Resources for helping elderly relatives?

Miscellaneous and Personal Stuff I Must Share
1

My spouse’s mother is in her late 80s. His father died a few years ago, leaving her living alone in their home, which is about an hour and a half from where we live. She has an extensive family (three of my spouse’s older siblings and their spouses, numerous adult grandchildren and great-grandchildren) in the immediate area who visit her often, so she’s not alone.

The problem is that the oldest sibling has been doing the bulk of taking care of her. She’s very responsible but also kind of a “my way or the highway” type, and the dynamic I’ve observed between her and her mother is very pushy/maternal. On the other hand, though, she’s really the only one who’s stepped up and done the bulk of the work, and she gets frustrated because Mom is pushing back against her and doesn’t want to do the things she needs to do (like take her meds).

The other female sibling helps out, but not as much, and she and the oldest get on each other’s nerves a lot. Middle sibling is more lenient with Mom, which frustrates older sibling.

The other male sibling who lives in the area is very responsible and handles most/all of Mom’s financial details, but I don’t think he gets involved with the caregiving very much. My spouse is pretty much out of the loop due to not living in the same town.

This is all kind of reaching a boiling point because Older Sibling is burned out and frustrated to the point where she wants to wash her hands of the whole thing, but she can’t/won’t do that because she thinks Middle Sibling will just let Mom have her way, which isn’t safe.

There are no bad guys here - everybody’s just trying to do what they think is best with a difficult situation. When my spouse told me about what was going on, I immediately wondered if there are resources the siblings can make use of to help them - caregivers or other such folks who could step in and help look after Mom without all the years of personal baggage getting in the way. They’re all kind of the self-reliant type, so it might not occur to them that help is available and might lighten their load. I sincerely doubt anyone (including her) would be in favor of moving her to some kind of assisted-living home, so an in-home solution would be best.

We all live in California. I figure there are a lot of folks around here who are dealing with elderly-parent issues, so I’m hoping to get a few ideas to suggest to them. I’m basically neutral in the whole thing, since I don’t interact with the family that much (they’re very nice people but we don’t have much in common). Thoughts?

2

There are definitely all levels of services for the elderly available, from light housekeeping all the way to hospice. My dad who is 96, has 24/7 live in care, plus nearby relatives, especially the oldest daughter (very traditional role, and yes, of course, bossy). It takes all of that, plus someone to manage his finances, do the gardening, keep the house repaired, do all the shopping …

There’s just one catch – it is very expensive. That’s why daughters and sons and spouses do all of it until they are completely overwhelmed. There’s essentially no government funding for this kind of care, in the US. My father is relatively wealthy, and he is spending everything he ever earned, now.

3

This might be a good jumping off point for locating specific resources in her/their county:

4

Wow, this surprises me. I would have thought there’d be government resources (connected with Medicare) for this kind of thing. I guess I’m more clueless than I thought. Now I’m wondering if they did check into such things and found out they were too expensive.

5

Yes, Medicare does provide some coverage:

6

The oldest sibling is doing a saint’s work by taking all this on. I’m sure it’s taking a huge toll on her and on her relationships. Ideally, the other siblings would 100% support her no matter what since she’s providing this level of support. But in the real world, that rarely happens.

There are paid caregivers who can help, but I doubt they’d provide the level of help that the oldest sibling would be happy with. However, the caregivers can help with the generic other stuff so that the oldest doesn’t feel such a burden. Even a simple maid service could greatly help, as any time not cleaning could be spent with mom or simply relaxing.

One thing I might suggest would be to have the siblings commit to the oldest that they’ll give up all or part of their inheritance to help compensate the her for her time and effort taking care of mom. This can be troublesome to discuss, but if it can be worked out, may have the effect of making the oldest feel more appreciated and committed to taking care of mom.

7

A very important stipulation needs to be addressed from that cite:

… * Home health aide: Medicare pays in full for an aide if you require skilled care (skilled nursing or therapy services). A home health aide provides personal care services, including help with bathing, toileting, and dressing. Medicare will not pay for an aide if you only require personal care and do not need skilled care.…

Medicare rarely ever pays for the kind of personal care that the OP is asking about. The trick is that the person has to be receiving skilled nursing services and then Medicare will maybe, perhaps, eventually pay for some personal care liking showering, bathing, toileting, etc. That won’t include basic housekeeping, cleaning, shopping, errands, more than light cooking to heat up or prepare basic meals. Requiring enough skilled nursing services to quality for those personal services is a high bar to clear and usually requires many authorization attempts and even more laborious appeals.

You can need a lot of hours of personal care without needing any skilled nursing (or other professional skilled services), that is where the reality falls apart for most people.

8

This is pretty accurate from my experience. I have seen budget-minded friends take-in and look after an elderly parent and say “Oh, it’s not that bad. It’s no problem taking care of her!” at first. But after a two-year soul-crushing (and nearly marriage-ending) grind of gradually deteriorating health and increased care needs, they finally moved her into a care facility. At some point you either throw-in the towel or the relative dies, but IMHO it’s better to do it too early than too late (move them to a proper care facility). Honestly, it’s not a matter of choice - it’s a safety thing - most people are not trained to tend to the needs of the infirm or the elderly, and are certainly not prepared for everything that entails. And their health is not going to get better, only worse.

I recommend the family get together and talk about the situation openly and honestly, and align on a solution that works for the relative as well as the rest of the family (and with available budget resources). The sooner everyone is aligned, the better.

9

i was just talking with a guy whose elderly mom refuses to move to assisted living. He works for a major financial company that contracts with companies around the US to provide subsidized home health care aides for employee family members. He’s been having aides come in for 6 hours a day, 4 hours in the morning to help Mom get up, dressed, breakfast, light cleaning, laundry and prepare lunch. Then another person comes in the evening to help with dinner and getting settled for the evening. It might be worth finding out whether any of your MIL’s kids work for companies with any program of this type.

Here’s a link with info on resources: Aging in Place: Growing Older at Home | National Institute on Aging

10

There’s no real help. For free or low cost.

I pay a CNA because I’m not anywhere near(age related or physically near)receiving any services or handicapped enough to be in a place.

This is a personal choice, mostly my family want peace of mind.
My private insurance covers my CNA, a tiny fraction, only because she chooses to live in. A visiting aide would not be covered. Zero.
You tell me why?

My glucose going very low at night is a problem, so it works for us.

I’m here to tell you it’s very expensive. Very expensive.
If I live long enough it will eat all my savings.

Any private help will be pricey. The government will do the bare minimum after taking all the assets. It’s best to have her in assisted living.
Find a good one that meets her needs the closest. The government will still take all the assets.
But then no one needs to mow the lawn, deal with sibling rivalry, go nuts when the aide skips while you’re on vacation. No rides to a multitude of appts. Meds will be given. She will be cared for, fed and safe.
(If it’s a good nursing/assisted care home, there’s no guarantee that will happen).

If family can manage, that of course, would be best.
They cannot always do that. No shame. It just needs to be discussed. The whole family needs to be in on the care decisions.
A good place will require the family to have meetings at the start.
That’s when things get aired.