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My mother-in-law is 83 with severe rheumatoid arthritis. She is still of pretty good sound mind and living by herself in her home. She is spending more and more time in bed. Eating a very poor diet, and her mobility is very poor. She probably should not be driving. She does not see a need for help. One of her sons would like to put a care plan into action, but the other two siblings have a wait until there is a crisis attitude. Suggestions? (I'm the wife of the one who is concerned, but we live 350 miles away).

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I’ve been dealing with stubborn elder parents for about 6 years now from 600 miles away. I’m all they’ve got. A few tips:

Provide as much help as she will allow and push it as much as possible but don’t waste time and stress on constant battles.

Do not hesitate to fib to get stuff done. Neither of my folks have good reasoning skills any longer. WE’RE JUST FINE! I’ve learned I will never convince them of much so I don’t ask and try to get approval in advance to buy a new dryer or replace a tv, I just get one sent over. After a bit of alarm and puffery everything settles down and by the next day wheel a fortune looks really good on the new tv.

Pick your battles. I don’t care anymore about the disgusting old sofa, got tired of arguing about it,  but the carpet had to be cleaned.

Somebody, and only one person, needs to get poa. Three kids? They need to fight this out. They can cooperate in moms care and make it easier but most likely won’t.

Yes, it’s usually crisis driven. I’ve been able to help my folks tremendously but they won’t get outside help or move until a crisis forces the issue.
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Perhaps some holiday gifts that include things like weekly housecleaning for a month or two and meals on wheels would be the thin edge of the wedge in getting her to accept help.
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I am the local child (3 golden boy brothers out of state). They would like my mother in an AL facility. She is "not ready" for that. So a crisis it will be to make her move (and possibly it would be right to a nursing home, if she injures herself badly enough.

She is 91, no sight in one eye, very bad balance, neuropathy in her feet, atrial fibrillation, bad hearing, and anxiety and a VERY controlling personality. My one brother (and his wife) told me that she needs a cleaner. My mother has been "looking into it for more than a year." This brother and his wife always scrub her bathroom when they are here. Another brother and I don't think it is filthy. (And the third can't be bothered to get here enough to notice.) Everything in the condo is OCD neat. Deep cleaning isn't getting done, though.

But there's more...my mother needs someone to monitor her showers (can't feel her feet, she says, and has to lift them out of the tub sometimes). She refuses to have the tub retrofitted. She could use some help with getting dressed (it takes her a longggg time).

I'm sure my brothers would love it if I just stepped quietly into the cleaner/shower attendant mode. But I won't. I resent what I have to do for my mother already. I am her taxi driver. And she calls me (because I'm a free call) for little things. She doesn't talk to my brothers but once a week (and for the most disenged one, not that often). She hash a tracphone, and still pays for minutes. (She is cheap....but has funds.)

So my brothers blow into town, stay a few days, and then are gone. They might mention something to my mother about AL or cleaning help, but they don't follow up. No one likes to cross my mother.

So we are all waiting for a crisis to happen. I am never taking her into my (ranch) home, and I will never stay with her (did that once, got the shirt, burned it!).

My mother has been very nasty to me when crossed. She is ungrateful. I don't like her.

I was explaining the situation to a woman at the gym one time (of course she helped her "dear mama" a lot), and she looked at me and said, "You shouldn't be involved with your mother." The hostility must have been obvious. I said, "You are right." I wasn't given a choice, though. If I'd refused the car-in-exchange-for-transportation deal (which of course includes a lot more than transportation, although I've greatly pulled back on the other expectations), I don't know what would have happened.

IF/when my mother ends up in an AL, it will probably be local. But if she qualifies for a SNF/nursing home, I'm going to push that she goes out of state to be near one of my brothers. I've read how we still have to be involved, and I am not willing to do that. (I read last week that nursing homes don't take care of residents' teeth, and a family member has to brush and floss the resident's teeth? NO THANKS! And never mind the million and one things she would want to complain to me about.)

I will never be able to get her screaming fit out of my mind, the one where she screamed that I was "not right in the head." And all because I pointed out to her that 24/7 care when she was nearly helpless for 8+ days because she strained her back would have been AT LEAST $2000. (Of course I got nothing.) She screamed that I was a liar, that it was only one or two days, she didn't need me there and that I was trying to take advantage of her.

After that, I fully document every hour I spend with my mother and send a summary to my brothers via email. They don't even reply most of the time. But it's there, and if I ever needed to prove what I've done, there it is.

I don't think my mother would have the wherewithal to change her trust (split 4 ways). And it costs more $ to change a trust.

She refuses to see a geriatric psych, and refuses to even allow me in to see the doctor anymore (she doesn't care if I know what they say, but dislikes that they talk to me sometimes and not her). I'm also not to be involved with anyone else, as she handles all of her own affairs.

She is slipping cognitively, but is a long way from being declared incompetent, so I've accepted that she is creating her own future, even if it's increasingly becoming physically unsafe for her.

Thanks for letting me get all of this off my chest.
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Make it a contingency care plan, fleshing out as many options as possible so that if/when a crisis occurs, you've already done your research. But start little by little as CWillie suggests.

I suspect that the holdouts may be unsure of what to do, hoping nothing will happen that necessitates more involvement, and when a crisis does occur, will be too unsettled to help.

Accepting the drastic changes that occur as people age and face crises is I think probably one of the hardest things for adult children to do. They just keep hoping it won't happen, are very unprepared and indecisive when it does.

I've been through that and I'm sure I'm not alone.
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This is difficult and i witnessed same with my mom AND HAD A SUPPORTIVE SIBLING -- I too was long distance and worried about my mom and her inability to take care of herself -- but without POA (and incompetence declaration) -- you have no legal authority to make mom move or accept in-home services/care. Elder, even with dementia has legal rights to make their own decisions -- even if poor ones.

I suggest you start by documenting all your observations, concerns, dates, times, etc. to build a case. Send a copy to mom's doctor (ask him to review prior to mom's next visit and schedule an elder evaluation including physical and mental health workup). Try to make an appt when you can be present with mom at the doctor or have one of the siblings attend with mom. That way you should get a clearer picture and professional assessment of mom's needs and abilities.

Following that, talk with siblings and collectively maybe approach mom to at least allow a skilled CNA or other to come to house 4-8 hours per week (maybe 2 days a week) to help her with household chores, grocery shopping and maybe preparing meals for mom.

My mom refused all help and assistance, doctors diagnosed dementia (several) but none would step up and declare incompetent. I was one of those you mentioned who had to wait for the crisis and there were several, but until there was a big one (she flooded house and fire dept came) -- and social services, family, and residential care facility all had to beg doctor to finally sign incompetence to get mom placed in memory care.

I hope you and your siblings have better luck. I worried constantly, knew my mom was struggling and couldn't even cook for a year -- but she had her legal rights which I had to honor (short of taking guardianship -- which is a route others warned me DONT DO).

Maybe your mom will be more cooperative with all sibs gathered and talking mom through it. My friend did a sort of intervention with her sibs and parents -- and though parents didn't want to listen, they finally agreed to try the change and they were placed in assisted living (shortly thereafter dad went to on-site nursing home).
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First I would check into the title to her home and remove ownership. If she goes to a nursing home, not by choice, assets are involved. I believe there is a 5 year back rule but check it out. Next, whichever sibling she will listen to, needs to explain she is not 25 anymore and slow change is better than abrupt change. My mother fought me, hearing aid especially. If they can't hear, they manifest what they think they hear and this to me, expedites dementia. Many elderly don't want to be a burden and portray the I'm still good. She needs a portable commode next to her bed or over her toilet to make the seat higher. A hospital bed would be great for her to elevate her legs when she sleeps to alleviate pain from arthritis in her legs. Furniture should be thinned out to prevent fall risks. Someone should do her grocery shopping for her to ensure she eats right including some sort of vitamins or Boost drinks. I got a Trend Secure Lynx camera in my mom's bedroom which I can watch her in real time while I am at the store, etc. from my cell phone. She would need internet service, but my mother loves watching youtube as so many of her old shows I can type in, Bonanza, etc.
'Good luck.
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I remember visiting my parents a few years ago and then explaining to my sister that they don't seem to be doing so well. (I lived 500 miles away, and there were a couple people who gave them some help). She said they seemed fine when she visited a few months earlier, and on the phone everything seemed okay. I insisted that if you just make a trip I think you'll understand what I'm talking about. She came, and her reaction was along the lines of "OMG--we have to DO something!" Because the situation can change considerably over a short time, getting siblings to see the CURRENT situation can give them a real eye-opener and motivate planning. To take off on the old Ford tagline: "Have you visited your parents---LATELY?"
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Wonderful answers! And I have to write down CWillie's phrase, it's "the thin edge of the wedge", that's the exact idea! Working in elder care I've seen many times of when an elder gets their back up, one woman was just known for not letting a helper come in. They paid to have help come anyway, and I too sat in the parking lot, waiting. Next time I asked to come in and use the phone for my job, and she said yes, and in the process of talking nicely about some aspect of life, she kept talking and I stayed, and just helped a little - and turned out her internet was not connected and I fixed it. While there, I looked and actually didn't see much I could do, but that's the method, someone who can give help without waiting for permission, but be ready to back up with good cheer, if refused, and stay engaged. Eventually that woman got used to a few helpers, and even enjoyed the company.

I like all the ideas - when visiting, see what's missing and provide it, without trying to have anyone take over the whole control. Stay in the conversation with siblings, and also do research - I investigated several nursing homes myself, just went to visit and in that process I found one with a setup that my brother would be able to like and enjoy. They have taken good care of him, and by now the other brothers like to call and visit more.
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I don't know why there is so much resistance to assisted living, except for cost. Meals, companionship, activities, scheduled transportation are provided, sometimes physical therapy is available. Better than living alone, I would think.
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This is an excellent discussion about probably the most common problem for caregivers.

Before my sibs passed away I made the long trip to see my folks only once a year. I could see they were aging but nothing was scary. My sister and brother died within 2 years of each other and as I spent time at home dealing with these tragedies I realized that Dad was developing dementia and how moms mobility had declined drastically.

So I went into panic mode, got all the legal, poa, financial stuff started and sorted out the medical issues. I ran around the first year or so like a nut, cleaning, fixing, shopping and trying to get them to move to assisted living. After losing that battle I fought them about getting help in their home. Lost that battle too.

Every time I’d leave for another long trip to check on them I’d swear to God in heaven, and anyone else, THIS TIME THEY ARE GOING INTO CARE!!

After my last battle with the folks I came home, didn’t feel so good, turned out I was having A Fib. So had  to go through the cardio factory of tests and so on.

I’m doing better now. No more battles. Yes they should have moved 5 years ago. No they don’t eat well and they mess up on their meds. But they are not “Legally” incompetent. The furnace and tv is working, they still can use a micro wave.  I’m in more of a monitor mode now.  The crisis will hit and away we go.

I’ve accepted that this is what they want and all the previous battles, tears and angst was about what I wanted. It had become a power struggle.  

No, It’s not fair to me. They didn’t prepare for this, I had to do it all, but that’s the way most old folks are. I can already see myself in my father. Like double OMG!!

But overall my folks are “Easy Keepers” compared to all the horror stories that land on this site.  I’ll call mom this afternoon, make sure the tv and furnace are working.  Monitoring.....My new mode of caregiving.
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