Opinions Sought. Parental and Family Issues Involved

Miscellaneous and Personal Stuff I Must Share
1

I don’t trust my instincts. I’m too pissed. I’m in pain from a gout attack and have been majorly stressed for most of the past month. (If you don’t know why I’d been stressed, check out this thread.) My mother, sister, and I have been going around, with my father, to consider some kind of elder living arrangement for him, ranging from Assisted Living to Enriched Living, to simply Independent Living.

My sister, who lives in Northern VA, has a very busy career and barely gets to spend much time with her husband is not happy about this. I thought we’d agreed it was a necessity, but today she asked me, “Why is it that Dad has to move out, and not Mom?”

I sputtered some stuff, then she had to leave to handle one of her phone calls, and I’ve been too pissed to call her back, myself, and explain.

I have had chronic problems with her not listening to me in the first place. She’s a supremely self-confident person*. It doesn’t help that her professional career is with Special Ed, and one of her crusades is to convince educators and parents to stop limiting the children in their charges by setting up false limits for them. So, she thinks that a lot of the frustration she sees Mom and I having with Dad is all self-imposed, and that he’s the soul of reason.

I have composed this email for her, and I’m hoping it might managed to get through to her why I think that Dad shouldn’t be staying in the house any longer.

The big question I have is: Do I sound rational, or am I acting the screaming freak. It doesn’t help that I am not precisely sane, so she already discounts about 80% of what I say anyways. So, this has to hit the right tone.

Critiques, and advice with the note are very welcome.

Why Dad and Not Mom
Okay, let’s go over this again.

Mom obeys the restrictions given to her by physical therapists. She also will do the exercises given to her. She keeps her cell phone charged and in her purse with her.

Dad ignores the restrictions given to him by physical therapists. He believes that if he can do something with a PT hovering over him he can do it anytime he wants and on his own. I confirmed at his PT session this past Wednesday: He is not cleared to walk without the walker, unless he has close personal supervision. He is not cleared to take steps, unless he has close personal supervision. He does not ask for that supervision. To be honest he ignores the physical therapist’s recommendations whenever he has a whim.

This is a major reason Mom wasn’t sleeping at night before her incident. He’s supposed to be taking the walker into the bathroom, or at least having it near, in case he needs help getting off the toilet. He generally goes to the bathroom without the walker completely at night.

He doesn’t give a shit about what this behavior does to anyone who is trying to care for him. He’s not going to ask for the help he’s supposed to have, and so either I have to accept that the physical therapists don’t know what they’re doing (which is Dad’s position, and seems to be yours) or I have to try to monitor him all the time. And that is driving me further nuts. Let me add, too, I’m 99% convinced that if he does fall in spite of my care, or when I’m not in the house you are going to blame me for it. So, on the one hand you’re telling me that I have to let Dad do what he wants in spite of medical orders. And on the other hand you’ve not said one word about accepting that something terrible could happen because of it.

He has very little muscle tissue over his hips, where they were replaced. In part because he’s been so reluctant to exercise. Which means he’s even more at risk for a hip displacement should he fall on his hips. I do not want that to happen, but he still sees nothing wrong with using the steps without any supervision. He misses details, and his reflexes are not what they used to be. He can and does trip over lines in the floor. Do you really understand how friable his bones are? Do you really understand that his artificial joints are weaker than his bones, and less able to handle stresses out of line with the normal use for the hips? I do not have that impression.

He needs either more supervision, or fewer opportunities to break various directives from the physical therapists. For that matter the only exercise he’s doing is going to see mom, or walking around housing communities. He will not exercise on his own, and Mom and I had to stop reminding him of his exercises because being ignored was stressing us the fuck out.

I can not care for Dad, long term, in this house.

As a temporary thing I’m handling it, and I’ve already had to leave the house several times to keep from blowing up at him. Have you forgotten that blood pressure reading I had the other day? 188/116. It’s in the VA records. If I have to have my doctor email that to you I’ll get it. That is worse than what my blood pressure (systolic) had been before I started treatment.

Now, shall we talk expenses? For a 2 hour visit from a home health aide contractor: That’s $100. If they’re authorized to handle meds, it goes up. They only come in visits to the house in two hour blocks. And Dad needs daily care, if only to get the wraps on his legs. The VA will cover 2 two hour visits. So, that’s about $500 a week. For two hours of supervision, and assistance when they can fit him in. Over this past summer, the hours they were available weren’t all that great - the established clients get the 9 AM appointments. Grandma Dessel’s experience was that HHAs were unreliable - because they’re the lowest trained of any healthcare worker they are easily replaced, and often find reasons to quit or skip appointments. She was getting about 50% arrival rate from what Mom remembers. Which is not really acceptable.

If Mom and Dad choose to pay for a HHA to come in daily, and that might be possible, that’s actually MORE than they’d pay for dad living in the Gables. And he’d still have to supply his own food, and meals, and linens, and pay the service to come and clean the house twice a month, instead of once a week.

And these buildings are all constructed without stairs that Dad would be tempted by. He’s also have to walk a fair distance, every day, just to get his meals. Which would improve the exercise he’s getting.

Mom doesn’t seem to me to need nearly the same benefits and care that Dad does.

Mom has never, to my knowledge, taken the wrong set of pills. Dad has. Several times, now.

Putting in a railing on the stairs in the garage is not going to suddenly make the house safe for Dad.

Love,
-Loki

*I’ll admit, I’m thinking arrogant, here. But I’m trying to be charitable.

2

“Why don’t we just have Dad come live with you, sis? I’m sure it’ll work out fine.”

StG

3

Is it at all possible that what your sister meant by “Why is it that Dad has to move out, and not Mom?” wasn’t that Mom should move out instead of Dad, but that they should move together? Since you didn’t mention a nursing home, I assume that your father does not need that level of care, and at least some assisted and independent living facilities accept couples.

4

Dear Sis,

I appreciate your input and will certainly give your perspective consideration along with the advice of dad’s medical professionals. Perhaps we could include having dad move in with you as one of our options? Let me know if that will work for you!

Love,
Bro

5

Yeah, that’s what I thought, too, maybe. It’s probably hard on a couple who’s been together so long to be apart, too, I’m sure.

6

I’d like to thank everyone who’s responded to this. I appreciate the feedback.

As much as suggesting that Dad move in with my sister might appeal, it’s just not feasible: she and her husband live in a two bedroom, second story, walk-up condo in northern VA. She is often out of town for work three days a week, or more. Her husband doesn’t travel nearly as much, but his work does involve some travel, too. While I think I’m allowed a life, even if I am on disability - I don’t think that she should have to choose between work and taking care of Dad, either.

The absolute best that she could arrange would be to move Dad into an assisted living or independent living facility near her. And since I’m not moving (I just, before all this blew up, signed an 18 month lease on my apartment), and my mother isn’t moving (She’s made it clear, she is not willing to pull up roots, now, and leave all her friends and supports behind.) - that would mean that he’d go from being assured daily visits, to getting maybe two or three a week.

One of the reasons that I’m willing to consider independent living (vice assisted living) for my father is because I know that he’ll be getting daily visits from family, checking up on his condition. I’m less sanguine with the idea of less frequent visits.

I think I heard her suggest Mom moving out instead of Dad. I’m trying to keep from reacting emotionally to my sister, but it’s hard, and that may have been what she meant. Considering that the rest of the conversation focused on things to be done to allow Dad to stay in the house, I believe that’s what she meant, not what you’re suggesting, doreen.

As a solution, moving both of them together sounds like a good idea, but…

The problem with this is that my mother, for all her wonderful qualities, is a worrier. (As am I.) And she stresses hugely about the things he won’t do. Even removing some of the every day temptations from my father won’t remove the temptation to walk through his living areas without the walker, for example. Nor will anything, I think, induce him to perform more than the minimum exercise he can get away with.

And given that my mother just had something that could be described as a stress-caused heart incident, we must reduce stress in her life. I don’t think that she can do that while sleeping in the same room as my father. While there are two bedroom apartments available, I’m not sure how well sound-isolated the two are.
An imponderable that my sister may not be aware of, is that my parents may have a stable 40 year old marriage, but that doesn’t mean it’s idyllic. Before my father’s NPH has struck back this late spring and early summer, they’d been building to one of their periodic major fights. Over this past decade the pattern has been that every two or three years they’d have a knock-down, drag-out screaming verbal fight, where they’d both stake out positions and insist on changes or compromises on the issues that was bothering them both.

My father, now, is much recovered from his nadir this summer. He is notably, however, not his old self. There are times that he’s acting far more like a toddler than an adult. There is no negotiation with him, for a number of reasons. Part of it is his increasing memory problems - he’s not always making the linkage between short-term and long-term memory. He can still make new memories, but for something like changing habitual behaviors, he doesn’t always remember agreeing to change them. Then there’s willful disobedience. Which is also happening.

So, my mother is stuck in an emotional position vis-a-vis my father where she’s angry at him for a lot of things that he can’t or won’t change. And he’s sufficiently off his feed that he’s not going to fight back - which is a necessary part of the dynamic between them for how they’d worked things in the past. Continuing to do things, now, is doubly infuriating for my mother, because she responds so strongly to the perception of being ignored.

In my opinion, she loves my father - but she doesn’t much like him, right now.

Which is, alas, another factor behind my wanting to get him out of the house. Get some space between them while the marriage is still alive, so that doesn’t get destroyed, too.
ETA: With the gout attack over, I’m finding it a lot easier to be patient with my sister, and to be more charitable, too. I’m glad the indomethacin works.

7

I think you missed the point. Asking her if she will consider taking dad in is a way of subtly saying, “unless you’re the one who has to take care of him day to day, STFU.”

8

No, I got that.

I’m simply not willing to lose the face that would be involved in making a suggestion that I know is impossible. I want to pick and choose my battles, and for the big things it seems to be working: I’ve got Dad’s tentative agreement about which facility looks best of those that we’ve seen. And I’ve managed to sell Mom on it, too. (It helps that they were recommended by a friend of my mother, as well as the social worker in the rehab center she’s at, now. The fact that we keep running into people working at several different facilities through town who keep saying, “My parent was/is there, and it was great,” is lubricating the whole process.) I’m trying to avoid escalating the emotional tone, and I can’t see the suggestion (which I parsed as you’ve translated it) as being able to do anything but escalate things.

A large way I’ve been lubricating this whole situation with my sister is to keep the clashes as unemotional as possible - I have to get around her automatic assumption that because I’m crazy I should have been locked up years ago. (Yes, that’s come out once, already.) She can be emotional. She has that kind of maneuver room. I don’t. Anything that is likely to involve her guilt for not being able to be here is going to throw the whole debate onto an emotional level - and I cannot afford that. I have to maintain as much of an attitude of fact and logic as possible.

9

I would re-write your letter to your sister and take the emotional, personal stuff out and give her just the facts, ma’am (and make it a lot shorter, too - that’s a long read there). You might think that it already is unemotional, but it isn’t - there are any number of barbs or self-pitying bits in there that she’ll react to.

10

I’ve never had to go through anything like this, so I can’t offer any opinion worth a damn.

But I can offer my condolences that you are going through this difficulty. I hope everything works out in a way that is mutually agreeable to all parties.

11

Why are you e-mailing your sister? Why aren’t you picking up the phone and calling her with all this? It sounds completely reasonable.

12

ivylass, we’re doing a lot of this through email, because it’s not as immediate as phone conversations. We both have issues*. So, in an effort to avoid saying anything unforgivable, we’re doing a lot of communicating about this via email. Especially anything that is not time sensitive.
*Hers towards me are largely rooted in having had the same teachers who had treated me like crap asking her “Why aren’t you smart, like your brother?” From what she says it was pretty constant, too.

13

Things are calming down. We’re reaching more of a meeting of the minds, now. I think we have a common ground for a solution, now. And so far - no blood. Which is good.