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In home care fired inlaws
rexob
Posted: Friday, October 12, 2018 11:14 AM
Joined: 6/26/2017
Posts: 6


MIL has dementia and FIL has something going on as well. Two years ago their doctor said they both need 24/7 care. Both refused to leave their home or to have in home assistance. Fast forward two years and a lot of arguing....in home care started and ENDED this week. Just the start of the 3rd day. This was with supervision! The adult children were taking shifts and were there at every visit (two 3 hour shifts each day) in an effort to get this new routine working.

The siblings can't continue the weekly (more often daily) visits to their parents house to literally take care of everything that a normal home needs to have done.They have jobs, their own lives and families. Inlaws won't allow others do to anything except their children. Daily laundry from constant soiled bedding and clothing. Grocery shopping, meds, cleaning, dog care, meals, etc...They can't continue down this road and something has to give!

Is waiting for something bad to happen really the only thing they can do? They are at a loss. They have POA for both parents but can you really just transport someone to a facility against their will?

MIL had been so ugly with the workers that one reported the poor working environment to her administrators and the company cut ties. MIL was doing all the normal things one hears about. Nasty, foul language was just the tip of the iceberg.

They don't have proper nutrition. Meds are not being taken correctly or at all. Both have been falling. MIL is incontinent with both. They don't bathe minus when the daughters can get MIL in bath but not bathing her allowing her to do a shoddy job herself. A small kitchen fire has happened. Luckily they are not driving but swear they can and do. MIL has had a chronic UTI for 2 years. It won't go away since she won't take meds consistently and sits in her own filth.

The siblings are at a loss. Where do they go from here? I read the posts here daily. I've read the books suggested. I pass along the info I learn but these are not my parents so I don't have much say.


Eric L
Posted: Friday, October 12, 2018 12:09 PM
Joined: 12/5/2014
Posts: 594


Really, I think the best solution is that whomever has POA needs to take charge. Lots of folks here have been in your shoes and hopefully, they can help you out.

MIL probably needs start seeing a geriatric psychiatrist at this point. There is a good chance that she won't be able to be properly placed until her mood is stabilized. The most valuable member of my MILs care team at this moment is her geriatric psych. He doesn't do therapy or anything of that sort. He adjusts her medication in order for us to at least have relatively peaceful environment at our home.

If the siblings can't live with their parents or move them in, they need to start looking at placement options. Many of the problems that you describe (poor nutrition, improper med management, uti's, etc) can hopefully be solved in a facility.

Really (and I know this is a gigantic hurdle for most adult children).. someone has to decide to be in charge. Find a facility (parents don't need to be involved), make arrangements, and move them.
rexob
Posted: Friday, October 12, 2018 12:30 PM
Joined: 6/26/2017
Posts: 6


Thanks for your response. All 3 siblings have POA and each "take charge" of different things. My hubby gets his dad out to have his haircut, takes care of the yard, vehicle and home maintenance, snow in winter, cleans out fridge weekly, dishes and floors and helps get his mother to dr visits. 2 sisters do groceries, bills, meds, dr visits, etc. They have all taken their parents to a facility for a dinner visit and tour however their father refuses to leave his home or to allow his wife to go. Maybe with this weeks fiasco they can get him to see the error of his ways. He does nothing to help with his wifes care (or his own) and continues to ask when she is going to take some responsibility for herself. He just keeps saying she is nuts while making hand gestures like one might if they thought something someone said was a bit nutty. The whole thing has become insane to say the least.

None of the siblings want to go against their parents wishes and I keep trying to explain that they are letting people who don't have sound judgement continue to make bad decisions and remain in charge. MIL has no clue anything happened this week much less anything is wrong with her. FIL just wants to know who is going to feed him and wait on him.

Its just very sad to watch your spouse not know what to do or where to turn and be so frustrated that nothing they do is solving the problem. They know it isn't going to get any better but they can't even maintain status quo.


D in law
Posted: Friday, October 12, 2018 12:41 PM
Joined: 4/24/2017
Posts: 296


I am in the same boat.  About 2 years ago I hired a care coordinator thinking a neutral yet professional party could meet with the entire family and in laws to develop a plan.  It failed miserably but we did learn some information.  We also tried the paid caretakers but they were met with resistance.  We are down to 4 hours per week! With only 1 SIL available during the day she quickly got burnt out and very resentful.  She started spending less and less time there which as you fear, the waiting for something to happen WILL happen. Believe that. It is very hard dealing with just 1 person, let alone 2 and they're married. My only suggestions would be:

1.  Listen to Eric and get the sib with the POA to take charge.

2.  If that doesn't work, if there is a sib that parents respond to better, get that sib with the POA sib together to talk, or get the POA changed.

3.  Try a geriatric care manager.  It is a little pricey but in your case maybe this outside professional would benefit the family with what is needed to get done both in the home and possible future placement in a suitable facility.

4.  For free you can call the ALZ hotline, or even your county/state department of the aging. Depending on their situation they will come out for free and do an assessment and they may qualify for different programs.  At the very least you will get an education on all the red tape should they be unable to self pay for help in the home, or assisted living.

5.  As a last resort if their environment gets too volatile look up your local hospital that has a geriatric psychiatric wing and/or Dr. on staff.  Call 911 if necessary.

6.  Remain calm.  It does really help to walk away for a minute, take some deep breaths.

My very best wishes to you, your in laws, and family.


Victoria2020
Posted: Friday, October 12, 2018 3:02 PM
Joined: 9/21/2017
Posts: 215


Doesn't seem like anything will happen with them in the home- the POA people seem to be working around the actual physical /mental issues. Cleaning leaves off the porch but not poop off a butt. It *is* hard to put blinders on and act against a parents "wishes" even if they are not rational.

 Why not call 911 and say they are malnourished, falling, meds not being taken, she has active untreated infection- the paramedics can remove them to the hospital under a psych hold where they can be fed, treated evaluated. Don't forget to mention the fire - that is a danger to neighbors also.

 Sad, but society removes dogs and horses from a home for this level neglect.With humans, it is self-neglect from a damaged mind(s). At the hospital then you can look at placement etc. 

If not, her infection gets worse , they fall and die, another fire  etc. They do need to get out of there. Really sad. Thanks for helping and researching.


Misssy2
Posted: Friday, October 12, 2018 8:40 PM
Joined: 12/14/2017
Posts: 1681


I would call Adult Protective Services on these two.

One of the criteria is that they are neglecting themselves which is clearly met.

Then something for sure will happen....THEN the POA can step in and help make the choices.

Or the 911 option.

But if someone calls APS here...then this will stop really quick.

And it sounds like it needs to and the family is burnt out...

This is way above everyones pay scale...call in the experts.

 


Mimi S.
Posted: Friday, October 12, 2018 8:47 PM
Joined: 11/29/2011
Posts: 6500


i would suggest you give the kids our help line #. Have them ask to speak with a Care Consultant. perhaps a conference call can be set up. 800-272-3900.

 

Who has dementia?  The people with the POA have the authority to just do it.... arrange for Assisgted living or whatever is appropriate.  What was the process of diagnosis.?  hopefully it was a complete workup at an institution that is qualified for such diagnosis.  The foul language is ften a smtom of Fronto-temporal dementia which is different from Alzheimer's
Misssy2
Posted: Saturday, October 13, 2018 6:54 AM
Joined: 12/14/2017
Posts: 1681


There is a misconception about POA someone with POA can NOT force anyone into anything. You can try but if she gets there and says she doesn't want to be there...they are not going to forcefully make her stay there.  The POA can make decisions for her CARE once she is there...but Guardianship is the only way to force someone into anything that can only be obtained in a court process.

Seems many people have many misunderstandings about the role of DPOA and POA.

Guardianship is completely different than POA...its not a "document"  No document has the power that many here suggest it does.

 


King Boo
Posted: Saturday, October 13, 2018 7:26 AM
Joined: 1/9/2012
Posts: 2749


If you have a Power of Attorney, you are the decision maker according to the terms of this important legal document.   By the time most of our loved ones are placed, even if they are squawking loudly and don't want to stay, it is usually crystal clear that they are so impaired in cognition that the Power of Attorney is not questioned.   

If it is, then the next step is not guardianship, but rather, the question arises of the need for proxy (that is, someone to represent your interests).   At that point, a fully neuropsychological evaluation with a PhD neuropsychologist can be obtained - this involves lots of testing of executive function, memory testing, insight, safety awareness, etc.  A report that documents lots of deficits is very useful - the neuropsychologist can document need for proxy, and likely the geriatric psychiatrist who is prescribing medication for MIL will too.    Then, the Power of Attorney, if it has been questioned, has 'backup'.

This strategy is also useful if one of the siblings is objecting to the care plan because they are not on board with how compromised their parents are - or being held hostage to the old 'against their wishes' line - which is not in play at this point as their well being is compromised.

BTW, naming co power attorneys (you have 3!!!!) is a horrible idea because all must agree and be in tandem.  Good luck with that!  Much better to choose one person and then a sucessor if they cannot serve, for future reference.

Do not call adult protective services, you do not need a case file opened on your in laws, that just gives hubby another whole layer of problems to deal with.  APS only steps in when there is an immediate danger, if they have a roof over their head and food in the fridge they are unlikely to do anything - there is a misconception that APS can force placement or reception of care, not true for the typical gradual decline of the elderly.  

WWID?    What is your relationship among the 3 sibs?  Start with hubby - support him, tell him you know it is very difficult - but that unless they all get on board together with a care plan they are going to bear the responsibility for their parents well being, and if something bad should happen, as POA's they are legally responsible...................

And that care needs drive the decision making - not wishes and past wants, which were hypothetical at the time (the old never put me in a nursing home guilt trip line)

Have your first, second and third choice of Memory Care (NOT ASSISTED LIVING, that ship has long ago sailed from what you describe, unless it is called dementia care assisted living).  It can also help to point out that no decision is forever and can be changed as needed.  

The outcome will be much better for your in laws if a move is accomplished before a hospital crisis, but if this is not possible, be able to provide the hospital social worker with your first second and third choice of a nursing home and then your first and second choice of long term care (Memory care or nursing home) immediately upon admittance.  It greatly improves your possibility of a good outcome.  There is NO TIME WHATSOEVER to research this during a hospitalization.  

They need to accept the responsibility of a POA and work together.  You don't want a court decided outcome via guardianship, there is no need, they have the POA.  They have to get their act together and start the hard work.  Painful but needed.   Care needs are only going to increase.

Lastly, you could try another home care agency.  Sometimes trained aides can do better if the family are not in the house.  That could have been the downfall of the whole thing too-if MIL gets a geriatric psychiatric consult and mood improves, it may be better the second time around (though is still only a temporary measure, 24/7 care will eventuallly come)


 
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