My 97 year old mother lives by herself on 20 acres -cannot hear, severe arthritis in her knees cannot walk. She refuses assisted living. Advice?

You've probably noticed by now that there isn't a right answer and it's hard.

They don't think about what happens if they get hurt and how they are going to be cared for. The biggest risk isn't dying, dying is kind of easy logistically, breaking a hip can ruin years and not just their years, yours too if you have to care for them. As someone I know put it, "he was climbing the ladder to fix something, didn't want to be a burden, well, he's a $%^@# burden now isn't he."

At the same time, do you really want to lock someone up in a home for years too? Isn't that kind of like breaking their hip for them?

Me, I just try to take pieces out of the equation. I have most of my father's finances, except for his investments, mail, and I work on little things where I can. I got a handyman to install some stuff, got him a new oven, etc.

The other day I noticed his electrical outlets were a mess, looked like a Jenga game with all the bricks on them. So I ordered him some surge protectors, threw a couple of things away. You'd have thought I was tearing down a wall with all the grumbling and griping he did but it was a mess, unsafe, and easy to fix, so I did it. It helped when he stepped on one of the power cables and pulled it from the wall before I got to it.

Look, it's messy, you don't want to 100% protect them, you don't want the consequences for them, or you, if they don't. All you can do is the best you can do. It'll be good enough.

A week or two ago I read a short story about two boys who got on well with a feisty old woman who lived near them, just outside a small country town. She told them that she had always loved starry frosty nights. Eventually she was found dead in the morning on the ground, after walking out on her own on a starry frosty night, to look at the stars. Perhaps it was her choice of how to go. It could be as ‘good’ as going in your sleep. It sounds as though your mother is well aware of what may happen to her, and accepts it in just this way.

How does she get food to eat? Can she still cook? Could she call for help on a phone? Or an alert system? I would think that farm could be sold to pay for a place that would take care of her. Can you get her a phone that she can read what is being said? Could you present her with a list of options to consider and when she wants a change she can select her choice? Could someone be sent to her house 2 or 3 times a week for a few hours to help her? I hope to be able to live on my own until the end. Our homes are our world and so much a part of us, Some of us become hermits. Somehow she has managed thus far and does not have much time left. That may be her choice to die in her home. I would think she knows what that means. On the other hand, if you present her with some options, she would be free to make a different choice one day. It is nice that you are showing you care.

Well your mother is probably remembers the "old" nursing homes - right?

My great grandfather lived rural for many many years and as he aged the family got all riled up about something happening to him and no assistance available (before AL facilities). Dad's (his Grandfather IL) view was just leave him alone - if he dies out there then so be it. While I agree with that to a certain extent the only thing is that he didn't die right away but would lie on the floor in agony or pain before his death. At some point in his 90s he did end up in a nursing home - due to his leg needing amputation - he lived to be 97 and was proposing to the nurses to marry him up to the end.

On my mother's other side of her family - she had an aunt living on a farm in one of the Dakotas into her 90s and didn't want to leave her farm. The family was able to finally get her to move to town one winter (only the winter so if the weather was bad they'd be able to get to her) and she never went back to her farm.

If your mom is competent, it will be a lot harder to get her off the farm. If you have concerns for her safety - see if social services or adult protective services won't go out to check on her and evaluate her.

At a recent book club meeting within the HOA I live in one of the women assisted her daughter going door to door to those who hadn't responded to a recent query regarding the community. She was surprised at the number of elderly in our community that appeared to need assistance and maybe should no longer be living alone. That could be me someday as I have no children and will be responsible for myself.

You have a lot of great ideas here. I just wanted to comment on the assisted living idea (should you get her to a placement). She's obviously got pretty good cognition and is amazingly able despite her health issues. My dad is 93 and I looked at all levels of care for him and tried an assisted living apartment which he loved...but it was not the right thing for him.

He needed to be in an environment where they get people out of their rooms/apartments and into common areas. One such place, which you mom might really like, is a board and care home... maybe with 10 residents in a larger home. Some we found had large back yards and a feeling of space...which she might like because she's used to being on the farm. Because it feels like home and not a nursing home.

We ended up finding a memory care facility that was larger but still set up in a homey way with small "pods" of community. He is not as demented as some but he has plenty of medical issues and therefore needs the help they can offer at memory care. Of course, they can't do skilled nursing but I already decided that we were done with IV's etc.

The other thing I wanted to say (which isn't too helpful really), is that dad would have done fine at assisted living if we had moved him at 88-90 but he refused. Adjusting is very difficult as their hearing/eyes and bodies get weaker. So, the sooner the better.

I agree with everything said here. If your mother is of sound mind she gets to make her own decisions even if they are not in her best interest.

Nothing like well-meaning relatives you think they have a say in what is going on. I had a cousin who tried to involve herself in my father's well-being. She would leave messages for me on the phone and on Facebook asking what I was doing about this or that and I needed to get back to her right away. Unless she was offering to run him to a dr appt or two she had no business in what was going on. She lived 2000 miles away so what help did she think she could offer? Another aunt would give me stink eye if my father's bathroom was not clean enough. I had a full-time job and my own home to clean. He was perfectly capable of cleaning his own place but my aunt was old school and women were the only ones who cleaned. If she wanted to clean she was welcome to it.

My suggestion is to go and visit and assess the situation. Would your mother agree to paying a helper to stop by once or twice a week just to look in and take care of whatever she needs done? Say it is for your peace of mind. Talk to the cousins and explain the situation. They may just be tired of helping her. Maybe they could talk to her about assisted living. I know my father would never listen to my suggestions but be totally on board with the word of a stranger.

Dealing with decision making with seemingly competent & cognitive nonagenarians, aka 90+ set, is IMO really a whole different process than for parents who are in their 70’s or 80’s. At 90+ they have outlived all the actuarial tables for risk and outlived the “death by” for diseases. It really truly is as Barb posted that if she wants to stay living at the farm & she appears competent then you cannot make her move.

The only way around to “force” her & do this, there would ime need to be an… ahem… very authoritative personality that is already her DPOA & MPOA & is on her banking in some way & someone that she will acquiesce to & go along with AND then DPOA is able to be there for the maybe 2-4 periods of time to get her moved to a NH, get house shuttered and deal with whatever other farm stuff needed and get her financials cleared & streamlined to pay for her care & property costs.
It doesn’t sound like you or your siblings are this. Amirite?
If this is accurate then you can wait for the inevitable….. she will fall, break a hip, the fire department or EMS will come take her to the ER and then she gets admitted to hospital; and then she’s either going to have surgery (if she could possibly be a candidate at 97) or hospital will discharge her to either a NH for rehab or long term care OR a family member takes her into their home to live. This is the scenario over & over again. If she refuses to move, just wait, something like this will happen. & it takes the decision making away from you & to be done by others.

I’d b somewhat concerned with your cousins, when you say they think you & your Sisters are being irresponsible, well, how serious are they when they say this? Like would they contact APS that mom is in danger? would they contact fire or police to do a welfare check? All these create a paper trail that can be used for the State to place mom under “ward of the State” status.

You are extremely fortunate that those cousins do actually look out for her. But I’d be cautious. Would any of the cousins want to become moms DPoA and willing do a legal agreement to be paid to take over management of the farm? Would mom sign over a new POA?
Or horrors, there is no POA or secondary signature on her banking that’s already done by mom to you or one of your other Sisters?

On mom doesn’t have lot of $, well she has monthly income, like SS, and has a home & farm as assets. You can do a bit of sleuthing to see what’s up w assets. I’d look online to see if she’s current on property taxes & what the assessor has as value. If she has not paid prop taxes, then I bet she’s delinquent on other things. Unless you are already a signature on her banking, you cannot get into those, so for them you’ll have to look at her actual statements which hopefully she has somewhere in the farmhouse.

Should anyone mention her getting Medicaid to pay for care, I’d suggest that you meet with an attorney who has Medicaid compliance experience before anything is ever attempted. To me, the “farm” status will be critical if she can even be eligible. Medicaid by & large in any state allows the elder to continue to own their homestead as an exempt asset for their lifetime. They won’t have any $ to pay property costs but it stays exempt asset. BUT if that house is on a farm or ranch, it seems that in order for them to be exempt, they have to be “working”. Like for TX, ranches mostly are huge, like several sections as you need hundreds of ac. for cattle & all exempt if working ranch. (& it’s exempt from estate recovery as well). But one that’s fallow & hasn’t been used forever will not be exempt & has to be sold (or put on the market) before Medicaid will allow eligibility usually. To show “working”, you’ll need documentation, like IRS filings, membership in organizations. Won’t be simple.

Also at 97, I bet needs assessment will show SNF placement. AL won’t want to take someone likely to need to move to SNF in few months.

If your mother is of sound mind then you have absolutely no power in this, so that should make it much easier to "let go of". She has had a good long life. She may be nearing the end of her life. If she would prefer that to be in her own home, and is of sound enough mind to make that choice then I would let this go and let her make her own decision for her own life.

Ask her County Office of Aging if they can evaluate her situation. This will give you a better idea of how to handle things.

Maybe time to sell some of that land for her care. You are not being selfish. You have your own future to consider. Do not spend ur own money not even thinking u will recoup it in the end.

So sorry you are going through this. My Dad 88 yo lived alone in a 3-story house until health and falls landed him in hospitals and rehabs (multiple ones. My Dad still likes to be in control. We manage by the following:
1. Tell him anything I suggest is in his best interest and out of love

2. We give him choices with the pluses to each choice and negatives where needed(in your case…..maybe AL near her home or near the home of one of the children)

AL has been a good choice for Dad as they take the residents out to stores, doctors, etc. He has met people he knows and new friends that are residents. He has friends and family visit him and goes out to his church when he wants. His personal care (ie hygiene and clothes) is better too.

In home care was a concern for us if someone were to call out and if I am out of town (I travel a lot for work) then what? He got it and understood after multiple discussions.

She needs to understand that cousins love her but are unable to manage her care any longer.

I would suggest having a cousin take her to see a few places if possible. Maybe try a few nights of respite care at one of the finalist locations.

Sisters need to understand it depends on the AL the care given. Some we saw I would not let them care for a pet.

Best wishes.

The usual aging process is something like;
Independence, Semi-Dependant, Crises until the final Demise.

It seems to me that inbetween stage of Semi-Dependant is what wears out the helpers, whether they be caring neighbours, friends or nearby relatives - in this case, the local cousins. IMHO this is your Mother's current stage 'Semi-Dependant'.
A *Slippery Slope*.

The cousins stepped in to help it now find themselves sliding down this slippery slope doing more & more & turning their frustrations & resentment your way. Right?

This was a gift your cousin's gave. It was admirable of them & you can thank them. If they can no longer keep up their gift, wish to reduce or withdraw their help, they should directly tell your Mother. The responsibility is actually hers to find replacements. Before you laugh outright... they should at least try this.

What's Mother's reaction? Does she have insight?

Yes? She may call you to arrange alternative assistance, discuss her future living arrangements (even to discuss the hated AL option).

No? Do they get a wall of "I'll manage, I'll be fine, don't you worry about me.." A wall of denial, lack of insight, lack of reason, lack of problem solving all adding up to what looks like stubbornness but could be cognitive decline.

Going forward & keeping good relationships with the cousins would be my goal. You can't just march in, take over & move Mother to an AL setting. They just may not get this, even if explained. Be best if you can all work, if possible though.

What they CAN do, since they take her to the Doctor already is report your Mother's situation to her Doctor asap - "we are concerned...".

Sometimes... when the Doctor says "It's time to move" they actually do.

Assisted Living is the opposite of a death sentence... it has extended my mother's life to the point where she says she wants to die daily due to pain and exhaustion at 94+.

I honestly don't see how your 97 year old mother is safe living alone in a home on 20 acres, being deaf and unable to walk, with her children being 500 miles away! How can she even function? Your cousins have been saddled with driving her to the doctor and some other care, so I can see why they think you're being irresponsible. If they weren't doing this for your mother, then what?

At 97, your mother needs help. If she won't move into Assisted Living and you children are 500 miles away, rather than leave the care up to your cousin's, hire in home caregivers to come in daily to cook, clean, drive, do errands and insure your mother is looked after properly, even if she balks about it. What happens when she falls and isn't found for days??? Daily in home caregivers prevents that scenario from happening. Just her being deaf is a huge danger!

She needs and deserves some level of daily care and attention at 97. You should not be paying for it, either, your mother should. If that's an issue, apply for Medicaid to help.

Good luck

Honestly, your mom seems to be plugging along in a manner that suits her. You say "they" are thinking you're being irresponsible, but you don't say who "they" are. Don't listen to anyone, and leave her alone unless she's been deemed to be incompetent. That's the only time I'd say you'd be irresponsible to leave her in her house alone.

I'd say your mother has chosen to die the way she wants to die. Moving to assisted living might be exactly the opposite of a death sentence and may keep her going longer than she'd like. She values her independence, warts and all, so let her be.

Unless your mom is deemed mentally incompetent or a danger to herself or others, no one can "make her" do anything.

If folks think you should take over, explain that to them and give them the number for mom's local Adult Protective Services office so that someone with official standing can explain it to them.

Do NOT spend your own money trying to solve this.

Your mother needs to put in the appropriate facility, where she can live out her days receiving the care she deserves. She cannot have any quality of life at this point, if she's in her home unable to walk, and her only children are over 500 miles away. Who is helping her bathe, get and cook her food, etc.? She is not your cousins responsibility, and she is not safe in her home. And your sister is ignorant if she believes an Assisted Living facility is a death sentence. The way your mom is living now is a death sentence.
If mom doesn't have the money, you can apply for Medicaid for her. You don't ever spend your own money for her care. Your money is for you and your husband.
You don't mention if you or your sister have any of the necessary POA's for your mom, but I'm guessing you don't. Without them your hands are probably tied, sadly, and you might have to wait for a crisis, before anything can be done. And don't worry, a crisis will come and that will be your opportunity to get her placed.

I'm so sorry for the situation you're in---

BUT--it sounds like you should leave well enough alone. Mom is 97? She doesn't have 5 years and certainly not 10.

She's going to either have something catastrophic happen to her, living alone like that, or she's going to die in her sleep. Can you live with that? I could. Sounds like your sisters agree.

People have a right to live as they choose--and your mom is doing that. Honestly, do you WANT to insert yourself into this situation at this point in the game? Just b/c you're oldest doesn't mean anything. Your youngest sister is as responsible as you are...if you want to label it.

Go see your mom, just for the sake of a visit. You should NOT be spending your own money on mom's needs. If she's lived to 97 in what can be considered Independent Living--then I'd let her go on.

Maybe have neighbors check in on her a couple times a week and report to you, but really? If you don't have a relationship with her now, it's kind of too late.

You have absolutely NOTHING about which to feel selfish. Let the cousins know you appreciate their help and let them know you are simply letting your mom have her life her way.

And actually, you ARE the children and she IS the mother. There's a certain measure of respect inherent in that dynamic--whether you are close or not.