Taking care of both parents. One refuses to consider skilled nursing. What are the conversations to have with him?

If dad has a sound mind, and that definition is pretty loose, he’s able to make his own decisions, even the bad ones. He has the right to refuse to move even if it’s a bad choice. I hope you’ll get your mother back in care you feel good about, and accept his refusal to change. Also, don’t rescue him or come to his aid and provide help to him. It’ll help him see his need for care, even though it may take a major event to force change

It sounds to me like the whole family isn't expected to take care of dad and that it's pretty much only you doing anything for him and your mom in the nursing home.
As for not thinking it unfair to ask your father to live in a nursing home when he doesn't need to, well it is unfair. Extremely unfair. There's nothing wrong with him for not being willing to confine himself to a nursing home for the rest of his life. It is not for you to judge how much he loves his wife. He would not have stayed married to her for 52 years if he didn't love her.
You're suffering terribly because no one is helping you with your parents. You and all your siblings need to get together and decide upon some homecare help for your father. Of course, he will be stubborn about it as most elderly people are, but if you and your siblings are united together about it, he will accept outside help if he understands that you will not be doing everything for him and he'll end up in the nursing home himself because he'll get sick the way he's going.

You have been "assumed" and "defaulted" into the caregiver role, which is unfair. I don't think you're going to change his mind. Therefore with that as a reality, what is your goal for yourself in this situation?

- who are your parent's PoA?
- has he ever had a cognitive exam that is recorded in his medical files?
- is he actually living in your home? I'm a little confused about that...

1) you won't "reason" him into leaving so please don't exhaust yourself trying. You should *tell* him he is moving out, not *ask* him. Stop giving him a choice.
2) if no one has PoA for him this is a whole other level of problem that will eventually kick in
3) if he won't leave your home you can legally evict him.

What are you willing to do to regain your sanity?

Can you move your mom to a care community that as a continuum of care (IL, AL, MC, LTC)? He can have an apartment on the campus if he doesn't want to bunk with your mom. The question is can they afford this? But the goal is for him to get out of your house. I don't envy you. You won't be able to have it both ways (him move out AND him doing it voluntarily). I wish you all the best.

Love for better or worse but that doesn't mean one has to go into assisted living just because a spouse does.
Your Father doesn't feel like he needs assisted living at this time and he probably doesn't so why should he.

Would you want to go into assisted living just because your husband did?

Most want to stay and live in their own homes where they are familiar and will be their happiest.

You should let them stay in their own home and see about what kind of help you can get come to their home.

Beleven me Assisted Living places are mostly not always as they're presented to be.

You give up everything and have to do what someone else tells you to do and when. Not Fun at all.
My 96 yr old Dad made it plain that he never wanted to leave his home.
He lived by himself til he was in his 90's.

He had his fall alert and Nest Cameras where he could be watched from a cell phone or computer 24 7.

At 94 he had a priblem of not being able to urinate which ended in a 4 day Hospital Stay and dementia and a Cathiter.

I hired 24 7 Care Givers which is very expensive and using up all his saved money but he gets to stay in his own home.

Nown I'm considering hiring a Live In because it would be half the price and his money would last longer.

He says he's going to live to be a hundred.

The only thing that Dad's Health Insurance pays for regarding his Care is with a Home Health Service, he gets a Nurse come twice a month to check on him and change his Cathiter.

He also has a Nurse Practioner come once a month.

Dad's Ins doesn't pay for anything else.

They would pay for putting him in a Senior Home but my Dad would be miserable and probably not last a month.

You should see what your mom and Dad's Insurance would cover regarding In Home Care.

If they don't have money and on Medicare then they usually will give up to 40 hrs a week Care and you can even get paid yourself to take care of them.

Find out your resources.

Prayers

I am confused as to the living situation here. Your parents live on your property? Or you on theirs? Separate homes?

You are not going to be able to convince your father to go into a facility, as it appears he has not been declared legally competent.

What you CAN do, though is to refuse to participate in his care. Who makes the decisions for your mother?

It is indeed unfortunate that all the care has landed on you. Please understand that it doesn't have to be this way.

The last few years of life are individual and look different for everyone. Clearly, your mom's inability to perform daily living tasks makes her eligible for nursing home care and in fact requires her to be there. Your dad in not in the same predicament and to expect him to do so is just not right. He may eventually require nursing home care, but his trajectory is quite different than your mom's and his care needs as he ages must be considered. I would question whether he would medically qualify for skilled nursing at this point. He will be the best husband he can be without giving up the life he wants to lead for as long as he can and bravo for him! You have done so much for your parents over the last few years and you are feeling burned out; I would too. (Just as your dad would feel sharing a tiny room with your mom in her condition.) You need a break or at least a reduction in the amount expected of you. Your dad is resist to losing his freedoms, but must learn that small concessions need to be made in order for him to retain as much independence as possible. This means learning to accept outside help. You need to explain to him that just as he expects his independence, so do you. You are too young to be constrained and stressed in this way. You will continue to be supportive, but something has to change and your life decisions are just that, yours. I'm not saying to be argumentative. Far from that. But you need to be firm about what you can and cannot do and he will need to hire help for certain things. Somehow, you must accept his freedoms so that he understands deep down that you are supportive of him, but not enabling him. Helping is good, but giving him a false sense of competency is not good. A very fine line, of course. It's time to make a list of the changes you need for yourself and research the various forms of home help, transportation, and medication assistance that your dad needs and formulate a plan. Implement each change one at a time if you can so you can see what works and what doesn't.

My dad is 90 and my mom is 89. Mom has been in a wheelchair for three years since her knee surgery. Three years ago I tried to do everything for them .Dad wants to take care of mom himself. They both live in their own house and dad cares for them both. I found out the best thing I could do for them after a lot of sleepless nights and fights with them, since that I knew best!! I have told my parents that I am their for them and call when they need my help!! I call them two times a day to check in with them. I found you can not help people if they do not want your help no matter how much you love them! I am the only child, and they do not want me to be their parent!! Yesterday they celebrated their 70 Anniversary. I find when they need help be there for them!

Please get your father evaluated by his primary care doctor and ask for a referral to a neurologist. He may have dementia (there are several types) and the neurologist can check to see which one he has (sounds like frontal temporal lobe problem with his difficult behavior) - and also test for "mental competency." If dad is deemed mentally incompetent, then he does not have the ability to make sound judgments - sounds like he is already there from your post above.

In the meantime, your father needs somebody to give him his medications, make sure he eats a healthy diet (for his multiple health challenges), and supervises him whenever he wants to putter in the workshop. It does NOT have to be you.

Time to call a family meeting. Make a list of all the are care tasks for your father and all the care tasks for your mother. List the amount of time it takes to complete each task. You may be surprised how much time it takes to care for both of them. Consider which tasks you can reasonably handle while making sure to care for yourself and your family: 7-9 hours of nightly sleep, 3 healthy meals at a reasonable pace in a stress free setting, "time off" to take care of your own health needs, and "time off" daily as well as weekly to nurture your soul doing things you enjoy in relationships you value. At the family meeting, explain that you can NOT do all the care tasks for both mom and dad alone anymore. Show the list and ask other family members for help. Help can take many forms: caring for parents for a period of time, taking care of household tasks, paying for help... Also consider asking friends and members of your faith community for help as well. If you can not get enough "free" helpers, you will need to investigate paid help. Home health aides through a reliable agency can fill in the gaps but usually are paid for privately (unless mom and dad have long term care insurance). Many long term residential facilities also have adult day programs - see if that is available where your live. Otherwise, your parents will need to go to a residential facility so that their needs can be met.

You will have more luck moving dad into a facility if his behavior issues are addressed. Even if your decide to keep everybody at home, addressing his behavior issues will make life easier. A neurologist or geriatric psychiatrist is probably the best health care providers to address these issues. Treatment usually takes the form of medication, but developing a consistent schedule and coping strategies for behavior "problems" can help make dad less anxious, less agitated, less controlling, and less outburts.

You are under no obligation to take care of your parents. Just because they brought you into the world--you were never asked, so you do not have to take care of them. If he knows best leave them to their own devices.

BIG BIG BIG mistake resigning your job. They are hard to get, and when your parents die they will not leave you with a cracker and can in fact badly affect your own retirement because it is based on your income. Well, it is your decision what to do but I would not leave a job unless your parents are well off they can afford the care and you as well.

This is a rather complex problem and a lot of good advice here. I suppose all decisions regarding aging parents are complex. One must respect the wishes of your parents even if you disagree with them. They are adults, not children and you really can't tell your father what to do if he is competent.

From the point of view of an older person, myself, now 70, I have given considerable thought to what my/our next move might be. We love our home and will stay here as long as we can. I find work in the gardens peaceful and exciting in turns.

Nevertheless, if at some point my husband needs more care than I can give him, I would absolutely move into assisted living with him. Our dedication to each other is such that I cannot imagine not living with him. Granted, I am not sure he would make the same decision. It is a somewhat easier decision for us than it might be for some as we did make investments in our youth that would allow us to move into a somewhat nicer facility than Medicaid would provide--though certainly not top end.

Not everyone would make the same decisions as I might. It is perfectly alright to allow your father to remain at "home" as long as he can maintain himself and his home and visit his wife at the residence where she can be cared for. He may change his mind after a few months of living alone if nobody pesters him about it. He may not. Let him be and see how it works out. You will all be much happier without trying so hard to over-manage his life.

Try to be at peace with the idea that in such complicated matters there is often no "best" or "perfect" solution.

"WHAT IS WRONG WITH HIM?"

That made me chuckle...

Some ideas of why could be;
1. He's a MAN. So always right, right? (Sorry guys for being sexist I'm sure some of you are flexible, gracious individuals).

2. Dad is fighting to keep control. Like 4 year olds do. MY WAY foot stamp stamp.

3. He has (un DX) vascular dementia & no longer has good judgement or planning skills

4. Fear. He is scared of change.

A social worker once told me it takes at least SIX times to have the conversation about moving/future needs for *reasonable* people to get it. For stubborn people... well... you may run out of time... or they never do. (They die fighting with their boots on in their own homes).

I'll be back once I read all the replies.

Prayers sent for this most difficult of situations.

Just a few ideas based on what I had to do.
My mom is now 90 and a half, and been in the nursing home for about two years. She has dementia which is pretty bad now, but wasn't at the time. The only way she would go to the nursing home is with Dad, but Dad doesn't need SN care even though he's 94 years. They had been living with us for about eight years at that point. At the time of her entering the home, we explained to both my parents that I was going on a vacation with my husband for a week and that we wanted them to be well cared for while we were gone. We didn't want them to worry about caring for the home or whether the aides "would take something" while we were gone.
We repeatedly explained to Mom that this time she and Dad would be on different floors of the nursing home because Dad would need help so that he wouldn't fall (a problem he was having), but she would need different help with using the toilet, getting dressed, etc. I laid on the guilt and told them we knew they loved us, knew they understood we need a break from our demanding jobs, and wouldn't want us to worry about them. I explained that they could see each other as much as the home would allow; Dad was actually on a rehab floor while we were away, Mom on a dementia floor. Dad understood he would be coming home after our return, but that Mom would not be.
When we returned, we went to the home. I gave Mom some excuse why she couldn't see Dad that day, while my husband took him home. Dad has been home since; Mom still thinks he's on the other floor of the home.
This passed November, they are married 66 years. Dad is willing to be in a nursing home, but so far, no need. Mom is asking to be home -- part of missing us due to COVID, but we get video-conferences twice a week. Dad has not gotten on the video-conference or come to a visit with Mom since he's been home. Mom and her family were deserted by her Dad, so this really bothered me, until very recently when a therapist started helping me understand. Dad doesn't speak about the situation -- except occassionaly he'll tell a doctor, he hates the situation, but doesn't know that there's any better solution. He still reviews her every monthly medication list, and demands that she get the specialist appointments her insurance entitles her to. After every video conference, he wants a report from me on how she is. When Mom was home, she started hitting and kicking at him, if he didn't respond to her every demand immediately. She'd started trying to do the same to me when I got home from work.
That's when I had to change the promise I had made to them,and more importantly to myself. Instead of telling them, I would always care for them and not place them in nursing homes (we lived through my grandparents and uncle being in them), I started telling Mom she would stay with us as long as she wouldn't hurt anyone, even herself. It's a hard, but necessary, message. And many places won't take someone in if they become too aggressive, so it's a real balancing issue as to the timing.
Anyway, thanks for listening to me vent. And I hope this gives you some ideas on how to "do the impossible", that so many of us now have to face doing every day.

There are facilities who offer independent living for active seniors too. Usually with a center of the courtyard dining area & good tasting meal with more than one choice at dinners. They have elevators for 2nd floor or more apartment levels. Then a portion of the campus is set up for SN patients too so couples can see one another and not be far apart. Thus leaving only the apartment chores to be determined. The facility director should be able to make checklist visits to comment where there might be issues of trash & safety concerns for the kitchen & bathroom. There are rules & you would not have to explain those to Dad & Mom could have her caregivers she needs or Mom could live in the SN room. I work at a lower level apartment only complex that is actually a refurbished former motel rehabed into brand new senior apartments. It offers a "community" room downstairs that is not open right now with Covid but it does have an attached patio & a gas BBQ for residents. Manager is on site at the lobby door which remains locked so only residents are allowed & caregivers get a pass key code. Pets are allowed as well, ONE per unit anyway even if it is not a service animal. Every month, one cake is on the table for all residents birthdays in that month. So there are other options for senior living & qualifying for the financial based apartments: waiting lists applications etc.

So when you have the next chance to chat to Dad, make it relaxed, a nice sit outside with a cuppa. Spell it out;
* Mom needs more care.
* He needs some help, & will required more in the future.
* You are but one person.
* You can't do it all.
* Things have to change.

Then wait a bit.
Then ask how he sees it.
Then ask what his solutions are.

What comes back to you? Is he sad? Fearful? Does he understand but just doesn't want to be old? Or does he truly not see it/not get it?

When I was in a similar boat (drowning under stress & obligation) I was given similar advice.

In my case, re planning for the future.. when the Doctor heard the tale she explained it as "one had denial & the other had lack of insight. One *wouldn't* understand & the other *couldn't*.

Where's your Dad at?

Wow, tough situation. I don't think YOU can reason with him. It needs to be a doctor or other adult type professional who will "negotiate" and implement the plan. Talk to Adult Protective Services and see if they can step in.

I’m sorry your really stressed and doing it alone. However, I know it’s tough but hang in there. Your parents love one another as well as u and ur sibs. Pray and do not let go of your parents. Dad is a a trooper. Leave him be. let him do as he’s pleases as long as he’s nothurting anyone. A few incidents he will be fine. I would take the keys get an aarp tracker do when he leaves u can track or make sure he has a phone. I know mom worked all her life or have income let her stay as well maybe if feasible get someone to assist to help her at home. If u can get a care provider to come in for a few days so u can go stay in a hotel for a breather. Dad feels if he goes he will lose his freedom and he will become ill. Remember when u were younger mom and dad had to put up a lot. I know it’s hard. What goes around comes around. You will be fine.

I’m not trying to be blunt or rude, but my sister and I have found the only way to deal with extremely stubborn parents who are in denial is to keep telling yourself you are in charge. Does your dad have the ability to chose? Do you have medical POA? It’s so difficult, but there comes a time when we end up having to put our foot down and not give in to what our parents want when it’s not in their best interest health wise as is greatly affecting your emotional and poss physical health. Just because he wants to live at home doesn’t mean you have to give in. Brainstorm the pros and cons of him being in a facility vs at home. It’s so sad my mom, who was recently diagnosed with Alzheimer’s after numerous falls and pelvis and tailbone breaks, can’t live out her remaining yrs at home. She’s a flight risk, does what she wants with no regard for her safety and expects whosever her caregiver to be at her beck and call for even repetitive questions at all hrs of the day. So sad how the elderly with major mental and physical issues become self absorbed with no regard for you and your life. You deserve to live your life and experience happiness. If taking care of your dad is too stressful and demanding, put your foot down and make arrangements to have him relocated to an appropriate care home. He will eventually hopefully get over it. I realized even having way-too expensive home care at night wouldn’t afford any peace and quiet to get any sleep.

He sounds reasonably compos mentis and for him one suspects the idea of a NH is mentally the beginning of the end. Its a big adjustment no one wants - and we won't either, only we shall have seen two generations do it - He wants his old life in his own home, where he is comfortable and "in control".
If it is possible I would try and get the NH to take them both for a period of respite whilst you go away, when you will be travelling around (or not but say you are - and don't be available apart from staff having a number in case of emergency). Let him see what it is like and what it is like being with your mother. You may not "win" and him want to stay when the respite period is up - but maybe Mum will decide to stay, and he will appreciate being with her - who knows, but a break will do everyone some good one way or the other.