71 year old housebound Mom lives 2 hours away and has a caregiver for 4 hours a week and a trainer for 1 hour a week. Recently her psychiatrist called me and asked me to be at mom's next appointment. Of course I was there and the doctor said my mom needs more help at home. Not assisted living but more help. My mom has been falling ( we did get her a lifeline button which she won't use) and hygiene is bad. She is isolated too, despite my past efforts to try and get her engaged. I do understand it is difficult for her to walk and incontinence issues don't help either. My mom can't afford more help. My husband and I just moved to a small rural town 2 hours away earlier this year. There are no independent livings she can qualify for in my town (there are only 3- one she can't afford and 2 she has too much for). The plan right now is for my husband and I to buy a house in a few months (when lease is up) with a separate casita or mother in law house on property so we are there but she is still independent. She lived with us after a hospital stay for several months and my husband was ready to end our marriage. That's a whole other issue. Bottom line it seems like she can stay with us and I risk affecting my marriage, stay 2 hours away and just decline, maybe find independent living in town she is in but be isolated or???? Am I missing another option? Thanks for any ideas.

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People who are already requiring assistance and it's the point that her doctor says she needs it......and she's having trouble with hygiene....I'd read a lot about people who are declining mentally. Did the doctor say that she has dementia or cognitive decline? It's progressive and can turn your life upside down. I'd be prepared for that. It's not just that they need's that they often RESIST the help, because their brain does not allow them to reason. So, you have to try to manage their care without their cooperation. It can be exhausting and overwhelming. I'd consider if you can take that on. I'd consider that living with her on the property, but, not directly with you would be shortlived, due to continued needs.

Before, I took it on, I'd go and visit with her for a few days, so you can actually see what she is doing in her home. It might surprise you. Often, they may put on a good show, but, then there's the truth. Have you been able to speak with her once a week care person? Do you have POA, so you can gather information and make decisions on her behalf? If not, I'd work on that while there is still time.
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Whatever you do, do not put your marriage at risk. I don't think that can be on the table at all.
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She can't stay with you.

Living on the same property MIGHT be an option, but realize that will still require much of your time and attention. You don't mention what your mother's mental illness is, but it appears to be getting worse. If it is a progressive condition (like dementia) then it is likely she will eventually need more supervision than simply living near you. You will have invested in a property that will no longer suit your needs. Then what?

Did the psychiatrist have suggestions for suitable arrangements for your mother? How much "more help" would be sufficient? 4 hours every day? Help 2 days a week? And what kind of help? Companionship? Bath aide? Housekeeping?

She falls. She obviously needs an alert device. She has one and won't use it. Does her psychiatrist know that?

One way to get a better handle on what she needs and how to get it would be to arrange for a needs assessment. In my family we've done this twice, through the person's county Human Services department. I understand that it can also be requested from the Area Agency on Aging. There may be a backlog; the sooner you make the request, the sooner the appointment will come up. If at all possible arrange to be there during the interview. Assessment workers understand that the person needing help isn't always truthful about their situation, but they have to base their decisions on the answers they get. Someone who knows the situation can say, "Yes, Mom, you have always been a good cook, but it is hard now for you to get groceries, and put them away, and cleanup after you eat. I found moldy food in your fridge on my most recent visit."

The person doing the needs assessment will also have suggestions for how to arrange for that help, including financial considerations. They might suggest applying for Medicaid.
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Please don’t do it. Think outside the box. Is there another location for you and your husband? While she may start out in a different part of the property (which can be very hard to find) she will end up in your house. Think of what happened when she was with you short term. Now multiply that times 10 and with no end. From experience as another only child I am telling you. You do not want to do this.
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Don't let her live with you even in a MIL addition- she will suck up your time as her care needs increase. You have good ideas above - get her a needs assessment and start working with county services. But do not take on the caregiving yourself - it will kill you and end your marriage.
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Why does she need to be in an independent living near you? What about in her home town?

Do not put your marriage at risk!!!! Do not move her onto your property, it would be no different than when she was living with you.

Why does she have a psychiatrist? Is she mentally ill, have dementia or what?

What is her regular doctor saying about her needs?

Is there an adult daycare program she can attend to help her feel engaged? Has she ever been engaged? My mil has never had much of a social network, to expect her to be engaged at 82 is nuts. My mother has a huge social network and would shrivel up and die if she did not have a lot of social interaction.
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I am an only child too. My parents moved down the street from me while still healthy. As they've declined, it's been a nightmare. Some has been as the result of poor self care. They have also become extremely isolated and relying on me more and more to be the only person in their lives.

I had to move my dad into assisted living this year and now my mom is alone. She rarely leaves the house and has become extremely negative and nasty. I've had to set my boundaries to protect the life I have built. If I had to do it all over again, I would have protested their move so close to me.

My advise is set your boundaries, keep your distance and do not sacrifice your marriage and your own personal life. I work in real estate and every case I've seen with the "casita" or moving the parents in ends up negative and the adult children resentful.
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@snoopylove. Thank you for your feedback.

@jeannegibbs. My mother has clinical depression- been on anti depressants for decades. Serious mental health issues that have resulted in two behavioral health hospital stays. Very smart- no dementia but heavily medicated and in denial. I've never heard of a needs assessment. Thank you so much for the suggestion.

@kjmorgan. Thank you for your advice. Just hearing from another only child means so much. It's a lot of pressure!!

@sunnygirl1. Thank you for the ideas. She does not have dementia but her mental health issues are definitely affecting her health and aging issues. These things are so difficult!!!

@kimber1666. Thank you for reminding me health will continue to decline.

@tothill. My mom is living where I lived. She retired there and has no real connection to the area. You make a good point my mother has always been introverted and will never be a social person.

I'm hearing everyone loud and clear - don't risk my marriage or my sanity :). How can I feel so loving towards her and yet I agree caring for her more would be so hard!! I feel so guilty!!! Caregiving is not for the faint of heart. Thank you for all the suggestions. She is with me now for a week and I am already reminded why this didn't work before. Crazy stuff!!
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Another option for needs assessment - my relative had a Medicare Advantage plan. We called the insurance company and they sent a nurse to the home to look at the patient, ask questions, take vital signs, and observe the situation. No cost to us.
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