Helping older parents who make bad choices

macamama · January 22, 2009, 4:20pm

I’m going to join the ranks of cc’ers seeking advice and counsel on issues related to the care of our aging parents–thanks in advance for your help.

The issue I’m wrestling with is whether or not to assist my mother in moving from one unsafe situation into another, quite likely worse. A bit of background: mom is in her 80s and has a host of physical and mental disabilities. She’s a long-term alcoholic, substance abuser, has major depression and related generalized anxiety, borderline personality and is a big time hoarder. She’s been divorced since I was an infant, has worked off and on in a professional field (she’s an Ivy grad), and been able to support herself for almost 40 years with a considerable trust fund, now almost gone. She’s also well-read, engaged in civic life, and, when she’s been able to work, has genuinely taken pleasure in helping others (and has been recognized for her distinguished work.)

Over the last couple of years as her physical illnesses have worsened she’s become more and more house-bound. Through the wonder of the internet she has continued to acquire “stuff” at an undiminished rate and the rooms of her house have become almost impassable due to piles of boxes, magazines, goods ordered through the mail, groceries delivered but never unpacked, etc. She has stumbled over the piles a number of times and several of these falls have resulted in hospitalization. She now spends a lot of time in bed huddled under an electric blanket (which has already shorted out once causing a small fire). About a year ago my brother and I began to urge her to consider a move into an assisted living facility–a suggestion she fiercely resisted at first as she didn’t feel she could leave her “stuff.” Long story short, she did finally put her name on a list and has now been offered (and accepted) a place at a reasonably nice facility in her community.

There are 2 problems, however. First, the economic crash has more or less wiped out the remains of her capital and if she moves she will be spending down the rest at about 3K/ month–she may only be able to finance about a year. Her house (which she owns outright) is in terrible condition due to the hoarding and general neglect (roof, furnace etc. need major repairs). Even if she could find a buyer in this market I doubt any bank would approve a loan. So the move puts her in real financial jeopardy. Second, Mom has just disclosed that she intends to take the majority of her “stuff” with her when she moves. Assuming the facility will allow her to do so, she would in fact be in a less safe environment in that her quarters would be even more crowded. I am angry, frustrated, and sad that she is determined to make this move without regard to the consequences. And I obviously have some unresolved issues of my own–the legacy of a lifetime of trying to contain the collateral damage of her choices. I am considering just telling her that I won’t participate–won’t fly down with husband and teens to pack up her house and then stay to execute the needed repairs to her house and try to get it on the market. However if I do so I suspect that my sweet, well-meaning and very passive brother will be left to do all of the above and I don;t want to put him that position.

Would be grateful for your thoughts and advice.

aibarr · January 22, 2009, 4:31pm

My situation was nearly identical to yours. We rented two storage units, with the caveat that in a year, she’ll have to pare down her belongings to ONE storage unit, and then pare things down to just keep them in her two-bedroom apartment at her assisted living facility. Given the time, she was okay with paring things down. When we insist, she’ll throw things out, so it might’ve been easier for us than it will be for you, but in the past she’s wanted to keep pots of broken glass for arts and crafts projects, so…

Best of luck to you. These situations are always frustrating.

NJres · January 22, 2009, 4:32pm

If the assisted living facility is typical, there is no way they will allow your mother to bring most of her stuff. My wife and her sister spent about a week going through their mother’s house after she went into assisted living. They filled up 3 dumpsters, sent a lot of junk to an auction house, saved a few things for themselves and put some stuff in a self storage unit. I salvaged a few tools that belonged to my father in law and several very musty magazines (Fortune from the 40s) , while the remaining boxes went to the dumpster.

ucsd_ucla_dad · January 22, 2009, 4:46pm

It sounds as if your mom needs to try to get herself into the correct mental shape first. The hoarding is a symptom of other issues. Is she seeing a therapist for this? If not, can you convince her to?

I can’t imagine that an assisted living place would allow her to bring much other than the basic items she needs for living depending on the place. Even if it’s the type that’s a more or less regular apartment but with assistance options, I can’t imagine they’d let her bring much of her ‘stuff’ regardless since they have safety and liability to be concerned about (fire hazard, varmint hazard, mold hazard, etc.).

Unless she needs the physical services of an assisted living place it seems that it’s an expensive route and if finances are an issue, just a temporary possible solution that could leave without means she might need in the future. If it wasn’t for the hoarding would the assisted living place even be a prpoposed option? If not, all the more reason to try to cure the problems causing the hoarding.

macamama · January 22, 2009, 5:00pm

I’m well aware that the AL facility may not allow her to import her entire entourage. In fact I very much fear a chaotic confrontation on her proposed moving day. When thwarted she can become pretty unpleasant–profane, calling 911 and accusing others of trying to harm her, etc. If this ensues she may well burn her bridges in terms of care options in her own (small) community. And she does need to be in a safer place–in addition to the falls and the fire she’s had several bouts of food poisoning due to the incredible filth of her kitchen.

UCdad, you’re right of course that she does need to address her underlying mental health issues. She’s had a series of MDs and therapists–she tends to “doctor-shop,” and there’s a pretty consistent pattern. She can be very charming (and is a health professional herself so knows how to work the system) but eventually the health care provider challenges her on something and then she can very quickly become enraged and acts out and is in effect “fired.” (Or she will fire the MD is they don’t give her the meds, diagnosis, etc. she is seeking.) At the moment she has a PCP who is prescribing a (to me) scary array of psychotropics as well as a couple of other specialists for other helath conditions. I’ve tried to get her hooked up with a geriatric/psychiatric social worker the last couple of times she’s been admitted but she is simply too charming–they will call me and say, in effect, “what’s the problem?”

thumper1 · January 22, 2009, 5:12pm

WE moved all of my mom’s “stuff” (42 huge moving boxes that came out of a 2 room apartment…no kidding…and NONE was furniture). However, we clearly labeled the boxes. The ones that were NEEDED were taken directly to her new apartment here. I unpacked them with her watchful eye. Of the remainder, about 2/3 were put into storage, and the rest into my garage. The ones in storage were labeled NOT NEEDED. I did the labeling. Every week I brought over one or two more boxes to unpack. At one point, mom said “this must be the last box”. It wasn’t. BUT I stopped bringing any more over. She never missed a thing that was in those boxes. She was a hoarder also, AND her mantra was “buy two because if the first one breaks, you won’t be able to find a replacement”. You get the picture. Sadly, she died less than a year after moving here. We had to go through all the remaining boxes, had them all moved to our garage…got a dumpster and then had a big tag sale (after putting aside anything my kids wanted).

NewHope33 · January 22, 2009, 5:27pm

Hmm bright, charming and manipulative … would she consider a career in politics?

This may sound unsympathetic, but you could be in LOTS worse shape. Your Mom has agreed to the AL facility. The cr*p has to go of course, but you and your brother are in control of that. I’m sure “being charming” runs in the family and that you can dream up good reasons why everything can’t arrive on move-in day. (A letter from the AL facility manager notifying your family that a list of your Mom’s belongings must be submitted BEFORE the items are moved in might help.) Get your Mom moved in sans junk, store anything the family wants/needs to keep, and hire a house emptying crew to remove the rest. (My brother’s in the business – a few hundred dollars plus the proceeds of anything they can sell on eBay.) Oh, and try to visit your Mom in the AL facility. It’s important that she feels it’s home.

geezermom · January 22, 2009, 6:35pm

Everyone is correct about the hoarded belongings–won’t fit or be permitted in assisted living. My mother had a severe stroke and so we were able to separate her from all the things she had “saved” without too much trouble. Be aware that assisted living facilities do have policies about the level of assistance they provide. Residents who require a higher level of care–including those who are severe fall risks or have disruptive mental health or behavioral/dementia issues–can be asked to leave.

Here’s the red flag for me: Who will pay for assisted living when your mother has spent all her assets? Medicaid only covers skilled nursing facilities, and then only if you qualify, which is harder and harder to do in most states. I have experienced “collateral damage,” too, from my parents’ poor financial choices. It’s not fun when you’re left with the debts and the bills.

I sent you a PM with some more information.

Helenback · January 22, 2009, 11:29pm

I have an alcoholic uncle that lives in those conditions as well–uncooked hamburger in the fridge that’s two months past date. We’ve tried many times to improve his situation but he resolutely refuses. My father is also an alcoholic, although a much higher functioning one. I also have an aunt that died from alcoholism last year. I can see what’s coming, and it’s not pretty. I guess what I’m saying is that the alcoholism is probably central to all of this, and maybe there are resources through al-anon on how to deal with the aging alcoholic. I feel for you, because it’s a completely thankless task.

NewHope33 · January 22, 2009, 11:51pm

IMO the fact that the AL facility has accepted the OP’s mother suggests that the alcoholism is not completely out of control. And there is the house, which should provide at least two years of AL beyond the one year already covered. I vote for the AL facility, even with the many concerns. [Full disclosure: I lost my otherwise healthy mother to a fall in her home.]

macamama · January 23, 2009, 8:55am

Thanks to all who’ve responded with advice and support. Yes, her drinking is (mostly) under control right now, or masked by other medications she’s taking. Admissions screening at the facility was minimal (no medical records check, she just had to sign something that said, in effect, “I’m healthy enough to be here.”)

The house is unlikely to sell anytime soon–it has a rotting roof, a furnace that needs complete repair, roaches, peeling vinyl floors, filthy kitchen and baths, etc. and, needless to say, she has neither the $ or the inclination to invest in repairs or even a thorough clean-up. Since other homes (in excellent condition) in her neighborhood are in foreclosure it’s hard to see how it will sell, though since she’s refused to allow a realtor or appraiser to come in this hasn’t been independently confirmed.

So yes, in addition to concerns about safety I am, candidly, concerned about assuming the burden of dealing with what happens when she runs through the very little cash she has on hand and/or is evicted due to her hoarding and/or acting out. She is unable to live with me or my brother because of her health condition and she has burned through the goodwill of her neighbors, church groups etc. As long as she owns the house she’d be unable to qualify for Medicaid, I assume.

Sorry this is so bleak–I am searching for options that will increase her safety and, to be honest, spare my own family the burden of taking on financial responsibility for her choices at the same time that we are struggling to pay for college and our own retirement (hoping not to pass these burdens on to our kids).

Karpov · January 23, 2009, 9:04am

She could always move in with you.

macamama · January 23, 2009, 9:16am

Actually, her doctors have old her she can’t live with either my bother or with my family because of one of her (medical) health problems. However, full disclosure, we are both relieved that this is the case as her mental health problems make it very difficult to co-exist peacefully with her.

nemom · January 23, 2009, 12:57pm

If you can afford it, consider a professional who can help her downsize her stuff. No matter what she does, that will be a good thing to have done. I hired one to help my mom which was key in enabling her to sell her house and move to a retirement community. The pros can do all sorts of things to help and because they are pros there is less emotional upset involved.
Look possibly at “Erickson” communities which have varying levels of assistance and vow to not kick folks out once they are in and have paid the entrance fee.

ellebud · January 23, 2009, 1:25pm

You have a lot on your plate. You have huge, and separate issues. Speaking as one who has recently assisted an inlaw as he or she (sorry…trying to protect identity) moved into an assisted living facility. The social worker assigned to my in law said that the optimal place for an elder person is living at home with a full time aid. (Her father has such a situation.) Have you considered the cost of cleaning out (forget the emotional stuff of getting rid of the crap) and fixing the house? What you describe can’t be fixed with a good fumigation and a new furnace and roof. How expensive/available are live-ins in your area? If the house isn’t huge the cost of a roof isn’t horrible and with so many businesses needing work you might be able to get some very competitive bids. Weigh the difference between your options AL or home with an aide. At some time you and your sibs will be selling the house anyway, so it has to be in decent shape anyway or sell it at land value. (Oh, and her neighbors will bless you as well.)

And with 20/20 hindsight: You and your brother have to be on the same page. Since you are not in the nearby (is he?) it is always better for the two of you to calmly and separately discuss all the options and the ramifications separately and then present the options (with a white board if necessary) to your mother. My bil told his parent that the parent could live with them…after one week his wife told the social worker that she was ready to shoot herself. So, the parent was off to assisted living. (Living with us is not an option: I sort of don’t like hearing bigotry 24/7 about any groups, but the parent sort of says things, and always has like, to my housekeeper, “Are you a good Mexican? Working hard?”…and no, it’s not dementia, the person has been like that all their lives.)

I will support my inlaw financially and emotionally, I will buy what they need, call and visit a lot (yes, with candy/donuts/bagels for the staff), but not in my house.

anon94785555 · January 23, 2009, 3:34pm

Tough to have to be parent to your parent, but you have to treat her like a child- using techniques above posters suggest (you choose the age level of the discussion/decsion making based on your feeling as to which one most fits). There is no way my F will ever live with my sister or me, B most likely out also, fortunately he doesn’t want to live with any of us and is still competent. His house will be sold some year “as is”, a true fixer upper- unless sibs want to put in (more) sweat equity before selling. Good luck.

pugmadkate · January 23, 2009, 6:25pm

Have you spoken with a lawyer about taking over her affairs? It sounds as though she is still in charge of her money and where she lives. Once the reality sets in about how little stuff she can bring with her, she may very well decide to move back home. That’s burning bridges and wasting money.

I highly recommend doing more pre-planning for moving day. Ideally, the place she is moving too should be helping you with that. Contact social services in her area for a recommendation. A social worker or someone who specializes in elder care can be very helpful in preparing your mother or, if nothing else, helping you and your siblings come up with plans to deal with the issues that will most likely come up during the day.

Another thing the assisted living place should be helping you out with is figuring out how far her money will go and when to apply for government help as her money runs out. Will this facility let her stay on what the government pays? That’s very important to know going into it.

anothermom2 · January 23, 2009, 6:31pm

Sorry to hear about your troubles. I have lived through my mother’s decline and eventual demise, and she had no mental health issues to speak of other than age related. I think that your mom is to be credited with a good decision to move to AL. I think the poster above with the box it and throw it out later idea is the best, and I hope something like it works for you. My inlaws should be in AL, and refuse to go. This will eventually result in some crisis based on the things that are going on, and I will hate to see it happen. However, I don’t see how we can get them to do otherwise, and nothing will change. Take the change as a positive, and just remember, lying about throwing out junk is a white lie…if it helps her it is actually good.

geezermom · January 23, 2009, 7:33pm

For the past few years we’ve wished our mother had a trust fund, but now I realize that, like your mother, she would have spent it all already! I agree that the financial piece is critical. There is no government assistance through Medicare or Medicaid to pay for assisted living. This is something that many in the sandwich generation–and many of our parents–don’t realize until the bank account is empty. In my mother’s state (Maryland) there are county and state subsidy arrangements, but they don’t pay for everything. Does your mother have social security as well as her trust fund? Options include assisted living facilities that charge on a sliding scale depending on ability to pay and (in our area) licensed assisted living group homes that are less expensive than larger facilities. In my mother’s case, the assisted living monitored her progress closely every time she was hospitalized (frequently) and eventually, after a major fracture, told us she could not come back. (We received only a couple of days notice.) I know that they also asked residents with advancing Alzheimer’s to find new homes. They were licensed only to provide certain levels of care (a standard elder care term). Most (but not all) nursing homes do accept Medicaid, but states are making it more difficult to qualify on medical grounds even if you have spent down your assets. You must require skilled care to get Medicaid for a nursing home, and there’s a test based on the “activities of daily living” (ADL) that you are able to perform.

In summary: Our “elder care system,” such as it is, is a bleeping nightmare.

paying3tuitions · January 23, 2009, 10:32pm

My widowed mom got tired of being lonely in her house, declined our offers to come live with us (her 3 sets of “kids”). Instead, she was attracted by all the activities and nearby people at a church-based setting that moves up into AL when that is needed. She’s not a member of the church that founded this senior center, so she had to get her head around that. She can, however, skip their services and commute to her own house of worship in the same city whenever she pleases.

In the meantime, their rent is reasonable because it begins as a senior apartment complex and only bumps up to AL when a person is ready and needful of that greater level of care.

Concerning her house, we showed her the costs of heat and daily maintenance of her house and she reasons that the same money could go towards rent while the house is on the market. Meanwhile, she can be that much happier living in quarters with more to do and people to “charm” as you say.

We convinced her that an empty house looks so much more attractive to a new buyer that it will hasten the day of sale. Her presence, her pets, her stuff makes the house look much smaller and less appealing to anyone shopping for a house. The chance to move in immediately is a positive selling point for many buyers.

The facility required my brother to declare his assets to serve as guarantor, but that’s really just a bridge to cover the time until her empty house sells, not forever. We hope it’ll sell sometime within the next two years, and once she’s not in it, we hope she’ll care a bit less about the price received. WHen a person isn’t living in a house, they become less emotional about it, at which point you can show her that it’s better to lower the price a bit to sell sooner and thus stop paying taxes on it sooner. It turns more into math when it’s not one’s actual domicile.

All the stuff your mom is hoarding is meeting some deep emotional need, as USCD wisely noted. I wonder if you’ve found the best possible new location for her. She should feel a bit of eagerness for it, even if it’s just to go to classes or activities as offered. Maybe shop a bit more to see if there’s a facility she wants more than the one currently identified. It doesn’t really have to be in her home community, as she’ll likely make new friends and if she still drives, can see old friends (or be visited) for a while, anyway.

So perhaps enlarge your geographic circle to see if there’s a place that is just a plain senior apartment complex that has the AL on the same campus, but not yet. That’s going to save her some money and stretch the resources longer. If they have a bus to use, she might even sell her car for big savings (fuel, maintenance, insurance).

I’m sorry you’re facing vermin. Once she’s out, you can fumigate for the roaches better than when she’s in it. After she moves, get all the food and dishes OUT, move the refrig to a garage and lock it (safety for children). Then get an exterminator to really “bomb” the place. You and your brother, if that’s not affordable, might loan your mom the cost of deep-cleaning and fumigating, then pay yourselves back someday from the house sale. (Write it down in a “memo of understanding” and all sign it.)

Can the sale of the house go into a trust run by you and her brother, rather than herself? If not, I guess the home will take it all, but either way, it should be in their interests to help her make those resources go as long as possible. The piece I’m not liking in your description is how little involved the administration seems to be with her longterm planning needs, or perhaps your brother hasn’t gone to the meetings yet. When you visit, you can all 3 go to discuss it, or if you think she’ll be difficult at that meeting, ask to meet with just your brother, yourself and a social worker or someone from that facility without your mom present. Can you phone in from long distance, even now, to talk to their people?

I found I had to make two trips: one to get the whole momentum going and put plans in place with my brothers who live nearby, then a second one some weeks later to pack with her. Plus many emails and phone calls with my brothers, once we had our plans set out. We had to also keep mom on track. Now the actual move is happening this weekend and she doesn’t even need me; my brothers are handling the moving day itself. Maybe you want to go yourself now and wait for your husband’s company until a second trip when there’s more physical to do. All depends on your family and especially your mom.

My trips in did kick-start a lot of decisions that tend to go undecided when people live closeby. But don’t underestimate all that your brother is doing, either. It’s hard to be living nearby and hard to be out-of-town. It’s just…hard. The more credit and praise you extend towards your brother, the stronger he’ll become to take on new roles. It’s actually hard for boys to push their moms around sometimes. So try to be a team.

I’m suggesting that you consider a place that is faith-based even if it’s not your own faith. We did that and so far (she moves this coming Sunday) their care and concern has been extremely helpful.

We also interviewed their clergy to find out how they’d relate to someone not from their denomination. Theirs is a more progressive denomination and won’t interfere with her or pressure her. In fact, their counselors actually have the skills to reach out to her to discuss the more common human dilemmas of aging, loneliness and other human issues. If your mom isn’t too prickly about church people, she might find more compassionate care and interest in her in such a facility. We certainly did.

Whether its secular or faith-based, these AL facilities deal with the same issues week in, week out; while each family does it once in a lifetime. So call on them for tips and guidance on such things as hoarding, parting with possessions, making new friends and other senior concerns. They deal with that with almost every client.

You will find that they have experience moving people in with hoarding backgrounds and you might even ask them for a required list. People who move to these situations also come from l0-room houses and have to be required to pare down, so they’re used to that story in one version or another.

PS, If the house is that much of a mess inside, the likely buyers might be adjacent property owners who want the land. Or some contractor who sees it as a “shell” to redo. Every house sells when it’s priced to sell, and not priced based on some memory of what it used to be or should have been under better circumstances.

Helping older parents who make bad choices

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