Is assisted living right for Mom even though it angers my siblings?

A fellow caregiver asked...

Mom has early dementia (80 y/o). She has no real support system--has a few friends, and is EXTREMELY SELF DIRECTED. She loves animals more than people or family. She has 3 dogs. Her doctor told her she needs to go to an ALF. She has atrial fib, and it sounds like she is having very minor TIA's. Her doctor has called me (I'm 3,000 miles away) and told me my mom needs to be in an assisted living facility. When I broach the subject, my mom slams the phone down. I have power of attorney and manage her finances. She is still independent in activities of daily living, ambulates independently without AD, still drives to store and doctor appointments, but mostly just stays at home and enjoys her pets. My brothers are angry at me for wanting to move my mom closer to me (they think she should remain in her home--I sense some desire for financial gain on their part--they are also NOT available to assist her at all, nor do they want to have her in either of THEIR communities, which is Mom's preference). In fact, my brothers no longer take my calls, so I am operating solo. I don't want to take her to court to get guardianship. I do want to move her closer, in a retirement home where she could have at least one animal, but she won't agree to that. If I do nothing, she will likely have a stroke in her home, and I'll have to try and make the best of the situation on her behalf. At that point, I wouldn't be able to move her because it would be too difficult and costly. My brothers are reactive by nature, I am pro-active, so this situation is difficult for me to manage. I'm not sure if I should let the "chips fall as they may" and let my mom decline (probably she'd live her last years alone in an extended care facility or assisted living facility) or if I should force the issue and do what it takes to get her out here. It would mean getting rid of 2 pets, and she'd never forgive me for that. I have never felt close to my siblings, and I don't think I've seen a more dysfunctional family. I am the person everyone in the family likes to denigrate, including my mom. I work as a professional in long term care, and I feel like I'm looking into a crystal ball, seeing all of our futures. I know what would be best, but can't seem to get cooperation to effect that change. Should I push it, or just let my mom continue to fail? I feel both guilty and angry, but I guess that is beside the point.

Expert Answer

Maria Basso Lipani writes a popular website on geriatric care topics, where she puts her expertise as a Licensed Clinical Social Worker to good use answering care planning questions. Maria is a graduate of Columbia University School of Social Work and is licensed in California and New York.

Probably the toughest part about caring for an aging parent (or caring for anyone for that matter) is that there is no handbook. Only you know your mom and her temperament so it's tough for me to lay out an exact strategy. That said, I think what's most important in all of this is that she be helped to maintain her independence and quality of life for as long as possible. If you make that your goal I'd hope you'd feel neither guilty nor angry about the outcome because I think it's the best you or anyone else can do.

Let me also say that from the outside looking in it seems clear that your mother is happiest in her home with her pets. If you think that she is safely performing her Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), then perhaps you can leave well enough alone for now. An even better strategy would be to try introducing the idea of help now before the disease progresses and she can't manage on her own.

Again, only you know your mom and what she'd say to this, but I've seen many people who are dead set against "help" or "home care" but are thrilled to get a visit from - in your mom's case "“ a fellow dog lover who can relate to her around animals while making sure that her medications are taken, food is eaten and the house is picked up.

Use the money you would have spent on moving her and paying for an assisted living on finding and retaining this kind of help and see how far it gets you. If it improves things, go with it as long as you can. If it doesn't then it might be time for guardianship.