How do we know when it's time for assisted living?

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My 94-year-old mother in law still lives alone in her own home. We live right around the corner from her. Physically she is in good shape and still takes care of the housework and her personal care. But she is becoming more confused as time goes on and is requiring more and more of our time. Her doctor says this is just "normal dementia that comes with age," and has not offered much in the way of help or advice. She is very lonely and sits and cries often because her husband, friends and simblings are all dead (can't really blame her there). She tends to fixate on this which makes the confusion worse as she becomes more upset. This makes her extremely needy and anxious and she calls us several times a day to tell us she is "just sitting there all alone." She is no longer able to handle her meds, my husband or I go there each day to give her pills. And she barely eats if left to her own. Even using phone is starting to be challenging for her.

The main problem is this neediness is constant and my husband and I have no freedom to be away from our home for long (fortunately he is able to work at home). Even a couple of hours to go out dinner is interrupted by phone calls for no logical reason. A vacation, even a short one, is out of the question. This is causing a great deal of stress in our lives and is starting to negatively affect our marriage. We feel that she could benefit from an assisted living environment where there are other people and activites to occupy her time. Of course she is dead set against this, but her dementia makes it difficult for us to discuss this with her. How do we know when it's time for her to no longer live alone? We don't want to wait for the crisis to happen (like a fall or other injury) but also don't want to force her into something she does not want. Looking for advice and others experience. We just don't know what to do. Thanks.

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She is scared, lonely, bored, and overwhelmed. Get an aide to come in a few hours a day 3x a week. We did that with our mother, and regained our sanity and lives. Naturally, Mom was dead set against it at first. There eas anger, tears, everything but we were adamant. We explained to Mom that it was somebody to keep her company for a few hours, drive her for errands, and just be her friend. And it would only be somebody she met and liked--she would have the final say. Thankfully, she loves her "friend"! As Mom's needs increased in the 3+ years the aide has been with us, so has all our time with Mom increased.

No where is it written that we have to stop living because our elderly parents need us more and more. Yet that is what happens, isn't it? Somehow or another we lose our lives in order to help an elderly parent retain theirs. This site is full of warnings about that. And suggestions/comments on how to get our lives back. The black hole of need can suck us right in.

I would be interested to hear the story of how it happened to be her own mother ended up in a NH instead of living out her days at home with her own daughter on 24/7 call. She didn't do that for her mother, yet she expects her son and DIL to do it for her.
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I do not believe there is such a thing as "normal dementia that comes with age." It is either normal age-related decline or it is dementia. It can't be both. Can you arrange for MIL to see a specialist? A geriatrician, or geriatric psychiatrist, or behavioral neurologist? If you are taking responsibility for her you certainly deserve more guidance and support than you are getting from her current doctor.

Unless she has been declared incompetent and you have gone through the legal process to become her guardians, you can't force her to leave her house. But you are perfectly free to make decisions about your own life. For example, you can decide that you are going on a two-week vacation and you can arrange suitable care for her while you are gone. You can give her the phone number of the care provider and she can call them instead of you. Unfortunately this "tough love" approach is easier to apply when the parent does not have dementia. It is theoretically possible in your situation, but emotionally extremely difficult.

I hope you can find the strength to at least stop enabling her dependence on you. For heaven's sake, go out to dinner! Is there someone you could forward your phone calls to, who would only answer if it is your MIL and then reassure her about when you will be home?

She thinks she can stay at home on her own, and she can -- as long as she has you at her instant beck and call. (whatever a beck is -- :D ) But that is not fair to you.

I hope having lunch at a few ALFs -- or going to play bingo or do crafts -- may help your MIL be open to change without a catastrophe forcing it.
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While the 3 things make total sense, it's also about her daily enrichment. As people become isolated, their health will decline. One of the great benefits of a properly run assisted living facility is the socialization and activities. Ischo818, I believe it's time for you to get your lives back. You are not only obligated to your MIL but to yourself and the rest of your family. No matter what you do, it's likely you will question your decision and feel guilt. When (not if) she has a safety issue such as a fall, you are going to feel guilty because you didn't find her a safe home.
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Ismiami: I like your 3 things - makes sense. I guess my concern is also with my husband and myself. At what point do we get our lives back? When is the sacrifice enough? Are we just obligated to continue putting everything on hold to take care of her? Those are the questions I also struggle with. Thanks for you response.
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I think it is about 3 things, 1. Can the person successfully and hygienically go to the bathroom. 2. Can the person call for help if needed. 3. Is the person still able to open the front door using good judgement.

Everything else can be scheduled or monitored: pills in a box, or drop by to medicate, baths, house chores, pay bills online and monitor accounts.
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If your mom has an official dementia diagnosis, you may have to find a place with a memory care facility. I don't know all of the laws from state-to-state but in California an assisted living facility can not legally accept a person diagnosed with dementia. Related to her doing the opposite of what you want, sometimes telling stories about how other people are coping helps - "did you know that Sally's mom...". Depending on her cognitive condition, she may come to some realization on her own.
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I feel for you as my mum is like this and only 77yrs old. I too am in this difficult position mum wants to stay in her home and be independent but shes not she depends on me for everything and i cant do this alone anymore im so tired she wont do anything for herself buti like you i dont want to force her into a home against her will its very tough and stressful damned if you do and damned if you dont. Sometimes i think well then maybe just leave them be as they will die no matter what we do they go downhill on thier own they go down hill in a home what do you do?
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Thanks for the great advice. We do have POA in place (both medical and durable) so that's done. I would love it if we could use the "help me help you" approach but unfortunately that has not worked in the past. It took us 4 years (and her pulling the grandfather clock over on her) after she fell in her garden to get her to wear a life alert. She has the type of personality that if you suggest/say should should do something she will automatically do the opposite. She was like this even before the dementia set in. And now it's even worse. We have been visiting assisted living facilities in our area and think it's a great idea to take her to one or two so she can see they are no longer the nursing home environment that her mother was in 60 years ago. We will also start looking into nursing homes in our area just in case the crisis does happen.
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Eyerishlass has provided great advice. Just know that there will never be an easy time. It is arguably the most difficult decision loved ones have to make. However, I continually hear from caregivers that have made the decision that although it is rough at first, it has had a positive impact on everyone's lives. Start now before there is an accident. Start by visiting places and follow your gut. If they don't feel right, then you will never be comfortable but remember it's about her being happy not the fact that you like the lobby or something silly like that. Best wishes.
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It sounds as if she already can no longer live alone if she's not able to take her medication, eat, and has trouble using the phone. There's no waiting for the time when she's eligible for assisted living....she's there already.

And you're right, you can't force her. At her age she may not even be able to live in assisted living for long before she needs a nursing home. And moving her twice in a short amount of time will send her over the edge. Moving is very, very difficult on elderly people. Oftentimes they don't bounce completely back from a move.

If you can't talk her into assisted living you may have no other choice but to wait for an emergency. But get your ducks in a row now. Has she designated you POA? If not, get that done now. Find a facility that you like and talk with them. You don't want to be figuring all of this out while your mom sits in a hospital bed waiting to be discharged.

In the meantime, keep talking up the assisted living. Getting her to tour a couple of places is a great idea. And there are different opinions on this but my opinion is that it's OK to tell your mom that you and your husband are not able to continue helping her as much and that you'd feel much better if she were somewhere so you wouldn't have to worry about her all the time. I cared for my dad in my home for 5 years and I call this the "Help me help you" approach. It always worked with my dad. If I was banging my head against the wall about something regarding my dad I'd finally just go to him and tell him that I was frustrated and could he please help me do what was best for him. And he would. It worked every time.

Keep talking to your mom. Maybe she'll agree just so she can stop talking about it.
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