Should I build a home extension (in-law suite) to house mom?

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Mom (~78-80) has been officially diagnosed with dementia about 5 months ago though I suspected she had it for over 10yrs. She also gets anxiety and depression. We had to convince her to sell her house since she could not take care of it and was getting depressively lonely after dad died over 2 yrs ago even though they didn't have a great marriage. However, now she has to live somewhere and we (me, brother, sister) don't think she can live by herself in an apartment or small house. We hoped that selling her 3 storied house could help her heal and move on essentially. It was a constant "anchor". She sleeps in my repurposed dinning room turned into a "bedroom area". My house is small and has no guest bedrooms. She is in complete denial about the dementia and can be very argumentative, makes poisonous/cruel statements at me cause she thinks I'm evil and constantly thinks people steal from her if she can't find something. I don't know what part of her personality is dementia related and what is really her own personality. She is very bitter about her life and blames everyone but herself. She doesn't want to goto a senior center (with transport) cause she doesn't want to be reminded of the old and decrepit though there are many active, healthy seniors there to just hangout. Physically, she is in good shape but her emotional ups/downs are hard to take. Her depressive nature is stressful on me cause it's hard to hide in a smaller house. One sister has a guest bedroom and could accommodate her but has never offered. The other sibling, brother, lives in a 2 bedroom condo rental with wife and 2 yr. old and has no room. Though he is looking for a new house with taking mom into this future house. However, they are nowhere near finding/locking into a house due to a not-so-great real estate market. I don't have high hopes of her moving in with them in the next 6 months to 1 yrs. However, I don't know if I can continue living in this "temporary" situation and she has voiced that I don't treat her well cause she lives like a vagabond and gypsy. Her stuff is stored at sister's basement. She tells my siblings that living at my house is horrible cause it's too loud, complains about my husband, etc...At the end of the day, she doesn't have a true home and I get that. Should i build an extension (with my money) so she can have her own suite and I can watch her or at some point hire home help as needed? I don't know what the alternative would be for the next year. I would build the extension whereby I can repurpose it for other uses in the future. I should say that this is a Chinese mom and the cultural expectations are not aligned with western culture. This is a quandary because she needs a real bedroom and we need to have space from her. It's too stressful with the current living situation.

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I just want to give the "Chinese" perspective. My husband is the oldest son...he was born in China. The care of his parents falls upon him. We have always had an active role in their lives...they have limited English, couldn't drive, etc. My FIL move in with us when he had congestive heart failure and we cared for him until he passed. My MIL lives a block away and we take her to all appointments and shopping. She has a demanding personality too but I realize that strength is what made it possible for them to escape from China and eventually come to the US. I understand your cultural need to care for your parents, but are you ready for all that entails with Alzheimer's? You have to make a decision that will provide for her needs and still keep your immediate family cared for.

Now the Alzheimer's part of the equation... My mom is the one with Alzheimer's. Many of the behaviors you mentioned are things my mom went through. I think it is common for the person who is the primary caregiver to take the brunt of the anger, and accusations...totally not fair but it is how their broken brain works. My mom is now in stage 7. She was diagnosed in 2009 but had been complaining of issue to her doctor for 3-5 years before. We have been dealing with this ugly disease for a long time. My step father cared for mom in the early stages with just a little support from my sister and me. As the disease progressed, we helped more and more. When mom needed more physical assistance, my sister couldn't do it so I took over most of the care. In mid stages I would arrive at mom's (a 40 minute drive) at 7:00. I would get her up, showered, dressed, feed breakfast and take her with me to work or my home. I worked some from home. Then take her back home, fix dinner, feed her and my step dad, get her ready for bed and head to my home. Then she had a fall after I left one day and my step dad couldn't get her up. Then my husband and I started sleeping there. (Days were still spent at our home or my office). When it got too tough to get her in and out of the car, we moved her to our home. Step dad visits 2-3 times a week.

This is what our day is like now...my boss allowed me to work mostly from home, a blessing. In the morning, my husband and I get mom up. She has a hospital bed with alternating pressure mattress pad. She is totally incontinent and it takes 2 to change her. We give her a sponge bath, and dress her. She can't stand or walk, so we lift her to her wheelchair and take her to the living room. We have a recliner with another alternating pressure mattress pad. We work very hard, and successfully, at preventing bed sores. My mom has to be changed every 2-3 hours. She has no control of her arms and hands so we feed her and give her drinks through a straw. She has some contractions so her legs curl making the transfers a bit difficult. She still eats and drinks well but has developed a delayed swallow so I have to watch carefully and prompt her as needed. She has very little comprehensible language, but she rambles all day long....and often all night. We do have a spare bedroom in our home, but it is small...8'x11' but we make it work. We put a small recliner in there because I often have to stay all night in there to comfort her. During all of this I still fit in 6-8 hours of work. This is a day in the life of caregiving.

I love my mom and am lucky enough to have a lot of support. My husband is amazing. We have 4 daughters and a son that help out. My sister helps. My step dad covers any expenses for my mom and visits often. I have a daughter that is a speech pathologist so she watches the swallow issues. I have a daughter who is a nutritionist and she helps with those needs. I have a Son In Law that is a doctor and he keeps an overview of her care. I also have a niece and nephew that help out. My grandchildren love to come here and hang out so I get my emotional needs met. I don't know many caregivers as lucky as me but I will say, without all of them, I am not sure I could do this.

Your only responsibility is to be sure your mom is safe and well cared for. That can happen in your home, or in a facility. You have to take care of yourself too. I wanted you to have a realistic view of what you would be getting into before you spend the money.
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Having mom move in to an addition my be a mistake. The extra costs plus it will take 5 months to do once you start. Then you have to pay taxes maintenance etc. 5 months may be a game changer with your mom. Look into a facility where she can live and you visit. It will be better for you in the long run. If she can afford it get her a place that has like minded people (culturally) if possible. Dad is with me in my house and it is challenging and we have room.
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I'm just going to chime in and say "don't do it". Things aren't good between you now, how will moving the problem IN with you make it better?

You have funds to give mom a lovely suite in an ALF. There you can more easily set boundaries and schedules visits.

Just my opinion. My brother moved mother and dad in 18 years ago, Dad passed 13 years ago. The last 13 years have been a nightmare. He wouldn't do this again for anything. Certainly not for trauma his family has had to endure.

However, this is just my opinion. I have never seen a MIL apartment situation that worked out well for everyone.
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"The price of an extension for a first floor inlaw suit (bedroom, small living room, bathroom) is going to cost me a good deal of money, probably over $150K." Small is absolutely not the way you want to go should you decide to build the extension. The space needs to be ADA compliant and open. The most important part of the extension is the bathroom, which must be designed for the worst case scenario, which would be a wheel-in shower with ample space for an aide to transfer her from toilet to shower to sink, etc. She does not *need* a living room, and a kitchenette with microwave (safer given her dementia) would be sufficient. In the future, this extension can serve as a home office or guest room and will add value to your small home.
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durian, you asked about the cost of Assisted Living/Memory Care. On average it is around $6k per month, with options for extra personal care. Price depends on your area, it could be less or could be more.

Downsizing isn't always easy for the parent. My Dad started downsizing by going into Independent Living first which was $5k per month for a nice sized 2 bedroom apartment which had a full size kitchen, plus he had his favorite caregiver come with him, to help him in the mornings. It gave him a routine as he was starting with dementia.

Later my Dad had to downsize again to move into Assisted Living/Memory Care. He was still able to budget for his caregiver, again to give him a routine in the morning, even though the Aides did most of the physical caregiving.

My Dad was happy as a clam in the facility even though he was quite shy and didn't want to join in activities. He spent his day watch the local 24 hour news and the weather channel, and reading. He always kept his apartment door opened and was happy whenever someone going by said "hello".
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For the well-being of your marriage, your own well-being and her well-being plus increasing care needs do not build an extension to your house.
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Chiming in here, have you considered getting your mom evaluated for meds for her depression and anxiety?
This situation could be majorly improved if mom's behavior wasn't so poisonous, yes?
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Talking money here, $150K would build a nice apartment. But keep in mind, unless you and other family members are doing the hands on caregiving you'll have to hire help. Eventually 24/7 help as mom declines. And living under your roof you would still have a "patient" who would most likely expect your undivided attention.

Medicaid pays for medical care and nursing home care for folks who have little or no funds. And these days people are outliving their funds and end up on Medicaid.

I don't think it's a good idea to spend your personal funds for an apartment and / or moms care. Your immediate family should come first. If she has money it should be spent on her care. If money is tight start learning about Medicaid requirements. It's complicated.

Medicaid does not usually cover assisted living but does cover skilled nursing care. Assisted living prices will vary depending on the level of services mom needs. They usually give you a menus of services with different levels of pricing.  Prices can range from $5K to $10k per month.

From your comments I think assisted living is your best route.
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Thank you. All of you have very good and correct thoughts. I do think assisted living maybe the ultimate answer, especially as it relates to my own health. I also had to manage my dad's cancer care for ~5 yrs before he died. My siblings did help with the work that was doled out, i.e., doctor's appointments but I did the heavy lifting in terms of really talking to all the doctors, the next steps, finding the best care, alternative clinical trials, etc...That took a toll on my health due to stress. Now, I just don't know if I can deal with another "patient". But she has to live somewhere. If she moves into an assisted living apartment, she may spiral down faster in her mental state. What is the average price of an assisted living apartment? The price of an extension for a first floor inlaw suit (bedroom, small living room, bathroom) is going to cost me a good deal of money, probably over $150K. Is that better spent at an assisted living place? I'm also worried on the quality of assisted living places. Some of the "cheaper" ones hire very low cost labor to care for the patients. I'm not sure how Medicaid will help her. Isn't that dependent on financial need for the very poor (or proof of little assets)? I'm surprised to hear that assisted living is half the price of in home care.
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I'm seeing red flags all over this. Bro and sis agree that mom can't live alone, but only you have stepped up to help even though you clearly don't have the means. If you think you are on your own now just wait until you have a permanent place for her, they will feel justified in believing that since you have made room for mom to live with you they don't need to concern themselves any more. Right now your mom is still in pretty good shape, but as every year passes she will get worse both mentally and physically. Don't go ahead with this unless you all have a clear plan for the future, including a firm timeline and an exit strategy.
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