Dear Family Advisor

Mom can't live alone but blows off my attempts to help

My diabetic mom is unable to take care of herself and her home, but she refuses my help. She even makes jokes about the situation or claims her feelings are hurt when I point out she needs assistance! The house is falling apart around her and poses a health and safety risk. (She has rats!) Her diet is terrible. In my last phone call with her (I live 1,000 miles away), she said she'd fallen in the tub. But she doesn't want any help.

Maybe I should let her make her own decisions, but it worries me to see how bad the situation has gotten. A couple years ago, when she needed foot surgery, I flew down and got her set up with a house cleaner, a gardener, and a handyman, but after I left she didn't follow through. She has lots of friends and strong church connections, but she has managed to hide or explain away her difficulties. I'm not sure how to proceed -- especially given that she doesn't want help or change.

Our loved ones say they don't want us to interfere, that they should be able to live life as they see fit -- but in times of emergency, they want us there. That's especially taxing on long-distance family caregivers. They can't have it both ways. We have to either cut ourselves off from our loved ones (generally not the best option), or we have to decide when and how much to involve ourselves.

I sometimes use the saying in my care talks, "Don't be afraid of your parents hating you." It's a twist on a parenting phrase that reminds us not to try to be our kid's friend. You can't let your 10-year-old drive your car no matter how big a temper tantrum he throws. Sometimes older adults' cognitive and reasoning abilities decline, or they just want their independence. But if your mom falls and breaks her hip, then most likely she'll want you to come care for her. That's six to eight weeks out of your life.

To avoid crises like that, it's time to make some tough decisions and try some new techniques.

Become proactive instead of reactive: You and your mom may not realize that your relationship has fallen into unhealthy habits. She may be manipulating you. My mom used to yell out from the other room, "I'm falling! I'm falling!" When I got in there, she was fine. I realized she was lonely and bored. I had to teach myself not to respond to every "cry wolf" scenario. To keep the exhausting, frustrating cycle from continuing, I learned to meet the needs I could and not react to non-emergencies.

Safety comes first: It's our main "job" to make sure that loved ones are safe and healthy. Your mantra should be prevention, prevention, prevention. Break your mom's situation into small areas you can seek solutions for. She may not like what you have to do, but she may grow to trust and respect you. Just keep saying, "You don't have to like me, but I have to do what's right."

Create a village: Let the pastor, neighbors, church volunteers, and close friends know what's going on. Don't harp on the negative -- simply state your mom's needs and ask for their help. I did something similar with my mom. She wanted to stay in her own home, so I created a team of neighbors, church friends, and extended family that became her lifeline. You need phone numbers and e-mail addresses, and they need yours. They can be your eyes and ears when you can't be there. Be sure to say thank you often.

Take advantage of other community resources: Don't ask your mom's friends to do things that other community resources can cover. Call a senior center or eldercare services to find out what's available. Tax and community dollars support these services, and your mom's entitled to them. This frees you and her friends to do more of the heart work -- to be that true friend and loving daughter.

Create consistent care: You mentioned that last year when your mom needed surgery, you hired a housekeeper and a gardener. Could you do that on a consistent basis? If her housekeeping poses a danger (falls, fires), regular help could be vital. If rats are a problem, hire an exterminator. Consider part-time home health care to assist her with meals and general cleanup and give you much-needed peace of mind. You may also want to look into hiring a geriatric care manager, a paid professional who can check in for you and arrange needed services.

Give up trying to change your mom: It's doubtful she's going to change, and that may be neurologically related. New research connects certain behaviors such as hoarding to OCD (obsessive compulsive disorder). Has your mom had a neurological evaluation? Many "odd" behaviors are actually precursors to dementia. Even her diabetes could contribute to her behavior, especially if she's not eating right and taking her medications.

People and situations change:It's only a matter of time until you'll have to make more permanent arrangements for her care. Just when I felt like I had worked out the kinks, my mom's health declined. I knew she needed a watchful eye 24/7, and her "village" was having to do more than they should. That's why you need a short- and long-term plan.

Look at all your options: In regard to your mom's housing, your options are: hiring part-time or full-time care so she can keep living at home, living with your mom or moving her in with you, or finding an assisted-living home, a small group home, or later, if needed, a full-care nursing home or a memory disorder home that cares for those with dementia-like diseases.

I can't emphasize this enough: Do what's best for you. Make caregiving as accessible and doable as possible. Separate your mom's care from your relationship as mother and daughter. If you get snagged in the details, you might miss your last years with her. Surround yourself with people who support and listen to you, and grab every celebratory moment you can. Try not to second-guess yourself about how you manage her care. Your mom's going to be a pain at times -- but that's family. The most we can hope for is to be each other's lifeline.