When aging in-laws live out of state, how do adult children provide care?

Sometimes you have to wait for that trip to the ER then tell the powers three that the parent is unsafe living alone and that you live several states away and need the parent needs to consider assisted living.

Ideally the place to start is to find out if they have all their legal ducks in a row: assigned medical and financial PoAs, Living Wills (Advance Health Care Directives) and assigned Medical Representatives (this is a HIPAA form that you request at their medical clinic for each doctor that permits the medical team to discuss your parents' private medical info with you without them being present). No one will be able to help them much without having the legal means to do so. And banks have their own PoA protocol, sometimes requires the account holder to come in with the PoA and create their own paperwork, or be joint on their accounts.

You should maybe consider paying for them to consult with an elder law attorney to create this paperwork and they can ask the lawyer anything and he'll give them unvarnished answers and a dose of reality -- like if something happened to them with assigning a PoA then it ties the hands of their children to legally manage their care and they'd have to pursue guardianship through the courts which is expensive, and the only other option is to become a ward of the county.

In the end, all you can do it give them accurate information so they can make informed decisions, assuming they have enough cognitive clarity to understand. Mild memory impairment is not as big an issue in creating legal docs, but impaired ability with reason and logic would be. The attorney would take each of them separately and privately perform a brief interview to assess their abilities to comprehend what they'd be signing, so there's no concern for coercion or abuse.

Also, you can have them read some of the posts from this forum written by distraught and burned out children who are valiantly attempting to help parents who didn't prepare for the inevitable. I was raised Catholic so I'm fond of using guilt because it is a potent motivator in some cases ;-) Wishing you much patience, wisdom and success.

Definitely make sure their paperwork is in order and whoever is POA should have a copy of it.

Will they consider AL? At least there is someone there to help the spouse that is not in the hospital etc.

This situation is tricky.
Get all Paperwork necessary together. Getting a stubborn parent to get a POA can also be challenging. When they believe they can do it all. That was one of my most challenging aspects with .y aging dad. His refusal to give control of his health or finances even if he knew I would not be able to do anything unless he was declared incompetent.
AL is usually also a absolute no. They don't want to give up their freedom or spacious living.
The hospitals generally won't help you place them. Our neighbors mom has been in hospital 9 times every thing from broken bones, burns, etc. While it was suggested for AL coerced or forced choices to an elder can equate into elder abuse. It takes an evaluation that confirms the elder is not competent to make a good decision.
I would just keep suggesting to your parents you love them, and worry about them and you would feel better if they would consider moving into a place where they could have a care tea. In event of emergency. You could consider an emergency button.
Best wishes.

Sometimes the parent is willing and wants to move. Is that your objective?

Otherwise the children need to help them with shopping for a new place and moving. I would guess that none of the children are offering to move closer to them and I wouldn't anticipate that. It feels the same for the folks. They likely want to remain in their home.

Could they bring in help? Remember do it legally by talking to an elder law attorney to prepare caregiver agreements first. Folks probably will not agree to that either. It is EXPENSIVE! Maybe they are situated that they can pay for that or they have a long term care policy?

What can help in the immediate future is to find a geriatric care manager. They could check in on the folks on a regular basis. If there is a hospitalization they can monitor that situation and their needs. https://www.aginglifecare.org/.

Good luck, this will be a journey. Do not expect the folks to do anything you wouldn't want to do.

My next-door neighbor is 92 and lives alone in a 2-story house (no full bathroom downstairs). Her children live hours away. She still drives, but not that much. She had hip surgery a year ago, and she would have gone to rehab afterwards, but her dr. didn't want that because of covid-19. There was no plan, so of course the sole D became the plan. She had to come down to be w/her mother for about 5 weeks. Sometimes one of her 2 brothers came down on the weekends. And then the mother went to stay with the D in her home, and maybe in one of the son's homes, too.

The mother is back now. She did have a helper come in the afternoons most days, but that has ended. So she's all alone now. I guess her children are waiting for the "event" to happen to force a permanent change. Their mother is very stubborn. This is a common tale.

Any type of family discussion is the first step. So they don’t want help. OK. Ask for a talk about what they do want now and about their future plans. Talk about an additional emergency “just in case”. Get in some more together time to get started and don’t push for resolution. Just get “your foot in the door”. Meanwhile, on your own, check out what is available (for every scenario.

My parents have had their ducks in a row for 20 years or so! Now that they are 94 living alone with minimal support the issue is getting them to commit to increased help and/or AL. My mom who is now showing dementia has every reason why any suggestion won’t work and my dad goes along to keep the peace. My dad always wants a family meeting but they turn into hours of mom rehashing everything that hasn’t gone right. We have put our foot down to only meeting for the purpose of planning or moving forward. It’s very hard, sad and frustrating to sit back and now wait for an event or for the two of them to reach out to us. Even with financial and health ducks in a row doesn’t mean the end is smooth sailing. Glad we’re all here fir each other!

If there is a friendly neighbor who you could call and they would check on your in-laws as well as watch them for you that would probably help for awhile. However the only way you are going to really resolve this situation is to move your in-laws, or have a family member live with them. Who has POA?

I have worked in home healthcare for almost 30 years as a caregiver, as a home health aide or nurse. You have asked how to make the realize they need help even though one of them stubbornly thinks they can do it all themselves? You can't. NO one can. This is one of the hallmarks of dementia. They cannot be reasoned with. It is NOT that they see what their problems are and just will not admit those problems, They CANNOT see them. Again, you cannot reason with a dementia patient and why you try to, you will only become frustrated and angry. So.. what to do? Agree with them and then go do what you HAVE to do to keep them safe and out of harms way which means, keeping them from harming themselves. Please get rid of any guns out of the house. Call Adult Protective Services, Talk to their primary doctor about what is going on. They can advise you. When it gets to the point that you describe, they need someone to be their advocate, to make the decisions that need to be made on their behalf. Leaving them home alone puts them in danger of not only maybe cooking and leaving a burner on and burning the house down with them inside, but setting fires to others homes nearby. They won't like what you do "for them" but you must. You have no choice. Again, someone has to make decisions for them because they no longer know what is right, what they are capable of.

We have faced that problem. Our family lives in Florida. BIL's family lives in California. In-laws live in Hawaii. BIL was asked by in-laws to manage their affairs. He flies out there at least once a year.

It became more of a problem when FIL developed end stage dementia and kept MIL up all hours of the day and night. She stopped feeding them both. When BIL visited, both were emaciated. He arranged meals for them and cleaned up their home but no day-to-day caregivers. FIL ended up dying later that year of dehydration and organ failure.

MIL ended up in hospital a year later with urosepsis. I "think" social work became involved and may have involved authorities since we can never get a straight story from BIL. He was "told" he needed to put full size refrigerator, full size stove, and hospital bed in their condo. They had round the clock home health aides. Nobody was allowed into her condo to visit per home health aide.

Now, MIL has 2 fulltime caregivers that take runs living with her during COVID. We call her primary caregiver for updates. We can see MIL via Facetime.

All this to say, you can arrange "services": meals, housekeeping, lawn service... The most important "service" that aging parents need is daily check-ins by caring family and friends.

Someone in the family needs to visit them for at least a week to learn exactly how they are managing. Some people at their age can manage fine on their own; others are good at hiding their deficiencies. Being in the home for at least a week will help you know whether they are current on meds, eating well, keeping house clean, keeping themselves clean, etc. Of course, at that age, the situation can go downhill very quickly.

I think it's time for out of state kids to start making some visits - like a week or so at a time. That's the only way you will see what the needs are. Are they doing unsafe things in house. Are they fixing meals or just eating junk because it's easier. Try to make the conversation about YOU when talking to them - "I" would feel better knowing someone comes in each day especially after that last medical emergency. Or, that last medical event got me thinking about what someone told me - the doctor can send a nurse to the house weekly to check on things, he can sent physical therapy, etc.

If they know their neighbors, offer to pay someone to drop by each day and observe the living situation and report back to you. Would be some extra cash for an older teen or college student who is mature enough to check things out. You need some eyes in the room on a regular basis.

There are "solutions" Some none will be happy with, others some will not be happy with.
There are Care Managers that can be hired. Not inexpensive. And I would think "Iffy" in an emergency unless they are contacted right away.
(You do not mention In-Laws in your profile so not sure what their overall health is)
A move to Assisted Living or even Independent Living would have a "community" around them so if something happens they will not be alone when it happens so care might be more prompt.
Moving them closer to one of the other family members might be an option. Or less likely a family member moving closer to them. (neither ideal as the "lucky" family member may become an unwilling caregiver.)
another option would be to hire caregivers that would come in a few times a week to check in on them do light housekeeping, fix several meals if needed and in general make sure they are alright.
(this is with the assumption that there is not a diagnosis of dementia with either or both. If there is then more aggressive measures should be taken.)

IF no one has POA for health or financial decisions that should be done.
Does your husband or his siblings know what the health care wishes are of the parents? If not that should be discussed. A visit to an attorney that is versed in estate planning, elder law might be in order.

* Consider moving them closer to you. I know this is not an easy decision although it may be either that or move them into a facility with levels of care.
* Hiring a care / case manager may be expensive although you need someone to 'manage' care - be it screening, hiring, supervising caregivers - and letting you know how they are doing. I provide a written assessment when I work with family members - who are either out-of-state, in the area professionals, with their own families, or who live close by and travel for work.

PLEASE READ below "Donna F777" -
she knows what she's talking about and I concur 100%.

Gena / Touch Matters

These are all excellent suggestions. The most important info provided is that you can’t reason with them. They do think they’re fine. Nothing you say will change that. Don’t ask them what they think. Don’t give them choices. They can’t give a reasonable answer. Present them with ideas and statements. Use the kind of person they are to your advantage. If they are generous, thoughtful, service minded, etc., use that.

In my support group we talk a lot about “lies of love”. In order to get assistance or services we’ve told our loved ones lies. Sometimes they accept different ideas. One person was able to bring in a part time nurse saying the nurse needed the work so they were helping her. One person hid paperwork that needed signing in another stack of bills so they could get access to finances to pay the bills. Thankfully many financial things can be managed online. Tell them someone is knew in the neighborhood and wants to be their friend. They don’t need to know the person is being paid to visit. I started managing the cash in my husband’s wallet so he couldn’t over tip waitstaff at restaurants. (He once left a $100 tip for 2 cups of coffee!) You do what you have to do to make sure they are cared for. As long as it’s done out of love (and the rest of the family understands) there is nothing to feel guilty about.

I agree, someone needs to visit for a week just to see what their needs are. Someone needs to be POA and at their age I would try for immediate. This so you don't have to get them declared incompetent with the Springing type. Not that you need to "take over" at this point but you will be able to step in when needed. Unless Dementia is involved, ur in-laws should be able to make decisions for themselves. My Dad was 79 when he passed. Mom was 78 and she always handled Dads emergencies. My MIL handled her own stuff till she was 91.

Don't treat them like children. Sit down and say "You have had some emergencies lately and we need a plan in place in case there is a next time." Maybe plant a seed about them moving closer to one of the children. "What do you think about moving closer to one of us? That way if you have this type of emergency again, at least one of us is close by. No decision now, just think about it." My daughter has worked rehab/NH for 20 yrs and she says "let them think they made the decision". She used getting a bath as an example. She doesn't say "do u want to get a bath" because the answer is no. "Time for a bath" may get a no. When she gets a no she says "Mrs M wouldn't you feel so much better with a nice bath and clean fresh clothes" Mrs M agrees because she was allowed to make the decision.

TG my MIL had good neighbors because she lived 16 hrs from us, 12 from another son and 8 from the son who held the POA. But I don't think we should expect neighbors to help out. These neighbors could easily be taken advantage of and we have read of this on the forum. One OP the neighbor started relying on her too much and the woman needed more help than the neighbor could give. Thats when family needs to get involved or u call APS.

You can only do the best you can. If they are still able to make decisions on there own there is not much you can do. They make decisions until they can't & they live with the consequences of their decisions. Going thru this now with in law parents 96 & 86 yrs. Tried many times to get different things set up, house cleaning, in home care, meals, POA's you name it. They are both one fall away. Yes it happened wife now in a care home & not doing good. Husband scrambling to try to get things done now. He doesn't drive. Siblings all live out of state. What a mess, but they created this. It's so sad & hard it didn't have to be this way. Good luck & hope your journey is better.

Imagine how you would feel if someone was having this conversation with you before you start. We will all be there someday if we are lucky enough to live that long.

Consider and respect their need for independence. Listen. Respect their decisions. Implement and honor them - do not interrupt. Virtually any course they choose can be followed.

So many people are not given the grace to make these choices for themselves these days.

I had done this the last two years, well let’s go longer than that how about 10. Start making sure things are in place . Medical POA, durable financial POA, will, DNR etc. Get educated on Medicaid.

Make a list, of all accounts/ get signed up for online banking,
make certain that you’re able to get information by having your loved one giving permission for you to talk to the various companies. I hadn’t done that so I was stonewalled a few times. But since I have all the passwordsSecurity phrases etc. I was able to get the information I needed
Make sure you have Social Security numbers ,Medicare numbers, insurance numbers , doctor numbers , basically all the information that you will need to transact with.
I took over paying the bills probably three or four years ago, should’ve done it sooner.

and don’t take your loved ones word for how well they’re doing. My mother wasn’t doing as well as I thought. I thought she was handling her medication pretty good. Even when I came to visit I thought that. Not until I got her placed into an assistant living but I realize I was wrong.

Amazon is your friend along with Instacart. grocery deliveries.I also used Costco.

Contact your counties aged and disability departments. They will have all kinds of information to help you along this journey

I started with having in-home care come in, and yes she sent them away, and yes she paid for someone not to be there, but I persisted. Eventually she accepted it.

I was able to move my mom into an assistant living. It was difficult she didn’t like it, she made waves. I have just recently moved my mom , here by me. What I did not do , that I wished I had, was toured some of the assistant living places here. I had always known I was going to have to move my mom from where she was , when she ran out of money. I found there are a number of good assisted-living‘s by me , if you self pay for one, two, or three years , dependent upon the company, will not make you leave or make you share a room, whatever there company policy is, when going on to Medicaid.m I’m lucky I found one that was only a year.

it’s a process…

There is actually nothing you can do about it if your parents want to stay in their own home except hire a Caregiver to show up a a few hours a day or week or whatever is needed. Hire a yard guy if Fad is trying to do the yard. Have them wear a necklace in case they fall.

Inite them to live with you.

NotMyFamily: I hear you; I truly do. In my case, my late mother was adamant about living alone in her own home seven states from mine. I had to move there and in with her. I do NOT advocate this.

You might check into hiring, or at least consulting, a Geriatric Care Manager in their area. Then when the inevitable accident happens you will have someone nearby ready to jump in and deal with things until you can get there. https://www.coasc.org

Also, prepare a list of all the legal documents, medical release forms, doctor and medication lists, etc. that might be needed. Then sit down with the parents and review the list. Tell them that all of this information will be needed at some point and someone, doesn’t have to be you, needs to know where to find the information.

When Mom ended up in the hospital with a broken hip Dad and I searched for a week to find the checkbook she had hidden away! After that I gave them the information about drawing up wills and POAs. I told them that SOMEONE needed to be trusted to act for them if they were incapacitated. It took several years but they finally did it.

You do not move and you do not take them into your home. You work with an eldercare attorney to make sure you have the Power of Attorney, they have a will and do whatever else is needed to make sure their affairs are in current perfect order. If they refuse then back off and simply tell them they are on their own unless they cooperate. If possible, hire someone to look after them and their affairs and be up to date with you. If all else fails, face the fact they will do what they want and will have to lie in the beds they make. But you must protect yourself in advance to the maximum possible because it will eventually hit you in the nose. You get very tough and make them know there are now rules to be followed - or else.

In whatever plans your family makes for your in-laws remember that the said in-laws are the responsibility of all of their children not just the female children.