenty of means but a narcissistic father and mom with a terminal illness. Father wasn't letting hospice give mom appropriate anti-anxiety meds because then she'd sleep and he selfishly wanted her awake to interact with him. And he couldn't accept that mom had a terminal illness, so he constantly tried to have her do therapies and moved her from place to place. Mom suffered great and unnecessary anxiety as a result. My friend stressed herself out to the point it negatively affected her health over attempts to get her father to change.

I kept reminding her that her mom knew who the father was (he's always been narcissistic) and chose to be with him when she was young and healthy. She had a very sad and unnecessarily heartwrenching end, but no one was going to be able to change that. That die was cast many, many years ago.

So I support you going low-contact with your parents and establishing firm boundaries, just to keep YOU healthy. Your uncle can keep an eye on your father. I'd let him know you're concerned, but he's also probably powerless to effect any changes either. You can only do what you can do. You don't rule the world. {{{Hugs}}}

Countrymouse: Well said!!

To elderly daily living, which we will all face should we be lucky enough to live that long--the once very active wife now breaks a hip. The husband may not take on the role of caregiving well.....or possibly not al all. So the happily married framework of the couple has now changed because of health issues, which are of paramount importance. Solving the issue is very difficult. Go to the Lord in prayer. Now I'm not saying that is the only solution. Though the process must be started to aid the weaker spouse. Social workers, town elder case workers, etc.