Where Mom Lives – How Can I Make Her?

Recently, I was in my car listening to a local radio call-in show with an attorney as the guest expert.  He is a general practice attorney – meaning he has no specific specialty and most certainly, he was not one who specializes in elder issues.

The caller’s question was as follows:  “My mother is 86 and can no longer take care of herself.  She has been living with me, but that is becoming hard for me. My sister and I would like to have her move in to an assisted living but Mother says she won’t go.  How can we make her?”

The attorney immediately began to explain the complicated process of seeking guardianship for her mother. Rightfully, he explained how time consuming this could be, that she and her sister would need an attorney and that the court will appoint an attorney for her mother as well.   Of course, he suggested the woman call his office later that day.

I found myself shrieking at the radio!  There are so many other options before suggesting this route – which is the most complicated and often emotionally painful.   I knew it would not do any good to call in myself, I am certain the attorney pays a fee to have that half hour all to himself.  I doubted they would allow me to add to his answer. I also didn’t have time to pull over, to make the call safely.   Therefore, I decided to write this post!  The caller may never see it but some of you may find it helpful and share with others.

While the attorney is correct that seeking guardianship could be a way to take control of her mother’s living situation, this should be the very last resort as it can be expensive and unpleasant.  Let’s take a look at this scenario and talk about all the options and strategies.

First, the attorney should have asked several questions before he moved directly to the guardianship plan.  The caller did not explain what she meant by saying that her mother could no longer care for herself.  What kind of care needs does she have? Does the mother need assistance dressing herself, toileting, assistance getting in to and out of the bathtub?  Is there a walk in shower in the daughter’s home?  Are there grab bars?  What kinds of medications does her mother need?  Does she has memory loss and if so, how extensive?  Does she forget details of conversations or names or does she forget where the bathroom is located and who her daughter is?   Does she use a walker or wheelchair?  Does she use any portable medical equipment such as oxygen?

The next question I would ask would be about the daughter’s statement that caring for her mother is becoming hard for her.  Why is it becoming a problem? What does this mean?  Is her mother too heavy for her to lift in to the bath and back out?  Does the home have too many stairs? Or is the daughter simply missing her independence and flexibility having to stay at home with her mother?

These are all pertinent questions. If the problem is the lifting or the lack of flexibility has the daughter considered hiring an in home care worker.   If the family can afford the cost of assisted living, they should also be able to hire an in-home worker to help with the bathing tasks or staying with the mother while the daughter goes out.  When families complain that their loved one doesn’t sleep at night and keeps them from sleeping as well, they often seem surprised when I suggest hiring an in home caregiver to be up and awake with their loved on at night. This way the family caregiver can get a good night’s sleep. Yes, it means you will have someone else coming in to your household, but it can also make the family caregiving burden a bit lighter.

Is the situation more complicated?  We don’t know if the daughter is married. Perhaps her husband is no longer accepting of having the mother stay with them.  Of course, if part of the problem is the actual design of the home itself – too many stairs, no walk in shower, certainly the solution won’t be a quick fix.

A very important question concerns powers of attorney.  Has the mother designated a power of attorney?  Is someone both the power of attorney for healthcare as well as financial decisions?  I recommend everyone have a designated power of attorney, as well as a living will in the event you should become incapacitated and cannot make your own decisions.  Remember, powers of attorney do not go in to affect until you are deemed incapacitated by a medical professional.  Thus, in this particular case, if a physician deems that the mother is not capable of making responsible decisions, the physician would then sign a capacity statement that states such. Only then would the power of attorney be activated.  Most physicians take this very seriously and give such a decision great consideration.  With my own mother, her physician met with her several times and spent quite a bit of time talking with her and questioning her before he decided that she truly did not have the capacity to understand and make important decisions.

Now let’s call out the elephant in the room. Please bear with me as me as we talk this through.  The caller said the mother is 86 and can no longer care for herself.  Yet the mother “won’t go” to the assisted living.  I don’t like the daughter’s phrase “How can I make her?”  Few of us like to force or be forced.   However, let’s give the daughter the benefit of the doubt for a moment.  If the mother cannot care for herself and there are legitimate reasons why the daughters cannot care for her in their homes, what is her choice?   Caregiving takes a toll.  Not only is it physically exhausting, it can be emotionally exhausting as well.  Numerous studies show statistics that indicate as much.  In a study done in partnership with AARP and the National Alliance for Caregiving, 11% of family caregivers indicate caregiving has caused their own health to deteriorate.  A National Family Caregiving Alliance report published in 2012 states that anywhere from 40 to 70% of family caregivers are clinically depressed.  I can go and on.  My point here is we tend to focus on the person needing care rather than on the caregiver.  The health and well-being of the caregiver is often overlooked.    As with any relationship, and in any disagreement, both parties should be considered.

I do not mean to sound cruel, but sometimes there are no perfect answers.  If the daughter can no longer keep mother in her home, this may be the next best choice.  No, Mother may not want to go.  Often families simply stop here.  Maybe a more forceful conversation or action should occur.  Many older adults become very resistant to change.  The thoughts of any kind of change in routine or living arrangements can be difficult for them to accept.  This is particularly challenging if the person has a dementia.  However, sometimes it is simply unavoidable.    What if the daughters had a very frank discussion with their mother, and urged her to simply visit or do a short-term stay at an assisted living?   Maybe Mom is not aware of the toll her care is taking on her daughter.

 

Understand that I am not comparing an 86 year old to a toddler, (Although frankly, sometimes the behavior is similar!), but often children do not want to go to school or to the church nursery in the beginning. They may cry and put up a fuss the first few times.  My own three-year-old granddaughter says she loves preschool.   Upon pick up she always says that she enjoyed it. Yet, she was crying almost every time her mother dropped her off.  Not only did the teachers assure my daughter that the child stopped  crying shortly after arriving, but she goes on to have a good experience. In addition, my daughter watches through a one-way window to the classroom and can see that she does stop crying quickly and joins the children in activities.  Lately she is crying less and less often.  It is a great relief to all of us.  Often, in the beginning the older adult complains and is unhappy in a new living situation. But after a time, the person becomes more settled.

This is another area where the physician may be helpful.  My mother’s doctor stated it quite clearly after her second broken hip.   “Ruth, you cannot go back home to live. Your condition will not allow it. You can no longer do stairs so I don’t think you can go to your daughter’s either. I suggest you try assisted living. “

There are some caveats to the short-term stay, but often, if the stay is strategically planned, the individual adapts. Many of today’s assisted living communities are quite lovely and offer wonderful amenities. Many allow pets.  Mother may have a preconceived notion of what an assisted living may be like and this could change upon visiting.  Many of them also provide the opportunity for a short-term stay, often called a “respite stay”.  This refers to allowing the caregiver to have a time of respite from caregiving duties.    This may even be a potential solution for this daughter.  Maybe she really just needs a break.

If a short term stay to determine if your loved one can adapt is used, careful planning is necessary.  I have seen families plop Mom or Dad down for a short-term stay at an assisted living “just to see if it works” without taking any of the individual’s personal effects. The thinking is “why bother if it doesn’t work out?” Well, you should “bother” to help ensure it does work out!  I am not suggesting you initially bring all of the person’s possessions but some familiar items are crucial to a successful stay. If possible, choose a time when some particular activity will occur that your loved one may enjoy such as a concert or outing.

One situation of which I was aware involved the son taking his mom to a local assisted living for a short stay just to see if it might work.  Her room was basic, with no artwork on the walls, unfamiliar furniture and bedding.  The son brought only some clothing. There was no familiar blanket or bedspread, nor any familiar family photos.   While this woman was used to calling her friends and children daily, there was no phone in her room.  The family felt it was not worth the trouble in case it didn’t work out.   She had a cat at home that she dearly loved. Of course, the cat (assisted living rules would have allowed her to bring her cat) did not come with her.   I was not surprised that after one week, the poor woman was miserable, uncooperative and the son said, “This just isn’t going to work”.

The challenges of caring for aging loved ones are many.  There are situations where seeking legal guardianship is necessary, but even legal experts say it can be time consuming and costly. It can be humiliating for the older adult who may be somewhat capable. In addition, it can cause irreparable emotional damage to a family.  I believe all other avenues should be pursued first.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s