Aging abusive parent moving closer to me
July 26, 2020 3:26 PM   Subscribe

My sister has been primary "fall intervention" and general crisis response/informal nurse for our narcissistic mother the last few years. It's only fair that I take a turn. But I am absolutely dreading it. Our mother is trying to move into an assisted living facility. I need some anecdata about the role of adult children in this level of care.

My mother is fairly independent but has mobility/balance issues and if she has a bout of illness, it often causes a loss of functioning in other areas. I am the breadwinner and have a preschooler and can't exactly go to part time work to accommodate elder care. I also have chronic illnesses and can't do crisis response stuff without losing my own functionality for existing responsiblities. This is all entirely separate from the emotional challenges of taking care of someone who has mostly been a drain on me emotionally for as long as I can remember.

I guess I'm wondering when you don't have a ton of money to throw at the problem and can't reduce your work hours how do you survive the sandwich generation? And as it says in the first section, what level of effort is expected of adult children when the parent is in assisted living?
posted by crunchy potato to Health & Fitness (20 answers total) 14 users marked this as a favorite
 
Quick clarifying question: has she assigned either of you financial and/or medical power of attorney?
posted by muddgirl at 3:40 PM on July 26, 2020


Or whatever the equivalent if you are outside the US.
posted by muddgirl at 3:40 PM on July 26, 2020


Response by poster: Sister has power of attorney. I believe it covers both.
posted by crunchy potato at 3:48 PM on July 26, 2020


my mother's biological father wound up becoming a ward of the state
posted by brujita at 3:58 PM on July 26, 2020


You have no reason to destroy your own mental health to look after this person. She's in an assisted living environment, so leave her to the professionals whom she can't manipulate. You owe her absolutely nothing.
posted by SPrintF at 4:15 PM on July 26, 2020 [30 favorites]


My father was, until just a couple weeks ago due to her death via the pandemic, in your position for his mother (aka my evil grandmother.) The thing is that distance did nothing to help the situation. For the entire time he was stuck dealing with things he lived states away, nearly the whole country between them, but he still had to fly to where she was living to deal with legal issues and wrangle situations back into shape. His brother lived nearby and would visit her sometimes but did not assist in official matters whatsoever. So much money was spent on plane tickets, and in recent months, a lot of fear and anxiety about catching the virus because of flying. So I suppose my advice to you is to say that living nearby will, at least, save you money.

That said, my father willingly took on these obligations. He's a lawyer himself and we have financial resources in the family and he has a pretty good emotional support system. I suspect that if we didn't have all those things in place it would have been much easier for my dad to just wash his hands of the woman entirely (something that my generation of the family had been encouraging him to do since we grew up). Assisted living varies widely. I guarantee you that there will be people working at the facility who have experience working with people in your situation - you should be upfront about it.
posted by Mizu at 4:20 PM on July 26, 2020 [1 favorite]


Response by poster: I should clarify that my mother is about to choose assisted living either near my sis or near me, so the distance won't be a factor if I take over primary care outside of what assisted living does. If she chooses near me, then I need to understand what is a reasonable expectation and how to avoid being roped into crises that probably have some level of manipulation behind them.
posted by crunchy potato at 5:11 PM on July 26, 2020


What you do in that case is hook her up with supports. It does vary some from region and facility to region and facility. But speaking from my region, if she’s moving into assisted living they should likely have resources on site to do most things for her/refer her. So for example, hairdressing. Is there a hairdresser’s there or do they have a “shopping shuttle” once a week to a mall (all pre-Covid) or are there people that come in? Ask the facilities.

Also, is it your turn because you think it’s fair? Because recalling everything you’re doing right now, maybe that’s not how it works this year, and she stays closer to your sister.
posted by warriorqueen at 5:16 PM on July 26, 2020 [6 favorites]


I watched my mother deal with my grandmother and later my great-aunt and uncle; more recently, a much older friend had to put her husband into care. The thing is that they absolutely had to be on top of things all the time, and in all three cases they were dealing with high-end facilities. Wait, where did the Depends I purchased for her go? Why was the attendant not properly wearing PPE? What do you mean he fell and you didn't contact me immediately?! Um, why is it that you don't know where he's gone? Etc., etc., etc. Daily phone calls, multiple visits per week, and so on. Both my mother and my friend found that they really needed to be actively monitoring the situation, or else things would just...slip. Tl;dr: you do need to be alert and checking in constantly.
posted by thomas j wise at 5:22 PM on July 26, 2020 [4 favorites]


I've made it clear to my brother that if our mother becomes incapacitated he's the one who will have to deal with it.
posted by brujita at 6:09 PM on July 26, 2020


My mother-in-law, who has borderline personality disorder, tends to cry "emergency" when there is none. She's at an assisted living home that has a doctor who comes in 3 times a week. When she wants to talk about medical problems, my husband says, "I'm not talking about that with you. Ask the doctor to call me if there's something I need to know." In fact, that's his basic reaction to any complaining or negativity. "No, I don't hear complaints."

As for MIL's ambulatory problems, we've made sure she has a walker and whatever other items she's needed to be independent. More recently, we got her a wheelchair. We feel that she doesn't need to be able to function at what she used to consider a normal level. She's old and has arthritis and some dizziness, and that's reality.
posted by wryly at 6:27 PM on July 26, 2020 [1 favorite]


My brothers and I dealt with our mom, but for most stuff we called the facility social worker. Things like, she is complaining they won't let her go to dinner. We would call the social worker and see what that really meant. Oh, your mother had a slight fever so we brought dinner to her room. Each of us spoke to our mom once a week but we made sure it was on different days. If something came up we would call the social worker. I think it depends on the facility and your mother, but I doubt it will be a large burden. More emotional dealing with an aging deteriorating mother.
posted by AugustWest at 6:51 PM on July 26, 2020 [1 favorite]


When my mother was in assisted living, the main things that she needed us for
- taking her doctor's appointments and going in with her to help.
- taking care of financial stuff - in the beginning just as a back up when she got sick but later full-time.
- helping her buy things she needed, get cable tv and internet, deal with technology

The assisted living people took care of meals, administering medication (optional), doing laundry, cleaning her room. They had a small shop where she could buy (or order) supplied. There were activities and trips. They could also help with showering and dressing.

However, later when she had a fall and couldn't be counted on not to get up without help, they refused to take her back to assisted living - she needed too much help and they weren't willing to take it on.
posted by metahawk at 7:36 PM on July 26, 2020


And as it says in the first section, what level of effort is expected of adult children when the parent is in assisted living?

Like other people have said here, you don't have a legal or moral obligation to do anything at all. But because you asked, here are the packages of work that my family has found ourselves doing to support my father, who lives in a retirement community.

-- The medical staff at the facility wants someone they can call to set up my father's medical appointments (for tests etc.) and who will drive him back and forth to them. Similarly, somebody needs to keep track of things like teeth cleaning and feet checking and haircuts, and make the appointments and take him to those things, or set up people to come to him.

-- Somebody needs to monitor day-to-day necessities in his apartment, and make sure he doesn't run out. Stuff like paper towels, skincare supplies, hearing aid batteries, tea, stationery. We have some stuff set up through auto-ship, and other stuff we restock when we notice it's low.

-- Somebody needs to monitor if equipment in his apartment has stopped working properly, like the TV, landline, Echo device, air conditioner, refrigerator, showerhead. It needs to get flagged to the facility if it's their responsibility, or handled by the family if it's ours. Somebody needs to pay attention to safety stuff like trip hazards, like if a carpet is curling up at the edges.

-- Somebody needs to ensure that the facility is providing the services it's supposed to provide, like is the apartment being cleaned, is the laundry getting done, is the newspaper being brought upstairs.

-- We spend A LOT of time helping my father navigate technology, and liaising between him and Apple/ISPs/etc. etc. etc. The facility offers zero help with this, which is understandable but horrible :(

-- Somebody needs to keep an eye on his overall health, and flag to the medical staff if e.g. he's experiencing side effects from a medication change, or is in some way deteriorating. We need to be attuned to whether he's gotten to a point where he might need a walker, or a better recliner, or will no longer use a computer and needs an electric typewriter instead.

-- The facility administrators will want someone they can call to help resolve interpersonal disputes. I once had to have four 90-minute conference calls, in a single two-week period because a resident was complaining about my father's tiny dog getting up on the furniture in the lounge. Eviction was threatened, I could not fucking believe it. This could be a danger area for you because your mother is narcissistic and the building will threaten to evict her if she's causing problems, and they will use that threat as leverage against you, to get you to help them solve whatever's wrong. Ugh so you should try to have a strategy for that.

-- Somebody needs to pay all the bills, move money around, and make sure the taxes get done.

I just want to say again that despite my phrasing here, you don't need to personally do all of these things or even any of these things. It is perfectly reasonable for you to leave many/most/all of them for your mother to handle herself. I'll also say that at my father's building at least, the people working there seem super-understanding and not judgey. Good luck.
posted by Susan PG at 8:04 PM on July 26, 2020 [6 favorites]


Have you talked openly with your sister? Does she agree it’s your turn or is this guilt coming from you? I absolutely understand if it’s the latter; it’s hard to be the one far away and adult children of narcissistic parents are especially prone to manufacturing guilt in situations where it’s maybe not necessary.

If your mom is going in to assisted living near your sister, maybe that alone will be respite enough for now. You sound like you’re at the end of your rope, it doesn’t make you a bad kid to not be able to accommodate a parent that hurt you. Captain Awkward has a lot of resources and writing that might help you, and I found Anne Lamott’s essays on her historically difficult relationship with her narcissistic aging mom particularly validating.
posted by stellaluna at 8:30 PM on July 26, 2020 [2 favorites]


With assisted living, there are many, many individuals who go into assisted living and don't have support, same goes for nursing homes.

You don't mention income, or location which can change things up.

If your mother is in the US and qualifies for medicaid, her entire benefit except for 90 a month will go to the facility. They will provide, shelter, utilities and stated services. They will not provide a cell phone, internet access, cable TV, netflix,a computer, snacks of ones chosing, prefered items likes pens, stationary, bedsheets, pillows, (they will provide whatever they use, but it will be cheap and uncomfortable), clothes, shoes , preferred hygenene products, etc.

Basically, the facility will provide exactly what one needs to subsist and not a cent more, and it will be poor quality. Decide now if you are willing to provide your mom financial assistance each month, and what for. People live like that and do okay, and they live, but it will be way more limiting than what she is use to and many people suffer from mental health changes especially depression.

Ultimately the facility can do things like make appointments and arrange transportation. But , if you are involved they will foist that onto you happpily.

Assisted living facilities and nursing homes do have people who end up falling, so be prepared. Especially with people who get offended by waiting for assistance. To many falls, and she will be required to move to a higher level of care. Ideally she would choose a facility that has is connected higher level of care so the transfer is seamless, but that's not always possible.

Is your mom paying for a single room? Many places require roomates, and this can be a huge source of contention. Some people enjoy the social interaction, but it might stress her, or the other person out and depending on how she tries to address problems she might cause problems at the facility. You do not have to offer for her to live with you or take her back. you don't. You can let the facility handle it to however they wish. Eviction proceedings can happen, but it isn't instantaneous n and there's a whole process . There will be outside advocates based on your region .

More involvement is good, because at the end of the day these facilities are generally understaffed but it is not required. It is good to familiarize yourself with local laws and reporting procedures, to report unsafe practices or dangerous behaviors. I had to report my MIL assisted living for improper medication dispensing when they started reporting opiates being stolen, and I was in her room alone when a nurse dropped an entire bag of medication including fentanyl patches, that were clearly labeled in the room and walked off, not having the patient sign for them and I could have just walked out with all of it. It wasn't even my MILs meds, it was her roomates! That's unacceptable practice.

Anyway, I wish you luck and that you take gentle care of you during this time.
posted by AlexiaSky at 11:09 PM on July 26, 2020 [3 favorites]


Random notes: We learned from experience with my MIL that our Netflix and other subscription services passwords spread through that place like wildfire until we changed the password and logged it in without telling them what it was. We paid for the internet, which also got shared with many other tenants which was more fine.

My MIL isn't tech savvy, but really enjoyed her movies.

Echoing above they won't tech support, which was really frustrating.

Another thing, paying rent. My MIL had a thing in which she must give Christmas gifts and decided that her assisted living didn't deserve her rent, and ultimately ended up getting evicted over it after refusing to do a payment plan or work it out. We'd saved her once or twice for smaller amounts of money, but this was too much at the time. It was this long drawn out drama that ended up with her at a different facility father away from us . She was determined that it would be better, it was not. This happened twice, and the second time we told her that whatever happened was her, and that we couldn't help. She had managed to do okay, but it there were definately times of drama.

The facility really pushed us to resolve it with money. We just couldn't. I mention this because some people get the idea that their money has power to improve their situation, but there is such a high need, that they'll just boot someone for someone who will follow the rules. She thought she was making a statement about her treatment and the income problems and all these things. It really wasn't. If your mother is prone to things like this you may want to pay attention that rent is being paid.
posted by AlexiaSky at 11:33 PM on July 26, 2020 [1 favorite]


A person close to me works in assisted living and I posed to him the question, what if you’re in assisted living and your kids can’t/won’t help or you just don’t have a support person at all?

He says that the key person here to think of is the geriatric care manager. This person can be hired long term (e.g. monthly basis) to take care of all the things assisted living doesn’t (or to arrange for them to be taken care of). They can be paid from the estate. In at least one case he knows of where support was absent, the assisted living facility set up the arrangement with the geriatric care manager for the resident (I.e., kids didn’t get involved at all). The manager billed the facility and the facility billed the resident.

But the first thing assisted living will do is call the poa and then if poa unresponsive, move on to other children... So you are smart to try to understand this process.
posted by Tandem Affinity at 4:17 AM on July 27, 2020 [7 favorites]


Seconding the recommendation for a Geriatric Care Manager - that made all the difference for some friends currently going through relocating a "difficult" parent. Let the professionals save your sanity!
posted by Freyja at 7:38 AM on July 27, 2020 [1 favorite]


If you can throw enough money for a geriatric care manager at the problem, then all you will have to do is sign paperwork.
If you can't do that, the bare minimum that would be expected, when I was an assisted living director, was
1) pay the bill
2) take her to appointments or pay for her to be taken by the facility (we dropped people off for free but charged if they needed to be accompanied through the actual appointment)
3) stock up personal supplies and refill prescriptions or pay for the facility to order them
4) receive notification of any emergency, which could mean a 911 call, a report of a fall even though she's fine, some sort of issue that arises at the facility, etc.

It can be pretty minimal! We had several families that either lived far away or who just for reasons of family dynamic weren't very involved and it was fine. Many places can just order all personal care supplies from wherever they get their PPE and add it to the rent bill. The way to avoid getting roped in is truly to be straightforward from the beginning about what is OK to call you about and what is not--and also to get comfortable with rejecting calls and listening to voicemail right after. If it's an emergency, the facility will call you from their number, so I would encourage you to consider not answering direct calls from your mother once she moves.
posted by assenav at 12:56 PM on July 27, 2020 [2 favorites]


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