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I am the out of state daughter of an 93 year old mother with neuropathy, on a walker, bad shoulders, and living in independent living apt. attached to a larger facility. My sister lives in town and has primary responsibility for mom's needs. I travel to their city where I spend 4 months in the summer to help - but with Covid, I didn't get up there this year. Additionally, I do and keep all of mom's finances and make any and every call needed to outside agencies as needed for mom.
My sister is very dramatic and has a love/hate relationship with my mom. My mom can be very passive aggressive to us both. She wants mom out of her life. Recently, in the past few years, my sister has taken out her resentment and anger on me. She is deeply furious that I live out of state and cannot take my "50% of mom." She stops talking to me, or says something nasty to me, and then apologizes which are now hollow to me. I have had much counseling to deal with the dynamics of our family and mom's aging care. It has helped me so much and I have offered to take my sister, pay for it, to help her deal with this time in life. She refuses. I write because this year, with me not getting there, everything has gotten worse. Sister feels so put upon. I have offered additional homecare for mom, I have tried to arrange other rides for mom if she needs to get to a Dr. So far, my sister does it all.
So this week, my sister now wants mom is assisted living because of her neuropathy and being a fall risk, among other changes that my sister reports to me. Mom cannot afford assisted living on her own. But we have long term care insurance and the possibility of VA funding if medical criteria are met. Mom is still independent on her walker, although feeble. She meets all of her activities of daily living so her long term care insurance would not pay for her to go to assisted living.
Today, I checked with homecare with some questions for the aide who sees mom weekly on changes in mental and physical status. I have been informed that there have been no changes in mom. That mom still bathes herself although the aide helps her get in and out of the shower. That mom still dresses herself. I reported this to my sister and her response was, "well I'm glad you have THEM to ask."
My sister and I used to be great friends. She has pushed me completely out of her life. It happens over and over again. A couple of years ago I was devastated by her stopping talking to me. I'm better now but what a waste. We could be such a good team, but I feel like through this aging process with mom, I have lost a sister.
Sorry this is so long. Just needed to vent.

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I’m sorry for the strife, it’s not at all uncommon when trying to balance care for a parent. Invariably a sibling feels resentful that they are doing “more” I’ve been there myself. What’s missing here is that your sister isn’t taking responsibility that what she does or doesn’t do for your mother is her choice. She’s an adult and free to choose her level of involvement and caregiving. She shouldn’t be doing anything that causes her this level of resentment and then blaming it on you. If mom needs care that she doesn’t want to provide, she’s not obligated, other arrangements can be made. I’d let her know this and stop listening to the nasty comments. Always be receptive to working with her and finding a way to help, but rude talk helps nothing
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Seems sister inherited Moms passive-aggressive personality.
If Mom is in a community, are there resources they have on the AL level that Mom can get by paying for it. My Aunt has this option. Doesn't Mom have the ability to eat in a dining room. Do they offer housekeeping even if she pays for it? A Van for rides to the doctors.

As I said in another post, maybe Mom doesn't need as many doctors visits. Once they are stable on a med and numbers are good, patients don't need as many visits. Sometimes labs can be done in between visits. If OK, they should not need an appt. If not, maybe a visit but sometimes its just a matter of adjusting meds.

I really don't think you r going to make ur sister happy. Really, doing Moms finances and making calls is a BIG thing to me. I did it ALL with no help. You can't help that COVID happened. Next time she gets going is tell her, I have made suggestions. You turn them down at every turn. I am willing to pay. I don't know what more I can do but move there and that is not an option. Your sister needs to realize, this is her life right now. And its up to her to set boundries and to figure out what she will or will not do. And what she won't do, find a resource to do it. I think you have tried. I really don't know what more you can do. Some people are never satisfied.
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Sorry, to hear your pain. I feel you and your sister are doing the best you can.
however, your sister is not really seeing your both helping. In the Bible it says
you reap what you sow. we also, forget were going to grow old and one day be
in the same situation. It's best you work together as a team like your doing. Everyone
needs, a break from time to time. I think mom wherever she's happy and wants to go
so be it. make sacrifices. we only have one mom and unfortunately, we all don't stick
around to long. we all have to go one day. when we have children believe they are listening
and follow what we do. Of course, we don't want our kids to mess out on there life and they
did not ask to come into this world. but it is was it is. we must love and work together do the
best we can and have love in our hearts, communicate . were all children of God. As my favorite
pastor in the world says. what would God say or think? its, all about communicating with sis, mom and everyone can be happy. we should never be selfish and worry about our own precious
time. because if we focus more on what we want we wont have it bc we didn't go all out for mom. do your best and definitely pray.
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You may have a great reason for not going this year, but it does make sister's  life harder.  You may be offering very legitimate help, but if mom will only have sister drive her, I can see sister's frustration.  Not certain what an answer is.
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Your sister is burned out.
Does your mom have funds to private pay for AL? Does this facility have graduated care - from IL to AL to SNF? Your mom is 93 with health issues...I would think it's not going to be long until she will need assistance with her ADL's and then her plan should kick in to pay. If your mom needs that much help or if she is becoming a fall risk, she probably should be thinking about making the move to AL sooner rather than later.

It's hard, when you're the sibling who is the primary caregiver to an elderly, unwell parent, to not feel some form of resentment towards your siblings who, in your mind's eye, are free to come and go as they please, while you're tethered to one place. I know we all have the choice to be a caregiver or not- but when you're dealing with a slow and steady decline, when it's not sudden, it's often not a conscious progression from concerned child to full-time nursemaid. You start off just getting groceries; just making meals; just one trip to a doctor; just one load of laundry; then before you know it your LO can't be left alone for more than an hour, and you're not even 100% sure how you ended up in this position.

I'm sorry that you're relationship with your sister is becoming a victim of this quagmire we call caregiving. There really aren't any easy answers, because it's not an easy situation. But if your sister is really pushing for AL, then you might want to work with her to see if there is a solution beyond her LTC policy paying for it. I would contact the AL facility and ask who they have or recommend who can do an assessment on your mom's ADL's. You might be surprised at what the assessment says.
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The idea of getting specifics from the aid is good. Now get out the LTC policy and read the section that defines ADLs carefully.

Bathing that requires substantial human physical assistance with getting in and out of tub or shower is a deficiency under our policy.

Then look at dressing and consider if Mom is skipping undergarments or stockings because she can't do them on her own. What does her policy define as a deficiency?

Do two ADL deficiencies qualify her for non Nursing home benefits?
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Thank you all so much. I very much appreciate all of your comments.
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Sounds like you are compassionate. She’s struggling and she feels she can be herself with you. She would never speak to a stranger like she speaks to you.

You have offered solutions. She refuses. Nothing left to do but continue to speak with the caregiver.

Your sister needs a break. All of you need harmony and peace in your lives.

Don’t listen to her if you find it is repetitive.

Best wishes to you and your family.
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Your Sister is probably burning out.

But is also probably being a drama Queen.

OK she has a lot on her plate. But she put it there - or allowed it to be there. She is acting like YOU heaped it on her. This is incorrect.

In her story, she is the victim & she is trying make you the villan. Drama nonsense.

Keep your common sense.

Now if she has done enough, the current year has made it even harder, Mother is getting frailer etc - it's OK to change the plan! She is tallking assisted living. So with common sense you are researching the options for that. Good.

You may need an OT functional assessment to support applications. I have done this as 1. self-assessment was made up wishful thinking rubbish & 2. the family reporters upsold all abilities - more rubbish. OT & Aides took a professional view. Soften that for your sister as I did, of course she knows what goes on but that a professional assessment is required.

Her flair for drama will be an asset when being the bright visitor for Mother in Assisted Living. Hopefully then she will have room to become a sister again too. ((((Hugs))))
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I'll take a blunt stab at this one.

So your "very dramatic" sister who has been doing the primary care for your 93 year old out of state mother who is known to be "passive aggressive" finally decides it's time for assisted living and reports to you the reasons why.

And your response is to check with the aid to see if your mother really does need assisted living?

As the dramatic primary care sister in our family my advice is that you ask your sister what you can do to help with the transition of your mother to assisted living.

Otherwise, down the road, when this is all over, don't be surprised when your sister finally gets HER life back if she decides you don't need to be in it anymore.

Like all the "it's her choice" people like to say-- it will be her choice then too.
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I am sorry to hear that. I am 63 and have dealt with the family drama. I was sole caregiver for my mom 24+ years, her father, raised my sister and did it all. I totally decided to kick all my brothers and sister to the curb. Whe. Mom got sick, I had no real support. Don't miss the drama. I have a congregation of sisters and brothers who love me, encourage, helped when they could. More reliable than the biologicals. My motto for 1993 when I dismissed them was, I can love them from a distance. I hope it works out for you to reunite with your sister, if not you have to do what is best for you mentally, spiritually and emotionally.
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I think you have been a little naive.

I understand why you thought it sensible to run the ADL questions past the aide. Get an objective professional opinion that would satisfy the insurer, right?

Ah me. You were forgetting that once your mother is in the ALF the homecare people will lose a client.

Take dressing. Does your mother need:
no support
minimal physical support
verbal prompting
physical prompting
full support?

And where, on any given day, do you draw those lines?

The project is: how do we present the argument for mother to be admitted to ALF with funding from her insurer and the VA?

It may not be possible yet. I would be the last person to suggest getting too "creative" with your replies. But there is so much that goes on in the way of choice of words and fancy footwork depending on whether the form filler-in's goal is to admit the person, or to prove that she doesn't need admission.

First question first, though: what are you mother's views on moving to an ALF?

Next question: if, God forbid, your sister were to break down and be taken hors de combat altogether, how sustainable would it be for your mother to continue living at home? - because, when you boil it down, that's how independent your mother is.
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I was thinking along the same lines as Country Mouse.

BBK, if your mom needs not only the daily support of one of her children but additionally needs more and more outside help coming in, she's really not living independently anymore.
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I'm the caregiver for Mom.

I have a sister who lives in town who helps when she wants (and tells me what I should do, even if she isn't willing to help) which has caused a few blow ups - the last one resulting my husband telling her that the next time she saw Mom would be at the funeral home because she was no longer welcome here. She asked me if I would bring mom over to her house to visit or if I could meet her in town so she could take her home to visit. I said yes, of course. Anyway, 3 weeks later she apologized for her blow up and said she was sorry and wished she could say it would never happen again but that we all know better. At least she's honest.

My brother lives 6 hours away, His wife and 20-year-old daughter were here from March-October every week for several days almost (missed a few weeks here and there) when Daddy was in hospice but when Daddy passed, they stopped coming. THAT was a little hard for me to accept. I felt abandoned even though I knew they had their own lives.

When mom entered hospice a month ago, brother called and said he would gladly move Mom in with them as they would be better able to provide care (maybe true, but it hurt my feelings, and they will take Mom over my dead body unless Mom wants to go, and she doesn't).

I try very hard to not be like your sister but I'm sure sometimes I sound like her. I have another sister who listens from afar (Alaska and I live in the southern US) and keeps me in touch with reality. Telling me I can't pour from an empty cup, I need to make time for myself, and, when necessary, gently helps me see how unreasonable I am being. Also have a counselor who tells me that what should be reasonably be expected is not always realistic when it comes to the expectation being filled.

Sounds like your sister has had too much and feels under appreciated and is taking it out on you. Your offers have gone unaccepted, so it sounds like she is taking it out on you and I'm sorry for that. There probably isn't much you can do for her except tell her you will help as much as you can (it doesn't sound like she hears that) and maybe when she complains to you say "I wish I could do something to help you feel better" instead of trying to suggest ways to make it better. She may need to just vent....kind of like we do here. You may even suggest this forum to her. I asked for my user name to be changed after I realized that a sibling might stumble across this site, see my name and read what I had written.

Good luck. I hope your sister will eventually realize how much you love and support her in every way you can.
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I also am the “out of state sibling. My brother retired early and is moms executor. The other 3 of us were still working full time. This went on for 10 or so years. Then he blew up at us. Said he quit. He had sacrificed all his time. I am still out state (2000 miles) he moved out of town. My sister drives 3 hours back and forth, 2 days a month. My younger brother is still working and has children at home. The executor brother really wrote a nasty letter and still is estranged from us. I don’t think it will ever resolve. It would break my Dads heart to know this. No real suggestions just know you are not the only one.
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Your sister does not hate you for living out of state, she does not like or hates you because she discussed concerns with you and instead of listening to her you went to an aide. Thats a major slap in the face. Additional homecare does not stop the phone calls or neediness. You should check out trusts and resources for placement.
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It's unfortunate the sister took offence to the OP asking the Aides for ADL feedback.
This was to check insurance/funding for Assisted Living coverage I believe. (I would be surprised if the insurer went only on the word of family - I would think it usual for them to request professional feedback).
Explain this, apologise & move past that.

Country Mouse is wise indeed - if living alone, could Mother manage? Could she arrange her own home health Aides, groceries & transport?

If no, then maybe you will find she DOES quality for Assisted Living? Or if borderline, it may be good to get ready. Choose a place & get on the waiting list.
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It's not fair for your sister. Obviously your mom can't do it by yourself if your sister is asking for placement and she is burned out. They don't get better over time. They need more help and it's not fair to have your sisters life on hold and you make the decision for her while you get to do it. If you think your mom should stay in her home place then hire a caregiver so your sister can get out and be free, or you come down and do it if you think she should continue to do it or respect your sister's life and put you mom in an assisted home so your sister can get her life back. She reached out to you and you made the decision yourself and put your opinion to keep your sister hostage while you have the luxury of living your life. This probably isn't about you being down there not helping. You are probably making suggestions to make her fo more and have unknowingly made judgement while you get to live your life. This probably isn't the first time she asked for help and you made a decision for her
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Sorry to hear this! Yes! Aging parents tend to destroy the best of the relationships.
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She would meet the daily living requirements - don't talk to an aide, talk to the social worker or the head nurse or Director at the assisted side. Needing help getting in the shower is a criteria so is walking independently ( she needs a walker and probably someone to watch her since she's feeble). Request that she be evaluated formally for assisted living - it's not someone's opinion if she qualifies! Use that long term care insurance and get her over to the assisted side - that's why your Mom got it!!!
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Been there, done ALL the caregiving for 14 years while my sister lived in another state and did nothing. It’s HELL caring for the elderly parent. See it from your sister’s view. You have a life, she doesn’t. Go out there, get mom placed in an assisted living and give your sister her life back. You BOTH have the same parent, not just her. “Caring for finances“ takes a few hours but caring for a parent takes everything. If you have Insurance, she doesn’t need advanced care to get her admitted. Your sister is doing her best and needs help. Put mom in an assisted living as I had to do when it finally got to be too much. Be prepared to help pay for it if needed. Send your sister gift cards for restaurants, maybe a spa nearby. She’s doing all the work, you’re not.
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If your mother is 93, I would start the process of having her assessed by the ltc insurance. Their criteria may result in findings that could be different than your or your sister's observations. You might be surprised by what they come up with for a care plan. Also, it can take a while and during that time, there could be some decline in her capacity in which case you'd have already done some of the initial legwork. If your sister is really ready for placement, and the ltc says no, then you're not the bad guy. Your sister would have to accept that assessment. No matter what, it sucks to feel hated. It definitely colors the events and responsibilities you're already dealing with with more stress and less clarity and peace.
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If I were your sister I would be upset too. My moms care falls heavily on my sister but the rest of us try to help out when we can. We all live further away from Mom than she does and she retired early. The bulk of the work has fallen on her. I finally had a talk with her and told her to do what she can and is willing to do - and no more. Mom can hire help - she’d just rather we do it instead of strangers. I get that too. But the sibling the care has fallen onto has to take a stand and stand up for themselves or they will have no life.
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Sounds like your sister has had enough and needs a probably well deserved break.

Snd if you want your sister to get back to being your sister then you need to release her of the stress of taking the responsibility for your mom.

If you can't or don't want to move back there full time, you should see if your sister and mom would like to move where you are and find a place close by.

If neither you or your sister want to move, then just have your mom move in to an assisted apartment and live close by you and you be responsible for her, to give your sister a break before she has a nervous breakdown.
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Have you talked to someone in VA about benefits? My mother's husband was a veteran with Alzheimers but she was very much independent living at the same ALF. Once he passed she got enough benefits to help continue living there but she also had his pension and SS. It would be beneficial to contact a local VA rep. You didn't say but I assume you are her POA.
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I have experienced this conflict and, non matter how hard it is for you, it’s toughest on the one “stuck with it!”
It sounds to me like you’re doing what you can. You need to see that she’s getting care; you shouldn’t have to provide all of it!
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Let your sister hate you! There will never be a happy relationship with your sister. If she refuses any kind of help from you she obviously needs the martyrdom that comes into play here. Do not enable this sickness in her just if necessary keep reminding her she has refused all the help you have offered. If she stops listening, hang up on her, change your phone number, do whatever is necessary to save yourself from this very unreasonable person. The chance of a healthy relationship with your sister is nil. I have been through this with my brother and I sleep like a baby because many hours of therapy later I have learned that I owe him nothing, not even my respect! Good luck. On your own arrange for someone to check on your mother rather than counting on your sister to tell you. Pay for a visiting nurse if you can and if your sister refuses to accommodate her, inform your sister that you will report her for abuse.
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Asking a sister to uproot her life and her family’s life to care for an elderly parent living in another state is absolutely ridiculous. That sister’s first responsibility is to her husband and children. There are many other solutions available other than such a dramatic move such as moving. Especially when that sister is willing to help in other ways and has been refused. Your sister is being a martyr and I would bet she is loving it! Also, I know for a fact that my mother just loved all the drama she was causing. My mother lived for all the drama she caused between me, my brother, and my sister-in-law. Fortunately I had medical professionals advising as to what I “owed” my mother. You would be surprised how little was necessary because what was needed and what was wanted were vastly different and unreasonable. My mother’s visiting nurse took me aside on one her visits and told me I needed to take care of myself first!
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I "am" your sister. I feel angry, and tired, and resentful for having to take care of my mother, who has Alzheimer's.

I am the one who has to deal with the crazy, creepy behavior 24/7. My sister helps when she can, but I still resent that I have to do most of the care. I am also trying to work from home.

I know that you are helping a lot, but helping is not the same as full-time caregiving.

The best thing that you can do is to go ahead and place your mother in Assisted Living so that your sister can have a life.
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As the sibling taking care of my parents’ needs, this was good for me to read through. I have found myself having thoughts of drastically reducing interaction with my sister because of her apparent lack of interest in my parents’ well-being. I’m doing it all as a single person trying to keep from losing my job because the duties of PoA and making sure my parents are safe have taken over my life. My sister lives 4 hrs away, has been here once in the past year and can’t even be bothered to ask me about them or call them more than once a month. I’ve become very angry. However, after reading this I realize I need to let go of that...my sister has always been self-centered. But I don’t want family estrangement. It’s her conscience that she’ll have to live with. Mine is clear, knowing I’ve done all I can to make sure Mom and Dad are living in a safe and comfortable place and that I am there visiting as often as COVID restrictions allow. Yes, my opinion of my sister has been drastically altered because of this and our relationship will never be close because of that. But I’m now vowing to not let it turn me into a bitter person. Sorry for rambling on about myself...new to this forum and needed to vent. But I VERY much agree with everyone who has said that exploring every option regarding ALF should be done. Maybe that is something the out-of-state sister could help with. I know ALF are very expensive...I just moved my parents into Memory Care. But perhaps a private personal care home would be more affordable.
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