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Hi all,
In the last few months, I've assumed more responsibility in my Grandmother's affairs. She is 83, lives alone in a 2-story home in NY state, and is declining. I'm 30F, married, and live a few hours away. I'm sorry for writing a book here. I literally have no one to talk to. My mother is an only child, and she and Grandma hate each other and no longer speak. (I don't speak to my mother either). My sister isn't in a position to help. My husband says he "doesn't want to get involved" because "someone else" will deal with it. Believe me, I wish someone else would.. And I feel guilty for saying that. I'm feeling really lost and terrible.


Previous post here: https://www.agingcare.com/questions/what-can-we-do-can-we-compel-grandma-into-a-safer-living-arrangement-and-how-do-we-pay-for-it-448248.htm?orderby=recent󺇩


Honestly, Grandma is a "tough customer". She had been diagnosed with Borderline Personality Disorder. She tends to fire people for no reason. She used to like to play emotional games with people, but now I don't know what is a game and what is cognitive decline.


I frequently buy Grandma supplies and have them shipped to her. I signed her up for local charitable meal deliveries and found a volunteer grocery shopper in her area. She has been extremely resistant to these services, but has accepted them more recently. She can no longer anticipate when she will run out of supplies, so if she does notify me, it will be after she has not eaten for a day... I try to track her rate of consumption on a calendar and ship things to her sooner than she will need them.


I also mail her a narrative "photo diary" 1-2 times per month, so she can reference pictures and keep albums of the family, our homes, pets, her great-grandchild, and family events, which really seemed to help orient her... but, this isn't helping so much any more. She used to only become slightly confused, occasionally during dusk, but now it's become much more than that... She frequently complains of feeling "confused" or "mixed up", and she needs a lot of prompting to maintain a conversation. She's physically become very frail, weak, and struggles to walk. She is greatly neglecting her physical hygiene (for a little while, I was driving several hours to see her, give her a bath, then drive back home). She is a fall-risk and has fallen several times - twice in the last 3 months requiring an ambulance trip, same day discharge.


Grandma's neighbor Maureen is a kind and friendly woman, who has been a Godsend. She keeps me posted on Grandma's needs and activities - but it's really become much more than she signed up for... Recently, Grandma made Maureen her medical proxy and Maureen is very uncomfortable with it.


We also have a Social Worker from Adult Protective Services, named Zack. He has been helpful in arranging incontinence supplies and recently, home welfare visits. This past week, he paid Grandma a visit at our request. He fixed Grandma's microwave (simple circuit breaker issue), and got her cable turned back on (it was turned off due to lack of payment, she got the checks/ envelopes mixed up when she mailed the utility payments...). She did not even tell me about either of these issues, and was unable to troubleshoot them herself.


Maureen, Zack, and I have tried several times previously to arrange a home aide. She has previously agreed, then withdrawn consent. She fears they will rob her. I had a home safe sent to her home this week, so she can put any valuables in it and hopefully be more compliant. She is now admitting she needs in-home help. Zack will go to her house this Monday and complete the 3-hour long phone/ video assessment with Grandma.


Will a home aide really help as much as I hope it will? I feel like I've built this up in my head as the answer to all our problems. I can't move closer; my husband and I were supposed to move out of the country next month. I'm so overwhelmed I feel like I'm losing my mind.

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Thank you all for your responses! :)
It turns out Grandma canceled the home aide evaluation. I could've cried. She called Zack from APS that morning, canceled, cursed him out, then called him later and ranted almost incoherently about him canceling on her. She has been increasingly erratic lately... She has been refusing to answer the door for the volunteer shopper (or will answer without dressing appropriately). She will often will not answer the phone for days at a time, and is now (falsely) saying that Zack made inappropriate advances the last time he was at her home. Maureen (the very helpful neighbor) seems to be trying to distance herself from everything, and I'm feeling very alone. If Grandma does answer the phone, she often complains of feeling very tired, "mixed up", dizzy, or confused, and then will become defensive at the drop of a hat, and say she needs to go and rest, and to "give her a break" and not call for a while. She's back to saying she doesn't need any help at home, and has stopped doing any of the minimal hygiene practices she was doing... I'm feeling very hopeless. What are my options here?
Wait until she falls again and needs SNF rehab?
Wait until she is having a "bad day", is ranting, undressed, and unwashed, and has allowed herself to be completely out of food, and then call for a welfare check and hope they transport her somewhere?
If she goes to the hospital, what if literally everyone says she is unsafe at home and refuses to pick her up - will she be transported somewhere?
I'm starting to think it's better for her to be somewhere that she can get regular care.

I thought we could keep her in her home, but I'm feeling very discouraged. It's only a matter of time until she brings a terrible situation on herself. I think I keep holding on because I'm worried about the welfare of her cats, and I hope on some level I can "win" this fight.
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Imho, a home aide will not be "the saving grace" for the long run as Grandma's health will worsen. However, for the time being, it could definitely be a Godsend since it will assist Grandma and ease the burden of your worry (and your mother's since your post from April, 2019, said "mom and you"). I truly commend you for all that you have done and continue to do for Grandma. You have gone above and beyond the call of duty! No one does what you've accomplished.
My own late mother became overwhelmed at 92 years of age with the smallest things, e.g, incoming mail and Meals on Wheels. What she used to accomplish was then significantly diminished. She actually sobbed about her mail and I had to take over.
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A home health aide will not solve all of your problems, but a caregiver will allow for you to take time to care for yourself and manage other issues as well. Hiring someone may also alleviate any simmering resentment that may be developing. However, I would caution you to be specific regarding caregiving tasks. I would also recommend hiring through an agency and ask for references. You may also want to trial the caregiver to make sure they are a good you your your loved one and the family. Good luck.
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You’ve done an amazing job helping your grandmother! Whether she acknowledges it or not, she’s been blessed by you. My dad has also been adamant to stay in his home. He hasn’t dealt with dementia, but is very frail physically. I hired a helper for him a while back. I interviewed several people before finding one that has truly been a godsend. It was difficult to get me dad onboard with having someone in his home, but he quickly came to depend on her and value her help. She’s been kind, beyond helpful, trustworthy, and a huge source of encouragement for him. Honestly, it’s worked out better than I ever thought it would. It hasn’t solved all issues, she’s not there all the time, he’s still a big fall risk, but she’s made life much better than it was. If you decide to go with a helper, be very honest as to what grandma is like, and tell exactly what is expected. I wrote out a list of both. I wish you the best
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Yes! im So amazed at your wonderful help over and above what most people could even imagine! Get that in home care going ASAP . Take it day by day . See if you can get the same person or couple of people to come as they can know your grandmother better that way. It takes time . Try to stay out and let them do what they are good at, in other words don’t micro manage because it will make you crazy. My mom has to have stuff her way and I knew her caregiver would see how she is and work with her plus seems like not having a family member doing all that is so so much easier anyway . Good luck !
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Besides an aide, if you also need someone to assist your grandmother in day-to-day financial management, there are licensed "money managers" who can come in weekly, or at some other interval. They can help in bill paying, keeping track of insurance claims, balancing the budget, etc. https://www.aarp.org/money/budgeting-saving/info-2016/money-management-on-a-budget.html WE haven't used thse kinds of services, but perhaps others have and can chime in here.

I think a home aide would be a godsend for your grma (and you!). If you go through an agency, it's a lot easier than hiring priovately, especially since you are so far away. You mention your grma is a difficult person, and if you go through an agency they can keep trying to find someone who is a good fit with grma if she "fires" or doesn't get on with someone. Most agencies these days prefer to send people for 4-hour shifts and charge more per hour for shorter shifts.
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A daily aid (even for only a few hours) can make all the difference in extending the time someone can safely remain in their home. The aid can assist/prompt bathing, medication management, meal prep and fridge clean out, transportation for doctor's appointments, etc.
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When dad and mom had to move in with us, we were both still working. Mom was in a rehab, and dad had ALZ. We hired a young man first, to take dad to visit mom and keep him company. He was OK.. but when mom came home we got a middle aged country gal ( no judgements here,, she was) and Dad and mom both adored her! She kept dad busy and involved, and was a great companion for Mom. She was quickly like part of the family, even brought home cooked food for them. My mom is also a queen of her house sort, but as she got used to the CG she came to trust her and her care of dad. I swear she was like Alice from the Brady Bunch! We wanted to hire her as a housekeeper/live in, but the buy out was terrible from the agency. As mom is declining, we are possibly thinking of trying to hire her back.
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I am going to start by saying my Husband was a DREAM to care for. he was compliant and never resisted any care that was done.
The last 2 caregivers I hired were AMAZING. I contacted the local Community College and spoke to the director of the Nursing program and I said I was interested in hiring caregivers and she gave a few my contact information The two I hired had completed the CNA certification course, that is required prior to going to Nursing school and I told them I would be willing to work with their upcoming course schedule. I think there were with me/us for about 6 months and my Husband died right before the start of the Nursing School program that these students wanted to take. I told them both that they were Angels.
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I truly understand your anxiety, it is difficult to care for someone long distance. I lived 750 miles away from my mom. I drove the 12 hour trip once a month for a year and a half. We had home help for the last 15 months of her life with 24/7 care for the last 3 months.
Zack and Maureen sound great, but you need more help. The aides that we had were great. They cooked, did some light cleaning, laundry, fed the dogs. They helped her dress, kept her company, which was probably the best part.
We did keep valuables put away, no need tempting anyone, but never had any problem.
I had a woman that acted as a sort of care manager. She made sure that the helpers were scheduled as needed and would fill in as needed. We couldn’t have made it without her. It allowed me to relax a little when I was home.
I had to let one aide go due to a personality clash between her and my mom, but even that went okay.
We were very fortunate that mom had some money put away to pay for all of this care. She also lived in a rural area which made salaries a little more affordable as well.
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CirclingSkies Jun 2020
Wow that's a long monthly trip! Thank you so much for sharing your experience; it sounds like the aides were really helpful to your family. Grandma also lives in a rural area; we're not really sure of her finances though. I'm really anxious for her to get some help.
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