Cockroach Cafe - Autumn

As @GnomeDePlume alluded to, so many things have changed that together create an almost impossible situation for many 'women of a certain age'. I know lots of women in their fifties an sixties who have no choice but to work full time as they still have a mortgage to pay and are also supporting DC through University etc but are also now being expected to juggle the needs of elderly parents. Some are also trying to help their own adult DC with childcare, since many employers still seem to expect parents to be at work from 8.30am-6pm when nurseries/wrap around care etc have shorter hours.

Another aspect is that in past generations, it was common for a wife not to work, even once children were at school. I was at secondary school in the 1970s and my mum had gone back to work, but quite a few mothers of friends didn't work. But this meant that there was a nonworking adult to care for the older generation.

Go back further and families were bigger, with family members less likely to live in other parts of the country or world, so there were more people to share the load. (This is still more often the case in some cultures of course).

That's so true. I also think the family/societal expectations around how elderly people are helped/cared for have not caught up with the realities of modern working lives or the fact that people are now living for longer in increased frailty.

I know many people with elderly parents who insist that they must remain in 'the family home' for the rest of their lives and expect their adult children to facilitate it. Their rationale for this usually involves not wanting to give up the lifestyle they have worked for or their independence, wanting their children to inherit 'the family home' and a claim that looking after your elderly relatives is 'what's right'/'just what we do' because previous generations did.

As well as the fact that many of these people are far older and need far more care than the previous generation, this fails to take in to consideration the fact that the adult children being expected to take on caring responsibilities now are themselves older but usually still also working full time. Or the fact that 'the family home' is often unsuitable/dangerous for a frail older person.

No one seems to take into account the physical and mental health implications for the carers. Of course, no one can force anyone to take on caring responsibilities but it is very difficult to simply walk away and leave an elderly parent to fend for themselves in an unsuitable home.

So many things have shifted in the last few decades.

Living on with increasing frailty because of improved testing and treatment. This means an increased burden on older DCs. State resourses are being stretched over a bigger frail population.

The growth of home ownership means we have an increasing number of frail, elderly people unwilling to give up their homes. It was their big achievement, to own rather than rent, now they dont want to give up their biggest asset to pay for care.

Fewer people have extended family in the same area. So the burden of care falls on a smaller number of family members.

So many shifts in society, health, wealth. Each in themselves are positive but the overall effect can create a huge negative.

I don’t think enough people plan for their old age - they spend all their time trying to get rid of their cash so they can access free care - that free care can be excellent but it can also be bloody awful and if it’s awful - who picks up the pieces? Do you burden your family or get left by them to get on with it?

@MotherOfCatBoy you are so right. My dm cared for her FIL but he died aged 65 so she would have been mid 30s and working v part time. And it was months rather than years. My SIL cared for her dad at home with a bit of help from us, she took compassionate leave and it was 7 weeks from diagnosis to death at age 70. Again my SIL was in her 40s.
Im late 60s, DH not in great health at the moment, looking after grandkids a bit which is a pleasure. DM and DF in early 90s, both in poor health but not enough to need carers but do need checking in on daily, shopping, admin and taking to appointments. In a paradoxical situation where you don’t want to lose them but wonder just how long this limbo living can go on. It’s affecting my mental health particularly around avoiding planning future stuff, just in case

I think people accepted caring for elderly relatives more in the past because people just didn’t live as long, on average, so the burden wasn’t for so many years. (Plus factors like fewer women employed outside the home, higher birth rate so more siblings and extended family possibly in the house to watch over someone). They would have heart failure or lung disease or cancer or a heart attack; fewer antibiotics available, fewer vaccinations, so they were just more prone to simply die. Nowadays everyone lives for bloody ever, so you could be carrying the care for 10 years or more. I think it’s changed things massively but it doesn’t get noticed unless you’re in the arena as it were.

@glasswings a risk assessment sounds like a good idea. Have you seen how the carer moves MIL? Any limb or clothes holding is an absolute non starter. Huge risk of direct fractures or clothes ripping resulting in a fall.

Exactly the same risk with SIL if she is moving MIL in the night.

You could frame this as concern for carer safety as there is risk to them as well from incorrect technique being used.

I did notice that CH staff were much more competent than hospital staff in moving DM. Hospital staff were prone to grabbing rather than using the safety straps. DB thought this was better but he's a moron.

@bigdogpaws
It is so hard to say no to overnight care - the pressure on our the other sister is enormous and we are trying to support her too.
I think we need to ask the carers if they have done a risk assessment in light of the recent deterioration, it might be that they haven't given this enough thought and that they need 2 carers to do their job safely.

@glasswings I completely understand how your DH feels. But in my own situation, to protect my own position on this I've found I need to mention alternatives sometimes otherwise the accepted narrative very quickly becomes 'everyone agrees that care at home by family is the only way, but leaves it all to Brother'. In my situation this narrative meant even more upset and frustration when I have refused to step in to the role of overnight carer for a few weeks.

You do come to a point were you just have to say "ok then". But my strategy was to have done some research about options when the inevitable happens to minimise the pain at that point.

@bigdogpawsno we have already had that conversation and she will just say she doesn’t have a choice and she hopes her health will allow her to continue for the sake of her mum.
Dh feels he’s hit a brick wall and having any more conversations is just causing upset and for everyone’s sake they are best avoided.

@glasswings Do you think there's any way you could appeal to SIL to consider the impact on MIL of putting off considering residential care? In particular the fact that it would only take SIL to be unwell for a few nights for her to need overnight carers to be organised at very short notice which will mean much less choice and no chance to really think about options. Is there a chance that this sort of reasoning (rather then the impact on her own health) might encourage SIL to agree to at least looking in to other options (even if just for a short term respite/emergency care arrangement)?
I know the answer may well be no. My brother (I suspect with much less altruistic motives) refuses to even consider the possibility of residential care at any point for DM so I know that sometimes absolutely nothing can get past the 'Never ever going in a home no matter what' stance.

@glasswings you are probably right.

I think the only way this situation will get resolved is when the carers say they can’t manage with one person and they don’t have enough people to cover two and/or sil can’t do nights alone or sil breaks and there is no choice - until there is absolutely no choice then she will battle on.

@glasswings it sounds like SIL is very much part of the problem. She has set an expectation that your MIL will be cared for in a certain way and that is what your MIL now expects. Maybe over time your SIL will have no choice but to look at other options as it all becomes too much. Unfair of her though to expect you and other SIL to step into a situation that she has created.

@funnelfan thank you. I think there's a feeling (from my Mum and also my Dad when he was alive) that my DM simply can't be responsible for her own happiness and therefore others need to pick up the slack. But it's impossible, as you say we can only be responsible for our own. If I have mentioned this IRL a couple of friends have taken the "oh but she's elderly and frail, why don't you <insert some additional thing I need to do to try and make her happy>"

I think a lot of people believe that old age is a free pass to give up personal responsibility and that we shouldn't expect anything more of them.

@glasswings if SIL breaks, and this sounds like it is coming, MIL is going to be left quite literally sitting in her own mess. Possibly for hours.

These are the hard facts which need to be spelt out first to SIL then to MIL. It sounds brutal but the reality is brutal.

My DM is bed bound virtually immobile. To avoid pressure sores she has an air mattress which inflates and deflates to move her weight. Does MIL have similar?

Before DM became fully bed bound her carers could use an array of different lifting equipment to move her from bed/wheelchair/chair/toilet. It always involved 2 trained carers. At no point was anyone supposed to hold or grab DM, hold her clothes etc to move her. Is SIL trained? Does she have the necessary equipment?

This is the big advantage of care homes. They have trained staff 24/7, the equipment. They are designed to host elderly people with constantly evolving needs.

Sil feels that just because the system does not allow for exceptional care to be provided, it doesn't mean it shouldn't be provided. Nothing will convince her, she knows the impact it is having on her - she wants all of us to be in it along with her but we won't, we don't agree with her and that causes it's own problems but were are still trying to be supportive.

Again I am very much reminded that we should not do this to our kids but I fear MIL would have said the same thing when she was younger - she's scared and vulnerable now and she's using everything she has to survive.

I think MIL has become so stubborn she'd say leave me to die, she's not had a good ending - she's been utterly miserable for months.

I have seen so many families in which a promise has been made that they would NEVER "put their ER into a home". So many of the family members end up totally exhausted, depressed and burnt out - but they made a promise and feel they have to keep it, come what may.

People don't realise how hard it is to care for someone full-time.

Professional nurses and carers don't do 24 hour shifts; they don't work 7 days a week; they don't work singlehandedly; they are trained to give personal care, to use equipment and to know when to seek other help; and they can access that help or equipment. They get paid holidays and can take sick leave. They also don't carry so much of an emotional burden as we do when caring for family members.

The absence of all those protective factors for the workers can even lead inadvertently to safeguarding issues for the elderly person (eg suboptimal care leading to bedsores or DOL concerns).

@glasswings , feel free to show your SIL this response from someone who's seen it all, many times before.

I agree with you both - but there is a lot of history here, when dh has discussed going a home with mil in the recent past and despite dh being very careful in his approach, mil called sil afterwards and was extremely upset, almost hysterical by sil's account, sil felt that she had to pick up the pieces and it wasn't fair on her - things were hard enough, the ramifications and accusations thrown at dh were incredibly upsetting for him and in the end nothing changed - except the relationship with sil. Dh is incredibly careful about making the situation worse - sil has set a standard of care and if the other siblings aren't willing to step up to that standard she will go it alone - she won't stop until she breaks.
That's not easy to watch and every time there is a crisis the problem gets bigger.

I would agree with this @glasswings - I appreciate SIL may always be present so it’s difficult, but it is not SIL’s decision what your DH may choose to discuss with his DM. Easy for me to say, much harder to apply in reality, but worth considering given SIL does seem to be burning out with this way of managing it. Good luck xxx

@glasswings at the moment it sounds like SIL is as much part of the problem as MIL. I am guessing that SIL is soldiering on as it is easier, in the short term only, than having the conversation with MIL.

For MIL 'keeping it in the family' is a way of pretending she is still coping.

SIL has fallen into the boiling frog scenario. It starts as a little bit of help and support then slowly grows to full time care.

I do think that once independent continence is lost the next step is care home. Are there funds to pay for this?

Is there anyway that SIL could be persuaded to go away for a day? Be out of sight while you and other SIL have a stern conversation with MIL. The two of you be the bad guys.

You also need a firm conversation with SIL. If MIL is bedbound she needs profesional care. Turning, moving, equipment and training to avoid injuring herself and MIL.

Again you and other SIL taking the role of bad guys to hammer the message home.

Not being able to see the reality of her situation was one of my DM's earlier dementia symptoms. She did use her upset (screwing her face up and pretending to cry) to try to manipulate DB/me into 'taking her home'.

@funnelfan
We are not entirely sure whether she is being upset to get her own way as such - there has been that suspicion. We have suggested it but we aren't allowed to talk to her about respite. She does understand she is getting worse.

I agree that daycare and/or a short respite stay at a home of your choosing would be the best route @glasswings. Because to be honest, if your SIL falls ill with the strain she’s under, your MIL won’t have a choice and she’ll end up somewhere (any where) at short notice. At least this way you/her have a semblance of choice and control.

Sorry if this sounds a bit blunt - but is your MIL genuinely scared about residential care? Is it possible there’s an element of “getting upset” to keep your SIL there? You need the least painful way of getting through the upset and past it. Respite care is respite for the carers not her, you could try that approach?

@Exhaustedpickle my number one rule these days is that the only persons happiness I am responsible for is mine. I think it’s a realisation of how much my mums anxiety impacted all the family with us having to do stuff because otherwise she’d worry. It’s only relatively recently that I’ve realised it was her responsibility to deal with her anxiety and not lay it on us with an airy “you know what I’m like”.

I don't know - I think the consequences of her decision to stay at home on her dd's mental health and the family in general are not something she's been asked to face. And we are not allowed (by sil) to tell her. I don't know if she has capacity, dh says she is less alert than she was the last time I saw her - 7 days ago.