How do we get my mother into assisted living with ensured around the clock care?
Father, very elderly with many health problems is ready to move and just relax the remaining days of his life. He does not want to have to worry about pipes, bills, cars, driving etc. anymore. He just wants peace.
Mother has increasing dementia, COPD (no tank yet), diabetes, battle of breast cancer and we think sciatica but not sure as she won't go to doctor and have it checked out. She takes a break to lie down a good part of the day because she says she has back pain.
Have a 50ish aged brother with his 18 year old son living in the basement who are supposed to be looking after them and helping keep up the house. This has not been done.
Mother refuses to leave home as son does not have the means to have a place to live and she wants to remain in her home like her mother did. (Her mother did not have these type of health issues). Son has lived totally free for 15 years yet has NO savings whatsoever to speak of. Works an hourly job so if he does not work he does not get paid. Grandson never has had a job and only takes out garbage when reminded.
My parents can remain in their current house but with great health cost to them (especially my father) and great concern to other children or sell the house and go into assisted living. My father won't 'abandon' my mother and they can't afford 2 places. House continues to get run down every day as nothing has been updated in 40 years.
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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.
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.
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...
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.
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.
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
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.