Anonymous wrote:I would hope for her sake and yours thar her next fall is fatal.

+1 I agree with this with kindness.

OP, your mother is 88, has dementia, and is clearly failing physically. You should be thinking in context of supporting her comfort until she makes a graceful exit, hopefully sooner rather than later. What is her current joy in life? Right now it’s probably just living with you and having her grandchildren around.

My dad was 90 and living in our basement when he began having mini strokes. We had an aide come during the daytime to help him in case he fell and to help with bathing. His diet was pretty much cheese pizza and water. But he was happy reading all day and knowing his family was upstairs. He had a DNR. Unfortunately he had a stroke that was severe enough to put him in the hospital but not severe enough to kill him. He had to go to a nursing home after that. They are very good at hydration and diet - his body was well taken care of, but to what purpose? He lived 6 more years parked in front of a TV, with visits from the three kids once per week, burning through his life savings, unhappy about the situation because he was DNR and this was exactly what he didn’t want for his end of life. He eventually passed from pneumonia during the winter.

My suggestion is to make the house as suitable for your mother as you can and to have an aide during the day when you aren’t there. Let her drink all the Pepsi and tea she wants. Focus on quality of life, not “health.” It’s definitely hard to manage this type of care at home, but it will likely be for a shorter amount of time than if she’s in a nursing home.

You probably should not have updated her house because now that is HER asset to sell.

Anonymous wrote:You hire help and make it work. You are living there for free, so you should do the cooking, cleaning, and updates. Who is paying utilities, insurance and taxes? The agreement was you live there and care for her. She cannot help if she's having dementia.

+1. You moved into her home and now you want to kick her out? Your sister is right--you hire 24/7 help so she can live her remaining time at home. It won't be long with her current rate of deterioration and the falls.

I always thought that constant falling was a sign of something failing with their health. One of these times, she will break a hip and end up in rehab or a skilled nursing center. It will only be a matter of time.

I don't know what you should do, but I will say that patients with dementia who are living at home also say they "want to go home." What does "home" mean when you are confused and disoriented a lot of time? She is probably looking to feel safe and secure but it isn't necessarily the case that moving her back to the house will accomplish that, sadly.

Anonymous wrote:This isn't as easy as you seem to think. You can't really force her to leave her own home, and to enter a nursing home against her will unless she is shown to be incompetent to manage her affairs and someone with Power or Attorney makes this decision on her behalf. Power of Attorney would need to have been signed when she was competent, or you would need to petition a court for it now.

Yes, you can. We put my MIL in a nursing home against her will when I could no longer care for her (I tried my best) but she lived in our home. No POA. Eventually we got guardianship but not for that reason. However, if they move her to a nursing home, they should pay full market rent if they plan to live in the house.

You hire help and make it work. You are living there for free, so you should do the cooking, cleaning, and updates. Who is paying utilities, insurance and taxes? The agreement was you live there and care for her. She cannot help if she's having dementia.

Anonymous wrote:This isn't as easy as you seem to think. You can't really force her to leave her own home, and to enter a nursing home against her will unless she is shown to be incompetent to manage her affairs and someone with Power or Attorney makes this decision on her behalf. Power of Attorney would need to have been signed when she was competent, or you would need to petition a court for it now.

True but you can insist to the med staff that releasing her to home is an unsafe discharge if there is no one to watch her and she will be on her own unable to care for herself. (Harder to make that argument when you live with her though.) And this could buy you some time to figure out what to do

OP—first off I am sorry your family is going through this.
It is NOT easy.

pPs are correct that you will not find a nursing home or assisted living community for under $6500/month. At least not in DMV.
You will find base rate rooms for between $5500-7000 but then you have to add daily care fees and medication management fees in tio of that, depending on what level of care she needs.

Here is the very difficult part that you need to truly understand: residing in a nursing home will not reduce her fall risk, unfortunately. Falls will continue to happen because she is unstable and because of her dementia.

But private in-home 24/7 care at $32-36/hour is about $24,000/month.
If she has LTC insurance then it helps, but likely won’t cover all of it.

If she owns the home that you all currently live in, you might need to consider selling her home to pay for the nursing home care costs.
Or maybe you can hire in-home help during the day and then you can put an alarm on her bed at night to reduce falls.

My moms care 5 years ago was $11k per month.

Sorry, you won’t be able to find anything for $6500 a month, and that won’t even get you 8 hours of care a day.

I sympathize, OP. Try to talk to your Mom about why returning home is not good for the family and that she will be in (hopefully) better hands in a proper facility. It will not be an easy series of conversations. And you should definitely check the financial aspects - this is not something you can easily do on the “cheap”.

This isn't as easy as you seem to think. You can't really force her to leave her own home, and to enter a nursing home against her will unless she is shown to be incompetent to manage her affairs and someone with Power or Attorney makes this decision on her behalf. Power of Attorney would need to have been signed when she was competent, or you would need to petition a court for it now.

You aren’t likely to find a nursing home for $6500 a month. If that’s your
Plan you are going to have to liquidate assets including maybe sell her house.

I think you might want to spend some time looking into what you can find for what you are willing to spend.

Would love the board’s thoughts on a difficult situation that my family is facing.

My mother is 88 and for the last several years her mobility has progressively worsened and she is now showing signs of dementia.

My family (husband and 2 boys, ages 6 and 2) live with her - we have been here since July 2020. We were living in another part of the country and moved back in with her when we returned to the area. Even then, her health was not great and we didn’t think she ought to be alone, certainly not during the first months of the pandemic. We expected this move to be temporary, but ultimately decided to stay here and have refurbished/updated the house to make it more family-friendly. And since our arrival, Mom has not had to lift a finger. Everyone has been happy although living with an 88 year old and two small kids has not been without its challenges.

Fast forward to today - Mom is not doing well. Her first hip replacement took place in 2015 and the second in January of this year. She has progressed from walking with a cane to now using a walker, and falls often in the house. We’ve woken up in the middle of the night several times to find her on the living room floor. She no longer can consistently remember how to use the television, phone, check her email etc. She does not feel comfortable showering without assistance. She stopped driving a few years ago. (FWIW, my dad passed away in 2006 so only need to focus on Mom)

Despite our best efforts, her diet is terrible - does not cook anymore. She does not eat very much at meal time, but still likes to snack on sweets throughout the day. She prefers to drink tea and Pepsi (her beverages of choice) - and as a result is not well-hydrated and generally not very energetic.

As this year has progressed, she has been increasingly disoriented, which exacerbates her already being unsteady on her feet. She was never a great sleeper, and being tired only makes everything even worse.

Over the last year she has been to the hospital 5 times. Three of these were trips to the ER in ambulances coming to the house - in September she fell in the bathroom and hit her head on the sink (bleeding all over and requiring stitches), and in October she (not her fault) also spent a week in the hospital because she caught COVID.

Earlier this month she fell in the driveway and hit her head on the sidewalk. They feared a hemorrhage but it “only” was a concussion. After a week in the hospital, she went to a rehab center - and on the first night, tried to get out of bed and fell once again, only to be brought back to the ER first thing in the morning. She has virtually no recollection of any of this.

The doctors have said any of these situations could have been fatal.

We now know she needs constant supervision. However all Mom wants to do is “go home”. My sister thinks we should honor her wishes and hire 24-7 care for Mom at home, while my view is that bringing her back here solves nothing - and that she needs to be in a nursing home. DH and I don’t like the idea of random helpers coming and going at all hours, nor having them around the house during the day when nobody is home - or even being here when we are home, as we don’t have a bedroom to spare. (DH works, I recently started a new job after being SAHM for 6 years, and kids are at school/daycare all day). We don’t want our children to be witnesses to the decline of their grandmother day in and day out.

Mom gets a pension check totaling about $4500 per month. My family could pay ~$2000 a month as well. So I am hopeful we could find something that is suitable and comfortable for her. (My sister and her husband are not high earners, and have already told us that they cannot help defray any of the costs.)

I will listen to sister’s input (we generally have a good relationship) but I do not feel it is really her decision to make - The burden for having Mom back home here falls 100% on to me and my family. Sister does not live here, and furthermore DH and I will be paying. Mom will not like this decision, but I strongly feel she is at the stage now where she needs to be in a nursing home.

Hope this all makes sense and thanks for reading if you have made it this far.

WWYD?