Sorry if this is too long or rambly -- it feels like most of the details are relevant so its hard for me to summarize and may not be ideally organized. I appreciate if you actually have the time to read the whole thing. Basically my mother has usually been doing a pretty good job of taking care of my dad with dementia full time for the last few years. The only part that is not good is that she is sometimes verbally abusive because she has depression/mood problems and when he is confused or can't move properly she flips out and yells at him. She also tends to rage out and yell at me or anyone else if she gets much criticism or feels defensive. When she is not in a rage she is a pretty nice person though. Unfortunately I have "inherited" somehow the anger/flipping out problem and sometimes flip out at her or recently my brother. This is a big problem for me in general but also makes the situation with her more difficult. The issue that brought on my verbal abuse towards my brother was about a sliding barn-style door for the bathroom which we need now that we have toilet rails, because my dad's rollerator doesn't fit right with those rails there. So he said he was going to buy some about a week ago, but when I asked about it he said he had to wait for his bonus check to come in. This unfortunately initiated a rage/flip-out/cuss-out from me because my brother just bought a new custom-built house and replaced his second car and was in the conversation earlier discussing how he had almost gone to put down his wife's dog to prevent suffering. I was very angry because the door and sliding kit he was discussing cost about the same as the amount he had already budgeted to put down the dog, yet the door would have to wait for a budget check, even though I had explained that there was a safety issue. Taking the rails away is not a good option either because without the rail handles he cannot get up without being hauled off the toilet and it is extremely hard for me or my mother to do that and she will not be able to do that on a daily basis. It seems unfair for him not to help our dad more since he has in the past paid for nursing care for his wife's mother and also the main design feature of their new home is a second master bedroom for his mother-in-law even though she is actually perfectly capable of taking care of herself. Since my mother was recently diagnosed with congestive heart failure and in the hospital for a few days, one of my sisters moved in to help her take care of my dad since she could no longer do things like haul him up off of the toilet etc. and generally needed to rest. This sister has her own very serious health issues though too and had to have a surgery, so I have been staying for the last two or three weeks to help with my dad and buying groceries etc. My mother has been 'discharged' from her home monitoring and some medications related to her congestive heart failure. However I am certain if I leave and go back to my apartment for a few days, there will be multiple instances of verbal abuse and possible small amount of danger for my father from falling because he is quite unsteady and needs quite a lot of patience and sometimes force to prevent him from falling. I think my mother has mainly managed quite well despite his difficulties to keep him from falling when he goes to the bathroom and the living room and back and forth, but because she loses patience and sometimes has to really exert herself to help him, I believe this may cause her heart to be overworked after a few incidents and her end up in the hospital again. Now to the 'hell' part. I feel like the ethical thing is for me to just give up my apartment and stay here, but it seems like it may not be possible. The biggest issue is that it is southern California and until now the house had no air conditioning. This makes it difficult for me to work (I work online) and also twice as hard to do things like help my dad move around or changing his diaper etc. There is also a ton of junk in the house which is difficult to remove without initiating fights with my mother, and incredibly poor ventilation. I installed an air conditioner and fan in the attic to help with the climate in the house and it is an amazing difference. However my mother refuses to acknowledge that it is needed and only allows it for a certain period in the middle of the day. She seems to resent the air conditioner, the safety rails, the ventilation, the internet, ideas related to solving my dad's serious constipation issues, any attempt to discuss solving very bad maintenance issues around the house, etc. Its like she is going to a huge effort just to tolerate things. Unfortunately I do not have the money to replace the roof and the plumbing etc. which both need replacing, or to pay all utility bills myself, although I have offered to pay for electricity. She flips out/verbally abuses me and seems to resent me... but her or my dad may die if I leave.

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On reflection - never mind my last question. If their income was anything like adequate for their needs your poor mother wouldn't be living this utter nightmare. I'm welling up for her.

You need to call a social worker this morning, check office hours online. Write yourself a bullet point summary similar to the one above, and tell him or her what you've told us. The financial issues are a very important factor - they are deeply in debt, they cannot meet their current living expenses, they cannot repay their loans and they cannot afford to stay where they are.

Don't hesitate. You think you might be in trouble for doing this? If your mother God forbid has a heart attack or stroke and dies or is severely disabled, how much trouble will you all be in then? I can't begin to imagine the degree of stress she has been under, or for how long, or for how long she has been lying to you (and maybe to herself) about how bad things are. She must be terrified. Get her help, do it today.
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Your very elderly father has dementia.
Your mother has congestive heart failure for which she has recently been hospitalised.
Their house is falling to pieces.
And now you get round to mentioning that their house is in negative equity, so that they can afford neither to repair it nor to sell it.
And your mother EITHER has heroically curtailed her one major form of stress relief OR is struggling to control her gambling addiction; but either way this is not a small detail.

Deep breath.

What sources of income do they have?
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Thanks a lot for the answers. I will see if I can get it to separate paragraphs this time, not sure why they disappeared last time. Probably need an extra line in between or something.

One other meta comment, it only allowed a certain number of characters, so I did not get to include some information in the original question.

BarbBrooklyn, it is not obvious to me that she has any _new_ cognitive issues, but she definitely has been telling me her judgement is not very good, at least over the last few days while she was on the anti-depressant. I think the name of it starts with a 'T'. It is also a sedative so she can't really function adequately to help my dad until the afternoon. So she stopped taking it. To me it seems more like psychological issues that she has had for a long time with anger. I believe the depression has been known by the doctor for a long time and at one point she was on an antidepressant before, don't remember why she went off of it. I told her she needs a non-sedative replacement antidepressant because she flips out and she didn't argue about that and I believe she will book an appointment with the doctor about it.

Also one thing I forgot, due to my dad forgetting things within sometimes 30 seconds, he doesn't really function as the owner of the house or really figure out most things these days.  My mother must handle serious decisions for him.  He has no idea how much a dollar is worth anymore and often doesn't believe us when we tell him he is 91 years old.  But within say a sentence or two and in terms of listening to ideas for what to do, where to turn, whether its time to stand up or whatever, he understands.

CountryMouse, good that you mention the training etc.  I did not actually even know about the AAA thing so thanks to both of you for telling me about it. I looked up the local agency in this area and I will call to find out about the needs assessment and give the 800 number to my mom to see about getting someone to help. Right now someone has to help him in and out of the bathroom etc. and I am doing it every time except once two nights ago. I have not been trained but I did switch to the regular walker tonight instead of the rollerator and I felt like my dad was pretty safe with it.

This is a big challenge to call in another person to do the needs assessment or outfitting house etc. since it seems like it has been such a strain just for my mom to accept the safety rails and my suggestions for Miralax and probiotics etc. rather than always resorting to DRF. Also I am not sure if I should try to get her to buy into it first or just book someone to come over -- either way she will resist and will probably get angry if I try to insist. Although with that anti-depressant some days she has almost seemed reasonable.  Basically part of the reason she has flipped out is because I keep suggesting things and this needs assessment/outfitting sounds like probably an additional expense and another big suggestion so I sort of dread bringing it up.  Maybe I can just get someone to come over when she is not here?  Or maybe she will be in a good mood and not fight about it.

What prompted the question on here was one of her defensive flip out episodes where she was lashing out and basically saying lots of things that motivated me to want to leave. This was because of just one too many comments from me about the way she does things. She was going around the house checking mostly empty garbage bins for 15 minutes and getting herself tired out, even though I had already taken out the inside garbage out as it filled up during the week. I had just put the garbage bins out by the curb in about 45 seconds and she had made it into a sort of busywork chore that lasted a long time and got her out of breath and it didn't make sense so I tried to just explain you take the individual ones out when they are full and don't leave them to the end of the week and then you just have to take the big bins out on trash day.. so what she was doing was unnecessary. Anyway I gave her a shorter sentence than those run-ons about it, about 15 seconds, "no one else leaves everything to the end of the week" or something and she flipped and started like 'threatening' to hire someone to help her and just saying mean and untrue things about me, I wasn't helping, I was attacking her (I wasn't) she didn't need this or that, etc.

That was practically the only episode she has had on any day that she was on that medication. It was at night so I think it had worn off. The weird thing is, today she was very happy to finally get back to shopping at Walmart and it was not unpleasant dealing with her, except for the fact that we couldn't continue using the AC after 6pm even though the house stayed at the 82 degrees plus 80% humidity for another two hours.

Anyway so last night I told her to please do look into hiring someone. But it seems pretty borderline that she will be able to get much help because it is so expensive and there isn't really that much extra in her budget. Seems like she might only be able to manage about an extra $500 or $600 and then may have to cut back on her cigarettes and even normal groceries. Which she refuses to quit despite everyone telling her.  She seems in denial that the nicotine affects her poor sleep.

As far as selling off the place, this is also a good idea that I believe she would consider if there were a way to do it. Unless I read the mortgage statements wrong though it seems extremely problematic, maybe kind of infeasible, because there is 0 equity and the value of the home, despite massive home value increases in the area, is significantly less than the total of the loans, because of very major repair and renovations being necessary. I think the problem is the result of her gambling habit, which actually seems sort of in control compared to the way it was several years ago where she would just take off all night. She hasn't been to the casino at all since she was in the hospital and when she was going before she seemed to be able to control it.

But maybe a real estate person or lawyer or something would be able to say for sure what the options are. Its certainly not a prison, but I don't really think buying another place will be an option, only renting. But maybe I misunderstood or misread the loan statements.
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Stay away and let your parents die, or stay with them and live in h*ll, you ask.

So you're only allowing yourself the two options, neither terribly attractive?

Your parents are a self-contained unit. Their accommodation, their care, their finances, any services or support or adaptation they need: you and your brother must both learn to allow these things to be arranged for them and paid for by them, without your financial or physical input.

I'm a yeller too, only I get it from my father, not my mother. I know how shaming it is, I know how hard you try not to do it. It's a response to stress: breathing techniques and anger management techniques will help. But when you make a simple request and your brother not only overlooks it and makes excuses but then expects applause for dealing deftly with much more complicated, less important ones from outsiders..? I'd have been doing the hair-tearing dance too - though his hair, for preference.

Let's assume for present purposes that your mother wants to stay in her own home, caring for your father. Fine. But to do that, she will need increasing levels of support. There need to be properly installed adaptations to the bathroom, and probably around the bedroom and passageways too. She needs to STOP manual handling until she has had training, and has the proper equipment - at the moment she risks serious injury to herself, your father or both.

As BB says, step one has to be a formal needs assessment, leading to a properly worked out care plan. That way, they stay home. Keep on as they are doing, they will break everyone and lose everything.

You have many many more than just the two options you've already thought of. Please take deep breaths and let us know if any of these ideas are helpful?
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So, you don't think that your mom is really doing a good job of caring for dad, do you?

Do you think MOM may have developed some cognitive issues? It sure sounds like that to me, the way you present it.

I think I would call in the local Area Agency on Aging and get a needs assessment (be there when that happens so they get a full picture of what is going on). You also want them to help you with finding local resources to get help coming into their home.

Your brother should not be paying for modifications to their home. THEY should be paying for that. And if they don't have the funds, then it's clear that they need to sell up and move someplace smaller and possibly more supportive. Has anyone looked into the feasibility of doing that?

Have you been with mom to a doctor's appointment lately? Does the doc know about the verbal abuse she's dishing out to your dad? It's a symptom; treat it as such.
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