My mother in law has had several health and mobility issues. She lives at home, and is mentally very sharp. She beat breast cancer about 10 years ago, but developed lymphedema which has caused severe mobility issues. She has been prescribed physical therapy, which she's able to do for awhile, but then typically has a set back that causes her to give it up (or billing/Medicare/coverage issues cause her to give it up). She is also diabetic and overweight, which compounds the problems. She currently can't drive, can't take stairs, can't stand for long periods of time, and can't bend over well. She struggles to change her clothes/depends. She doesn't bathe as her shower is upstairs. She can cook and get herself to the bathroom (for the most part). She is able to manage her medication. She has a visiting nurse changing the bandages on the wounds she recently developed from the lymphedema. She has hired someone to come once a week to clean her house, put away the groceries she has delivered, etc. My husband and I live far away, so we're unable to help her in daily activities. I know that she can't continue to live in her current home because too many of the necessities require the use of stairs (entry into the house, access to the washer/dryer, access to the shower). I found a condo that is one story and has a walk in shower, but is that enough? Does she need to be in an AL facility? She's only 68, and feels she's far too young to need AL, but with her complications... I also get all of my medical information from her, and I feel like her doctors are not giving her complete information. She has so many specialists - cardiac, oncologists, endocronologists, etc., and I don't believe they're talking to each other, so it always looks like the thing they specialize in will get better as soon as the issue that another doctor specializes in improves. Her treatment plans are always only two weeks out at a time, and she continues to believe that "someday" she'll be well enough to walk up and down stairs again, but "someday" has been coming for 5 years. I want to help her and I don't want to discourage her or make her feel insulted or depressed, but I worry her current situation is too risky. She's fallen a few times, she's had diabetic issues, she's been unable to enter her house without help and almost hurt the friend who was attempting to help her since they were not physically up to the assistance she needed. I'm don't know what I need to push for? New house or ALH? Talk to her doctors? My husband is an only child and feels out of his depth having to make these tough decisions and have these tough conversations, and I want to help both as much as I can. Any assistance/advice you can offer would be very appreciated. Thanks in advance!!
Things they are considering are *current* ability & mobility & *likely* ability & mobility.
If your MIL had a temporary situation (like surgery recovery) then the condo may be good. But if more long term, as Geaton said, it may be a very short term fix. Then all the work & costs again.
My relative, is still clinging onto IL apt living. Wants to stay "as long as possible". Many falls & really just one bad fall away from "not possible". Will then be hospital-rehab-nursinghome. Could have settled into & been thriving in an AL of her choice for years now.. & a bad fall may have meant more add-on services (not an emergency transfer to some dire NH).
I tell you these stories in case it is useful to consider these scenarios.
All the best with being an advocate for your MIL. She is blessed to have you in her corner.
Without her losing significant weight in order to improve her diabetes and mobility, she will surely be having more problems soon. She needs to at the very least go into a IL community where she can "move up" into AL when she sees it is necessary. She will probably enjoy being with people rather than being cloistered in her home.
I agree that 68 seems too young but I have a cousin who was just diagnosed with ALZ at that same age (and she's had it for a few years but no one realized it). Like my own MIL (who I thought was "pretty sharp") there is a thing called "apparent competency". This means their impairment isn't obvious because you aren't asking her the right questions or seeing the disarray in her checkbook or refrigerator or mail, not taking her meds even though she said she was. If you asked my MIL "How's it going?" she'd give a very enthusiastic -- but very vaguely general -- answer, like "I'm great, just doing my thing!" But when you asked her what day it was, what season, what she ate for breakfast, she couldn't tell you. We were dumbfounded. We only lived 6 miles from her. Please understand that just because your MIL is telling you things with apparent confident does NOT mean she is remembering correctly. An in-person visit would be necessary (and then a doc appointment to test her) to confirm where she's really at cognitively. This will really be the guide as to where she moves next.
Your husband will be in Difficult Land for a while. And his mom probably won't like the poking in on her life but there really isn't any other solution.
Is he her durable PoA? If not, this definitely needs to happen or else managing her care and making decisions in her best interest will be exponentially more difficult because he won't have the legal authority to do so once she's incapacitated. If you do go to visit her, plan to go during the week and maybe make an appointment with an elder law attorney just in case you are able to convince her to go then do it immediately. Wishing you and your husband success in helping her to understand.
Ask her if she would feel better in Assisted Living or in a Condo.
Is she a "joiner" or does she enjoy her solitude? If given the chance would she participate or would she prefer to remain by herself?
Do you anticipate her health declining significantly in the next 1, 2 years? If so maybe Assisted Living would be a better option. If you think she will be stable and the wounds heal then maybe she would be fine in a condo. Would you be prepared to sell the condo in a year and have her move to AL if she declines?
Moving is a PITA (pain in the @ss) and I would not do it again!
But since she is sharp mentally I think this is a decision that she should have the most to say about what happens.
Some places will let you "try on" the community to see if it would work out. If there is a place like that near you see if MIL would stay for a week and try it out.
If she's getting PT & OT, I would think the occupational therapist can offer suggestions for in home alterations to help her ie: a chair lift to get her up the stairs. But, the big problem is diabetes and her being unable to shower. She can and will develop UTIs and other problems from lack of hygiene, and the issues that arise from diabetes alone can kill her!! My SIL just had her foot amputated up to the knee due to a diabetic bone infection in her foot that refused to clear up.
At a minimum, it sounds to me like your MIL needs to live in Assisted Living and have help with twice weekly showers, getting dressed, and all the rest of the ADLs (activities of daily life) that she's unable to manage alone. At my mother's ALF, there's a lady named Linda who's lived there for many years who's in her 60s and has a little dog. She gets migraines (which is her only issue) and didn't want to live alone & care for herself after her husband passed away, so she moved into a lovely apt at the ALF. A person is never really 'too young' to live in Assisted Living, esp if they need help with ADLs. Your MIL is a recipe for disaster with her combined issues and it's only a matter of time before a crisis happens, she goes to the hospital and rehab, and the doctor won't release her back home to live alone ANYWAY. She may as well make the decision to move into an ALF on her own before she's forced into it by someone else!!! Most ALs have a mini bus that takes residents to their doctor appointments on certain days of the week, which would be ideal for your MIL. Most also have doctors/dentists who come into the facility to care for the patients who don't want to travel, like my mother.
Lastly, your DH is not 'out of his depth' any more so than the rest of us who have aging stubborn parents who need help and leave us in a terrible position where we're forced to help them, like it or not. He may not enjoy having the tough conversations with his mother, but it's not YOUR job to do so! It's time to plan a trip to go see your MIL and see for yourselves what's going on, firsthand. Then you can have a real talk with her about what comes next, with your DH taking the lead. She may have to sell her house to finance her stay in AL, and that will have to be discussed as well. Don't wait for a crisis to hit before you figure out a blueprint for the future. And this includes getting a POA written up so your DH can make decisions on her behalf, both financial & medical.
You are about to embark on a journey nobody wants to embark on, really. That's what this site is all about; a whole bunch of care givers getting together to talk about solutions and problems and venting our hearts out. Because it's really really tough stuff, all of this. Wishing you the best of luck coming up with a plan for your MILs future. I hope for your sake she's on board & acts reasonable about it all!