Anonymous wrote:How healthy is your stepmother? If anything happens to her, from a fall to the flu, how will your father manage? At the least, I would INSIST on daily help within the home. This is a lot for your stepmother to manage.

The resuscitation request is odd, don’t you think?

She has some back pain but is otherwise physically healthy. My dad doesn’t need much physical help, he gets himself to and from the kitchen, the bathroom, etc but I have a sense that he’s barking orders at her all day while he sits in his chair and watches tv. She manages his pills and he gives her the 3rd degree about it every day. At a minimum I think they could hire someone to set up his pills for the week and maybe if a “professional” does it he’d trust that it was done right.

What is odd - that he doesn’t have a DNR or that I’d like him to consider having a DNR? If the latter I’d invite you to read this article: https://www.npr.org/sections/health-shots/2023/05/29/1177914622/a-natural-death-may-be-preferable-for-many-than-enduring-cpr

How healthy is your stepmother? If anything happens to her, from a fall to the flu, how will your father manage? At the least, I would INSIST on daily help within the home. This is a lot for your stepmother to manage.

The resuscitation request is odd, don’t you think?

Anonymous wrote:Hire a once a week aid for 3 or 4 hours (most agencies have a 3 or 4 hour minimum) .

When the aid comes in call them a cleaning lady (to father),

Let MIL drive off for the 3 or 4 hours so she gets a real break.

Tell her she can drive off and go to the spa, get her hair done, go to the mall etc.

Can I make a request that you not say this? People mean well but “go to a spa” is so insulting. She’s probably going to go to the dentist, to which she’s overdue. Or cry alone in a parking lot. Or go to target and buy stuff they need. The idea that 3-4 hours of respite care is so amazing and restorative to a caregiver that they’ll “go to a spa” is so out of touch with their reality that it borders on cruel.

Anonymous wrote:Hire a once a week aid for 3 or 4 hours (most agencies have a 3 or 4 hour minimum) .

When the aid comes in call them a cleaning lady (to father),

Let MIL drive off for the 3 or 4 hours so she gets a real break.

Tell her she can drive off and go to the spa, get her hair done, go to the mall etc.

+1

You might also consider asking your stepmom if she’d consider meeting with a geriatric care manager in their area:

https://www.aarp.org/caregiving/basics/geriatric-care-manager/

”Many care managers started out in nursing, occupational therapy, physical therapy or social work, often with a focus on geriatrics, and decided to switch careers to meet clients’ needs for broader care services, says Julie Wagner, CEO of the Aging Life Care Association.”

“Establishing a human connection with care recipients and caregivers is a big part of what care managers do, she says.”

It’s kind of you to show such empathy for your dad and stepmom. Hoping things become a bit less stressful for all with some additional support in place.

I don’t know what it is with the elderly/severely disabled (and their kids) not wanting to be put in a facility. And yes they’re generally awful (and will likely get worse with this administration and PE) but hopefully you have more money and can get into the “nicer” ones. But let’s be realistic. The vast majority of middle class or even upper middle class families with aging parents CANNOT AFFORD to age in place!!

Hire a once a week aid for 3 or 4 hours (most agencies have a 3 or 4 hour minimum) .

When the aid comes in call them a cleaning lady (to father),

Let MIL drive off for the 3 or 4 hours so she gets a real break.

Tell her she can drive off and go to the spa, get her hair done, go to the mall etc.

Thanks all. Legal stuff is all tied up and well planned. My stepmom has not mentioned physical aggression at all - he’s quite frail so don’t really think this is a concern.

Watch the nastiness and any tendencies toward getting physically aggressive. It could be start of dementia and not just decline. Any legal arrangements need to be done before it’s too late.

As hard as it is to watch, they can make their own choices and "own" the outcomes.

What you get to decide is how much energy you are going to spend trying to convince them to change their plan AND how much of yourself you will give to them.

Typically there is a catastrophic event that occurs that forces change - i.e. your dad falls and breaks a hip or your stepmom reaches a breaking point.

Until then you are unlikely to convince them of anything. It is super hard to watch.

Their absolute priority is to keep him out of a facility (for better or worse - they won't budge on this issue).

This is the only problem

Suggest they consult an elder care attorney to lay out the medical directive and plans. It will come with plenty of scary stories and possible outcomes to avoid.

My 77 yo dad, in a different state, has a set of complex chronic health conditions including: congestive heart failure, chronic liver and kidney disease, severe peripheral arterial disease, mild cognitive impairment and complete neuropathy in both feet. His mobility is severely limited though he can walk around the house (to and from the bathroom for instance), to the car (driven by my stepmom) and from the car to a table at a restaurant or to his theater seats.

He is always in pain, depressed and sick of pills, procedures and doctor's appointments. And according to my stepmom has become quite nasty to her. She's exhausted, sad and angry.

Their absolute priority is to keep him out of a facility (for better or worse - they won't budge on this issue).

They lean on me a lot to help interpret their medical info and both vent to me often about their situation. I've suggested anti-depressants for him (she already takes them) and therapy for one or both them (they are resistant). I've suggested multiple ways they could outsource stuff to make their lives easier (they are resistant).

I know there isn't much I can do - they are who they are but it's hard and sad to see them struggle and suffer.

All of that being said I'm wondering if:

1) Whether seeing a geriatrician as his PCP could help him prioritize so he could maybe only take the pills that help him feel better and prioritize the specialist appointments. And also maybe suggest some things to focus on if the stated goal is to remain in the house. Atul Gawande in Being Mortal talks a lot about how great geriatricians are.

2) He is currently full code - wants full resuscitation efforts. I fear he will be so so infirm if he survives a heart attack that his quality of life will be even worse. I'd like to suggest they reconsider this but I'm having trouble imagining an appropriate way to bring this up.

Anyone else BTDT and have advice to share?