My large family is in conflict whether to respect my mother's wishes to stay in and die in her home or now that she has mild cognitive disorder/dementia or to move her into a nursing home which may be more specialized in such conditions (if good) and she may get more interactions beyond those of her 24/7 caregivers, family and friends. 24/7 care is expensive however she currently has enough money in her assets to support it.
Did it get easier for the family members including the HCP when the senior was admitted to the nursing home?
Me and my sister want her to stay at home and with the support of palliative care eventually die there. It is my way from afar to support her wishes.
My brother who has complex medical issues, is her POA, and has been living rent free for about the last 10 years in her home wants her in a nursing home and has for quite a while. He demands family members pay for my mother's home care and does not support getting more home equity and a reverse mortgage loan. Though I think overall he is a good guy, it is hard not to at times question his intentions as he seems so comfortable living in her home and driving her car. He is demanding we come up with a financial contingency plan for my mother (isn't this the POA's job). Yet, dismisses any plans (geriatric care manager, mediation, etc.) or ideas presented.
My memories from working in a nursing home in the early 80's as a teenager still haunt me. Are nursing homes better than they are in from the early 80's?
Has does admission to the nursing home effect HCP? For example, do you get calls all the time or just as needed for complex matters. Maybe this depends on the nursing home and proper training of staff.
Any thoughts or experience? I do not know how much his complex medical issues are effecting things. For example, I sense he needs less stress in his life to help deal with theses complex medical issues.
Thanks so much.
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My mother went into a nursing home after my dad (her caregiver) died. I could have kept her in her home with 24/7 care, constantly trying to ensure someone showed up to work every day for every hour, driving back and forth from my home more than an hour away to take her to doctor appointments, keep an eye on the caregivers, gardeners, do the grocery shopping, housecleaning, and laundry, but that wasn't feasible. (I had already been doing all that for the two months I lived with my parents during my father's illness, lost 10 pounds just from the stress, and never had more than four hours of sleep per night.)
However, it wasn't just for my convenience that I chose to move my mother but rather for her safety, her health, and most important, to give her the mental stimulation she had been missing for the previous four years as dementia crept up on her and led her to stay housebound and unwilling to go anywhere. My dad was consumed with doing all the cooking, cleaning, and shopping to keep the household going and was unable to spend much time keeping Mom awake and finding things to interest her. One-on-one care with dementia is, in my opinion,
not the best thing.
Once she was moved to memory care, she was not happy, but she also had caregivers who were trained to socialize their patients and not to merely hand out medications and go on their way. My mother was much more alert and went from sleeping 18 hours a day to not taking any naps during the day, because the policy of the MC was to bring the residents into the common room during the day, not allow them to just stay in their rooms.
Her place was sunny, happy, and friendly, and I don't have a single complaint about the facility. Because I didn't know the difference between types of nursing homes, she was first placed in a skilled nursing facility which was not a good experience, but the MC was wonderful. I rarely had a call about a crisis as they were properly trained to handle them.
Respectfully, I would say your brother has a better grasp on what's going on with Mom than you do from afar. He's dealing with all the things I mentioned above, Mom is not improving in any way, and you haven't even checked out what nursing home care is like 40 years after you last stepped in one.
That said, you have no obligation to pay for your mother's care, so if he wants things to change, then he needs to make it happen with her assets. It IS a lot to deal with when he has his own issues, so is there a named back-up POA who can step in? Also, what is the plan for his future if he's unable to work and has nowhere to live once Mom's gone and a reverse mortgage is going to have to be paid off with the sale of her (and his) home?
Seems to me like there needs to be a major face-to-face meeting with all the siblings to try to get onto the same page, and I hate to say it, but Mom's desire to die at home is the least of the concerns here.
That said he cannot demand you pay for mom’s care any more than you can demand he stay to care for mom — or insist mom stays in her home just because she wants to.
Your brother has siblings. Let them take care of mom in their house or hers … or get her into assisted living.
Sorry. Zero sympathy for family members who let one person do all the heavy lifting and do nothing but complain when that person has had enough.
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BUT..........................
As to family PAYING for placement, that needs to be a clear, loud and resounding "N-O!!!" You ALL will need all the savings you can muster now for your own old age. When you Mom passes you will understand how soon your own time for retirement support is coming. It is terribly wrong for children with limited income and a need to save to put money on a parent. Your Mom has resources. So the POA needs to be told to use those resources (other than the home) for her care, and then have her on Medicaid. There will be clawback on the home, but he apparently believes that he is major heir here, and not wanting Mom's money to go to her care.
Worst case screnario here is that someone in family more upstanding is going to need to get guardianship away from the brother, or at least have an examination of his bookkeeping and POA records requested through the court.
All that to the aside we come now to your question. Is it better. Yes, sometimes. Other times not. And that' can't be predicted. My own brother was diagnosed after a vehicle accident with probable early Lewy's Dementia. He was in his last little beloved and downsized home and in his mid 80s. He loved his neighbors and it was a tight community and because I, his only support, lived across the state he had a tough decision to make about entering care in ALF or waiting until he "had to". He had so many saying "Stay here; we will help" but he was wise and understood his accepting help would quickly move to his being a burden and he assigned me his POA and Trustee, and went into care.
There he thrives. He had lived a rather reclusive almost monk-like life, very private all his life. He thought he would have a terrible time adjusting. He said "You know, hon, kind of like I was young and in the Army; I don't much like it but I make the best out of it". However, he did more than make the best. He came to enjoy going to movies, on tours of the homes of the stars, to bingo, to social hour, to watch the news in the common room, to play a few games. Because I was now handling all his bills and business papers he was free of them. He began to have fewer, not more hallucinations. He got nothing but better. He died of Sepsis before his diagnosis could progress, so who knows what changes otherwise would have occurred.
You will find that the questions you have will be guessed at and answered by more than a few of us in more than a few ways. Your own experiences will be unique to you as your own thumbprint.
I sure do wish you the very best of luck.
Being afar off and putting up resistance to care options is just wrong. You just get to put your 2 cents in and go about your life but, your brother lives this 24/7/365 for 10 years.
To everyone jumping on the brother, SERIOUSLY? If he came here saying that his siblings are long distance, don't provide any hands on care and are stopping him from placing mom, you ALL would be telling him to tell her to go pound sand, he has the POA and mom did that because she knew he would make sure her care requirements were met. Instead your encouraging her, afar off sibling, to interfere with something that doesn't affect her life in the least. Really?
Original poster, if you want mom to stay in her home, go make that happen on your back or leave him to do what's best for him and your mom, because he matters to, regardless of what you think has been happening for the 10 years he's been there for your mom.
Your post keeps on saying Nursing Home. For memory issues, there are many other options than Nursing Home. Each one has a different living arrangement. There is Assisted Living, AL where the person can still mostly function on their own and make decisions regarding their life. However, they may need help remembering to take their medication or might need help preparing meals. Then there is Memory Care, MC, where it is typically a locked facility so that people cannot leave on their own. These people may or may not be able to feed themself, keep up hygiene, etc. Both AL and MC have daytime appropriate activities to keep the brain stimulated. Within the AL and MCs, there are some who live in clusters of houses and some that look like hotels, with or without roommates. Then there is Nursing Home, where people are totally dependent on someone else. I would suggest that you visit a few of each type, there are no standards unless your state has them.
In my state, once a person enters a Nursing Home or MC, it is assumed that the person can no longer make rational decisions and POA is generally assumed.
When my Mom lived in her own home. I did medication management, helped her with her bath, cooked meals, drove her to all her appointments, helped her write checks, filed her taxes, etc. We had caregivers 9 hours during the night, and she went to senior day care during the weekday (she was a fall risk so she had to have someone available to her 24 hours a day). No POA involved. The biggest headache during this time was finding reliable, compassionate, dependable people for that 9 hours. Even though we used an agency, once or twice a month, they couldn't find someone to take care of my Mom for the shift (my Mom was up and down all throughout the night)
Once my Mom started becoming incontinent, she would try to hide her incontinence by putting her wet clothes back with her dry clothes, go through the hamper and pull out dirty clothes to wear, etc. Now when she was with me, I had to keep a closer eye on her. When I added up the cost, we were playing more her her upkeep in her own house, than it would be for me to move her into a care homes. Now, that once or twice a month that there were no caregivers, became even more of a headache to me.
So I moved her into MC. I did NOT sign the document transferring her PCP and pharmacy to the facility's PCP and pharmacy. I get texts whenever something major happens, like her blood pressure dropped. or that they found a bedsore. I still take her to the doctor (they could take her to the doctor for me for a fee). So overall, I am doing less. They do her laundry, all her meals, bathe her and do daily activities. I see her everyday to brush her teeth and get her to exercise. About once a week, I take her out and do something "different", whether it is a run to Costco or just accompanying me on my errands.
Apparently, most people take their person to the AL or MC, and see them maybe once a month or once a week. They put the facility in full charge of the person's health.
If my Mom was bed-bound, I wouldn't be able to take her out.
So, depending upon what level of care your Mom needs, she could have a lot of different experiences that are not Nursing Home level. I would go and research a few places. The different care levels and different environments at the managed care facilities are quite different than the early 2000s and even 2010s. However, that doesn't mean that all managed care has improved. Some homes still operate as if they are in the 1950s.
So check them out just to get a sense of what is available. Then you can make a more informed decision about the future care of your Mom.
Hugs 🤗
There is a lot to unpack here. So I'll just share our experience. My FIL was hellbent on staying home. SIL and BIL lived with him for a lot of reasons. And his care began to become too much for the 4 of us to juggle. He was ready to sacrifice all of us to stay home.
The opportunity arose to move him to a Skilled Nursing Facility. He was still hellbent on staying home - but we told him and the rehab facility where he was at the time that if he was going home - he had to hire 24/7 caregivers or it was an Unsafe Discharge - because we could no longer ensure his safety or provide his care. We forced his hand and he did choose a SNF.
He has been in the SNF for 6 months. Has it been easier? To an extent yes. His physical care is no longer our responsibility. He is a 300lb nearly immobile 90 y ear old man. There are a lot of things that people don't think about caregiving that you have to really plan for someone of his age, mobility and size. Two family members had to accompany him everywhere. We did everything by committee, and any time he left his home someone had to take a day off of work. Anytime he fell, the fire department had to be called - every single time. He had to have bath aides scheduled, and physical therapy at home, and had to be overwatched to avoid scams, and random technicians would show up at the house "unannounced" because he would schedule them and forget about it - all in the middle of the night when BIL/SIL were sleeping. Every bit of his care had to be carefully scheduled and planned. And emergencies were always a huge deal.
When we moved him it was a huge weight off of us. But then he decided to make sure that we stayed involved. And I have not been able to teach my DH and SIL how to let their phones go to voice mail. They answer every single call every single time. He calls 10, 15, 20 times a day. His expectation has been that we would facilitate for him instead of him advocating for his own needs. He calls for them to call the nurse's station instead of just pushing his call button. We are slowly getting them to stop answering every single time he calls. And he is slowly beginning to either advocate for himself or just not get whatever it is that he needs. (Silly things like "I need more water." "Dad did you hit the call button?" "No, I want you to call them, they won't bring me water." "Dad they don't know that you need water!" )
So...does it get easier? It should and it can. But that depends on if you put them somewhere that you feel comfortable with, and you back away enough that you can let go some. Otherwise you will stay entangled and it won't get any easier. You have to find a happy medium of what works for you in your involvement and allowing them to care for your loved one. And then it can get easier.
It might help resolve things if you all stop talking about mother’s wishes to die in her own home, and start talking about the money. There’s a good chance that’s what it’s really all about.
Most people die in one room, looking at four walls, and it matters very little where the room is. My mother died at home with me sleeping just outside her bedroom door a few feet from her. My ex died in a NH which provided for our children to sleep in his room during the long wait. Family faces are more important than the walls.