Suggestions for structuring/balancing in home care?

You are doing way too much as I assume you are around the same age as your husband. Something tragic may happen to your health & that would make things more complicated. Reach out for help from church, friends, family ASAP. Check with their insurance companies to see if respite care is a possibility. If husband has Alzheimer's, call them for assistance If no luck, hire several people to take care of them for the majority of several days so that you can get some much needed rest, nutrition, time for self, etc. Speak with your husband about placing stepdaughter (who has POA?) in a facility unless she has the resources to hire help. See if someone can help you check out some of the facilities virtually if that is the decision made. Having someone to help with a lot of the physical care will free up some time for you to recharge & be able to provide care for the other hours. Also, check on your smoke alarm as it must not be working. Be relieved, it could have been a fire! It really was a wake-up call! So glad you came here to ask for help.

Imho, something must be amended, else you fall faint and ill and are good to no one. Seek respite through Visiting Nurses, facility living for them or VA assistance if your husband is a veteran.

If your husband qualifies you can apply for VA Aid and Attendance which is a benefit for sitters and aides. I used American Veterans Aid company to help sort through the application process. I have private in home sitters from the church for my mom(84) and aunt(91). I pay $17 an hour and right now daytime is more necessary. They are angels and I cannot imagine life without their help. One sitter can help with two people for the same cost.
Agencies cost a bit more and I have used in home Concierage Care. I am assuming you have no family to help even for brief relief.
Ask their primary care doctors for a social worker to help you sort out your options.
Good luck and take care of yourself.

You are not alone with this problem. Many of us are struggling with being overwhelmed. That said, that are help agencies who provide various types of assistance. It is pricey. $28.00 per hour seems to be what the agencies charge. I am a senior who has had surgeries and a husband who needs help, so I know where you are coming from. I have a woman who comes twice a week and does a set of chores for me , namely, the laundry and grocery shopping one day, changing the beds and some cleaning the second day. It’s easier if there is a set of chores that are on autopilot, but that is up to you.

it is a challenge to find the right person person for you and your needs. There are agencies listed on the Web near you, perhaps your Senior center has a list, or the local hospital which usually has a social worker who knows what is available. My mother had someone from Euro American healthcare in Connecticut. I don’t know what agencies are available to you.
the woman we had for my mother, helped with bathing, dressing, errands, breakfast etc
It is not easy to find someone who fits your needs and your household personality, but keep trying. It’s worth it.
The other suggestion is that you advertise for house work or home care in your local Penny Saver or Craig’s list. This will be cheaper, but the agencies have insurance and an abundance of choices of people and if one person doesn’t fit your needs, they have more to choose from.
time to reach out.
Best wishes
Bernadette

We just experienced this with our Mom, after a sudden change in her care needs, which was far more than we could handle. There are additional challenges because of Covid. Possible facilities for your stepdaughter may not be accepting new residents, or require quarantine. That said, you can find help! We called every available in-home care company for rates, availability, etc. We put feelers out to our local Church, Nursing Homes, hair stylist, extended family, Facebook, anyone and everyone who may know someone available and interested. We contacted our cousin, who had lived with her grandparents as a caregiver, knew Mom well, and was more than qualified to take this on, even though all of her training was OJT with her physically and mentally disabled grandparents. She was able to drop everything and move in to the family home. We paid her handsomely, as she was the perfect fit for our needs, and the situation was urgent, also short term as Mom deteriorated rapidly and passed away after several weeks. I feel awful for your situation. You are right to know you need to take care of yourself too. I am confident there is an answer for you. Cast a wide net in your outreach. I wish you the best of luck.

Emma,
You are a caring soul. Usually caring people don't set appropriate boundaries while meeting the needs of others. You have needs that are not being met and that is why you are exhausted.

Start by making sure your basic needs are met. 7-8 hours of uninterrupted sleep. 3 nutritious meals while sitting down to enjoy those meals - not a quick bite while feeding others or doing other tasks. 2 liters of water-based, no caffeine beverages. 1-2 hours of time outside in the sunshine. Regular doctor and dentist appointments for yourself. If you can't get these needs met - something needs to change NOW. Usually not getting enough sleep is the hardest need to meet if you are caring for others with unusual sleep habits. If your husband wanders at night or your daughter can not sleep through the night, talk with their doctors about sleep aides.

Next come those social connections and things that bring meaning or enjoyment to life. Besides your spouse and child, you need to communicate with other people. Try Facetime, Facebook, Skype or Zoom as well as phone calls talk to (and "see") other family members and friends several times throughout the week. Carve out at least 30 minutes every day to do something you love. Try to carve out a couple of hours to get some respite every week or 2; ask family, friends, people from your faith community or paid help to care for your loved ones while you get away for a bit.

You're probably saying "sounds nice but totally unrealistic." The problem is that your situation will not change unless you make the changes. If your basic needs can not be met because you are always "caring", then you need another person(s) to help meet their needs. That is why residential facilities came into existence - to provide 24/7 care that people can not do at home. Home health care aides can come into your home to help care as well. Sometimes insurance will pay for it.

Personal note, my MIL with dementia lives in Hawaii with 2 caretakers who split day and night shifts. She refused to live with us or her other son. It is financed through her late husband's life insurance benefit and liquidating all their assets.

There are 24 hours in a day. Would the entire roof cave in if you take just 5 minutes daily for yourself? Without you, you cannot be good to anyone else, so it is time for help. Don't get trapped!

Your agency or center for aging May have grant money for caregiver respite. Talk to them. Also consistent volunteers from church might help for short term.
contact your local nursing school and ask if there is a nursing student who would like to earn some money.
adult day care is another option but needs in person visit from you first.
what time of day stresses you the most?
for me two hours in the mornings is a huge help. Some else does the written morning routine with my mom which gives me time for me and for time to help my husband.

My dad receives home health. In April, I was informed by VA, b/c of covid, his hrs would be doubled. His hrs still had not increased by mid July. I contacted my senator. Within 5 days, my dad's hrs were approved & implemented. Contact your Senator.

Yes, its time to place stepdaughter. There are group homes for her. I went thru the State for my nephew and I do think it took a while to get him set up with an apartment, he can be on his own with a little overseeing. Do you have guardianship? Maybe in the meantime you can get her in a daycare program. If she is on Medicaid they may pay for it. This will at least give you sometime to yourself.

Wow, you have been carrying a load like a hero! I use in-home agency care for my 2 aunts out of state (Visiting Angels) and have had a great experience over the past 6 years with them.

I don't have any experience with the VA, so I'm thinking you will need to see what comes through from them but it may not hurt to start interviewing some agencies to even see if they have the qualified staffing. I'm an actual employer with employees and if you hire someone privately, that makes you an employer and required to follow the laws in terms of paying payroll taxes and anything else for your state. An agency does all the skills vetting and background checking, has subs, and is accountable for what their employees do for your LOs. If you go this route the "best" people are ones that get the most hours or best schedule. My aunts have had their Angel for 30 hours a week (part-time) consistently. Maybe you can start with getting covered for a full day so you get a complete break. Or 3 mornings a week, 4 hrs per day. Also, you can request a guy for your husband -- not just for modesty reasons but as a companion. My aunts' caregiver drives them places and plays cards with them, chats, watches tv and they love her to pieces.

I hope this info helps. I wish you much success in finding the right fit -- and soon!