<p>Sometimes folks are cannot understand how much help they may need to live safely and have no good understanding of how much that will cost. Sometimes, TEMPORARILY living in assisted living allows them to return to living independently in their own homes or gives them more insights about what options may be needed or make sense.</p>
<p>I think many have a more idyllic view of what living in their own homes looks like & feels like than the reality, especially when 24/7 care may be needed to make it possible. People don’t understand the things that are taken for granted in daily living until someone needs to be hired to be sure these things. </p>
<p>Blaming others and second-guessing these tough decisions really is counter productive. Everyone makes the best choices they can with the info they have at the time. There are pros & cons of assisted living and of course there are days when everyone wishes there were more and better options. I think it’s cruel to share the info that your cousin shared that your mom would have stayed in her home–that may have been one of her blue moods and may NOT have accurately reflected how she generally felt; even if it were true, how mean-spirited to share info that can’t now be changed and makes you sad and upset. It may not have been safe or even within her budget to remain in her own home with all the care she needed. It DOES cost money to allow folks to remain safely in the environment they prefer–it can be A LOT of money and supervising their cadre of healthcare workers is not for the faint-hearted.</p>
Not judging teriwtt’s situation at all but in the case of my family I’m sure my Mom would say the same thing … however she does not have the judgement at this point to make the choice … she has Alzheimer and did not want to move to assisted living, go to adult day care, to bring outside help in, or see the need for a family member to be with her at all times (or to give up her license). As her Alzheimer’s progressed she was a wandering and was not safe near any electrical or mechanical appliances … so for 6 months my Dad, sister, and I rotated full-time coverage for her at home (over her objection) … eventually when we all wore out we “forced” her to go to first outside help in the house, then adult day care, and eventually assisted living. Neither choice was her preference but her choices were not rational, in her best interest (although I tend to bend over backwards to respect the wishes of elders), or fair or reasonable to the rest of her family. Deciding when she had passed the line of being able to decide for herself is the hardest decision I’ve ever been part of.</p>
<p>My mother lived until 98. She needed help to do just basic things like get out of bed, bathe, eat. In the end she lived with me. I had a live in helper. We had all special furniture. All the docs visited. Physical therapists visited. Blood work was done at home. I was the pill lady. Himom, when you wrote that last bit about not being for the fainthearted! :)</p>
<p>I’d recommend reading Gail Sheehy’s Passages in Caretaking–or close to that! Fessing up, I haven’t actually read it; I just went to a talk she gave about the book. She has a lot of good, practical suggestions about how to face issues like this.</p>
<p>I applaud those who are willing and able to allow their loved ones to live in their own homes or whatever their preferred environment is. As you say, Overseas, it is a major job for those who make the adjustments to make this possible. For the woman in our case, she does not have a lot of people who want to hover over her. Her nieces & nephews are very busy, as is her brother (all working or in school full-time). Her children & grandchildren live elsewhere and are busy with their lives. She has been a loner all her life and has not attracted many people to her life.</p>
<p>HImom, there are such things as gerentology counsultants and care services where professionals will come into a home and do an assessment of what’s needed. That can range from offering suggestions about staff help, making the home safer for someone, meal and transport services, and so forth. [National</a> Association of Professional Geriatric Care Managers](<a href=“http://www.caremanager.org/]National”>http://www.caremanager.org/) This is something that the children can set up remotely. </p>
<p>I’ll second the advice about being careful to be nonjudgemental when talking to the California-based children, though it sounds like you don’t need to be warned about that regardless. We’ve had the unhappy experience of being blasted by my in-laws’ neighbor for our lack of caring. Of course, the neighbor doesn’t know “the rest of the story” (including how we’ve struggled for years to get my in-laws to accept help), nor are we inclined to share it with her. </p>
<p>teriwtt, thank you so much for your words of wisdom.</p>
<p>Actually, I like the CA children & get along OK with them, but know that they really don’t have any means of getting a good picture of how their mom is doing. These situations are so difficult and I am trying to give them some accurate factual information so they can make choices that are as informed as possible.</p>
<p>Thanks for the info about assessments that can be done remotely. It seems this has all come to a head so recently that no one has a good sense of how things really stand and now suddenly or gradually it has been brewing.</p>
<p>I can readily ID with the adult kids who are not living in the same state as their mom–so tough for them to have a good handle on things. We are all so busy with our own lives, it is hard to figure out how to add more and take care of these delicate situations. Life seems so much more complex these days, with so many competing needs and problems, especially when folks live until their 80s, 90s & beyond. I can see that this will be an issue as my relatives tend to live a very long time–uncle recently died at 107 or older; he lived at home with his wife and housekeeper until he & W died.</p>
<p>My siblings and I have had many, many long talks with dad, especially in the last several months. He had a major health scare last summer, and he is finally coming around to the idea of moving closer. He seems especially attached to his house, something I’ve noticed with other elderly folks - it’s all about the home and what is familiar and comfortable. While I appreciate and understand this, I’ve tried to explain to him that he needs to put people first and houses second. I’ve assured him that he’ll love a new house too; in fact, he has always appreciated whatever house he’s lived in throughout his lifetime and I know that once he moves, he will be fine. We also explained that realistically, he’ll most likely have more years of living in his own home near a relative than he would far away.</p>
<p>We tried in-home help several times and he always ends up having a “personality conflict,” and firing the person. They talk too much, don’t do enough, don’t do it the way he wants it, they don’t listen…and he just doesn’t need them!</p>
<p>I think everyone likes what is near and dear. There are a LOT of memories and neighbors in the neighborhood that people have lived in all their lives, but it is so tough when geographically folks are spread so far apart. My folks fortunately have many of us living a 5-10 minute drive from their home, but it’s just the two of them in a rambling 4-5 bedroom home. Not sure how things will play out, but hopefully we will all be able to make things work for them. Changes ARE harder as people get older and very attached, especially as loved ones move away and die.</p>
<p>Actually I did not see it as cruel at all. That was certainly not her intention - she was a very attentive niece and is a very kind cousin. She just had a different sort of relationship with my mom, and saw her more often than me. I think she and my mom had the kinds of conversations that my mom wished she’d been able to have with me, had I lived closer and seen her more often. But H and I made a choice to live far away due to his job opportunities, and with that, I had to accept that it would make some aspects of the relationship more difficult. So I am at peace with it, and the fact that my cousin (who was named after my mom) was able to provide that kind of relationship that I couldn’t, sort of brings me some comfort. My mom, herself, chose to live away from most of her family due opportunities for my dad, so I knew she understood and would respect us when we made the same kind of decision. </p>
<p>In regards to the costs, thankfully my mom had long-term care insurance, and due to her chronic illnesses, was able to use it toward rent in her assisted living facility after the initial deductible of a couple of months. In our area (where I presently live as well as where my mom lived) there are not such huge differences in costs between having live-in help vs. moving to assisted living (or paying room and board at a skilled nursing facility). It’s more a matter of preference. My mom felt really conflicted over the idea of someone living in her home with her, which is why I think she was rather silent about the suggestion of moving to assisted living. And it’s true, some people just will be miserable and paranoid if they choose to stay in their home with a live-in, so their next best option is assisted living. If she had voiced her feelings and been more adamant, perhaps my brothers might have realized she needed to explore her options a bit more before so quickly agreeing with her that moving was the only answer. But part of that was her fault for not being more articulate. Even if she hadn’t had the long-term care insurance to pay for the assisted living, her finances were such that both staying in the home with a live-in and assisted living were options. Finances really did not play into the decision.</p>
<p>I meant to add that when any dementia/Alzheimers figures in, all bets are off. At some point they do need intervention as it becomes a safety issue for others and they are not competent to make decisions for themselves once the dementia sets in. However, some people do have that conversation ahead of time, i.e., what an elderly parent would want their family to do if they develop dementia, and from that perspective, a family can do their best to honor their parent’s wishes within reason.</p>
<p>That’s a situation where more intervention, rather than less, might be important. From what you say, HImom, this woman perhaps shouldn’t be driving. Elders should be allowed to make their own choices even when that results in premature death, maybe-- but only when that premature death is their own. An unsafe driver (if that’s what she is) shouldn’t be on the road. She shouldn’t be taking chances with everyone else’s safety.</p>
<p>I have little patience with unsafe drivers who “need” to be on the road. I need not to be struck and killed by drivers who have no business behind the wheel, and who selfishly insist that their convenience overrides someone else’s health.</p>
<p>We set up meals on wheels for my mother when she was ill, but discharged. At first she was resistant, but then enjoyed the visit and the convenience. We also were able to work with the social worker at the hospital to have a visiting nurse do an assessment and then visit twice a week. Home health aides were an option, but my mother was upset by so many ‘visitors’ so we backed off. I think a cleaning lady is also a must, if you can find one, to make sure laundry is done, beds and towels cleaned, and bathrooms and the kitchen kept clean. If you or someone can set up some assistance, she may be able to do fine. I have three elderly that we keep tabs on…mother in law, father in law (divorced) and my mother. The cleaning lady is the biggest help…she often runs errands for my inlaws who share the same cleaning lady and she keeps tabs on them for us.</p>
<p>Good news–because of my e-mail & some other conversations, the son is working out his schedule & has spoken with the medical social worker and will be coming for a visit to see how things are and help his mother make some decisions about her care. He has a better handle on her finances and might be the one to persuade her to stop driving (she is totally deaf in one ear and with her current history of at least two recent strokes, hopefully he can persuade her). </p>
<p>Unfortunately, it will only be a very short visit, but at least perhaps he can take her around to explore some of the options in the neighborhood. There are some very nice extended care options nearby that MIGHT be good for her to start considering. He is a good and very devoted son, so I think he will help her explore the options that could work best for her. Having her get a driver to help with errands and taking her to evening events would also be a good thing.</p>
<p>Sorry, Teriwtt, that your mom decided she wasn’t happy with her choice and wished she could have chosen differently. You’re right that time needs to be taken to explore options so that people can have what works for them, to the extent possible, with resources that make things work.</p>
<p>I am fortunate that I had a very close relationship with one of my aunts as well–probably closer than her kids who mostly lived out of state. She chose to live in a senior/retirement community so she would not become a burden to her kids & loved ones, since she had cared for several as they aged. These are tough issues and so hard to KNOW what will work best–so many variables.</p>
<p>Amen, Cardinal Fang. Some of us discussed this recently on another thread, but it can’t be overemphasized: We must get our elderly unsafe drivers off the road before a horrible accident happens. We shouldn’t expect them to like it, but we can’t allow them to endanger others. We just can’t.</p>
<p>HImom: There have been several cases where I believed my dad was being discharged prematurely. I’ve spoken to discharge nurses and even doctors about it; what I say is: “He cannot do any of his own aftercare, and my mother cannot do it for him. He is unable to take care of any of his own medical needs. If he’s released now, I’m afraid he’ll be back this afternoon [which has happened twice – and apparently being rapidly readmitted is considered a very bad thing in hospital-land]. If you feel that he no longer needs hospital care, please discharge him to skilled nursing.” And they’ve always done exactly that. Maybe this approach would work with your relative.</p>
<p>ETA – Oops! I posted before I read your last post. I’ll leave it, though, in case it might help someone else who’s trying to prevent the early boot out of the hospital.</p>
<p>Unfortunately, the medical social worker insisted that she’s fully capable of attending to her activities of daily living and NOT suitable for skilled nursing, which she refused in any case. I shared the contact info with the medical social worker with her son, who also had a very long discussion with the medical social worker.</p>
<p>I believe the son is very caring and capable of helping figure out good choices with his mom. She seems to listen to him more than she does most others (she is EXTREMELY stubborn). Fortunately, her good friend has agreed to spend the night at her home tonight & they will install the emergency medical alert system in her home tomorrow & the son arrives Thursday.</p>
<p>They taught her how to clean the wound for her IV & she showed them she was capable of cleaning & changing that bandage, tho she joked that she doesn’t even wash her hair but has the beauty shop do that (true). They said that tho she does get confused and forgetful, she is EASY TO REORIENT, so they think that’s “fine.”</p>
<p>My sister says it is really up to her adult kids to figure out what to do & how to get her to choose an option that will work for her & keep her safe. She wants them to take a more active role–both have empty nests and no spouses so she is irritated that they are so slow to step up.</p>
<p>Denial runs strong and it is not easy to face loved ones aging, especially when they always say, “everything’s fine–leave me alone.” Will see what happens–no idea how long the son plans to remain in town and what he can accomplish in his visit, but shall see. At least, he will probably start some discussion & maybe work with his sister to figure out how between them they can spend more time with their mom–either her coming to visit them or them taking turns visiting her (plus their kids coming to visit as well).</p>
<p>Just came back from a visit–she was very confused about whether or not she had taken each of the two pills she was supposed to take with her dinner. She must have asked about each of them individually and collectively a bunch of times in only 15-20 minutes. She is mostly pleasant and cheerful, but very confused about details, like which med is for what and whether she has or has not taken the specific medication.</p>
<p>I sent an e-mail to both her kids, one of whom is arriving tomorrow and will be going with her & the best friend to her doctor. She happily told us about all-inclusive trips she & the best friend have already bought for Vegas for May and also October; it is one of their favorite destinations.</p>
<p>Earlier today, she also had a lifeline service installed, one that has a device permanently attached to you and can get wet (shower and/or bath). It can and does sense falls and the operator calls you and then the next two people you have listed & then 911 for help. I believe she will be sleeping alone tonight.</p>
<p>She was puzzled about how we arrived at her house and was very surprised when we told her we each drove (though mom arrived at 11 & was there continuously & I didn’t arrive until about 4 or so). She thought we somehow appeared and were waiting to be picked up when we told her we had to leave and each drive ourselves home.</p>