My grandmother cannot live alone anymore, but insists on staying in her home. How do we manage this when we live out of state?

SamiandPickles, welcome to the forum. The vast majority of us who needed to care for or over-watch an elder have run into a similar situation. Usually what we have to do is wait for a medical emergency, 911, hospital, rehab, and then we place that love one into senior living.

We tell the love one the move to senior living is an extension of rehab, doctor's orders. If that elder wants to move back to their home, it is ok to use what is called a "therapeutic fib" such as the plumbing needs to be replace, etc. Something you feel that Grandmother would believe.

The hard part is now sitting and waiting for the next emergency.

After her last accident why was she released to live alone? At that point you should have told them she lived alone and it was an unsafe discharge. So now you just need to wait for the next emergency and tell them she can't go home alone.

I cared for my mom out of state as well. I found an independent home care agency that was fantastic. I used the lie of “ you always wanted a maid “ she did numerous times send them away, but she finally realized she was paying either way, and came around about it. Get a first alert. Teach her. My mom said she couldn’t afford it , told her she can’t afford to be without it. Told her of my neighbor across the street, fell outside her door and someone finally heard her at two in the morning… You will probably need to go out and get things put in place. Your neighbors will eventually not be able to help .. I had the never ending battle of theft accusations… that I know did not happen, and she knew she was lying about it.. cant change it. I used Amazon , and home delivery groceries.

if your moms finances will not sustain her in AL for the rest of her life , I would start looking now for one that will eventually take Medicaid. That was the biggest mistake I made. AL s that take Medicaid vary with a period of self pay . You have lots of choices of AL s that require 2 or 3 years of self pay. When I finally moved my mom near me, she had about 10 months of self pay and pickins was slim. I had an independent care advisor from a franchise called Carepatrol, who helped me find a place.. invaluable !

You can take grandmom to her PCP but she needs a Neurologist to determine if she has Dementia and what type. IMO, grandmom should not be living on her own. You never know what someone with Dementia, even early stage, is going to do. I hope you or Mom have POA. If not, you may want to get guardianship. Its not what grandma wants now, its what she needs and she needs to be safe. Your too far away to guarantee that.

You say "We have had to take over all finances". I hope that this was legally done and that you understand the fiduciary legal duty you have under the law as regards this; POA or guardianship is required and meticulous record keeping. I am assuming you know that.
You also say the following: "I know we are likely waiting for the next incident and then she'll goi to a facility...."
EXACTLY. As soon as she is in hospital you should contact Social services to begin placement and discharge planning.
This is the best you can do, and to be frank this is almost impossible to do long distance. I sure wish you the best. Not everything has a good answer, and an uncooperative, failing senior has no good answers at all. Sounds you are doing the best you can. I sure wish you luck and hope you'll update us and share with us all you learn; you can be of great help to others. When I first came to Forum I learned that my anxiety and helplessness shared helped me enormously. I at least knew I wasn't alone.

No you are not alone.

I too am in 'The Club'. The 'Awaiting the Crises Club' to effect a move from solo to supported living.

A Social Worker explained the process. Advised to;
- Focus on what I can control (not what cannot).
- To inform the medical team of situation where I could (when a crises happens).
- Begin researching suitable living options & locations. Eg near LO's home or near mine.
- In summary: to be an Advocate for their care - for a NEW plan, rather than step in to prop things up that are no longer working.

To be 'ready to roll'.

legally, it’s your Mother’s right to make her own bad decisions so long she’s not a threat to herself or others. Medically, she has a right to make own decisions unless two licensed physicians cRibg for her at least 10 years test her and sign a certification is isn’t able to handle her own affairs. But that does NOT give you right to handle her decisions. Then you must take thst letter to Court and get a conservatorship. That’s the law if she refused to leave.

Thibg is, let her stay. My Mum has dimentia. She lives alone and doctors let’s her per signing she is legally able. It’s a modern world. Dimentia and Alzheimer’s do not mean a person suffering from thide must leave their home or have a conservatorship.

Your hassle of her being in her own home are less then if she was in assisted or memory care at at your own home. You will have same amount of duties if not more if she leaves her home. People misunderstand this. Removing from her home isn’t necessarily needed just because you fell it is. You don’t see her daily. Clearly she’s feeding and dressing herself and able to answer phone for you to speak with her to confirm convince her to leave her home.

it is her right to die in her home or wait to live in it until doctors and the court say she cannot. Moderate Dementia Broken hips, cancer is what my Mum has. She legally can still drive yet she chose not to and is fine in her home. It is only once severe dimentia or Alzheimer’s is existing.

It is NOT safer in institutional residential care. My mother in law fell geode with personal assistants right next to her. They can’t stop fails only reduce them and be immediately there to administer aid and call paramedics when one falls.

Point is it is not always safer, easier, better or legal to remove your mother. It’s her right to stay unless you get a conservative or convince her. Elder attorneys say is a senior citizen’s rights, even with dimentia Alzheimer’s that no doctor had tekrn rifhts away with certified and you don’t have conservatorship.

So be patient. She will either see she needs to leave one day or doctors will tell you she must. Elderly still have rights to stay in home even id adult children disagree so long as they are not a threat to themselves or others and can do five tasks I’d daily living. That’s the law.

It is hard news to take when you care about your parent. But it is their right to die in their home or be their as long as above qualifications Re met. Remember, you will want to remain in your home also for as long as possible. It’s just familiar and with good memories. Do you want to removed prematurely? Nope. So be patient. A situation will occur that shows she is unsafe and that will decide it. Sometimes a fall isn’t enough to remove a person since they rehabilitate well.

good luck. Sorry for honest information you and many may disagree with. But it’s the law.

I think you are correct in wanting to move your mom into a facility before a crisis occurs.

I certainly hope this will somehow become possible for you to do.

My mom ended up going to an ‘end of life’ hospice care home. I had enormous relief knowing that she was cared for 24 hours a day/7days a week.

You will have peace of mind if your mom is looked after by a professional staff in a facility.

When I was touring facilities that I was considering placing her in, I would ask when is the best time to place her. Every facility told me to do so before it is absolutely necessary. The reason being that they will adjust better to their surroundings.

Have you selected any places that you like? Some children take their loved ones to have a nice lunch at the facility that they are interested in as an introduction to them. Could you schedule a tour with lunch included for the next time you visit with her?

Some parents won’t go willingly. Then, you do have to wait for the crisis.

It’s especially hard for you, since you live far away. I am so sorry that you are dealing with this. Wishing you all the best.

Sami,

Keep in mind that facilities are not like they were years ago. They aren’t the same as the ones that your great grandmother was in. They have activity directors and plan lots of activities for them to participate in.

Look at some of their websites online for her area to get an idea of which ones are suitable.

Sami - when you read this forum, some advice will work better for you than others. Take what you like, toss what you don't. Try not to take it personally.

Since your mom has POA, maybe she should go ahead and sign mom up for a place that she thinks is best for her. Frankly, I think it would drive me crazy, waiting for something bad to happen. I did wait for it for awhile, but it was much too long in coming for me and I placed mom in assisted living, against her wishes. I told her 2 days before and hubby and I set up the apartment the next day and moved her in the next. It took her a bit to adjust but she's doing fine. Still snarky comments here and there, but that's ok. She's safe and I am not burnt out anymore. Win-win.

With dementia, you just never really know what they're up to, they can't tell you and whatever they do tell you can't trust it.

She may say she's fine but that really doesn't mean much. You know that's not really the truth.

So, get ready. Have a place lined up. Try to make a plan on getting her moved sooner rather than later.

Best of luck.

I just re-read the question.

"Cannot live alone anymore, but insists on staying in her home."

Somewhere betweeen independent & dependant. This is what Grandma has not come to accept yet - won't or can't.

But if Grandma can accept this, accept some help (home services, cleaning, deliveries etc) this will KEEP her independence for longer. Increase safety therefore stay at home longer.

However, by staying in denial, refusing help, this will do the opposite. Reduce safety eg increase risk of falls, serious injury, hospital admission.

Stubborness gets you a faster ticket to the nursing home.

So keep talking it over with Grandma. Let her choose her way but knowing the risks. Keep the message simple. We care. We are concerned. We want you to have some more help around your home.

Basically choice A. or B.
A. accept help
B. be stubborn & take the risks

Then I guess sitting down with the concern family members & working out your own risk tolerances. What will your *line in the sand* be?

I've had to move my line a few times... Despite my many real concerns - safety, nutrition & hygiene, my LO still ives solo.

Things to weigh up examples;
Eating crackers for dinner (not ideal) vs missing meals for days (dangerous).
Being fearful at night & calling you (acceptable) vs fearfully leaving the house at night (highly dangerous).

If I am way off here, old let me know.

Maybe you want more practical examples of what services to sneak in??

I just re-read the question.

"Cannot live alone anymore, but insists on staying in her home."

"Cannot". Or maybe technically 'can' but shouldn't. Somewhere betweeen independent & dependant. This is what Grandma has not come to accept yet - her new level of function. (won't or can't)

But if Grandma can accept this, accept some help (home services, cleaning, deliveries etc) this will KEEP her independence for longer. Increase safety & stay at home longer.

However, by staying in denial, refusing help, this will do the opposite. Reduce safety eg increase risk of falls, serious injury, hospital admission.

Stubbornness may get you into a nursing home faster!

So keep talking it over with Grandma. Let her choose her way but knowing the risks. Keep the message simple. We care. We are concerned. We want you to have some more help around your home.

Basically choice A. or B.
A. accept help
B. be stubborn & take the risks

Then I guess sitting down with the concerned family members & working out your own risk tolerances are. What will your *line in the sand* be? When you force Grandma to move.

I've had to move my line a few times... Despite my many real concerns - safety, nutrition & hygiene, my LO still ives solo.

Things to weigh up examples;
Eating crackers for dinner (not ideal) vs missing meals for days (big risk).
Being fearful at night & calling you (acceptable) vs fearfully leaving the house at night (highly dangerous).

If I am way off here, pls let me know.

Maybe you want more practical examples of what services to sneak in??

Sami, our elders often get to the point of it’s not what they want any longer but what they need and sadly in many if not most cases it take a crisis to push the issue. We can’t let the dementia and inability to reason rule the day. Just like with elders driving, many think they are fine but they are a danger on the roads and many loved ones afraid to face the anger of stopping the driving.

my case was much like yours. I was dealing with both parents who were not safe at home. I was making a crazy long drive every few weeks, crisis after crisis to be dealt with. My folks refused any help, no one was allowed in the house, we’re just fine! Moms falls were getting more frequent and her injuries worse. Dad had moderate dementia and could hardly tell if she were dead or sleeping.

Finally, after a bad fall and three days in the hospital I had her moved to an assisted living facility that I had previously visited and kept in contact with.

I told mom it was just until she got well. I got dad in a few days later by telling him mom needs your help over at the rehab. It was still a big hot mess for a few weeks but at least they were safe, clean, had in-house medical care and were not in danger of burning the house down or freezing to death in the back yard.

if you haven’t already done so visit some facilities in the area and keep a couple on deck for when the next crisis hits. Granny is never going to voluntarily move. You’ll just have to do what has to be done.

best of luck to you.

You've pretty much answered all of your own questions. Really the choices are grandma (and her family including you) accept a live-in caregiver who may not be perfect and doesn't arrive on a flying umbrella like Mary Poppins.
Or grandma has to be placed in a residential care facility where she is safe and can be looked after.
From what you're saying here, she definitely has dementia. No old person ever willingly goes into a care facility and they usually don't accept homecare unless someone forces it on them.
How you deal with the asinine often dangerous stubborness is by asking the local police and APS to make wellness checks on her. Explain to them that you and your mom live out of state and that she villifies and lies about both of you to anyone that will listen. Also tell them that she is unsafe and refuses to move or accept help in her home. This will get the ball rolling for her.
There's really nothing more you can do. It's a terrible situation that many families face every day. Usually it has to come to a crisis like a fall happening and the elder getting placed against their will.

People who don’t know what day it is don’t call the shots.

Wait for a tragic event that may even leave her dead? As told earlier, contact the local police to do welfare checks so no one is charged with elder neglect. Your grandmother lacks judgement and is no longer safe living alone that requires facility placement now. Get a social worker to talk sense into her and deal with her protests since you do not have remote control with her situation.

I have been in your shoes with my mother. I kept her in her home as long as possible - supported that by making visits from out of town. When she became unsafe I drew a line in the sand - I sat her down and said I could no longer support her living there. I told her it was unsafe now and why; and that I couldn’t keep up with the upkeep of the home any longer because it needed too much and I lived out of town. I gave her 4 scenarios - She could live with family, she could move to an independent living apt (with a continuing care contract), she could bring a caregiver into her home, or she could apply for Medicaid and move to a nursing home. I gave her projected financials for each scenario and explained all of this to her so she could understand it. Some of these scenarios cost more than others of course. She chose independent living. I moved her last Feb. I sold her home. She is doing fine now. All that said, none of it was easy. She went through cycles of ambivalence, arguments, resistance, denial, tantrums, blaming me for everything under the sun until she accepted the reality of her situation. It took a year to get her out of the house. The beginnings of some dementia intensified her feelings and behavior. It was very stressful for both her and I and my husband. But it had to be done and she wasn’t going to get to that point on her own. I didn’t want a social worker to do it - I wanted control over how it was done and I was the one who’d have to support the decision so I wanted control in order that my needs were considered too. Things worked out. She lives in our area now. But its still a lot of work. I long for the day that I am free again to work professionally without interruption on a daily basis, live my own life, take vacations, work out, garden, read, take care of myself and my husband.

Sounds as if she is past the point of being able to care for herself and make safe decisions for herself. She needs to be placed for her own safety, but it sounds like she is going to fight you on the matter. You could contact adult protective services to get involved.

I have similar problems with my dad who lives with me. He sends money to scammers, angry, and hostile toward me. How were you able to take over your loved one's finances? My father refuses help from anyone.

Just because you don't like the answer does not mean the answer is rude or unhelpful. You said she can't live on her own which is why I asked how she managed to get discharged in the first place. I was not accusing you of anything. I was just asking if the facility she was leaving was aware she lived on her own with no one nearby to help. Another poster said that as a competent adult she is allowed to make her own decisions even if they are bad ones. Again, how is that rude, it is just a fact. She was just pointing out that if Grandma is competent to make her own decisions, you can't force her to do something she doesn't want to do. Sadly at this stage you have to wait for the next event(accident) then inform the facility she is in that she is an unsafe discharge.

We have all been through this and sometimes the answers are not all butterflies and roses. Sometimes you have to make the tough decisions that are really horrible to live through.

The choice is live-in care or a residential facility.

A family meeting with a Geriatric Psychiatrist can be enlightening; the doctor can educate, mediate and medicate. You and mom can discuss what you learn and make your own end-of-life plans so that you don't end up like grandma. If grandma can be sedated, she could be moved to Assisted Living near you; that way you can keep tabs on her, but not living with her.

Until then, you might want to look into "Visiting Angels" or the Care Advisor on this site. You also might want to video her behavior (sundowning, etc.) and living conditions to show Adult Protective Services if needed.

Three months ago I could have written this exact scenario verbatim. I really feel for you, it's frustrating and scary being in the "watch and wait" club. Someone in the following answers said it best with " be ready to roll." It's really the best you can do.

Prior to the defining incident in October when my mother fractured her femur and could no longer return home, I toured facilities, made financial plans and applied for state insurance. We were as prepared as we could be. It would be great to avoid the crisis but sometimes it's unavoidable. Best to you and your family.

I've been there myself with my late mother back in 2013. She was very hostile and refused help to keep her safely at home. Several falls continued until Mom was sent to rehab for a fractured pelvis, later to a NH near nyself instead of undafe back home. She tried to threaten me for court claim claiming I threw her out of "her place" when we actually purchased it together. An ombusdman and my family talked with her explaining what she was unsafe alone at home when I had to work.

Finally after one nasty protest, my brother moved her out of State to a NH near where he lived. Her anger got reduced with social workers assistance. I was finally free find professional help myself so I was able to seek work and call my mother just one day weekly.

She wants to have her cake and eat it too…..

Biggest thing I can tell you that has set me on the path to freedom is we all have free will. We have the freedom of making choices, good or bad. All of us have been gifted this privilege in life. How are we going to use it? Are we going to use it for us or against us? Can we sit and in honor others free will without imposing? Simply choices…..

I’ve been telling my daughter for years something I made up after my ex and I divorced - Haters gonna hate, bakers gonna bake, takers gonna take, why we gonna wait?

Why are we going to wait on other people to change? Why are other people going to wait on us to change?

Do we have the capacity to live in an inner world where we let people make choices they feel best for themselves without taking responsibility or ownership of their choices?

I know that you love and care for your grandmother but it sounds like she wants to be in full control of her life without any help or suggestions. I would lend her an open ear and heart and allow her to continue to live her life as she sees fit.

We are in the same boat, but with my MIL. She uses a walker, but her spine and shoulders are so weak, she can only go from one room to another. She absolutely refuses to give anyone POA, and refuses to hire someone even part time, because family should be taking care of her, even though most live in other states. She can afford care, but refuses because she helped care for her parents, who lived 4 blocks away. Good luck to you.

SamiandPickles: On the incident where she was hit by a car and had to go to the hospital and rehab, she never should have been released to go home. It should have been noted as an unsafe discharge to home. Ergo, now she requires managed care facility living.

SamiandPickles, apart from being generally concerned and believing that your grandmother would be better off not living alone, what has happened that you're worried about?

She isn't using her walker - has she fallen since being home?
Taking medication daily - is she taking it, as far as you can tell?
The smoke alarm - she did know what to do. She called the handyman, who replaced the battery. I get annoyed when my smoke alarm starts squeaking at me, too (the noise is supposed to be annoying - it makes you do something about it quicker).
You mention in a reply that she's mainly living on cookies and ice cream... H'mm. Who wouldn't if no one was watching?! But seriously, what happens about groceries, has your mother set up deliveries or anything like that?
The loneliness and dissatisfaction she describes, which you and your mother feel guilty about... Look. She's telling you about her day. If she isn't all sunshine and roses, is that your fault? What I'm saying is that guilt isn't an appropriate response to her giving you an account of how she's feeling, and she isn't talking to you with any intention of making you feel responsible for her, is she? She doesn't want you to devote your lives to her and she's already made that plain.

I'm sorry to hear that you felt you couldn't trust the support worker, but there again I'm not quite clear what the problem was. She was taking your grandmother out on unauthorized visits where? Why did you object to her running errands on her own time? And were there any substantial accounts of money going missing? - in which case, was this taken any further?

What outcome are you and your mother actually aiming for?

At the dr appt, ask for some in-home therapy sessions for her. Start with PT (the legs) and when that is exhausted, after a mo or so because of Medicare, change over to OT, the arms and upper body.

Write a letter to the dr ahead of the appt and discuss all concerns. Request that he can put it to her as coming from him. That she could benefit from in-home therapy, the weekly nurse that comes with it. He may be able to talk her into a private paid caretaker (however many hrs she can afford) to come in and do some heavy cleaning in the house for her and be able to observe.

You can ask her if her goal is to stay in her home, she needs some folks coming in to help and check on her. The walker is also a must. To put it in perspective, tell her you know she doesn't always use the walker and if she continues to make that choice/falls down, you know she won't be happy ending up laying in the bed at a NH all the time. If she argues about it, tell her it's definitely her choice on being safe and selecting where she wants to go if she falls down and breaks a hip or other permanent injury. Then walk away and let that simmer a while.

You need to get her doctor onboard so when something serious happens he will be able to have her admitted to some kind of facility. Unfortunately, stubborn people are not likely to change.