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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
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V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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"I am caring for my mother, who is 79 years old, living in independent living with age-related decline, alzheimer's / dementia, diabetes, heart disease, and mobility problems.
"My sister and I are primarily responsible for our Mom, with my sister physically helping her 75% of the time. Our mom has dialysis treatments 3 times a week. My sister drives her there at 7 a.m. Mom decides at least once or twice a week that she just can't go to dialysis. She does not grasp the fact that missing dialysis is not an option. She has been in and out of the hospital 3 or 4 times in the past two months. We know she needs to be in assisted living. At this point our problem is convincing her. Being able to afford it is another problem we are having but can probably figure that out with us contributing monthly."
Caregiving happens on the caregiver's terms, not just on the wants and needs of the recipient (which, in people with dementia, are often not based in reality).
Do you and/or your sister have PoA for your Mom? If so, read the document to see what activates the authority to begin making decisions in her best interests.
You do not need to get her to buy into accepting an increase in her care. She may even be beyond AL. Getting some place by 7am would be hard even for me, healthy and at 65.
Start researching local facilities. Go on Nextdoor.com and get recommendations from non-anonymous neighbors in your own community. Talk to a financial or estate planner to see what she can afford and for how long. Talk to a Medicaid Planner for strategies for this very likely probability (for LTC only in most states).
You can use therapeutic fibs to get her to move. You can consider meds for anxiety and depression before she goes in to help her acclimate (this is very very common for elders with cognitive decline to need). The admins of the facility will know how to play along with whatever narrative you give your Mom to get her to go with the least amount of upset.
Your profile says your mother has dementia. If so, she has lost the ability to reason and make sound decisions in her best interests. This means she will most likely never decide or cooperate with moving to managed care, just like she’s making the poor choice to refuse dialysis. In fact, have you considered her refusal of dialysis (also noted in profile) possibly meaning she has tired of the treatment and perhaps there should be a consideration of stopping it and pursuing end of life care? The dementia may also mean she will need memory care instead of assisted living at some point. Consider heavily of it’s wise for you to financially contribute to her care. With all of her conditions, it may be needed to use nursing home level care. Medicaid can help with that cost when she cannot pay any longer. Please look into all options, be sure documents such as POA for healthcare and financial decisions are in place, and consider seeing an elder care attorney. You’re in the time where you’ll act for mom despite her wants, to help with her needs
I am copying your profile information so responders here can see what you and your sister are dealing with. "My sister and I are primarily responsible for our Mom, with my sister physically helping her 75% of the time. Our mom has dialysis treatments 3 times a week. My sister drives her there at 7 a.m. Mom decides at least once or twice a week that she just can't go to dialysis. She does not grasp the fact that missing dialysis is not an option. She has been in and out of the hospital 3 or 4 times in the past two months. We know she needs to be in assisted living. At this point our problem is convincing her. Being able to afford it is another problem we are having but can probably figure that out with us contributing monthly. see less
I don't know if there is dementia involved, but from her deep denial it would seem so. I don't know if either of you is POA or not. At some point, when the burden is too much on the family it is not a matter of "convincing" but of "informing". You cannot convince someone with any level of dementia OR denial of anything.
You admit your sister is responsible for 75% of the care. I'm hoping that mother doesn't live with either of you, as everything will be thereby so much more difficult if you've painted yourselves into that corner.
You have fallen into the deep black hole that claims many care givers. You feel responsible for your mother's happiness. You are no longer daughers, but caregivers. You didn't cause this and can't fix it, and I only hope against hope that your mother was given ALL OPTIONS as regards dialysis. As a retired RN I would never accept it, and would be willing to have good end of life care instead.
Given you did not cause/fix this it's time now to level with HONESTY with your mother. Tell her that you and Sister are both unwilling/unable to provide the level of care she now requires. That you will not be helping her with appointments and dialysis care in future. That she will require placement now. She will be furious. She will be broken-hearted. She will accuse you of any number of mean and cruel intentions, and will be mourning one of the last awful losses that age and medical care dependency is a precursor of. The only other final loss before death is that of mind and ability to make decisions for one's own life. She will likely lash out at you. You can grieve, mourn, weep and wail with her for this is worth grieving. But you cannot allow her to avoid the facts, the needs and the truths and the decisions you have made for your one and only lives.
I am so sorry, but wanting our seniors to WANT and AGREE to all this is asking a bit much of them at a time they are at their weakest and most wanting. There is nothing to WANT or to LIKE or to find ACCEPTABLE about this. It is a great tragedy.
I wish you the very best, but throwing your own lives on her funeral pyre will help NO ONE, and may well kill you off before her.
POSTSCRIPT to my earlier comment, Laura-- one more thing. Now is time to get all papers, POA and etc into effect and to go over Mom's finances with her. If she has enough to self pay in care for a while be sure it is someplace that will allow her to stay on Medicaid when her funds run out. Then apply for Medicaid for her in a timely manner. She will spend her own money on her own care and the government will fund the rest for her lifetime. If she has home or car she can keep those until her death; then medicaid will do clawback on sale profits on those things at her death. DO NOT USE YOUR OWN MONEY. First of all, no one's that rich. Secondly, it will take you and your Sis a lifetime to save enough so that you are not in the position your Mom is now at the end of your own lives. Your savings and your assets are for YOUR CARE.
When it was time for me to put my husband in assisted living, it wasn't a "honey, it's time you are in assisted living, you'll get more care there." It was, Honey, I have to go away for a few days and I'm going to take you to a place where you will have some free time, maybe meet some new people, and you will have someone giving you your meals and a nice place to be. You will sleep overnight until I get home." His dementia didn't allow him to think I might be lying, nor his physical condition allowing him to fight back with me. The facility asked me NOT TO visit for 3 weeks, which I complied with. When I visited him after the 3 weeks, he accepted he was in a place they fed him, got him to shower, take for walks, take him to the movie room or to play cards with others. And to happy hour where he did not get drinks, but some entertainment for a half hour. I visited him later and he did not fight with me for "doing this to me". His dementia didn't let him think that far. He was over 200 lbs so keeping him at home where he could fall, walk out of the house when I was not in the room with him, etc. was not an option. My concern was his safety and me NOT being charged with neglect if he went out into the street. He loved to take walks. I learned to let him go, and I discreetly walked behind him, slower pace, enough behind he didn't know I was there. We weren't far from a main road 55 mph type, so I had to keep an eye on him if he decided to take a different route walk. Lies to the demented is not a sin. It is a safety measure to protect the demented person to save himself from getting hurt or killed.
Let me ask you a question... What are you doing for her that makes her think she does not need AL? Are you doing her shopping? Cleaning? Setting up her pills? ANYTHING you do FOR her props her up and fulfills the illusion of independence.
My LO had shopping, cleaning, laundry, setting up pills, bills, transport arranged & appointments made.
I call it The Magic Doll House.
Different - as a this was a younger person with disabilities & the tasks done by the well meaning family. But same result: did not see or feel how much help was being given, therefore, did not see or feel that a higher level of care was needed.
In fact, my LO told a Social Worker "I live alone, independantly".
Once all the help was listed down, the SW reprased "You are living alone, dependantly".
It was suggested for a kind transistion, a Psychologist could assist to move the thinking along from denial to acceptance.
Or there's the *hard way*. Await a crises to force change.
I am dealing with this right now. My mother refuses to go to an assisted living. for the 4 time we have found her close to death. She won’t wear an alert button. Not driving right now. Has a “Housecleaner” and friend who take her places. I have her POA and designated as her caregiver. She is very defiant, resentful, ungrateful to me. She is currently in a rehab facility because of her resent hospital stay. Will go tomorrow and hear the rehabs recommendation for her future. Wish there was someway to get her I to a safe place where we don’t have this issue again! Any suggestions?
The rehab can not, or should not discharge her if she is unsafe at home. If you think that she is not safe living at home make sure that they are aware of this.
Maybe stop helping her in anyway, and ask others to stop, just for a little bit and see if she realizes she needs to go into a home. I know it sounds mean, not sure if I could do that, myself, I'd be so worried about her.
@ Taarna, I agree and all too often people think that skilled nursing care can effectively be done at home but I do not see this as being possible. If so, this would likely cost thousands of dollars to have certified people coming in shifts to help with getting in and out of bed, baths, changing pullups or diapers, helping the person change positions every 2 hours and etc. I think our LO do better in a place where they can be cared for.
You can't convince someone with dementia of anything. Even if they nod their head and say they understand, they really don't. And if they actually did understand for that minute, they'll forget soon after. Dementia robs them not only of memory, but the ability to understand, reason, or recognize their own deficits.
When left to their own devices, people with dementia can end up living in filth, eating spoiled food, forgetting to eat at all, walking outside naked and freezing, yet in their mind, they don't think they need any help at all. And if they do recognize that something is wrong, like a toilet accident on the furniture, they're unable to understand they did it themselves and blame it on someone else.
My aunt had accidents all over the carpet and beds and was enraged that I stayed at her neighbors home when I visited her until we had it professionally cleaned. She couldn't understand the filth.
Sometimes if they're just too stubborn, they must become a ward of the state. I tried. Even with POA, I tried. I was told they have their rights, even if we don't agree with them. My aunt lives in her own home and I was told that I cannot lock someone up against their wishes. I just let the POA go, stopped helping and let the chips fall. My cousin lives close by and checks on her, but I decided I cannot make myself crazy. I worry about her every minute of the day but we cannot do anything.
Laura, is it possible to apply what I call the 'Holiday Test' of logic to Mom's situatuon?
Your sister & yourself are Mom's caregivers, providing huge support & care. Right?
In therory, if you & your sister both took a week off, the same week, took a holiday together, what would that look like?
Could Mom cope?
Arrange her own transport to her medical appointments? Be OK at home with meal deliveries & groceries you pre-arranged? Be OK with sitters or care staff coming to assist?
I'm not asking what Mom would SAY.. that can be "Oh, I'll be fine, I'll manage."
I am asking what you think would happen.
If Mom could not cope - then she is dependnant on you. Therefore you are now in charge.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
"I am caring for my mother, who is 79 years old, living in independent living with age-related decline, alzheimer's / dementia, diabetes, heart disease, and mobility problems.
"My sister and I are primarily responsible for our Mom, with my sister physically helping her 75% of the time. Our mom has dialysis treatments 3 times a week. My sister drives her there at 7 a.m. Mom decides at least once or twice a week that she just can't go to dialysis. She does not grasp the fact that missing dialysis is not an option. She has been in and out of the hospital 3 or 4 times in the past two months. We know she needs to be in assisted living. At this point our problem is convincing her. Being able to afford it is another problem we are having but can probably figure that out with us contributing monthly."
Caregiving happens on the caregiver's terms, not just on the wants and needs of the recipient (which, in people with dementia, are often not based in reality).
Do you and/or your sister have PoA for your Mom? If so, read the document to see what activates the authority to begin making decisions in her best interests.
You do not need to get her to buy into accepting an increase in her care. She may even be beyond AL. Getting some place by 7am would be hard even for me, healthy and at 65.
Start researching local facilities. Go on Nextdoor.com and get recommendations from non-anonymous neighbors in your own community. Talk to a financial or estate planner to see what she can afford and for how long. Talk to a Medicaid Planner for strategies for this very likely probability (for LTC only in most states).
You can use therapeutic fibs to get her to move. You can consider meds for anxiety and depression before she goes in to help her acclimate (this is very very common for elders with cognitive decline to need). The admins of the facility will know how to play along with whatever narrative you give your Mom to get her to go with the least amount of upset.
I wish you a smooth transition for your Mom.
"My sister and I are primarily responsible for our Mom, with my sister physically helping her 75% of the time. Our mom has dialysis treatments 3 times a week. My sister drives her there at 7 a.m. Mom decides at least once or twice a week that she just can't go to dialysis. She does not grasp the fact that missing dialysis is not an option. She has been in and out of the hospital 3 or 4 times in the past two months. We know she needs to be in assisted living. At this point our problem is convincing her. Being able to afford it is another problem we are having but can probably figure that out with us contributing monthly. see less
I don't know if there is dementia involved, but from her deep denial it would seem so.
I don't know if either of you is POA or not.
At some point, when the burden is too much on the family it is not a matter of "convincing" but of "informing". You cannot convince someone with any level of dementia OR denial of anything.
You admit your sister is responsible for 75% of the care. I'm hoping that mother doesn't live with either of you, as everything will be thereby so much more difficult if you've painted yourselves into that corner.
You have fallen into the deep black hole that claims many care givers. You feel responsible for your mother's happiness. You are no longer daughers, but caregivers.
You didn't cause this and can't fix it, and I only hope against hope that your mother was given ALL OPTIONS as regards dialysis. As a retired RN I would never accept it, and would be willing to have good end of life care instead.
Given you did not cause/fix this it's time now to level with HONESTY with your mother.
Tell her that you and Sister are both unwilling/unable to provide the level of care she now requires. That you will not be helping her with appointments and dialysis care in future. That she will require placement now.
She will be furious. She will be broken-hearted. She will accuse you of any number of mean and cruel intentions, and will be mourning one of the last awful losses that age and medical care dependency is a precursor of. The only other final loss before death is that of mind and ability to make decisions for one's own life. She will likely lash out at you. You can grieve, mourn, weep and wail with her for this is worth grieving. But you cannot allow her to avoid the facts, the needs and the truths and the decisions you have made for your one and only lives.
I am so sorry, but wanting our seniors to WANT and AGREE to all this is asking a bit much of them at a time they are at their weakest and most wanting. There is nothing to WANT or to LIKE or to find ACCEPTABLE about this. It is a great tragedy.
I wish you the very best, but throwing your own lives on her funeral pyre will help NO ONE, and may well kill you off before her.
DO NOT USE YOUR OWN MONEY. First of all, no one's that rich. Secondly, it will take you and your Sis a lifetime to save enough so that you are not in the position your Mom is now at the end of your own lives. Your savings and your assets are for YOUR CARE.
He loved to take walks. I learned to let him go, and I discreetly walked behind him, slower pace, enough behind he didn't know I was there. We weren't far from a main road 55 mph type, so I had to keep an eye on him if he decided to take a different route walk. Lies to the demented is not a sin. It is a safety measure to protect the demented person to save himself from getting hurt or killed.
What are you doing for her that makes her think she does not need AL?
Are you doing her shopping?
Cleaning?
Setting up her pills?
ANYTHING you do FOR her props her up and fulfills the illusion of independence.
I call it The Magic Doll House.
Different - as a this was a younger person with disabilities & the tasks done by the well meaning family. But same result: did not see or feel how much help was being given, therefore, did not see or feel that a higher level of care was needed.
In fact, my LO told a Social Worker "I live alone, independantly".
Once all the help was listed down, the SW reprased "You are living alone, dependantly".
It was suggested for a kind transistion, a Psychologist could assist to move the thinking along from denial to acceptance.
Or there's the *hard way*.
Await a crises to force change.
If you think that she is not safe living at home make sure that they are aware of this.
To what aim is the the dialysis?
Is it temporary? With hope kidney function will be soon restored - dialysis provided until such time.
Or dialysis will be needed for the rest of her days?
I agree and all too often people think that skilled nursing care can effectively be done at home but I do not see this as being possible. If so, this would likely cost thousands of dollars to have certified people coming in shifts to help with getting in and out of bed, baths, changing pullups or diapers, helping the person change positions every 2 hours and etc. I think our LO do better in a place where they can be cared for.
When left to their own devices, people with dementia can end up living in filth, eating spoiled food, forgetting to eat at all, walking outside naked and freezing, yet in their mind, they don't think they need any help at all. And if they do recognize that something is wrong, like a toilet accident on the furniture, they're unable to understand they did it themselves and blame it on someone else.
Your sister & yourself are Mom's caregivers, providing huge support & care. Right?
In therory, if you & your sister both took a week off, the same week, took a holiday together, what would that look like?
Could Mom cope?
Arrange her own transport to her medical appointments?
Be OK at home with meal deliveries & groceries you pre-arranged?
Be OK with sitters or care staff coming to assist?
I'm not asking what Mom would SAY.. that can be "Oh, I'll be fine, I'll manage."
I am asking what you think would happen.
If Mom could not cope - then she is dependnant on you. Therefore you are now in charge.