Elderly parents/in-laws: how to help them recognize it's time to move?

[Anonymous]

My husband's parents have lived in the same house for four decades; he's been in the area for at least 50 years, she was born at Sibley Hospital and has never lived outside the DC area. FIL is in his 80s and in good physical health, but is showing his age with some memory challenges and judgment issues. MIL is in her early 70s and in terrible health (very limited mobility - like 30 feet and no stairs; breathing is terrible; weighs very little; has incontinence issues; is primarily housebound). MIL's physical issues mean she lives in a single room in their home that is not a bedroom. She's acknowledged that she's able to be alone for maybe 4 days at a time, if FIL has set up her meals and a neighbor checks in on her. It is TIME for them to move. There are more issues, but let's just say that the home is not a healthy place for them to be. Think mental health/hoarding issues.

My husband and I moved away from DC a number of years ago, and we're hoping we can get his parents to move to an apartment (ideally, senior living sort of place) in our state, so that we can help them and so FIL can spend more time with our kids, which he seems very much to want to do. MIL plain old needs help, and I think we're at the point where we need to take some drastic action. We've tried suggesting a move and showing them some great housing options; offering to help with the packing/sorting/moving process; making impassioned pleas for them to move; and more along the same lines. MIL is unwilling to leave her house for so much as a dinner out with visiting family (housebound primarily by choice); FIL doesn't want to move to a building filled with a bunch of old people. If FIL dies, MIL will need to be out of her house in under a week. She literally cannot care for herself and no amount of home health care (barring 24 hours) would suffice.

What else can we do to help move them along? Any recommended resources for supporting a move out of the home and into an appropriate residence? I'd especially appreciate recommendations if you've had experience with a particular consultant, support system, agency, etc. We really want to help them, but they're not ready for help.

[Anonymous]

Research and prepare. It doesn't sound like either one of them will be willing to move without a crisis precipitating it--which means you and DH ought to have your ducks in a row in terms of facilities identified and that sort of thing if/when a decision has to be made quickly.

If there are mental health/hoarding issues compounding, I doubt your MIL will leave willingly. Research companies that do estate sales and deal with hoarders (depending on how bad it is, there are hoarding clean up companies out there that are used to these situations). The last thing you and DH will need to do when there's a medical crisis is have to clean out the house yourselves, especially since you're long distance. Prepare to have help for that when the time comes also.

I imagine neither will move until one of them dies--MIL then unwillingly, FIL willingly. Good luck.

[Anonymous]

Anonymous wrote:Research and prepare. It doesn't sound like either one of them will be willing to move without a crisis precipitating it--which means you and DH ought to have your ducks in a row in terms of facilities identified and that sort of thing if/when a decision has to be made quickly.

If there are mental health/hoarding issues compounding, I doubt your MIL will leave willingly. Research companies that do estate sales and deal with hoarders (depending on how bad it is, there are hoarding clean up companies out there that are used to these situations). The last thing you and DH will need to do when there's a medical crisis is have to clean out the house yourselves, especially since you're long distance. Prepare to have help for that when the time comes also.

I imagine neither will move until one of them dies--MIL then unwillingly, FIL willingly. Good luck.

+1. Make a plan.

You may want to put their names down on the waiting list at a few places, just to move the ball along. The wait can be long for a good place.

How far away do you live?

[Anonymous]

Have you tried the state Department on Aging in your state and in their location? Sometimes also known as an "Office on Aging" etc. but most jurisdictions have some form of government department that handles issues related to the elderly. They should have lists of assisted living facilities and other resources for you. Also, is your MIL seeing a doctor, considering all her medical issues? I would contact that doctor and if his or her office specializes in geriatric issues, ask them to direct you to resources.

OP, I have been here both as the adult child trying to get a parent into assisted living, and as a friend observing an elderly friend having to sell her home and move into assisted living.

Please consider that uprooting them from the area where they now live and moving them to another state, even if you would be close by to help out, may be bad for their mental and emotional health. Elderly people who have lived in the same area for a long time often have roots that keep them going--friends, houses of worship if that's their thing, even just getting familiar food from familiar restaurants (actually an issue with my older friend--she would eat a lot more and be in better shape if she could eat what she truly likes, which she could not in her first assisted living home; she lost a lot of weight which harmed her health,and the food was a key reason she moved to another facility).

I knew my mother very well and had she been moved out of her home town, she would have withered quickly. Her friends -- who like her were getting older -- could not have visited her beyond maybe once every few months if she'd gone to live in my brother's town. We had to consider how her relationships, and her very real attachment to her house, affected her mental health. Yes, my brother and his wife would have been around more to help, but my mother would have been deprived of friends she'd known for decades.

I know that we adult children think that having parents near us for our help is the ultimate solution, but it isn't necessarily so. Is it possible for your in-laws to be cared for in their own home? Increasingly there are companies that do just that -- provide home health care. I know you wrote that "no amount of home health care (barring 24 hours) would suffice" but have you actually considered the possibility of 24-hour home health care, or at least care that's there during all hours but sleeping hours? It's tough to navigate that world and find the right people who work well with elderly parents, but it can be done, unless finances are so strained it's impossible financially; however, assisted living facilities are very pricey as well, and might be more expensive than in-home help in many areas. Your husband or you would have to spend some substantial time at their location while vetting firms and individuals. But it's something to think about if you have not seriously considered it.

You say your MIL is "housebound primarily by choice" and unwilling even to go out to dinner, but do you see how that might be a sign of depression, early stages of dementia, or just plain fear of the world? In other words, what you might view as her wrong choice to be housebound could be something she views as necessary. She might be wrong, sure, but that's how she sees things, and forcing a change on her if she is that entrenched could be a blow that will make her miserable (and a misery toward you) if a move is pushed on them. Of course since she cannot care for herself, if you are not able or willing to get them in-home care on the scale she needs, they'd have to move--but be prepared for blowback from MIL in particular. If you can win FIL over to the idea you might have a shot.

[Anonymous]

Let me know if you figure it out. My MIL and FIL live in a house that's way too big for them and that they are no longer capable of maintaining (and forget about the giant yard). My MIL has it in her head that a condo is terrible, for reasons I don't understand (and frankly, neither does she--it's just something she says because she doesn't want to move), and so they will not move until some huge health crisis comes along. It's really frustrating--they are near-hoarders and have so much crap--I want to tell them that they need to move while they are in charge of sorting their stuff and deciding what to get rid of, because when it's up to me (as the wife of the oldest kid), I'm calling in a clean-up company who is going to get rid of everything. All of it. Every bit. And I'm not going to feel bad about it.

But no amount of nudging helps. We can't make them move. And I don't even care where they move to, so long as it's a smaller home. We can help arrange cleaning services and home health care from here, if we need to.

[Anonymous]

Anonymous wrote:
Have you tried the state Department on Aging in your state and in their location? Sometimes also known as an "Office on Aging" etc. but most jurisdictions have some form of government department that handles issues related to the elderly. They should have lists of assisted living facilities and other resources for you. Also, is your MIL seeing a doctor, considering all her medical issues? I would contact that doctor and if his or her office specializes in geriatric issues, ask them to direct you to resources.

OP, I have been here both as the adult child trying to get a parent into assisted living, and as a friend observing an elderly friend having to sell her home and move into assisted living.

Please consider that uprooting them from the area where they now live and moving them to another state, even if you would be close by to help out, may be bad for their mental and emotional health. Elderly people who have lived in the same area for a long time often have roots that keep them going--friends, houses of worship if that's their thing, even just getting familiar food from familiar restaurants (actually an issue with my older friend--she would eat a lot more and be in better shape if she could eat what she truly likes, which she could not in her first assisted living home; she lost a lot of weight which harmed her health,and the food was a key reason she moved to another facility).

I knew my mother very well and had she been moved out of her home town, she would have withered quickly. Her friends -- who like her were getting older -- could not have visited her beyond maybe once every few months if she'd gone to live in my brother's town. We had to consider how her relationships, and her very real attachment to her house, affected her mental health. Yes, my brother and his wife would have been around more to help, but my mother would have been deprived of friends she'd known for decades.

I know that we adult children think that having parents near us for our help is the ultimate solution, but it isn't necessarily so. Is it possible for your in-laws to be cared for in their own home? Increasingly there are companies that do just that -- provide home health care. I know you wrote that "no amount of home health care (barring 24 hours) would suffice" but have you actually considered the possibility of 24-hour home health care, or at least care that's there during all hours but sleeping hours? It's tough to navigate that world and find the right people who work well with elderly parents, but it can be done, unless finances are so strained it's impossible financially; however, assisted living facilities are very pricey as well, and might be more expensive than in-home help in many areas. Your husband or you would have to spend some substantial time at their location while vetting firms and individuals. But it's something to think about if you have not seriously considered it.

You say your MIL is "housebound primarily by choice" and unwilling even to go out to dinner, but do you see how that might be a sign of depression, early stages of dementia, or just plain fear of the world? In other words, what you might view as her wrong choice to be housebound could be something she views as necessary. She might be wrong, sure, but that's how she sees things, and forcing a change on her if she is that entrenched could be a blow that will make her miserable (and a misery toward you) if a move is pushed on them. Of course since she cannot care for herself, if you are not able or willing to get them in-home care on the scale she needs, they'd have to move--but be prepared for blowback from MIL in particular. If you can win FIL over to the idea you might have a shot.

YOu mean, unless they are not rich, because at the tune of 15k/month they need to be rich. They live in the DC area, so that is the monthly cost they would be looking at for 24hr/7 help.

Assisted living here is between 7 and 11k/month.

You will just have to wait until a crisis happen op, and then move then to where you live. Hopefully a place with lower COL. If they can manage living in a condo (1st floor), I would pursue that instead of assisted living to save money until they truly need assisted living/nursing home. MY MIL was very frail like yours, and housebound. She lived until she was 95 with horrible dementia in the last 7 years or so.

It is important to have enough money for when they need nursing home care, so they can be in a good place. Otherwise, people at that stage, are at risk of mistreatment since they are not able to advocate for themselves.

[Anonymous]

How about asking the FIL? Something along the lines of...if you were to go first what do you feel MIL will need and how do you want it handled?

As he considers those things he might come to the conclusion that in her best interests he needs to have her somewhere that will benefit her in the long run.

So...can you two come up with questions that will act as somewhat of a trail that as he mentally navigates it will lead to a good destination/conclusion?

[Anonymous]

Oy. It took a crisis/hospitalization of the healthy parent to convince mine that they needed to make a change. And even then it took months, threatening to take guardianship of the parent with Alzheimer's (the one who was refusing to move). Worst several months of my life, consumed with worry. When they finally moved they did nothing to prepare. Nothing. No packing. It was like setting up my child's first apartment. The house with every stick of furniture still sits empty-ALZ parent won't give up any possessions and is still aware enough to protest.
Seriously. It took a crisis to get them to admit a change needed to be made. And several months after moving day, they still haven't changed the address for their mail, necessitating trips back to the old house, which of course makes the transition worse.
I knew it would be bad but I seriously never expected this level of difficulty. Good luck to you.

[Anonymous]

OP here. One of the PPs makes a good point about uprooting them from friends, etc., but in the case of my in-laws, their only remaining relationships in the area are with a hairdresser and another paid weekly service provider. FIL's friends have died; MIL never really had many friends and now has none. I am certain she suffers from, among other things, depression and anxiety. FIL is not in a position to help her get care for that. (She is a difficult person with a strong personality and he won't challenge her.)

I am willing to be the "bad guy" DIL in this situation, because they are in an unhealthy situation. FIL should not be providing this level of care to MIL. MIL will verbally abuse home health care workers unless someone else is to "blame" for the health care worker being there. Their home is dirty and cluttered to an unhealthy degree (it was so bad that I was truly uncomfortable with my children being in "her" space; I did stealth cleaning (picking up piles and cleaning underneath) and was overwhelmed by the accumulated grime. Her breathing is terrible and she attributes it to allergies; I can only imagine the impact the living situation is having on her. It is not just a convenience issue for US, but a health need for them.

Truth be told it is far easier on me to keep my in-laws far away and have no responsibilities with respect to their care. The logical part of my brain keeps saying "what are you doing? This will only lead to more work for you!" The decent human being part of my brain says it is something that needs to happen.

Oh, and husband is not going to be one to push this point. MIL is a very difficult parent to have; it is not easy to be in her good graces. He's comfortable with me being the bad guy and having the tough conversations because he just can't do it. Too much emotional baggage.

[Anonymous]

Rough spot OP. Sooner or later, there will be a health crisis and you will have to react and quickly. Since your FIL seems to be the more rational one, I would get him on your side and ask/tell him what your plans are. Don't give MIL the opportunity to say "no". Give her minimal notice that things are changing. She is going to be angry, but remind her that you care for her and need her to be safe. Best of luck. P.S. I gave my dad ONE day's notice that he needed to move in with me. I simply told him I would handle everything.

[Anonymous]

Get an evaluation from a geriatric case manager. I used Aging Network Services in Bethesda.

[Anonymous]

How much money do they have? Can they afford 24-7 home health care?

I would follow your husbands lead. Make him deal with it. These are his parents, not yours.

If fil dies, you can temporarily hire home health workers until an assisted living spot opens up.

[Anonymous]

Here's the thing: Does your MIL want to live as long as possible or live in her house as long as possible? Those aren't the same thing. I would urge you to consider what your ILs' ultimate goals might be...and if MIL goes first, FIL can move. If FIL's health collapses, have researched nursing homes where you are and health aide options here.

I don't see how forcing a mentally ill, verbally abusive frail woman to move is actually going to be good for anyone--not her, not you, not DH who she isn't close to. It is late in the game to change the rather less than ideal path they are on--and really late for you tackle any underlying dysfunction.

[Anonymous]

Anonymous wrote:Here's the thing: Does your MIL want to live as long as possible or live in her house as long as possible? Those aren't the same thing. I would urge you to consider what your ILs' ultimate goals might be...and if MIL goes first, FIL can move. If FIL's health collapses, have researched nursing homes where you are and health aide options here.

I don't see how forcing a mentally ill, verbally abusive frail woman to move is actually going to be good for anyone--not her, not you, not DH who she isn't close to. It is late in the game to change the rather less than ideal path they are on--and really late for you tackle any underlying dysfunction.

Honestly, I think MIL is just scared. Of everything. Scared to move. Scared of her current reality. Scared of the big What If should her spouse be unable to continue caring for her. She realizes she's in terrible health and entirely dependent on others. I spent several hours with her yesterday trying to clean the room in which she spends all day and all night. I think even she was shocked by how filthy it was. I approached it all very gently and made sure she was doing okay as we went along through the cleaning. In three hours, I was only able to make a tiny dent in getting her space reasonably habitable. I'll be spending another full day with them soon just to try to get that room to be less of a health hazard. I don't think it's her goal to stay in her home as long as possible. She's been stuck in a single room (that's not even a bedroom) for the last several years. Her home as she had known it has closed in on her to the point where she can't access common areas like the dining room because she can't safely get there (stairs - mobility and lung capacity makes the five steps of the split level a fifteen minute journey).

You ask good questions, though, and I should probably pose those questions to my in laws. I absolutely hate that this responsibility is falling on me. It's clear that there have been BIG issues that should have been addressed decades ago. But here we are, so we'll just have to do the best we can given circumstances that exist.

[Anonymous]

My mom was still in denial when I could see the time had come. So, I went to her house out of state, threw out thirty years of accumulated junk, gave her furniture to Goodwill, put her in the car along with a selection of clothes and cherished mementos, and drove her up her to live in assisted living.

That wasn't that... there was a lot more to it... but it had do be done.