Putting parents in a nursing home. How did you approach it?

In My Humble Opinion
1

My parents are both in their low to mid 80’s. My dad’s mind is still very sharp. He was a medical school professor and has always been quite intellectual. Having a conversation with him is just about like it has always been. Unfortunately, his body isn’t keeping up with his mind. His vision is poor from diabetes which leads to depth perception problems which leads to falling.

My mom is about the opposite. She gets confused easily. She has a very difficult time making decisions like what pop to order in a restaurant. My dad had to call 911 for her yesterday because she was so out of it. The hospital said that she has a virus, was dehydrated, and nutritionally deficient. I think she forgets to eat.

Further complicating matters is that I have an adult younger brother that is mentally disabled and lives in a group home not too far from my parents’ house. For the past 20 years or so, my dad had gone to get him twice a week and they go eat and “talk to the cows” that they drive past. My dad really shouldn’t be driving but not getting to take my brother out will be devastating to both of them. Unfortunately, I live about 5 hours away. Their are no closer healthy relatives. I have an older brother as well but he lives much further away than I do.

If you have had to find a nursing home or assisted living for elderly loved ones, I’d like to hear your stories and any words of wisdom that you may have learned from the experience.

TIA.

2

I had to cope with this five years ago. It took at least 18 months to persuade them to make the move. Fortunately (?), my father had several falls in the house and my mother was unable to move him or get him to his feet, which made it clear that he could not be at home without some outside aid. He was in bed at home for a couple months with daily home visits by a nursing service. Finally, we were able to get him in a nursing home, which led to my mother going through a year of visiting him twice a day (and feeling quite a bit of guilt).

My mother finally gave in and agreed to move to an assisted living facility, where my father could be in the skilled nursing unit and she could be in an apartment nearby. Money was not a problem, thanks to my father’s pre-planning for retirement.

Unfortunately, my father passed away just days after the move. About a year later, my mother thanked me for all the work I put into the effort and stated that it was a relief when my father finally passed. She lived for three more years and enjoyed the facility quite a bit.

IMHO, you have to start from a position where your parents trust you. I’m the “favorite son” and I can tell you that my parents completely ignored the pleas from my siblings. Furthermore, it was clear that they knew what they needed to do, they just had to have someone tell them the unvarnished truth and explain away any lingering guilt one or the other might feel.

Good luck!

3

My Husband and sibs spent all of his parents savings and more to keep them at home, when IMO they would fared better in a nursing facility. You gotta do what you can live with. If you have guilt or fear a professional can help you decide. Get your sibs together and visit a preferred location they have social workers on staff. Good luck!

4

I’m an only child. My 90-ish year old mother lived in an apartment by herself in San Diego. The neighbors helped keep an eye on her, but when it got to be too much responsibility for them, I hired a Geriatric Care Manager. This is a social work-y type person who coordinates what the elderly person needs. Sort of a surrogate me. I loved the Care Manager–she was fantastic! I hired her through Jewish Family Services (you don’t have to be Jewish to used their services, although I am. My mother isn’t.)

We did this for about a year, but it was getting problematic. So I just made the executive decision that she needed to go into Assisted Living. The Care Manager took her around to some places in San Diego, but (looking back) that NEVER would have worked. I decided that she needed to come here to Texas. I knew of an excellent facility and she’s been there now a little over a year. There was no “persuading” to be done. I just put the wheels in motion. She did accuse me a few times of “putting her in a home” so I could abandon her, and my dad could run off with her sister (both of whom have been dead for years), but she got over that.

I’m leaving out a TON of detail, especially the logistics of disposing of the stuff in her apartment (I used 1-800-GOTJUNK) and physically moving her here. It was a LOT for me to deal with without any help from anyone. But now that she’s been settled for a while, I go by to see her twice a week, and on one of those days, I do her laundry (they have washers there). The place itself is great. The staff is great. I know she’s safe and that’s the most important thing.

5

This might be too late, but consider independent living first. That is something that you might get Dad to agree to on his own. With Mom tagging along out of inertia and sorta-senile passivity.

My 92 yo MIL recently decided to switch from living in the apartment she’d loudly insisted she’d be in until she was dead. Somehow something changed and life alone on her own got just a little too hard. In independent living she has a one bedroom apartment, a kitchenette, and a chow hall in the next building. She is under zero supervision and can come and go as she pleases. Meantime the chow hall offers restaurant style meals 3x a day just by showing up. And they provide entertaiinment, activities and weekly maid service to change the bed and do the laundry. We took over managing her finances and administrivia; all she does all day is eat and play and read. She’s vastly happier than she was before. And much healthier too.

She’s very sensitive about being bossed around but finds none of that in her current situation. She’s doesn’t have Alzheimers but she does have encroaching senile dementia from multiple TIAs and will probably have more going forward. As her memory & executive ability fades she’ll eventually move to the assisted living section with more intrusive supervision. But that’s some ways off. We’re hoping / praying that she becomes more docile, not more cantankerous as her mind fades. But we’re as ready as we can be for either eventuality.

It sounds like the OP’s Dad would be a good fit for this. OP’s Mom might already be over the edge into assisted living. There are plenty of facilities that offer both side by side.
I guess my main advice is to eat the elephant in the smallest possible steps. If Dad will try independent he’ll probably find the support without strings suddenly gives him a lot more energy and capability for enjoyment, not just chores & Mom-maintenance. In that more supportive environment Mom may thrive a bit too. There’s certainly a lot more mental stimulation with so many similar seniors in one place.

For my MIL the independent living place doesn’t charge but $100/month more than she was already paying for a 2 bedroom ordinary apartment plus groceries and utilities. IOW, independent living is not expensive compared to ordinary life out on the economy like the rest of us. Assisted living and eventually a true nursing home with so-called “skilled care” is where the price ramps up smartly.

6

Independent living is a great place to start. When people have a fear of The Home, they should go and check out today’s “Homes.” Some of them are quite posh–more like living on a cruise ship. If anyone is wondering, the cost for my mother in assisted living is right at $4,000 per month, which is a mid-price. You can find them for less, but I don’t know what kind of care your loved one will get. The biggest cost to the facility is personnel, and you don’t want them skimping on that.

7

Consider taking them into your own home. A century ago, everyone in the world did that with their aged parents, and most of the world still does.

I saw my mother spend one day in a nursing home, and I got her out of there. I was already retired at the time, so my wife and I just found a suitable place, which Mom could afford to rent on her pension, and we moved in with her, committing ourselves to whatever housekeeping care she needed.

By the time your parents reach this stage, you are probably on the downward slope yourself, so make the commitment. You’ve raised your kids and you’t apexed your career, so just do what you need to do.

8

LSL Guy’s comments are spot on. PiperDad moved to an independent living place and sold his condo. His own decision; he was tired of cooking for himself, and the independent living place was just down the street from his condo. He was there for four years and enjoyed it, until the Alzheimer’s started to show. Then we moved him to an assisted living place, then a memory watch place. We just had to make those decisions for him.

With respect to the OP’s dad and brother, we had a similar issue. Dad really didn’t want to give up his car, but had to. We found a nice lady who we hired to drive him around and do minor shopping. That really helped with some of the transitions. Maybe the OP could find a similar person who could take dad and brother on drives a couple of times a week?

9

My parents moved into an assisted living place. I believe it was required that the were able to function independently to some extent, not requiring constant care/support. My mom was declining from breast cancer. My dad had had a stroke a decade earlier. Both were mentally with it up to the day they died. My dad REALLY didn’t want to leave the house he had lived in for 70 years - a bungalow an hour from their kids, which they could no longer maintain.

I guess my mom’s motivation was that she knew she was worse than we understood, as she died 1.5 months after moving in. My dad died in his sleep a month later.

They had an apartment with a kitchenette, but meals could be taken in a communal dining room. A van would take them anywhere in the vicinity, and there were stores and such they could walk to. It impressed me as a really nice option. But I’m sure if you asked my dad, up to the end he would have said something like, “Couldn’t I have just stayed in my house?”

A couple of years ago my wife and her sisters mover their mother into a similar place. She had dementia and COPD. We’d had a live-in caregiver for a couple of years, which worked well for a while, but over time, overseeing the caregiver got to be a bit of an issue. MIL STRONGLY resisted the move at first. We found one that had decor very similar to her tastes. Moving her furniture in made it really look similar to her previous place. Within a day or 2, she loved it. One time my wife asked her if she wanted to go with her to the condo as she cleaned it out, and MIL said, “I’m done with that place.” Only real problem ws when she started sneaking smokes in her unit (while on O2 24/7!) and the facility threatened to evict her!

In both instances, we were fortunate that the parents had sufficient savings. It was far from cheap. But it was SO nice to have competent staff whom you could expect to handle routine matters, and provide baseline safety/security.

If you do not already, you should STRONGLY encourage your parents to look into power-of attorney, living will, etc. Not words of wisdom, but I suggest you have to protect yourself against having your parents’ final years dominate your life. Eldercare is a total attention sink - no matter what you do, you could do more. And be fully prepared for your parents to not be appreciative of your efforts, and for friends and family members to criticize your choices and actions. Try to figure out ways to remember your parents as they used to be, as memories of their final days/months/years can crowd those out.

10

Agree with all your post, but this snip is totally the experience we hear from a lot of Mom’s new friends.
By and large the folks in independent living have very mild mental impairment or have mobility / dexterity challenges. But are otherwise capable, if slow-moving, people. They’re far from bed-ridden droolers.

It’s hard to live on your own in an apartment if you can’t drive, can’t walk real well, can’t reach the top cabinets or under the sink, and are becoming lazy or mildly forgetful. It’s harder yet if you live in a condo, a house, or at far worst, a rural property.

Most folks decline slowly and so don’t recognize that the habits of a lifetime involve more work than they now have capacity for. And so that therefore life is reduced to trying and failing to keep up with routine tasks while all the fun part of living is squeezed out.

Unless one is destitute it doesn’t have to be that way.

11

Destitute? There are so many articles about how high nursing home costs are and how much higher they are going to get, with no end in sight that it’s hard to know where to begin. From Forbes:

A good way to check out what you can afford would be to check out this health care guide and plug in the appropriate information to see what different kinds of care cost where you live.

12

We’re not talking about nursing homes. We’re (or at least I and several others) are talking about independent living facilities. That’s about like the difference between a doc-in-the-box urgent care storefront clinic and a major medical center ICU. Both contain doctors and sick people but that’s about where the similarity ends.

As I said in my earlier post, independent living facilities cost little more than ordinary apartments of the same general SES. As you say, there absolutely are more comprehensive care facilities that cost more money. In some cases unaffordably more money even for nominally successful people.

But if you (any you) believe the only two choices are to live alone in your own home or to be an inpatient in a full-bore “nursing home” with 24/7/365 skilled oversight you’re about 40 years behind the times.

13

My second link is about all types of assistance, including independent living facilities. I live in Portland, Oregon and the care you are talking about would cost $48,840 a year. Next door in Washington the average cost per year is $55,920.
What is your definition of “destitute”?

14

I just visited your link and tried both generic Florida and specifically the Miami area which is where both I and aged MIL live. The numbers are not far from the national median numbers that first pop up. Oregon’s numbers are about 10% above the national median numbers.

I note that zero of the information on that page is about independent living. They’re all about the more comprehensive (and expensive) options.

To be specific, Mom had been living in an ordinary 2-bedroom apartment costing $1700/mo. It wasn’t de luxe, but it wasn’t a dump either. There were plenty of new Toyotas or 4 year old BMWs in the parking lot. And no jalopies trailing a cloud of oil smoke. Plus she was buying utilities and groceries which drove her monthly total baseline living expenses to about $2100/mo.

The independent living place she lives now is a mile from the apartment and costs $2250/mo. Which includes 3 sit-down cooked meals a day and electricity, trash, and water she was paying separately for at the apartment. Plus weekly maid service and entertainment.

Mom was an ordinary office clerical worker her whole life after her husband died young. For a few years she worked for a state government and has a small pension from that. The small pension plus her social security *almost * covers the costs. Just as it did at her apartment. Her savings and interest cover the rest. She’s about as ordinary an earner as a single working woman from the 1950s-80s can be.

To be sure, if/when she needs to switch to assisted living the costs will roughly double according to the numbers on that website. To the numbers you keep quoting. Which for many people means some combo of doing without, spending all their savings in a year or two at most, or relying on their family to make up the shortfall.

As challenging as this situation is for the Depression era elderly people using it now, at least those people lived in an era of good wages, good retirements, and saving money as a virtue many people actually practiced, not just talked about.

The situation will be very different in 20 more years when my generation or subsequent get there. You know, the folks with little savings and no pensions; at best just a 401k with a small balance. Gonna be ugly; real ugly.

15

I really appreciate all of the advice offered in this thread. I went to visit my parents this weekend and ISTM that their current situation isn’t as critical as I was led to believe; which is good because it appears that these things take time to work out. My mother is going to start receiving home health care visits and my dad is still insisting that he will take care of her for as long as he is physically capable, and probably longer. The man is very stubborn and as long as his mental faculties are what they are, all that I can do is make suggestions.

16

The good news is the home help for Mom can be a real boon if the agency sends quality folks.

In more tepid news, note that Dad can (and probably did) put on an unsustainably good performance while you were there. The week to week reality may be a bunch more grim.

Speaking from some experience, the best thing to do now is take a more active interest in talking to him regularly, like 2x or more per week. Slowly ramp up how much you’re asking about the mundane tasks and events of daily living. “What was for dinner last night?”, etc. You’re hoping to both A) spot basic stuff not getting done now, and B) monitor the trend of declining mental or physical performance over time. Make sure to volunteer lots of similar info about yourself so it doesn’t sound like an interrogation. e.g. “I made a wonderful pot roast for dinner last night; the meat was even on sale. What did you have?”
Second topic:
If this isn’t already taken care of, now’s by far the time to ensure their end-of-life paperwork is set up properly. Dad’s fall risk coupled with Mom’s slow decline says there’s a nonzero chance things abruptly transition from him being the caregiver to him being (mostly) out of the picture while leaving Mom with nobody. That scenario needs to be covered for.

Which, at least in the US, means appropriate trusts created, a designated family or corporate trustee to handle his/her/their affairs if they can’t, etc. Plus having explored the practical side of which home care or facility care options are on the short list, etc.

As you say, Dad’s no dummy. And has probably seen several friends over the years screw this up totally. “It ain’t gonna happen to me” is not a plan. It’s wishful thinking unworthy of a smart & responsible man on whom other people depend. Expressed that way you have a small chance of planting a seed that germinates *before *the inevitable crisis. Also recognize that increasing stubbornness is itself a form of loss of mental capacity. And a particularly pernicious one.

17

I worry about my inlaws. They live 800 miles from us, they’re both in their mid-80s, they’re both as stubborn as can be, and I don’t think they’ll be able to live on their own much longer. MIL has macular degeneration, but she still insists on driving (I live in fear that she’s going to hurt or kill herself or someone else, but refer to what I said about stubborn…) FIL has cardiac issues, including really low BP, and he just had surgery for a torn Achilles, plus mentally, he’s lost a lot of his sharpness.

Of the 2 brothers who live near them, one has serious health issues of his own, so he can’t be relied upon, and the other is mentally handicapped, so he’s minimally helpful. We tried to persuade them to move nearer us, but they refuse. Heaven help us if we suggest any sort of assisted living situation. Did I mention stubborn? I find myself getting angry at them because of the stress it causes my husband, and while I understand their feelings, I wish they’d accept that they’re not the active, fit people they used to be.

Fortunately, my mother is less of a worry. My youngest sis is moving in with her, and another sister lives 6 miles away (I’m more than 100 miles away.)

I’m trying to keep all of this in mind so when I reach that age, I’m not a burden on my daughter, but I might be a teensy bit stubborn, too. Just a bit.

18

Anger is understandable but unhelpful. I’ve fought that tendency for years. It’s frustrating as hell dealing with people with their eyes screwed shut. Doubly so when you remember when they weren’t that way.

Ultimately they will decide what they do. Until they are utterly mentally incompetent they have the practical right to do dumb stuff up to and including drive their car through a crowd of people thereby eating “your” inheritance.

Like dealing with an alcoholic spouse or a troubled teen, ultimately serenity comes from saying “I *am *responsible for trying to help. I am NOT responsible for their outcome. NOT even a smidgen.” And leaving it at that.

They may decide to move to a facility. They may perish in the house fire they inadvertently set. Not your problem. Or more accurately, neither outcome is your fault.

It’s a different flavor of “tough love”. But until/unless they regress to toddler-like complaisance you can’t expect to manage them as you’d manage a recalcitrant toddler. IOW, where you can deliver a specific result over their most vehement objections. So accepting that you are not responsible for their outcome, only for your own efforts, is the only path to sanity and serenity for you.

Do a reasonable good effort by your lights given your circumstances and disregard the rest.

Those are the words I’ve been trying to live by. Not always easy, but so far it’s paying off in sanity and reduced tension with my oldsters.