Both of my parents have dementia and are living independently. How do we broach the subject of assisted living?
It is unsafe for them to live independently. Not taking medications, hygiene and house smells. My brothers are no help, but they are in control!! I need help!!
If you can't reason with your parents and for whatever reasons your brothers are ignoring the possible dangers involved here, you can call your local social services department and ask for help. They may involve APS to do a visit and evaluation and make suggestions your brothers will have to deal with. It's not the preferred route, but when you have siblings who will not cooperate or worse - fight over control - the only route may be calling social services for the help you and your parents need for safety sake. Best of luck to you all.
If brothers are in control, have you had a sibling meeting to review the issues in the home AND how they could be held accountable if someone reported unsafe living conditions. It might be better to ask if they can come to spend a week w/parents in the home to get a first hand look at what is going on. Show them the med bottles that have more pills left than should be in the bottle because they don't take them. Let them smell the house and the parents. Sometimes children don't really realize how much someone has digressed if they don't spend time around them. Brothers may not agree to move them out of house, but if they are in charge they need to get some in-home care to handle day to day tasks for the parents including the meds. If both brothers dig their heels in the dirt and fail to respond, then let them know you/your sister are going to be reporting the issue to prevent something bad from happening - and they will be hearing from the authorities who handle it.
I went through a similar thing, though I don't have any siblings. I have no POA or any thing else. I first discovered how bad things were when my Dad had a stroke. When I went through the house, I started to notice little things that were very telling.
There was oil spattered on the ceiling of the kitchen...OMG, can you only imagine how dangerous that must have been. The plumbing in the house was severely compromised, and wasn't working.
At any rate it turned out that my Dad was mid to late stage ALZ, and Mom had mid stage Vascular Dementia. I had to drag them out of the home, and move them into my home. It was a very difficult time. After about 6 months, I was able to get them into a home, albeit it took a bit of coercion.
It took a while for them to adjust, in fact my mom is only just getting fully adjusted to the fact that this is her new home.
If your brothers are "in control" and you truly feel your parents are not safe you could report the situation to Adult Protective Services. You might first want to stop by a place like your local Senior Center and ask a Social Worker there "what would happen if..." and give them a brief summary of the situation. You could also go to your local police department and pose the same question. Just to see what the answer might be. The reality is.... Probably nothing will happen until some catastrophic event sends one or both of your parents to the hospital. As in most cases some crisis has to occur before people will react. (I think for the most part people as a whole are REACTIVE not PROACTIVE) If there is a way to send a note to your parents doctors giving them a "heads up" as to what might be going on but if you do not have POA for Health or listed on forms as a HIPAA contact then that also may fall on deaf ears.
Unfortuneately, no one ever wants to leave their "home". They will never say they want to move to assisted living on their own, unless there is some type of accident (?) (to themselves or someone else) that opens their eyes. And even then, it would take several people (sons & Daughters, siblings, etc) to intervene. I know a situation where the kids would not believe there was anything wrong, until they got a phone call from the police at 3 AM. He was out driving around, following a truck (the truck driver called the police). He thought he was following his sons, which of course he wasn't. That was their eye-opener. It was almost necessary for them to realize the severity of his condition. Thankfully, that situation didn't harm him or anyone else. All I can say, is pray that they come to a realization soon,
Will their doctor verify that they can no longer live alone so an eldercare attorney can rule that they need to move to assisted living or hire live in help?
Sometimes we have to be the bad guy. Your parents are living by grace right now, I mean that it is grace that they haven't burned their house down, blown up the neighborhood or some such thing.
You as a nurse are a mandatory reporter and as hard as it is to report your own parents, you must do this before there is a tragedy.
Don't involve your brothers, let the authorities involve them. Sometimes it takes drastic measures to get changes implemented.
No one wants to see their parents loose their independence or have to do something that they don't want to, but they can't make reasonable decisions any longer and that endangers them and their neighbors.
I am sorry that you are having to deal with this, but deal you must.
Assuming 1) brothers have POAs and 2) they don't participate in any help/visit, then about the only things you can do is document what is/isn't being done, what is of concern (medications, dementia are the biggies!), and report all this to their doctors.
Broaching the subject - do you mean with brothers or parents? In either case, it is likely pointless. Brothers are likely in denial or just can't be bothered. POA gives them the ability to manage finances, and sign paperwork, MPOA gives them ability to discuss medical care, but otherwise nada. Parents are also going to deny they need help (dementia lies to them) and even if they agree, within minutes, hours, next day, inevitably they WILL forget they agreed and you get to start all over.
I would highly suggest you consult with EC atty about getting guardianship. Initial consult should be 30+ minutes free, so have all questions/concerns prepared and take notes! IF they feel this is doable, you may have to cover the cost initially, but if parents have assets, that should cover the costs associated with this. If the parents contest it, the court could order attorneys to represent them. If brothers contest, not sure who would pay their atty, but if you feel your parents are in dire need, this should not be a concern. Guardianship overrules ANY POAs, so you would have control over everything and see to it that they are properly cared for. If you can get this, then there would be no need to broach the subject with anyone - YOU get to decide where they live. POA, not so much. We had all that in place well before we needed to move mom, but the EC atty told us that we could not force mom to move (she refused to consider brothers' offers and AL.) He suggested guardianship, but the facility we had decided on wouldn't do committals, so we had to resort to "trickery" to facilitate the move.
I would find a good EC attys, ask questions, get quotes and then make the rights moves. Brothers can go pound sand.
HI & my goodness living independently with dementia is highly DANGEROUS. Simile to leaving children alone.. No easy way but to simply have a family pow wow.. everyone needs to be there or it won't work. Let the brother (s) know you all can get reported by a neighbor! By change they have kaiser,they are great. But white down what concerns ..you, & let them know they at least need a caregiver before a burner gets left on or heavens, anything could happen! Time to be stern.. & don't ask, TELL THEM, they need assistance
Make a list of tasks that your parents need help with. Try to get your brothers together with you to create a plan to address these problems. If they won't help, decide on what you are willing and capable of doing - it probably won't be everything. Do what you can, and do not feel guilty about what you can not do. Enlist help or family, friends, church, and pain help to manage the rest. If your parents balk, step back and allow your parents to feel consequences of their behavior - fall, illness... then they might be willing to allow changes.
Do you mean that your brothers have Power of Attorney?
Do they know the conditions of your parents' home?
Has your parents' doctor been informed that they are not taking meds as prescribed?
Inform the responsible parties, in writing.
Do not argue, especially not with your parents, if they are unwilling to accept help from others. One of the tragedies of many sorts of dementia is that the patient no longer sees the help they need. The only way to counter this is to step back if you've been propping them up.
You will need to wait for the fall or illness that puts one of them in the hospital.
It's sad, but true of a lot of posters here. You can only control your own actions.
Medicare pays for hospice for both. All you do is get their primary care physician to sign off. They will design a plan for medications and give you pointers about hiding the keys to vehicles etc.
I love the suggestion of adding a social worker to the mix. They will be viewed as an objective professional.
Then decide who will look at appropriate facilities. You can offer if you like or ask them to look as well or do it together.
It’s a matter of safety, personnel hygiene and the situation is becoming too hard to maintain. So, time for a positive change. Your parents will adjust.
So you are providing care but have no control? No PoA? I would give your brothers 1 chance by taking photos of their condition (and the house) and have a calm, non-contentious meeting informing them that if they don't get your parents appropriate help (by a deadline you think is reasonable) then you will report them and call APS to report that your parents are Vulnerable adults. If that doesn't move them then neglect charges should be on the table. BUT if you do this your brothers can ice you out completely if they are the ones with PoA so make sure you get everything documented before you go down this path. Good luck!
While I agree the brothers need a wake up call I don't think POA or even DPOA gives them any legal responsibility to care for their parents it just gives them the legal ability to speak and act on parents behalf. So reporting them, the brothers, to APS isn't really a threat. Now, if they feel the moral responsibility they should, having accepted the trust their parents placed in them, the talk about bringing in APS and in their face proof of the need should get a positive response. It may be that even with their cooperation APS will be needed if OP's parents are uncooperative with brothers too which is entirely possible. I think your suggestion is good I'm just not sure threatening the brothers with APS is worth it, maybe simply sharing the possible need.
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Show them the med bottles that have more pills left than should be in the bottle because they don't take them. Let them smell the house and the parents. Sometimes children don't really realize how much someone has digressed if they don't spend time around them. Brothers may not agree to move them out of house, but if they are in charge they need to get some in-home care to handle day to day tasks for the parents including the meds.
If both brothers dig their heels in the dirt and fail to respond, then let them know you/your sister are going to be reporting the issue to prevent something bad from happening - and they will be hearing from the authorities who handle it.
There was oil spattered on the ceiling of the kitchen...OMG, can you only imagine how dangerous that must have been. The plumbing in the house was severely compromised, and wasn't working.
At any rate it turned out that my Dad was mid to late stage ALZ, and Mom had mid stage Vascular Dementia. I had to drag them out of the home, and move them into my home. It was a very difficult time. After about 6 months, I was able to get them into a home, albeit it took a bit of coercion.
It took a while for them to adjust, in fact my mom is only just getting fully adjusted to the fact that this is her new home.
You might first want to stop by a place like your local Senior Center and ask a Social Worker there "what would happen if..." and give them a brief summary of the situation. You could also go to your local police department and pose the same question. Just to see what the answer might be.
The reality is....
Probably nothing will happen until some catastrophic event sends one or both of your parents to the hospital.
As in most cases some crisis has to occur before people will react.
(I think for the most part people as a whole are REACTIVE not PROACTIVE)
If there is a way to send a note to your parents doctors giving them a "heads up" as to what might be going on but if you do not have POA for Health or listed on forms as a HIPAA contact then that also may fall on deaf ears.
You as a nurse are a mandatory reporter and as hard as it is to report your own parents, you must do this before there is a tragedy.
Don't involve your brothers, let the authorities involve them. Sometimes it takes drastic measures to get changes implemented.
No one wants to see their parents loose their independence or have to do something that they don't want to, but they can't make reasonable decisions any longer and that endangers them and their neighbors.
I am sorry that you are having to deal with this, but deal you must.
However, while I am no housecleaner, I can attest that HHC told me my house was not the worst they had to visit.
Broaching the subject - do you mean with brothers or parents? In either case, it is likely pointless. Brothers are likely in denial or just can't be bothered. POA gives them the ability to manage finances, and sign paperwork, MPOA gives them ability to discuss medical care, but otherwise nada. Parents are also going to deny they need help (dementia lies to them) and even if they agree, within minutes, hours, next day, inevitably they WILL forget they agreed and you get to start all over.
I would highly suggest you consult with EC atty about getting guardianship. Initial consult should be 30+ minutes free, so have all questions/concerns prepared and take notes! IF they feel this is doable, you may have to cover the cost initially, but if parents have assets, that should cover the costs associated with this. If the parents contest it, the court could order attorneys to represent them. If brothers contest, not sure who would pay their atty, but if you feel your parents are in dire need, this should not be a concern. Guardianship overrules ANY POAs, so you would have control over everything and see to it that they are properly cared for. If you can get this, then there would be no need to broach the subject with anyone - YOU get to decide where they live. POA, not so much. We had all that in place well before we needed to move mom, but the EC atty told us that we could not force mom to move (she refused to consider brothers' offers and AL.) He suggested guardianship, but the facility we had decided on wouldn't do committals, so we had to resort to "trickery" to facilitate the move.
I would find a good EC attys, ask questions, get quotes and then make the rights moves. Brothers can go pound sand.
No easy way but to simply have a family pow wow.. everyone needs to be there or it won't work.
Let the brother (s) know you all can get reported by a neighbor!
By change they have kaiser,they are great. But white down what concerns ..you, & let them know they at least need a caregiver before a burner gets left on or heavens, anything could happen!
Time to be stern.. & don't ask, TELL THEM, they need assistance
Do they know the conditions of your parents' home?
Has your parents' doctor been informed that they are not taking meds as prescribed?
Inform the responsible parties, in writing.
Do not argue, especially not with your parents, if they are unwilling to accept help from others. One of the tragedies of many sorts of dementia is that the patient no longer sees the help they need. The only way to counter this is to step back if you've been propping them up.
You will need to wait for the fall or illness that puts one of them in the hospital.
It's sad, but true of a lot of posters here. You can only control your own actions.
What kind of help are you providing to your parents now? How often do you go over there, and what do you do?
When you say that your brothers control everything, do you mean that they have POA? As the oldest sibling, you weren't considered for POA?
Then decide who will look at appropriate facilities. You can offer if you like or ask them to look as well or do it together.
It’s a matter of safety, personnel hygiene and the situation is becoming too hard to maintain. So, time for a positive change. Your parents will adjust.
I typed personal hygiene.