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Bedroom and bathroom upstairs, some days she won’t go down and eat because it’s too painful to get downstairs. Doctor recommends one story home. Husband refuses to sell home, family owned house for 100 years. “I’ll die here”. That’s fine, his choice but it shouldn’t have to kill her too. She will not divorce him- he has diabetes and “needs me” extremely toxic relationship. She calls weekly crying to me how awful everything is and how cruel he is. Can he be reported for elder abuse?

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Is there a way of making her a living area upstairs. Like a sitting room with a microwave and frig in it. Maybe a small table she can have her meals on.

Who cooks for them? The person could take the meal up to her. The only other option you have is placing her is an AL but that cost money. A NH she could get Medicaid. Assets are split with Husband becoming the Community Spouse. Moms split gets spent down and the Medicaid applied for.
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next time she calls you crying tell her the good news that there’s a solution if she agrees to make some changes. If she says she doesn’t want to change anything then tell her not to call you crying anymore because you’ll hang up. This is what we had to do with my MIL. She chose to not call us crying rather than improve her situation.

If neither of them have been diagnosed with cognitive or memory impairment, you can’t force them to do anything. Call APS to report them as vulnerable adults. The county will become their guardians and they will make all their financial & medical decisions, including which facility they put them in. If your LOs don’t like this thought then they need to make changes now. The ball’s in their court.
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I'd say it's an equal co-enabler toxic relationship.

Look into a stair lift, perhaps?
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