What do you do when one parent needs nursing care and the other is active?

[Anonymous]

My mother is only 75 but she has pretty much lost the ability to walk due to joint deterioration. She is also becoming confused. She has been tested and had an MRI but they don't see anything unusual with her brain (although brain scans for the elderly are hard to read). My father is quite active and likes to go hiking and do handy things around the house. They still live in the 3-story house I grew up in. Mom thinks the stairs are not a problem but it's really the elephant in the room. She has refused to move for years and years but it has come to the point where she has no choice. Dad has wanted to move for years but he does not need any kind of assisted living. He has also become very frustrated being Mom's full-time caretaker. It has gotten to the point where she cannot use the bathroom or get dressed by herself. Dad says he's afraid to leave her alone. She has had three serious falls in the last two months, one required an ambulance and hospital stay. They have retirement savings and equity in the house but do not have mountains of money to spend on private nurses or a fancy nursing home. They will most definitely stay in Maryland.

Where do couples go with this kind of situation? Is there any kind of counselor or social working they can talk to who could lay out their options given their finances?

[Anonymous]

My parents will be facing something similar in the near future due to my dad's illness. Did your mom recently visit a hospital to where you can reach out to the social worker there? My dad is currently in the hospital out of state and the social worker walked my mom through assistance options available through Medicare (not sure if your parents are on Medicare). But there are services Medicare pays for.

Your mom may need to go into assisted living and your dad live outside of assisted living and visit as such. Or get nurse assistance at the house (not sure what is cheaper). Either way, I don't think there's an easy solution. I'm sorry you are facing this. I'm already stressed knowing what's to come

[Anonymous]

I would suggest starting with the local office of aging in your parents' locality to get information on assisted living and multi-level continuing care communities. There is a large one I ran across once in Gaithersburg or Frederick MD with a connection to the Methodist Church - though open to all that was on of the earliest senior communities. If you can look a bit outside metro DC, it might not be as expensive as you think if your folks were to move into even Independent Living and get support services for you Mom.

If their home is in DC area, it really might be worth quite a bit with some relatively inexpensive things done, cleaning out/staging etc. In addition in a senior community, one could compare the costs to what housing, food, care brought in etc. would be. In such a setting all would be on one floor in a unit with elevators between any floors so that would take care of mobility issues. There would be the option for meal(s) which might be better nutrition for both. There would be activities your Mom might be engaged in more than Dad, but that would give him the option to continue to come and go as he chooses on his interests and he might meet fellows in similar circumstances or with similar interests. Th

For any kind of supportive living situation, there is always an assessment done of both individuals and either the level of care needed will be presented or if one can get an independent living unit, needs will be noted that one can then hire an agency or approved private provider for. Your Mom sounds like if she had care getting showered and dressed in the morning, it would go a long way even 3-4 days a week. If she was in a setting with a more accessible bathroom with grab bars and walk-in-seated shower she also might do more herself. This would also afford your Dad a definite break time to be out.

Not an easy task as we had to wait for a second hip fracture this summer in my Mom to get Dad (93) to look at options and 7 of us to get the move done. She has memory. balance and mobility issues now, but he is like the 82 year old energizer golfer. Winter in Massachusetts after 27 years in Naples is not going to be easy, but it was time. Doing your research ahead of time and then presenting positives to your Dad is the way to go. 24/7 caregiving does wear down a spouse, too.

[Anonymous]

I would definitely looking at continuing care places where you can start well and move all the way towards nursing care.

There are a few places--rare--that will do that within one apartment. I know of one in another state. Most I think have separate units for each level of service. Assisted living often doesn't include that much assistance--if your mom can't get dressed or go to the bathroom alone, she would probably be in a nursing home care situation. These are called the "activities of daily living" and you have to do a certain number of them to be in assisted living.

But if you could find a place where your mom would be well cared for in the nursing wing while your dad could be nearby in his own senior apartment, that would probably be your best bet.

[Anonymous]

OP, at some point they live separately. The one in better health visits the other. Even in continuing care facilities it might be that at some point they live in different rooms.

[Anonymous]

Team up with your Dad and make this happen. They need to move. Ignore your Mom's objections. Your Mom is probably getting to the point of not being rational.

Can't tell you where they should move to. But you need to know their finances. This is the time. At some point your Dad may not be in such good shape. Sometimes the "well" parent dies first.

You're on deck. Take charge.

[Anonymous]

Agree with talking to their local Office on Aging.

I think there are two issues here: 1) where to live and 2) getting care for your mom so your dad is not so burnt out.

Living options are probably either making modifications to their existing home, selling and moving to a one-level house or apartment with handicap accessible features, and selling and moving to the independent living section of a community with a spectrum of care so your mom could move into skilled nursing care there if she gets worse.

I think in any case, your family should look into getting a health aide to come to help your mom bathe and look after her for a little bit so your dad can get a break. You could try to do a mix of family members providing more assistance and paid caregivers. There are also adult day programs where the family drops off the senior needing assistance and picks them up at the end of the day--program staff help them with the bathroom. You may be able to find one that your mother could go to 1 day a week or a couple mornings a week.

It sounds like your mother does not need skilled nursing care at this point, but may in the future. Best wishes to you and your family.

[Anonymous]

Anonymous wrote:Agree with talking to their local Office on Aging.

I think there are two issues here: 1) where to live and 2) getting care for your mom so your dad is not so burnt out.

Living options are probably either making modifications to their existing home, selling and moving to a one-level house or apartment with handicap accessible features, and selling and moving to the independent living section of a community with a spectrum of care so your mom could move into skilled nursing care there if she gets worse.

I think in any case, your family should look into getting a health aide to come to help your mom bathe and look after her for a little bit so your dad can get a break. You could try to do a mix of family members providing more assistance and paid caregivers. There are also adult day programs where the family drops off the senior needing assistance and picks them up at the end of the day--program staff help them with the bathroom. You may be able to find one that your mother could go to 1 day a week or a couple mornings a week.

It sounds like your mother does not need skilled nursing care at this point, but may in the future. Best wishes to you and your family.

^^ This! My husband and I were in this situation last year (became totally disabled from an accident). I totally sympathize with the situation. We ended up moving from an apartment to a house that was easy to modify. The whole process took almost a year and it was very nerve racking. If there is a room on first floor like a seperate dining near the powder room you could convert that to a bedroom suite with a full bath. You could then hire a private HHA for X amount of hours a day ... I find the morning and bed routine to be the hardest so maybe you could get someone come in the morning for 2 hrs... Get your mom of the bed, straighten her room give her a shower, run errands etc. then maybe you could have the aide come every other evening to help your mom with evening routine etc. I wish you the best in everything.

[Anonymous]

OP here ---
Thank you all for the encouragement and advice. I sent Dad some info from the local office on aging but it takes a lot of work to get him motivated for a big change like this. At some point, probably sooner rather than later, there's going to be some sort of emergency and that might be the only thing that gets the ball rolling. I tried giving him some very specific instructions on getting the house in order and who to call to get some help but he didn't like me telling him what to do. Apparently, the parent and the child have not entirely swapped rolls, yet.

[Anonymous]

Sadly, if he wants your help he has to be prepared for the fact that help isn't always in the form he wants. Otherwise this is his primary responsibility. And your mom is fortunate his health is good enough to bear it.

[Anonymous]

In the short term, I would arrange for some in-home care for your mom. Your dad, as the major caregiver, needs some coverage to give him a break. It's a tremendous amount of physical and emotional work and he needs help! This will give you time to look at your options. Go (with your dad) to a few nursing facilities and see what your financial choices are. I understand this situation is hard for you too, but your father needs your support and guidance now. Good luck.

[Anonymous]

People are giving you good advice on helping your mom. My advice is to talk with a financial planner. Your dad is only 75. He needs to protect some if their retirement funds for him to live on. It cannot all be used to pay for your moms care. It won't last long enough for you dad to continue to live his life.

I heard recently that laws are changing but it used to be that once a spouse enters a nursing facility, the facility will take all the money leaving the healthy spouse with nothing. To circumvent that, many elderly people in your parents situation used to divorce. I don't know if this is still the case but it's worth talking to someone about.

Your mom needs medical help but in doing so, make sure your dad is also protected.

Good luck!

[Anonymous]

I happened to see an ad in today's WP magazine for a place called the Virginian that advertises different levels of care in the same apt. No personal knowledge of the place--I just remembered the post.

[Anonymous]

OP, you need to do the research and then present your father with some concrete options that are viable. Google continuing care retirement community; it seems to be the next big thing, you buy into a property and then there are different levels of care available depending on needs. We moved my father to one almost 2 years ago. He lives independently but has a meal plan and eats every meal at one of the restaurants on site. We can arrange for (and pay for) assistance with basic care, etc. At some point, he will probably need a move to a part of the campus with higher nursing care. It's a great place, and he definitely has friends there like your parents, where one spouse requires significantly more care than the other.

[Anonymous]

A friend of my mom's moved into a place that has varying levels of care. She in an apartment now, but can move within the same complex for more care. The facility was extensive and I was impressed. My cousin said its like a college campus, but with old people . This was in NJ though, not sure where your folks are.

Also, I hear advertised a service called "A Place for Mom" that matches seniors with facilities that meet their needs. I know nothing about them besides the ads I've heard, but could be worth looking into.