advice on elder care wanted

[cap]

Mother in Law is going back to the hospital for a partial hip replacement. She was in about 6 weeks ago for a smaller hip operation that the doc thought would stabilize her. She got sprung from the hospital two weeks earlier than what she should have ... MIL told the social worker that the family would take care of her ... and they have. She has two sons who have been there taking turns. Except for the first couple weeks, Hubby has been staying with MIL every other week.

Unfortunately, my Brother-in-law is out on disability...We dont know for what exactly -- he wont discuss it. He had testicular cancer and then went into sepsis with renal failure about 18 months ago. He had a bone infection in his shoulder ... so his arm is not completely functioning. His stamina is low and he is still in a lot of pain. Enough pain so that he doesnt always sleep well at night. Also, diabetes is beginning to rear its head. He is on 4 metformin and is going to be evaluated for insulin next week. He has early stage neuropathy in his foot ... so they are watching that too. Also, he is just starting to lose vision from a cataract. BIL does not take care of himself -- diet or exercise. Right now, he is walking around just fine but there there are a lot of nasty things lurking in the near future. BIL did much of the caregiving the first 3 weeks -- We had the flu so we couldnt go to hospital or rehab. Obviously at some point in the future, BIL can not take care of MIL. MIL does not know about the progression in BIL's diabetes yet. He just told us. We want to tell her after the surgery because she will get very upset. We are also shielding her from the imminent demise of a cousin -- he's only expected to last another week. She had a hard time with her first surgery.

Oh... a little background on MIL. MIL is an 85 year old retired nurse. For 10 years, MIL nursed father-in-law through the multiple complications of diabetes at home by herself -- 24x7 with some assistance from the boys. Earlier, MIL also went home and nursed her parents for two months. MIL is expecting this level of service from us. We cant do it. We live 3 hours from her. BIL lives 20 miles. We dont know how long she will need care for the hip replacement -- it could be three months or it could be for the rest of her life. Even if it is only 3 months, we need to be prepared for future health care crises. We are concerned about hip fractures in the elderly... there is a 25% mortality rate during the first year. Most people dont recover full functionality... although many do.

The boys are exhausted at this point. They are really tired and can not keep doing this. MIL has not been easy. Her sister just died from complications from a broken hip... so she was really freaking out during the first surgery...aka PTSD...had to call in the shrink. It took us several days to realize that she wasnt just crabby ... that something was wrong... Today she cant remember exactly what was going on. Also, her level of pain is very high ...hopefully the second surgery will fix that. MIL hasnt been eating so we are concerned.

Also, BIL is very excitable and pessimistic. He gets on MILs nerves. Hubby is calming and soothing influence. It is hard for us to know what is going on unless we are there because BIL is very excitable. On the one hand, we are realizing that BIL is not the best reporter of events; on the other, we can't afford to discount what he is saying.

MIL is in good shape financially. She has a lot of insurance - Medicare and two others. No custodial care, however. Decent amount of savings and a pension and a valuable house. MIL wants to hang onto her assets... On the one hand, we dont care about an inheritance; on the other hand, given the rapacious greed of the Bush administration, we need to be wise about the future so that MIL is covered. If this were 20 years ago, I would have said that she was set.

The question is this... we need help. MIL doesnt want to leave her house...wild horses wont get her out. Her home is nicely set up for the handicapped. Insurance will cover 2 hours of help in the house for a short period. She can afford part time aid on her own for 3 days a week at $15/HR. However, we need a plan for the future and we realize she needs to be living with someone. I looked into agencies that provide companions and it is too expensive. They are all set up for someone who has long term care insurance -- they run $150/day... so about $4500/month. I am wondering what the going rate is on the open market... room and board and stipend... with every other weekend off. Does anybody have any ideas?

No one wants to live with each other. BIL and wife dont want to move in with MIL. We dont want to leave our home to live with MIL. MIL doesnt want to live with either of us... We have two story houses with no bedrooms/bathrooms on the first floor. Theoretically we could move into something else... but she just doesnt want to leave her house.

Also, MIL doesnt realize how unforgiving corporations are towards taking time off. Hubby is working for himself right now... and has put a lot of things on hold to take care of Mom. Hubby cant do this forever... Hubby may get a corporate job. For all the hue and cry, men just cant take off significant time for their loved ones... The most I see is one week when their parents die. It is grossly unfair but that's the way it is. Anyone replying saying that they do must realize that they are the exception to the norm and that most men just arent following their examples. I just dont see most men in their 40's and 50's leaving work to take care of their parents. Their female relatives are doing it for them. Sorry, I see more time taken off for little league than I do for sick relatives. MIL doesnt realize that Hubby just cant do this and keep his job. They would get rid of him. Elder care is crisis driven... it is not planned.

MIL can afford assisted living...it works out to be much cheaper than a companion. I found one place near us that works out financially. She can rent her house and the rental income will cover assisted living... she would actually come out ahead and not touch her pension or other assets. However, I am afraid about her leaving her home. I am afraid that she will get quite depressed and not try to take care of herself. This might impact her recovery. She is vulnerable to anxiety and depression and is on some medication for those conditions. Never mind the battle it will take for her to leave.

I would like for her to stay in her home and be confident in her ability to take care of herself. I dont know if we can find a suitable companion. Hubby is planning to talk about all this with the social worker at rehab. Everything needs to be laid out and talked about.
BIL's health. Options and prognosis....everything. They need to have a family conference with the social worker. Hubby is willing to come down every other weekend... but we cant afford for him to put everything on hold. Financially and emotionally we cant just keep doing this.

[radwriter0555]

1. So put her in the assisted living situation. It sounds like a win-win

situation.

The battle to get her there will be far less than the ongoing battle to hire help, drive, arrange schedules, arrange care, etc. Transfer her directly there from the hospital after the surgery, and tell her it's like a rehab place... and just um kind of leave her there? Well not LEAVE per se, since you'll be there a lot, visiting, etc. And it will just kind of go on, and on... and on.

Sounds like a rough, tough situation and that it's time for some serious decisions.

Lots of luck... and huge hugs.

[cap]

3. she is not mentally incompetent... so we cant

just sign her in somewhere. If she decides to go home, she can go home. Rehab can keep her for a few more weeks than otherwise but even they cant force her to do something she doesnt want to do.

I have my doubts about assisted living as being the best option. In many ways, it is...in some ways, especially given her mental condition, it isnt. I'd really like to see if it is possible for her to stay in her house.

[radwriter0555]

7. Okay, have you looked into "adult day care"? Where the patient is taken

daily or several times during the week to a day care place? You know, like for toddlers, but for elders instead?

Some even provide transport.

[cap]

9. maybe that's an option...

but I think the concern is leaving her alone in the home.

[nini]

2. She has to make a sacrifice one way or the other

She can't put all of this on the kids.


If she doesn't have the cash for a live-in.. she will have to sell the house (reality doesn't give her a choice) and use the proceeds to be in a nice assisted living location. OR look into reverse-equity loans to give her money to pay someone to live in with her. Of course when they money is gone - it's gone, but then she would be eligible for more medicare assistance.

You get to the point with ailing parents where you have to treat them like your children instead of your parent. It's hard as hell to do, but as you state the rest of you have other responsibilities too to keep your own families afloat.


Talk to a social worker and also contact any senior groups in your area. They also have resources for these situations. We got a great live-in for my dad from one of those groups.

Good Luck.. it's a tough time

[cap]

4. what senior group did you look into?

We'd like another alternative to agency or assisted living or just trying the newspaper.

[nini]

5. It was a community group.. not a major national thing

Check the phone book for senior services type stuff and start calling around. You'll eventually find one that has the resources and advice you need to find a solution. You shouldn't have to pay for this help either, so be aware of a place that would charge you.

[cap]

6. how much did it cost to get live in?

also what area of the country are you in?

[nini]

8. I'm in L.A. county

It was free room and board and I 'think' $400 a week - you've to remember this was 24 hour care - it was a good deal for both sides. My sister handled the finances, but I'm pretty sure it was around that amount. The woman was a God send. She cared for my dad until he died. Included meals, cleaning and everything. She couldn's sit still if he was asleep so she'd clean.. she didn't have to, but she did - an amazing woman.

[cap]

10. kick

[xmas74]

11. Depends on where you live.

I live in a college town. I've heard of a few arrangements that families have around here that are pretty inexpensive. They'll hire college kids who are nursing or education majors for $7 an hour to come in and do the chores. I've also heard of them running sleeping homes that they have college kids doing for a bit over minimum wage. The kid comes in, sleeps all night and is there in case there is help needed.

The families spoke w/ professors and got the recommendations on who they thought would be best for the positions. The sleeping position included making breakfast and the student ate w/ the father (in this case), cleaned up the kitchen and helped him dress for the day before he spent time in adult care.