Dear Family Advisor

My sister is jeopardizing her children by having our mom with Alzheimer's live with them.

Last updated: Jan 14, 2010

Every time I mention something about finding a good home for Mom, who has Alzheimer's, my sister bites my head off.

Mom lives with my sister and her family. But Mom screams all the time, tries to bite, hallucinates, and is downright ugly to my sister and her kids. Being exposed to all this can't be good for the children. They hide in their rooms playing video games, and they never invite friends over. My sister's putting our mom first, at her kids' expense. Yet every time I mention something about finding a good home for Mom, my sister accuses me of trying to "dump" her. Am I interfering too much?

A few years ago, you could have been my sister writing about me. My mother had Alzheimer's, and toward the end my children were subjected to too much caregiving and all that comes with it. Our home was no longer a healthy place to raise a child, and I realized the depression, despair, and mental climate could adversely affect them. I've never felt so torn, and my heart goes out to all of you.

While I strongly encourage family caregiving and multi-generational households, there can come a time when it's too much for a family to deal with -- physically and emotionally. You're probably right about your situation: It sounds like your mother's dementia has escalated to the point where it isn't healthy for the children to be subjected to some of her behaviors on a daily basis.

I don't think talking to your sister about this is interfering too much. As family, we can say things that other people can't. She might not listen to you -- and she has the right to decide what's good for her kids and what's not -- but as your mother's other daughter, you have the right to speak up and offer alternatives that might be better for everyone involved.

Every family has its own dynamics. How have the two of you worked through problems before -- does letter writing work? Tears and pleading? Or do you need a full-scale intervention to get through?

If she's biting your head off, that tells me she probably has her own doubts. Try asking questions instead of making statements. Gently ask, "How do the kids say they feel when their grandmother bites or sees things that aren't there?" or "Do you think _____ feels less important now that Mom needs so much attention?" She can mull these things over in private later on, when she has a moment to grapple with her emotions. This approach will help keep her from getting too defensive.

Also reassure your sister about what a good mom and daughter she is -- again and again. Empathize with her over how tough this is and thank her for being willing to try so hard to care for your mom. Tell her she's not alone, that you want to help, that the two of you can figure out what to do together. That will help keep her from feeling that you're swooping in and taking over or implying that she's a bad caregiver or mother.

If you can get her to open up, try to find out what she means by "dump" your mother. Is that something your mother always feared? Does she have a negative perception of care homes? Maybe you can help your sister work through her false assumption that placing someone in a care home means that you don't love her.

This kind of gentle persuasion may help your sister begin to see that her life doesn't have to be out of balance, that she might be even a better caregiver if she didn't have such a heavy load, and that her children need her to be there for them now.

She might dig in her heels for a while, and you may have to find other ways to help her and your mom, but don't give up. They need you. Can you offer to help out one day a week so that she can run errands, attend sporting events with her kids, get her hair done, or go on a date with her husband? Can you commit to do something with her kids once a week to get them out of the house? There's nothing like having a "cool" adult in your life when you're young -- someone who gives you a break from day-to-day realities.

Watch for signs of depression, anxiety, or acting out in the kids. If things seem truly unhealthy, risk a big blowup and push -- with kindness -- to persuade your sister that this is too much for her family to have to cope with.

As someone who cared for a mom with Alzheimer's, I have to share with you that things aren't likely to get better -- it's tough from here on. Your sister needs to know this. Your mom will probably get worse (anything from more outrageous behavior to going catatonic and becoming bedridden), so you need to plan for what might come next.

Suggest that your sister visit some nearby group homes with you just to know about options if things do worsen. Offer it as a no-pressure, "let's just check it out" kind of thing. Do some research first and eliminate ones that would turn her off. Look for those that specialize in dementia care.

This disease is hard on everyone, especially on our relationships. Keep a tender heart toward each other. See the good everywhere you can. In the end, all you can do is love one another and hold on.