What do you do when the siblings do not agree on a care plan for their mother?

Exactly how does your imagine he would put a care plan into action if his mother wants no part of it?

Unless MIL has been declared incompetent, you can't force her to accept anything.

Does someone in the family have medical and financial PoA, so that action can be taken when a crisis occurs?

Perhaps some holiday gifts that include things like weekly housecleaning for a month or two and meals on wheels would be the thin edge of the wedge in getting her to accept help.

Make it a contingency care plan, fleshing out as many options as possible so that if/when a crisis occurs, you've already done your research. But start little by little as CWillie suggests.

I suspect that the holdouts may be unsure of what to do, hoping nothing will happen that necessitates more involvement, and when a crisis does occur, will be too unsettled to help.

Accepting the drastic changes that occur as people age and face crises is I think probably one of the hardest things for adult children to do. They just keep hoping it won't happen, are very unprepared and indecisive when it does.

I've been through that and I'm sure I'm not alone.

This is difficult and i witnessed same with my mom AND HAD A SUPPORTIVE SIBLING -- I too was long distance and worried about my mom and her inability to take care of herself -- but without POA (and incompetence declaration) -- you have no legal authority to make mom move or accept in-home services/care. Elder, even with dementia has legal rights to make their own decisions -- even if poor ones.

I suggest you start by documenting all your observations, concerns, dates, times, etc. to build a case. Send a copy to mom's doctor (ask him to review prior to mom's next visit and schedule an elder evaluation including physical and mental health workup). Try to make an appt when you can be present with mom at the doctor or have one of the siblings attend with mom. That way you should get a clearer picture and professional assessment of mom's needs and abilities.

Following that, talk with siblings and collectively maybe approach mom to at least allow a skilled CNA or other to come to house 4-8 hours per week (maybe 2 days a week) to help her with household chores, grocery shopping and maybe preparing meals for mom.

My mom refused all help and assistance, doctors diagnosed dementia (several) but none would step up and declare incompetent. I was one of those you mentioned who had to wait for the crisis and there were several, but until there was a big one (she flooded house and fire dept came) -- and social services, family, and residential care facility all had to beg doctor to finally sign incompetence to get mom placed in memory care.

I hope you and your siblings have better luck. I worried constantly, knew my mom was struggling and couldn't even cook for a year -- but she had her legal rights which I had to honor (short of taking guardianship -- which is a route others warned me DONT DO).

Maybe your mom will be more cooperative with all sibs gathered and talking mom through it. My friend did a sort of intervention with her sibs and parents -- and though parents didn't want to listen, they finally agreed to try the change and they were placed in assisted living (shortly thereafter dad went to on-site nursing home).

I’ve been dealing with stubborn elder parents for about 6 years now from 600 miles away. I’m all they’ve got. A few tips:

Provide as much help as she will allow and push it as much as possible but don’t waste time and stress on constant battles.

Do not hesitate to fib to get stuff done. Neither of my folks have good reasoning skills any longer. WE’RE JUST FINE! I’ve learned I will never convince them of much so I don’t ask and try to get approval in advance to buy a new dryer or replace a tv, I just get one sent over. After a bit of alarm and puffery everything settles down and by the next day wheel a fortune looks really good on the new tv.

Pick your battles. I don’t care anymore about the disgusting old sofa, got tired of arguing about it,  but the carpet had to be cleaned.

Somebody, and only one person, needs to get poa. Three kids? They need to fight this out. They can cooperate in moms care and make it easier but most likely won’t.

Yes, it’s usually crisis driven. I’ve been able to help my folks tremendously but they won’t get outside help or move until a crisis forces the issue.

First I would check into the title to her home and remove ownership. If she goes to a nursing home, not by choice, assets are involved. I believe there is a 5 year back rule but check it out. Next, whichever sibling she will listen to, needs to explain she is not 25 anymore and slow change is better than abrupt change. My mother fought me, hearing aid especially. If they can't hear, they manifest what they think they hear and this to me, expedites dementia. Many elderly don't want to be a burden and portray the I'm still good. She needs a portable commode next to her bed or over her toilet to make the seat higher. A hospital bed would be great for her to elevate her legs when she sleeps to alleviate pain from arthritis in her legs. Furniture should be thinned out to prevent fall risks. Someone should do her grocery shopping for her to ensure she eats right including some sort of vitamins or Boost drinks. I got a Trend Secure Lynx camera in my mom's bedroom which I can watch her in real time while I am at the store, etc. from my cell phone. She would need internet service, but my mother loves watching youtube as so many of her old shows I can type in, Bonanza, etc.
'Good luck.

WindyRidge - that is exactly my story. Hard to watch or visit.

Wonderful answers! And I have to write down CWillie's phrase, it's "the thin edge of the wedge", that's the exact idea! Working in elder care I've seen many times of when an elder gets their back up, one woman was just known for not letting a helper come in. They paid to have help come anyway, and I too sat in the parking lot, waiting. Next time I asked to come in and use the phone for my job, and she said yes, and in the process of talking nicely about some aspect of life, she kept talking and I stayed, and just helped a little - and turned out her internet was not connected and I fixed it. While there, I looked and actually didn't see much I could do, but that's the method, someone who can give help without waiting for permission, but be ready to back up with good cheer, if refused, and stay engaged. Eventually that woman got used to a few helpers, and even enjoyed the company.

I like all the ideas - when visiting, see what's missing and provide it, without trying to have anyone take over the whole control. Stay in the conversation with siblings, and also do research - I investigated several nursing homes myself, just went to visit and in that process I found one with a setup that my brother would be able to like and enjoy. They have taken good care of him, and by now the other brothers like to call and visit more.

I am the local child (3 golden boy brothers out of state). They would like my mother in an AL facility. She is "not ready" for that. So a crisis it will be to make her move (and possibly it would be right to a nursing home, if she injures herself badly enough.

She is 91, no sight in one eye, very bad balance, neuropathy in her feet, atrial fibrillation, bad hearing, and anxiety and a VERY controlling personality. My one brother (and his wife) told me that she needs a cleaner. My mother has been "looking into it for more than a year." This brother and his wife always scrub her bathroom when they are here. Another brother and I don't think it is filthy. (And the third can't be bothered to get here enough to notice.) Everything in the condo is OCD neat. Deep cleaning isn't getting done, though.

But there's more...my mother needs someone to monitor her showers (can't feel her feet, she says, and has to lift them out of the tub sometimes). She refuses to have the tub retrofitted. She could use some help with getting dressed (it takes her a longggg time).

I'm sure my brothers would love it if I just stepped quietly into the cleaner/shower attendant mode. But I won't. I resent what I have to do for my mother already. I am her taxi driver. And she calls me (because I'm a free call) for little things. She doesn't talk to my brothers but once a week (and for the most disenged one, not that often). She hash a tracphone, and still pays for minutes. (She is cheap....but has funds.)

So my brothers blow into town, stay a few days, and then are gone. They might mention something to my mother about AL or cleaning help, but they don't follow up. No one likes to cross my mother.

So we are all waiting for a crisis to happen. I am never taking her into my (ranch) home, and I will never stay with her (did that once, got the shirt, burned it!).

My mother has been very nasty to me when crossed. She is ungrateful. I don't like her.

I was explaining the situation to a woman at the gym one time (of course she helped her "dear mama" a lot), and she looked at me and said, "You shouldn't be involved with your mother." The hostility must have been obvious. I said, "You are right." I wasn't given a choice, though. If I'd refused the car-in-exchange-for-transportation deal (which of course includes a lot more than transportation, although I've greatly pulled back on the other expectations), I don't know what would have happened.

IF/when my mother ends up in an AL, it will probably be local. But if she qualifies for a SNF/nursing home, I'm going to push that she goes out of state to be near one of my brothers. I've read how we still have to be involved, and I am not willing to do that. (I read last week that nursing homes don't take care of residents' teeth, and a family member has to brush and floss the resident's teeth? NO THANKS! And never mind the million and one things she would want to complain to me about.)

I will never be able to get her screaming fit out of my mind, the one where she screamed that I was "not right in the head." And all because I pointed out to her that 24/7 care when she was nearly helpless for 8+ days because she strained her back would have been AT LEAST $2000. (Of course I got nothing.) She screamed that I was a liar, that it was only one or two days, she didn't need me there and that I was trying to take advantage of her.

After that, I fully document every hour I spend with my mother and send a summary to my brothers via email. They don't even reply most of the time. But it's there, and if I ever needed to prove what I've done, there it is.

I don't think my mother would have the wherewithal to change her trust (split 4 ways). And it costs more $ to change a trust.

She refuses to see a geriatric psych, and refuses to even allow me in to see the doctor anymore (she doesn't care if I know what they say, but dislikes that they talk to me sometimes and not her). I'm also not to be involved with anyone else, as she handles all of her own affairs.

She is slipping cognitively, but is a long way from being declared incompetent, so I've accepted that she is creating her own future, even if it's increasingly becoming physically unsafe for her.

Thanks for letting me get all of this off my chest.

Your first priority should be to get her to stop driving. Our new vehicle was totaled when my husband, who had Parkinson's, was making a legal left turn onto a driveway, was hit by a teenager running a red light. I hope you and your concerned husband can convince two reluctant siblings to put a care plan in action. In my case, I was convinced to put a care plan in action only when hospice filled out care plan papers and asked me to sign them. I'm glad I did.

Our father refuses any support services and only wants his family. Our mom has alzheimers and, at times, gets restless and needs stimulation. Our dad is housebound and he is 88. Since I live closest and I don't have a paying job , he expects me to drop everything at a moment's notice and run over since he needs me to get our mom off his hands and give him a break since he can't chase her. He tries to use manipulation by stating our brother has a business, and since he lives with them, he does enough. But dad won't let our brother get our parent's the support services at home that they need. Dad can't be reasoned with and I refuse to come running inless there is a real emergency, and ma driving dad nuts doesn't qualify as an emergency. Our brother doesn't believe in forcing dad, even though dad can't be reasoned with. Dad is very old school, believing daughters take care of parents and he even says our mom only wants her daughters which is a lie. Our mom needs the stimulation and she welcomes it. Do we wait for a crisis and let the state step in? The 3 of us siblings trying to convince dad, who sees himself as the father in our family, will not work. Any suggestions? Thanks.

If you all can agree on who has the PoA, then that should be the end of it--no if's, and's or but's. But life isn't simple like that, is it? You're talking about really personal decisions and there's no sure fire thing that works. In my case, I just put foot down on what I felt was best for Mom. My sister wanted to put Mom in an AL but I didn't want that so Mom lives with me and my husband. Sometimes I resent that my sister doesn't help that much--she helps but obviously not as much since Mom lives with me--but I can't really say anything because it was my decision to look after Mom and when Mom and I are not having spats, when she's not the She-Devil, I adore every second I'm with her to the extent I feel a little guilty my sister doesn't get as much bonding time with Mom. Because I try to keep Mom active, we're going to places and doing things that I had never made the time for so it was an unforeseen silver lining to the situation. It's been a couple of years and sis has come around to thinking that it *is* better for Mom not to be in an AL.

I don't know why there is so much resistance to assisted living, except for cost. Meals, companionship, activities, scheduled transportation are provided, sometimes physical therapy is available. Better than living alone, I would think.

I remember visiting my parents a few years ago and then explaining to my sister that they don't seem to be doing so well. (I lived 500 miles away, and there were a couple people who gave them some help). She said they seemed fine when she visited a few months earlier, and on the phone everything seemed okay. I insisted that if you just make a trip I think you'll understand what I'm talking about. She came, and her reaction was along the lines of "OMG--we have to DO something!" Because the situation can change considerably over a short time, getting siblings to see the CURRENT situation can give them a real eye-opener and motivate planning. To take off on the old Ford tagline: "Have you visited your parents---LATELY?"

When my mother stayed at a rehab that also had an AL wing, it was one of the better ones that had a good reputation. They had decent meals, a range of activities and PT as well as OT. I took family leave from work cuz the rehab allowed me to stay with Mom 24/7 as Mom was a fall risk. But the fact remains that the limited staff will never be able to attend to the patients/residents as well as in a one-to-one patient/resident-caregiver situation (especially if the caregiver is a family member), nor will they be as forgiving when the patient/resident goes off on them during a dementia-stemmed rant that may be both verbal and physical. If the person in question is living alone, then yes, AL might be a good option but aside from cost you have to be on top of the care. I know of someone who paid for her dad's AL which was over $5k/month and it wasn't until her dad was moved to a different AL (to be closer to a different sibling, whose turn it was to look in on their dad) that they found out their dad wasn't getting his oxygen therapy in the old AL because the new place found that the oxygen delivery device wasn't working--no oxygen was ever delivered. Their dad had to be hospitalized for heart complications while at the old AL, but not sure if it had anything to do with his not getting the oxygen. The other sibling is a doctor so they thought it might be better for their dad to be closer to the doctor sibling but it was short lived as their dad passed away not long after the relocation.

A lot of people don't want to do anything to be proactive because it's not within their normal daily grind and they want to keep going as normal, for them, as long as possible. Sometimes it's nothing more than a form of avoidance.

But being proactive is important. A lot of elderly don't want help but at first, it's a struggle many have, but try to gradually work some help in.

If help is needed or there aren't any plans in place, it could make things a lot worse when something does happen.

I've gradually added things that I do, but I have a sister who didn't want to do any planning either. So its like your husbands siblings, but for my situation, the avoiding on my sister and brother in law's part continues and will never change, and you might end up on a similar situation.

Point is, planning is very helpful and I'd strongly suggest it. You obviously can't plan for everything, but there's so much that can happen and at the very least it's good to have some direction.

Check into some long term care policies. The benefit provides for reimbursement for in home care as well as down the road in-facility assisted living or nursing care. It really helps defray the cost of these services. Interview as many in home care companies as you can (and assisted living facilities). Check with the Dept of aging and disabilities for any reports against these companies. I suggest this because her health is probably the best it’s going to be right now. I found that my father’s primary care physician had a wealth of information and resources and was literally a Godsend. Also probably a good time to have a family meeting. Be prepared to appoint a trusted family member to be her POA and Medical POA if this has not already been done and make sure she has an updated will in place. My experience is the Elder in question will not be “on board” in the beginning. It’s a very difficult time for them when they give up being in charge of their future. However, my dad was a part of the decision making process because we had good, sound reasons for taking action and he had already appointed a POA and medical POA. It helps to have her will, POA, and medical POA done first in the event they resist the idea of in-home care or assisted living facility. Then decisions can be made on their behalf. They want to stay in their home as long as possible and who can blame them, I would too. But don’t leave her out of the meeting as long as she is of sound mind. Being sneaky will cause resentment and a host of many other issues. In my experience, waiting until there is a crisis will be awful for the children and well as the elder. Operating in “crisis mode” will allow for many mistakes to be made because you will be under pressure to take immediate action. You will find out almost immediately which of the children have her best interest in mind and the most responsible child always rises to the top in these situations. Be prepared. It may be you and your husband. This will take up a lot of your time but you will be glad you had the time to interview and make good decisions not under pressure and time constraints. Trust me, taking her driving privileges will be met with very strong resistance. But an in-home care company caregiver can drive her to the grocery store, hair appointments, ect. Most of these companies also contract with companies like Lyft at a discounted rate for other transportation needs. Wishing you the best of luck with your MIL. It will not be an easy process.

CTTN55 - I think you’re my twin! I am in the beginning stages of making these decisions for my mother. Ever since my stepfather passed away six years ago, I have had increasing responsibility for not only my mother, but her one-acre property as well. I moved to her city to take take if her as I was single at the time and had just lost my job. Perfect timing?

After my mother repeatedly spent almost all her money every month on nonsense (and having to pay bills late or not at all), I finally got a POA to manage her finances. Unfortunately, it took her having a car accident for me to take total control (the car was totalled and I did not replace it).

My brothers are useless and they only live a couple of hours away. They “thank” me for everything I do, but never offer to help.

I am 66 and just got married again this year and I am grateful for an understanding husband. It seems all my time is spent caring for my mother and her needs on three scheduled days a week, plus the unscheduled trips, or I am preparing to visit - grocery shopping, laundry, etc.
I am taking care of not only her, but her household, her property as well as my own and my dear husband. My own needs and just a break are low on the totem pole. I can’t tell you the number of times an evening out with my husband has been interrupted with frantic calls from my mother for one thing or another. She is becoming a fall risk. And by the way, she absolutely refuses and throws a fit at the mention of outside help.

She can’t or won’t bathe, eats little, has trouble walking ir standing for long periods, has phobias about using products she thinks is “old” - like soap, shampoo, and body lotion. She leaves a trail of dead skin everywhere she goes.

One brother, just this year, started having her stay with him for a few days at a time. In those few days it’s sunshine and rainbows. He doesn’t have to deal with all the day in and day out, week after week, year after year stuff and has the nerve to give advice on her care.

Now I am at a point where I am going to need to get my mother qualified for Medicaid and get her placed in a nursing home. My brother says he wants to move to my city, live with mom for a couple of months (with his partner) and once he gets on his feet then move into a house where all three can live together.

I don’t think this will ever happen, to be honest. My brother says a lot of things and I also think he has no idea what he is getting himself into.

So, as having POA, I am going forward with Medicaid and the nursing home as I believe this would be the best thing for her mentally, physically, and socially.

Does anyone have experience in getting Medicaid in Texas?

This is an excellent discussion about probably the most common problem for caregivers.

Before my sibs passed away I made the long trip to see my folks only once a year. I could see they were aging but nothing was scary. My sister and brother died within 2 years of each other and as I spent time at home dealing with these tragedies I realized that Dad was developing dementia and how moms mobility had declined drastically.

So I went into panic mode, got all the legal, poa, financial stuff started and sorted out the medical issues. I ran around the first year or so like a nut, cleaning, fixing, shopping and trying to get them to move to assisted living. After losing that battle I fought them about getting help in their home. Lost that battle too.

Every time I’d leave for another long trip to check on them I’d swear to God in heaven, and anyone else, THIS TIME THEY ARE GOING INTO CARE!!

After my last battle with the folks I came home, didn’t feel so good, turned out I was having A Fib. So had  to go through the cardio factory of tests and so on.

I’m doing better now. No more battles. Yes they should have moved 5 years ago. No they don’t eat well and they mess up on their meds. But they are not “Legally” incompetent. The furnace and tv is working, they still can use a micro wave.  I’m in more of a monitor mode now.  The crisis will hit and away we go.

I’ve accepted that this is what they want and all the previous battles, tears and angst was about what I wanted. It had become a power struggle.  

No, It’s not fair to me. They didn’t prepare for this, I had to do it all, but that’s the way most old folks are. I can already see myself in my father. Like double OMG!!

But overall my folks are “Easy Keepers” compared to all the horror stories that land on this site.  I’ll call mom this afternoon, make sure the tv and furnace are working.  Monitoring.....My new mode of caregiving.

Talk to an experienced elder care lawyer (and possibly a tax expert) about changing title on a house owned by your parents. Both the medicaid situation and the income tax due on sale could be a real issue down the line. It's usually safer to not take action without information. My husband and I did a living trust and it made things very easy for me to deal with after he died.

Where do the other siblings live? You say you live 350 miles away. Are you the closest one or do the others live closer?

Does anyone have durable power of attorney for both medical and financial at this time? If so, who does?

I think your husband first needs to be candid with his siblings that it's not a matter of "if something will happen" but rather "when something happens." Being proactive makes everything so much easier because living in crisis mode is no way to live.

That said, when something does happen be clear that you and your husband will not drop everything because his mother and siblings now have an emergency with which to deal. I know that sounds harsh but I know from experience that one sibling has to take the lead and get things done. In my case with my inlaws, that sibling was my husband.

If your husband is willing to take the lead on financial POA, that is a huge responsibility. Perhaps another sibling will take the lead on medical. This all needs to be discussed even when no one else wants to discuss it. It took many conversations with my inlaws to get my inlaws moved into independent living. Good luck!

I cannot assume what another family would do for their LO's. I can, however, say when it became apparent that my mother was failing at keeping house 400 miles from me, I said to my only sibling, my brother "I will leave my home, family and pets and move in with mother to provide care for her."