Asking ill father to move in--what do you wish you'd known first?
January 10, 2015 8:28 PM   Subscribe

Dad has been living alone and recently went into the hospital for emergency back surgery/COPD-related bronchitis. My sister and I are concerned for his health and she has asked him to move in to her house. How should we prepare and what house rules should she have in place?

We're brain-storming house rules and want to know if there are any additional suggestions.

So far we have:

1. Eat dinner with the family every night (he currently exists on peanut butter and beef jerky)
2. Quit smoking or smoke outdoors (because of the COPD)
3. Keep his room relatively clean and unsmelly (his apartment is filthy and I'm saying that as a certified slob)
4. Make an attempt to resolve long-standing mental health issues (currently untreated)

What are we missing? Have you ever asked a relative to move in with you before? What do you wish you'd known before asking them to move in? What do you wish you'd done differently?
posted by angelchrys to Human Relations (12 answers total) 4 users marked this as a favorite
Yikes. While I can understand where you are coming from, are you sure you want to establish 'house rules' for your aging, ill, fully-grown-adult-man, father? This sounds like a disaster if your lifestyles are as incompatible as your rules suggest.
posted by shew at 8:31 PM on January 10, 2015 [26 favorites]

I have to agree with shew, it's sounding like a huge conflict just waiting to explode.

Is there a medical/care reason for him to move in? Is he willing and wanting to make this change? If the answer to both of these is no, they I would let him know what the offer is (including the expectations) and let him decide. Keeping in mind the more restrictive you are, the less likely he is to accept the offer.

Sometimes a care facility, where there are no family issues to cloud things, is the better option.
posted by HuronBob at 8:35 PM on January 10, 2015 [4 favorites]

The time to lay out the "house rules" is before you make the offer to move in. Waiting until he's already committed himself sounds like a bait-and-switch.
posted by enn at 8:38 PM on January 10, 2015 [2 favorites]

He's not moved in yet, he's still in the hospital recovering from his surgery. We're trying to figure out the best option for him at this time. We're trying to clearly define the house rules so he can decide if he wants to move in or not.

He's currently on disability and living in an apartment in a Section 8 building. He's severely depressed and doesn't take care of himself. We've been worried about him for a while and want to help him get better, if possible. We do understand that his cooperation is needed and we don't plan to try to make him do anything.

His Medicare status is messed up, but we're trying to get it fixed for him. If so, that opens up the possibility of him staying in his apartment with visiting caregivers/cleaning assistance.
posted by angelchrys at 8:58 PM on January 10, 2015 [1 favorite]

Thanks for the update...

I've been involved in a number of situations where we hosted someone for care reasons, and a couple more where we attempted to maintain them in their own home/apartment.

The most important factor is their participation in the decision. Even when it was evident they shouldn't be living alone, we did our best to maintain them in their own place if that was at all possible, with the hope that eventually they would make the decision to accept some sort of assistance or move to a situation where they were fully cared for.

Again, if you're encouraging him to move in with his daughter, minimize the rules as much as possible....for example, the "no smoking in the house" rule makes sense, forcing him to eat with the family is not necessary for anyone's health or safety.

Best of luck with this, and, as you deal with a very difficult situation, make sure that everyone involved is getting the support they need.
posted by HuronBob at 9:09 PM on January 10, 2015 [3 favorites]

I would cut it down to one rule. Respect the others living in the apartment/house. That means, no smoking in the house if that is what your sister wants, that means taking care of his room, etc. Be prepared for him to say no thanks.
posted by 724A at 9:10 PM on January 10, 2015 [2 favorites]

I have been a caretaker of my FIL, who had heart failure.

What I can tell you is that it is like having a baby but who is an adult. You need someone to relieve you of the constant care.

You also need to know about medication and how to administer that.

Do not let your sister take him into her house without back up. I did that with my FIL and I had a nervous breakdown, trying to care for him 24/7. Nobody can do that.

The best option is he is in a house with a LOT of helpers. The 2nd best option is in a really good care facility where you are all involved and visiting.

But don't take him into the house and dump his care on someone if he is high care. It won't serve him or anyone.
posted by Marie Mon Dieu at 9:17 PM on January 10, 2015 [4 favorites]

What you can do to some extent: enforce doctor's orders. The smoking (maybe, or he burns the house down, who knows), the medication. Going to doctor's appointments because she takes him to them.

What may work out okay: the food. If someone else makes dinner, he'll probably show up. Or he won't come to the table, but will eat a prepared meal if taken to him.

What you cannot do: change him. If your sister does this, *she* will be cleaning up after him, and possibly, if she has a standard she wants enforced, cleaning his person. You cannot make him keep things clean, it's just not physically possible to force that. And he's probably not capable right now, with COPD and a back so bad it required surgery! Housekeeping requires range of motion, and the oxygen to exert a little bit. He can't clean.

The fact that this is being considered, like he's an exchange student from Germany or a local college student renting a room, says that you guys are not eyeball-to-eyeball with reality at all here.

Nobody should take this on without being reeeeeeal clear about how hard it is going to be to take care of someone who a) can't take care of himself, b) isn't interested in taking care of himself, c) probably doesn't want to do this but knows he's at the far limit of having a choice. Real talk: in all likelihood he will never get much better. He might get more stable living with her, for a while, but that's about the best case scenario.

If feels like you guys just think he's being a little stubborn and just needs to clean up his darn room and eat a hot meal. He's really sick, maybe a lot more than you guys have been willing to face yet, but it's going to become very real once you move him.

What you should be weighing this against is assisted living/nursing home, since he's no longer able to care for himself. Maybe he goes to your sister's to recover while y'all get his finances sorted and then figure out what your options are without committing to anyone what he's going to be living with her for a long time. That'll give you some time to see if he actually recovers from surgery enough to pick things up off the floor, bathe himself, etc.
posted by Lyn Never at 9:45 PM on January 10, 2015 [19 favorites]

I don't know about what Medicare can do with regard to caregiving and housecleaning, etc. - in my state, Medicaid will fund that type of thing if a person's income is sufficiently low that he can qualify. Does he get food stamps? If he does, he probably qualifies for some state-funded home care.

I'm on Section 8 subsidized housing and Medicare only - I don't qualify for Medicaid or food stamps, etc. Because my rent is subsidized and my utilities paid here - I rent an apartment from Catholic Charities - I have enough money to pay a lady to come in twice a month and do my laundry, change my bed, vacuum and dust the apartment, clean the tub, the kitchen and bathroom floor, and she'll always fuss around the kitchen, making sure it's up to snuff. I pay her about $100 a month - twice a month at $40-50 each time She is a jewel. Because my lungs are gone and I'm on high-flow oxygen and still can't breathe, I can't do a damn thing that requires the slightest amount of exertion, so my sweet friend Angie does it all for me. She works through an agency for those who qualify through Medicaid and she also works privately for people like me - she "does for" probably ten of us here in this building.

If your Dad's COPD has put him in the hospital, you must understand how difficult it is for him to do things for himself - that's why his apartment is a mess and he's living on peanut butter and beef jerky - because cooking takes effort, shopping takes effort, cleaning up afterward takes effort, and it's a lot easier to eat something quick that doesn't make a bunch of dirty dishes and pans. When you can't breathe and you're old and you feel like the devil all the time you can get pretty defensive and pretty crabby when cornered; one day you'll understand this - everyone does eventually. I'm not just speaking for myself - there are 150 apartments in my building and everyone's over 62 - most are in their 80s - and every one of us has different issues that limit our ability to "take care of" ourselves adequately - by the standards of our kids, anyway. Every few months someone has to move on to assisted living or, god forbid, to a nursing home - we're all trying to outrun the "warehouse" and hope to die first.

I can only say that if I was being forced to move in with my kids, I wouldn't even consider it if approached with a sheet of rules. Oh, heck - I wouldn't consider it, anyway. Seriously, if you really care about your Dad, consider leaving him where he is but arranging for a cleaning lady and someone to do the laundry and change his bed a couple times a month, check into Meals on Wheels or some other charitable meal service, if money is an issue, to guarantee that he has access to nutritional food every day. Then, if he chooses to eat jerky and PB, so be it. See to it that he gets to medical appointments and keeps his medications filled and maybe it will help if you set them out once a week for him in one of those plastic weekly pill box thingies. He may also need help bathing - does he have a shower chair and a hand-held shower? If not, get one for him - it makes a world of difference - trust me. Caregivers can be hired to help him bathe if the chair isn't enough help.

How's his vision? If he has untreated glaucoma or diabetic retinopathy or macular degeneration - all part of the plague of aging - he may not even be able to see the numbers on his microwave or telephone. That happened to my next-door neighbor; we called in the Lilac City Blind Foundation, who brought her all sorts of helpful stuff and got her set up with large-numbered everything, audio books, a blg, lighted magnifier - I don't know what all - and she wasn't even blind - just had deteriorating vision that was affecting her ability to do what she needed and wanted to do. How are your father's teeth? That's another one - you'd be surprised at how many old people don't eat well because they can't. Again, if his teeth are needing big help, there are charitable agencies that can help with that - some will actually pay his entire bill if he doesn't qualify for Medicaid but needs dental work. As far as his mental status goes, does he have a diagnosis of a mental disorder or dementia? If not, you might be surprised at the change in his mental status if his physical situation is drastically improved. If not, if he is seriously in need of therapy for mental problems, that's available, too. And he'll need that whether he's in his own apartment or in your sister's home if he needs it at all.

There are social service organizations and resources that you can access for your Dad that may cost you a little bit of money and definitely some time, but in the long run it's going to be a lot cheaper than having him move in with you and for sure it will be more comfortable for all of you. He can probably be a pain in the ass, but he's trying to keep going until he drops - try to think of it that way and respect him for it, even though it's not always easy.

I wish you all success and a peaceful year.
posted by aryma at 10:58 PM on January 10, 2015 [40 favorites]

Hm. I would recommend you read Atul Gawande's new book Being Mortal, which is very wise on the topic of people being invited to live with their adult children. Gawande says it's often less satisfying for everyone than they expect, because the older people want to be autonomous and are unhappy deferring to their kids' rules.

If I were you, I would pare the rules down to the minimum possible that your sister can live with, because your father is an adult not a child. And I would frame them like that. Like, "If you move in with me, here's how I need things to be. If you don't want to move in with me, that's fine, and in that case here's how I can help." I believe older people should be allowed as much autonomy as reasonably possible ('your right to lash out ends at my face' kind of thing) and I don't see why it's anyone's business, for example, what he eats or when, as long as he's not causing trouble for the household.

This stuff is really hard. Often I think people focus on some abstract "objective" idea of what a good outcome would look like -- like, from the perspective of a social worker or a doctor or some other authority. I think that's an error, and it's more appropriate to focus on what a good outcome would look like *from the perspective of the person in question*. What does he want, can you help him get it, and do you want to? That's where I'd start.

Good luck.
posted by Susan PG at 1:18 AM on January 11, 2015 [6 favorites]

I'm thinking that option #3 might be the way to go. He's already in the system, get his stuff sorted out and see if there's Assisted Living for him. It's great because he has folks checking in on him, and he can have a social worker assigned to him to insure that he's taking care of all of his health business. Lots of places cook a meal or two per day and it can be delivered to him. But it's all on his terms.

He has a lot of issues that spell disaster for living with your sister and her family. For lots of folks in this position rules are meant to be broken as a way to rebel against all these unwanted constraints against autonomy. His deteriorating health will make him cranky, demanding and a total PITA.

As much as you love him, this is NOT a good idea.

People live and die on their terms. You have to respect that. He is not an infant, he still gets to decide how he lives his life. Sure, optimally he gets mental heath sorted out and the physical health will follow. To that end, work with Social Workers to put a support system in place.

1. Meals on wheels delivery
2. A person to come in and clean for him once or twice a week
3. Transportation to all medical appointments
4. Perhaps a home health aid to insure that the meds are taken and all breathing apparatus is used appropriately.

If you or your sister can check in on him frequently, even for short visits, that might impact his outcome considerably.

His living situation is enmeshed with his physical and mental health. There has to be a multi-pronged approach to getting him to a healthier place.

Speak with his social worker at the hospital and ask for help. Your hearts are in the right place. Forcing him into a living situation that will feel awkward and will take away his autonomy is probably not the right answer here.

Since he's already been asked to move in, if he accepts her offer whole-heartedly, then aim to keep him as independent as possible. That means that what he eats is up to him, how he keeps his living quarters is up to him, he is not another child in the household. This will probably suck for your sister.

So perhaps come up with a new plan and broach it this way, "Dad, you know we love you and if you want to move in with Sissy that offer is still open, we've discuss other options with Lisa, your social worker, and she came up with an alternative and we wanted to see what you thought..."

Good luck, this is not easy, no matter how it goes.
posted by Ruthless Bunny at 6:25 AM on January 11, 2015 [1 favorite]

A lot of men of a certain generation really do not do well on their own, at all. And loneliness worsens all the ailments of age. It all depends on a million things (your dad's character, how well he gets along with your sister), but a motivation to ease loneliness might work slightly in your favour. It's highly unlikely your dad will do a 180, but you may find that he's willing and motivated to make a few small changes, e.g. picking up after himself in the common areas, at least, for the privilege of feeling a human presence, particularly if it's family.

That's about all you can (optimistically) expect, though, ime, and only (I think) if, as HuronBob and SusanPG and others say, your dad is a willing participant. I agree that the most effective way to do things is to work with him, not impose rules on him as though he were a child. If peanut butter and beef jerky are what he likes, let him eat that - food preferences are not to be messed with, ime.

You can't make him quit smoking, but asking him to do it outside or even off the property is fair, and it might mean he'll smoke less.

The mental health stuff... I would say there are limits to how much change you can expect from him at this point. If you stay open and non-judgemental, and put his health at the centre of it, he might be willing to let you in on some visits with the doctor, and maybe with a lot of time and trust, he might be willing to entertain an anti-depressant - it's a longshot, though.

(Though one thing I've found is that focusing on the things the parent cares about can act as a bridge to other things. Like if, e.g., it's prostate problems that he complains about and bother him the most, start with helping him with that, taking him to visits to the urologist and so on. That way, he is getting used to the idea of accepting help from you in this role, and he may allow you to take a more active role in other kinds of care. Keywords: may, might, longshot, difficult.)

Also, don't judge the comforts and company he finds too much (unless they're actively harmful). If e.g. you're not religious and going to e.g. church makes him feel good, support him anyway. Encourage any kind of social contact that's feasible, because it takes some of the load off you and your sister.

And, as Marie Mon Dieu suggests, try to share your sister's load as much as you can. Trade weekends if you can, give her a break whenever possible. Money makes a difference, but not in the way that hands-on help and relief can. Your relationship with your sister will likely survive your father's death - it's wise to safeguard it by minimizing possible resentment.
posted by cotton dress sock at 12:43 PM on January 11, 2015

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