How do we get my mother into assisted living with ensured around the clock care?

Having been through similar situations with my two parents....who both desired to be home, but exceedingly could not do it without fighting with each other due to dementias....I say most of the others have good ideas that I was able to institute at one point or another. BUT...to get helpers in the home, or get them to move out of the home.....the VERY easiest way to do it, is with a doctor's order or as a result of a hospitalization. It would help if you already have POA....as this is the only way that you can use their money to pay for things. No WAY should you go into this without that....and start to pay for anything yourself! If you do not have that....and they have a family lawyer...I suggest a quiet little visit to that person to let them know what is happening in the home. Perhaps he could call them in for an 'annual review' of their affairs, and then suggest, that based on their ages, it is time to get all that stuff in order...POA, health care paperwork, DNR paperwork etc..... that's what I did when I found my Dad was no longer paying his bills and Mom did not know how. A POA allows you to have control of what your parents are not able to handle....yet give them the decisions they are able to handle properly. My Dad ended up in Memory Care. My Mom was then home with caregivers part time, and a monitoring system in her house, with cameras so I could keep tabs on her when she was alone. NOW, Mom is in AL, Dad died last August and Mom;s house has been emptied and sold to pay for her AL apt. AL is NOT 24/7 care. But it IS 24/7 supervised care. My Mom is on oxygen constantly, so the staff must make rounds and check on her every two hours. They stand by for showers, and remind her about meals and other activities. They bring meds to her and assure they take them properly. But, in between, yes, she is alone in her 1 BR apt, that is furnished with her own furniture.. Two could live there, with a lesser rate for the other, so Dad and Mom could be together, and Dad would NOT have it all on his shoulders. My Mom gets weekly laundry and housekeeping including in her charges. She has Alzheimer's so she's on the waiting list for a Memory Care female bed. Her facility also has independent living....where two could be together, without the hassles of home ownership, IF Dad did not actually have to care for mom...assure she took her meds on time and was compliant with what the doctors wanted her to do. And as for the 'moochers' in the basement, YEP....IF they are named to inherit the house, then they need to be given notice that things are going to change, and there's no need for a great deal of sympathy.

If your mother does not want to move, and your father does, there is nothing you can do, except leave them be. Yes, it is hard to sit and watch and know that there is something better for your parents, but there is nothing you can do. For yourself, stop worrying about the future and look after yourself. All the best, Arlene Hutcheon

This post is not really about 24 hour one on one care, it is about the person with early dementia being the one who's calling the shots, making major life decisions on the basis of their own comfort zone and desires, which is unfortunately not necessarily the same as deciding rationally or with any real consideration for the needs of others, or even for the practical realities of the situation for that matter.

It will take a major shift in family dynamics for you to see what you want to happen - brother and nephew living as independent adults, Dad with some peace and security, and mom not able to keep those things from happening because she thinks she can just stay in her familiar home while maintenance type things just magically take care of themselves and her medical condition just stays stable without any medical care. These are unwelcome changes, I'd grant you (and her) that, but someone with a functional adult mindset and a POA should be the one to manage them if at all possible.

Someone should have power of attorney for their finances and health care to be able to step in and make decisions on their behalf. Getting mom to agree to anything is the big issue. Find out if there is a will and if not, arrange to have one made. The power of attorney forms have a list of things to check showing which areas the power if being given and there can be more than one person receiving this authority. The health care POA forms also get into end of life care issues that should be addressed, too. Your parents are soon facing them. You do not need an elder care attorney for this, but they are still a good resource to use to help explain your options and good ways to get things set up.
I have found a good AL facility with memory care floor for my friend and they will provide whatever level of care is needed, up through hospice at the end. Of course, I pay for this with my friend's money and it can vary month to month as the level of care varies. At this point with minimal care needed--meds and eye drops , laundry once a week, house cleaning, and reminders for meals--it is running about $7,000 a month. Between his monthly income, IRAs, savings, long-term care insurance and the sale of his condo, we can manage this for 3-4 years and then public financing will take over. The AL facility agrees to use public financing as an alternative after 18 months. There would be VA benefits then, too, once his assets become low enough to qualify. I am in frequent contact with the registered nurse in charge of the health care there as issues arise and she is so helpful explaining what needs to be thought of and what they are doing. Best of luck. The toughest part is dealing with the family dynamics. I was spared that for my friend--no children, no close relatives, just 3 POAs willing to see to things until the end. At that point, I am also the executor of his estate.

AL'S are not the place for 24/7 care. Look into an NH.

I would not make a single move without consulting professionals. If money is a problem, ask your potential consultants what they recommend in terms of getting your parents to pay for this 'essential' planning for the future.

Adult children do not decide what level of care their parents need.This is done by any facilities you may be exploring, but you also can do it beforehand 1 of 2 ways, I think: Ask your local elder service agency what they recommend for an in-home needs assessment for your mother, and/or ask her doc to order an eval by the VNA. They do care evaluations that carry much weight & can be very helpful with next steps. They could even recommend a social worker come out and assess the family situation as it impacts your Mom (that is how you get them in the door).

Simultaneously, find an elder law attorney. You do not need any family cooperation to get a consultation. You can expect to pay a fee, up-front, and you will be able to ask- and get answers to- all the questions you can fit into the hour+ you have with them. Some firms apply the consultation fee to future costs if you hire them. Obviously, it's a good idea to get recommendations about the best elder care law practices are in your area. All the decisions ahead have so many practical, legal & financial implications, that making uninformed choices now can have very expensive, even ruinous consequences.

Are there any board- certified Geriatric Physicians who could take your parents on as patients? She/you ought to be getting more help from her doc than is the case now. Really good Geriatric practices can be very helpful managing the issues you discuss. Certified Senior Care Managers can also be the salvation of many families, but they are expensive, and it is likely you would meet much resistance from the family to the level of involvement they need to do their jobs effectively.

Your father may be an ally in any of the above actions. Sounds like he is fed up, but feels powerless to effect any change. Feel him out, privately, about his thoughts/wishes. Finally, consider getting a social worker or other therapist with experience in these issues for *yourself.* You will need a lot of support for the long haul...nice to have an informed & objective ally.

Keep breathing. We get through these stages in the lives of our families of origin, somehow...

I think you might have to buy out your brother for his share of the house, is what I have heard. He could argue he could stay there and 'take care of the place" (and father, if father stays there). Don't fall for that! I would call an eldercare lawyer, definitely, this is more complicated situation that can't be easily answered here.

Can your brother and his son come live with you?

hahahaa, just kidding. Yes, find out if parents have a will (I hope) and who the house goes to. If it is to all the offspring, you can't evict them, I don't think.

Some ALF have levels of care which might accommodate your mom and dad together as roommates (less expensive for 2nd person sharing room). You would probably have to sell their home to pay for it which means son would have to vacate. You will likely need a lawyer (elder) as they deal with these things all of the time. Your brother may be difficult to remove due to something to do with squatters rights. Good luck.

As far as your brother and his son living in the basement. Does you mother own the house? Maybe you should find out who her house is willed to. Since he doesn't have a place to go, she may leave it to him. Then they would have legal right to live there. Stranger things have happened.

If your parents can afford a Geriatric Care Manager or Paitent Advocate I would strongly suggest that you hire one to work through the process with your parents. I would make sure you find a highly skilled registered nurse Geriatric Care Manager or Advocate Their situation is medically complex with lots of complicated family dynamics. Your brother and his son need to go and your parents need the properly level of care to avoid a crisis that is looming for them. Your Mom needs to seek medical care for her issues and your Dad needs to be able to live his life as he chooses with the proper care.

I agree with Pam and Angel. Assisted Living is just that: assisted. Not full-time care. Your folks would be living alone in their own apartment and I'm not sure if an assisted living facility would be appropriate for your mom. And if your dad is taking care of her I'm not sure they'd be eligible for AL. Your mom may need a higher level of care and if they won't split up your dad would need to go into a nursing home with your mom.

Home care might be your best bet. You wouldn't have to do 3 8-hour shifts. You could do 2 12-hour shifts. And in home care the caregivers don't usually take breaks because the patients can rarely be left alone (which is they the home care staff is there to begin with). It's just taken for granted that in a 12-hour period there are going to down times, times when the patient is sleeping or watching tv or occupied with visitors or whatever. Staff is rarely on their feet for any length of time and there is usually a lot of down time when the staff can eat or read a book (which is why there are no scheduled breaks). A caregiver from a home healthcare agency isn't going to be on her feet and busy the full 12 hours. Of course there are times of day when things get busy like in the morning and before bed. Meal times. Medication times. But all of this combined doesn't make up 12 hours. Home health professionals will be there around the clock if needed (for example, 8am-8pm and 8pm-8am). Your parents would get undivided attention and the family can rest easy knowing there's someone always there.

And I agree about the basement dwellers: time for Jr. to get his own place.

I think you may want to take a look at the definitions of the different levels of care you can get for your mom.

For example...assisted living means just that...they live on their own in a room or a small apartment and have assistance for things, such as meals being prepared for them in a cafeteria where they can go and eat, or things like lawn care, snow removal, even light housekeeping and laundry. However Assisted living is not guaranteed round the clock care...she will be alone in her room or apartment most of the time. You can pay extra for things like medication help.

A skilled nursing facility is a facility where patients have their own rooms or potentially share a room with a roommate. They are provided with meals (in a cafeteria or in their rooms, and have a nurse assigned to them. However please remember that the nurse is assigned to many patients at once. This also is not "guaranteed round the clock care". Sometimes in nursing homes, those that have certain risks...like trying to get out of bed alone when they are a fall risk, are placed near the nursing station for the nurses to keep their eyes on them. However there is no guarantee of care.

Memory care is generally more advanced than the previous two. It is often a locked unit (for those who wander or try to "escape". It has other more advanced care than a nursing home as well such as potentially a lower nurse to patient ratio and more tools to keep patients safe. However again...not guaranteed 24 hour care.

There really is no such thing as guaranteed 24 hour care. Even if you have three shifts, 8 hours each of caregivers..they still are due breaks and bathroom trips etc. And there is no guarantee that they have their eyes on the patient constantly as things need to be done...such as removing soiled garments from the home or getting cleaning materials from the kitchen to bring to the bedroom or answering the phone or whatever else comes up.

Since guaranteed 24 hour care doesn't exist, it is important that your mom see her doctor to treat the behaviors that could endanger her...such as treating anxiety to reduce wandering or violent outbursts, treating obsessions, treating pain, and having technological devices, such as bed or chair alarms for when she attempts to stand and shouldn't, or door alarms in case she tries to wander outside etc.

From your description it seems that she possibly can do many activities of daily living, such as toileting herself, cleaning herself, and feeding herself, so it doesn't sound like she really needs to be watched constantly. Certainly one of the options above would fit her (or a progressive one where she can advance up in care as the needs change).

As for the leeches in the basement...let them fend for themselves. They are adults. What would they do if your parents passed suddenly? Shrivel up and die? Certainly they would find a way to survive...well that time has come and their parents cannot take care of them any more...they need to stop being enabled and start taking care of themselves. This is non-negotiable.

Angel

Assisted Living will not take someone who needs round the clock care. Mother obviously has a controlling nature and a co-dependent son and grandson. She's not about to give up any one of the three. She's what I call a "designated driver". She's not an alcoholic but she has driven plenty of men to drink.
If you move her to assisted living, the other 3 will learn to fend for themselves.
That is exactly what happened when we moved mom to AL. Her 59 year old son lost 35 lbs without her cooking for him. From 250 to 215lbs. He did complain and whine for about 6 months, but he survived.