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My mother is 78 and has been taking care of her 81 year old brother for 5 years. His care is physically demanding because sometimes he won't move when he has to be moved, and other times he is agitated and has to be physically restrained for a couple minutes while he settles down. The work is aging my mother beyond her years.
She has had home care help most of the time, although reluctantly. The last one quit and now she is determined to take care of him herself without any home care. I've been pressing the issue (to get home care) and now she screams at me when I bring up the subject.
I went to a counselor who advised me to stay away until she agrees to home care. This hard because nobody checks on them if I don't.
What can I do before something bad happens?

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Patience is your ally. Stepping back means you no longer enable mom's poor decision. Like watching a baby try to walk; you let him try, you let him fail. You let him get up and try again. But if he gets hurt, you fix it.
Oh so hard, you wait until mom or he lands in the hospital. Then you fix it. You tell the discharge coordinator that neither one can take care of the other. A Social Worker comes in to sort things out for them.
Many of us here have had to wait for that ER visit before we could fix it.
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Mom is overwhelmed, but nagging her is going to make it harder for her to throw in the towel and get help. Be nice about it, don't ever say I told you so. Just step back quietly. If one of them ends up in crisis, don't go running over there; call 911. Wait for the EMTs to evaluate and meet them at the hospital. Then let the pros tell mom what needs to be done.
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This is so, so difficult for every one involved. When you feel calm, let your mom know you understand how hard this is, that you respect and honor what she is trying to do and that you're there for her. However, no one person can do everything, all the time, indefinitely. Not doctors, not nurses, not aides, not wives. Try to get a caregiver in by small steps. How about just some help with the most demanding job (s) of the day - jobs of your mother's choosing? Baby steps. If you have competent and compassionate caregivers, hopefully your mother will come to see them as valuable resources able to give your father high quality care and your mother the breathing room she needs to not become ill herself and continue to care for your father in the way she wants.
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My situation was a little different. I wanted my parents to get a cleaning lady twice a month because I was unable to clean 2 houses and take care of my parents and 3 kids. My parents were adamant that they did not want strangers in the house. A few months had passed and I found a cleaning lady that was a parent of one of my son's friends. The fact that I set it all up and knew this person made my parents much more open to the idea. From there my sister found someone through her church who would come in 2x per week and do laundry and lunch and look after my mom. We made sure we were there the first time these people came into the house to assure that our needs were being met. For my parents just saying do something was too overwhelming. They were much more open to the idea since we personally knew these people and set everything up and they didn't have to interview people, tslk on the phone, etc. stepping away was very hard for me to do. It was harder for me if one was in the hospital but you need to do what works best for you. Good luck.
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Extragarlic (great name!), I like this question. My mother is going to do the same thing, no strangers in the house. In some way, I'd try to make the one point with her that because it didn't work out with the person that was there it doesn't mean the help itself is a problem. (They get so inpatient with people/ personalities.). Great input, patrice, about them being known associates - sounds like the key to me. Also thatswhy, thanks for the idea about bringing in someone for just 1-2 functions. As to the point of 'something has to happen first,' hopefully you can watch for some glitch that occurs that you can tell really bothered her, and gently say, 'Yep, that's the kind of thing that'll happen' and let her think about it. Also, weak as he is now, her brother likely has a lot more strength than her and could potentially accidentally hurt her. I'd watch for signs of that, and point that out to her too... good luck, happy holidays to all of you!
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What do you do when the doctor's, social workers, and home nurse can't force your mother to go to a nursing home or some kind of assisted living. My mother broke her hip about four years ago. She ended up in rehab at a nursing home. They would not let her stay after she was not progressing anymore. I talked to several social workers when mom was in hospital several times or at the nursing home for discharge. They said I and they could not force her to leave her home if she didn't want to. Her internist told me my mom would be safer in assisted living. She asked me to convince mom to go. My mom will not listen to anyone. She is rigid. Mom is managing using a walker with a table top on it. She was taught how to function on her own in her house. She lives alone. My middle age brother stays over about three days a week. However, he has a personality disorder and won't do anything to help. Except take mom to a doctor appointment or buy something at a drugstore or grosery. Mom is 88 years old and sort of frail. She should not be living alone. But nobody can help me. She won't accept someone to stay with her during the day at home. She has a woman that does the laundry and light housekeeping once a week. And complains about the money it costs. She is only $16 an hour. Mom is obsessed with providing as much money for my brother to take care of his needs and cost of the house expenses when she is dead. She is afraid of him being kicked out of his subsdised apartment. It's possible (not his fault and not likely). So he made a deed or something that says he can live in the house after she is gone. He gets SSI and food stamps and doesn't work. Would get fired from each job he had. Has anger problems. Medication only helps a little. He is also not social. I could type for hours telling about my family and problems with my mother and brother. It is so upsetting and frustrating situation.
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@extragarlic - I can really relate. My mother is 85, widowed and insists on being independent - even though she is beginning w/dementia, has heart condition, etc., etc. Luckily, she has a cleaning woman 2x month. But otherwise everything is up to me. She just got out of the hospital after 10 days from a blood thinner bleed and is really weak and is finally realizing - albeit grudgingly - she can't do it all, NOR can I do it all for her. Sometimes I feel like a rented mule that she just runs in to the ground - and I have health issues of my own, so when it gets too much, I have to stay home and tend to MY needs. She had been told NOT to shower without someone (me, aide) in the house and twice she has defied the orders and intentionally showered alone. I almost freaked out! She does NOT eat, continues to run herself ragged with laundry, etc. and when told NOT to, does it anyway. Well, I was in a panic so had a heart to heart with the visiting nurse who gave me the same 'shocking' advice many have given here: You cannot FORCE someone to do/not to do something, and unfortunately many times we have to help out as best we can but when we meet such staunch resistance the only thing we CAN do is step back, hope for the best, but let nature take it's course. This is SO hard, and at first seemed like such a 'cold' way to handle things, AND like just throwing the person to the wolves, but we are not; we cannot FORCE anyone to do anything and that's the truth. I'm still getting used to the idea of handling things this way, but it has been 'liberating' to me, and quite frankly a relief to mom that I'm now off her back about certain things. I hope this helps a bit.
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PS: when I said above "I have to stay home and tend to MY needs" I don't mean take a couple days off to catch up and laze around...I mean actually stay at home either on the bed/couch flat on my back as I am literally too weak to be up walking around or driving or anything else.
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If she doesn't want home care, ask if she would at least be open to having someone come to cook, clean, do laundry, go rockery shopping, etc. if you are able, maybe chip in some money as a Christmas gift. Otherwise, just let her know that you are willing to help her find any help she decides that she needs and leave it at that. You might ask one of her neighbors to drop in or call occasionally just to be sure they are not in dire straights, but she is really going it have to come to the decision on her own. Older people don't like being told what to do. They feel that it infantilizes them. They want to be independent as long as they can. If you can convince her that everyone needs help sometimes and it is not taking away her independence (yet) to have help, that can be the first step.

I'll pry for you. It is hard.
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Sorry that is supposed to be "grocery shopping" above. My iPad sometimes changes the words on me.
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You can step back but still check on them by a simple phone call to say hi, how are you? Then you know she is still alive without physically going to her. And you can give her the space to realise what she can and can't do.
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As parents we want the best for our children. Knowing that your stress over her care is causing you such concern it's important to be firm and let her know you are going to get help permanently so you can enjoy your time with her more.
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With my dad we had a health assessor call on him when no one else was there. They made an assessment about him from the state of his house and himself and discussed his status and were upfront and honest with him and explained what would happen and how care services could help reduce the risks without taking away his privacy or indepedence
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I agree, if you step back and she realizes she doesn't have you to depend on and fall back on, perhaps she will "see the light".
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