In laws in declining health - all advice gratefully received!

[Lottapianos]

In laws live a 6 hour drive from us. MIL is 75 and has been in poor health for a few years now, partially house bound. FIL is 83 and has been in good health until recently, and did all shopping, cleaning, cooking etc. He has recently been diagnosed with cirrhosis and heart failure, and obviously his energy is severely limited. Hes waiting to see a cardiologist and liver specialist

We will be visiting them in a few weeks and I want to use our time there to arrange some support for them. I'm thinking at the very least a weekly cleaner and an online grocery delivery, although we may have a battle on our hands getting agreement out of FIL.

Should we be requesting an adult needs assessment from social care as well? They can both wash, dress, feed and toilet themselves independently, I think they need help with daily living stuff (shopping, cleaning, laundry, maybe cooking) rather than personal care. FIL still drives so can get to his health appointments but MIL would benefit from some help with transport. They have a seriously acrimonious relationship and honestly can't stand each other, and DP has a complicated relationship with both of them too. Any advice would be appreciated. They live in Cornwall if that's useful. Thanks!

Is power of attorney set up? Make that a high priority

Is your dp in agreement with your plans for when you visit them? If so before doing anything he needs to discuss it with his parents and ask them what they want and need to make things easier for them. By all means make suggestions of online shopping, cleaners etc, but don't be surprised if they turn down those suggestions. You cannot force the issue if they don't want to allow cleaners or home help into their house.

Urgh. And so it begins...

Firstly, if relationships are difficult, you may have to accept that your role is going to be crisis management rather than preventative and proactive help. This will drive you nuts but you can't force help on them.

Definitely POA. If they are resistant emphasise that this is a just-in-case measure that only comes into play if one of them is permanently not able to make decisions (eg has fallen under a bus). They retain full control until something very significant changes.

Find out who their gp/banks/utilities etc are with

Investigate Attendance Allowance for FIL although he may not qualify yet. Also Disabled parking badge.

See what services Age UK Cornwall have to offer (not national Age UK) - they may do transport, or have a very good information and advice service that can help with stuff. Independent Age are good too.

Good luck.

I would investigate local groups such as befrienders or volunteer groups that help with transport. Number of social services so they know who to call if they need help. Wiltshire farm Foods

As above for LPA.
Their GP would usually be the first port of call for an assessment by SS. So that would need to be kicked off by them or your son if he has power of attorney.

They ought to look into benefits. They might be eligible for carers allowance ( the FIL claiming for his wife) or something slightly different.

Age UK is a good place to start- their website is very helpful.

I can only relate our experience with my late, very infirm housebound MIL for years. Things may have changed a bit.

Most carers coming in will not cook, in our experience of my MIL.
They also don't usually shop. If you need this kind of thing doing, you'd probably have to go through an agency offering private services. Care provided by SS is often just personal care, like help with dressing, getting out of bed, etc.

You and your DH could arrange a weekly online food delivery.

And a weekly cleaner.

For your MILs appts, there is usually transport available through 'hospital ambulances' which can be a mini-bus type of thing. The downside with those is they do , literally, go round the houses picking up lots of patients. If they can afford it, a taxi is the best option or your FIL driving her.

Do they not have any friends on the doorstep? Most elderly people I know of have a combination of local friends and neighbours, and family all chipping in.

Thanks so much for responses so far. We found out 2 years ago that they had no wills!!! Had a huge panic, and it has all been sorted,including POA, which DP and I share for both his parents

Yes of course will be agreeing any suggestions with DP before suggesting to his parents. We are prepared for suggestions of cleaners and online deliveries to be refused - I will find this incredibly frustrating, but they are adults, and have capacity so their decision ultimately.

Also, they should be entitled to attendance allowance, which can help towards paying for cleaner etc.

Erm. Do they have "capacity"? You haven't mentioned dementia or similar, so have you actually asked them whether they want you to do this, and whether what you think they need (from 6 hours away ) is actually what they want?

Yes they have capacity, to make their own decisions. The cleaner and online grocery delivery will be suggestions from us, and we will of course ask if there is anything else they would like us to arrange. They are very passive people, and unless we make some suggestions and offer some options, nothing will ever change

When my grandmother got too frail to do her laundry we arranged a collection and delivery service for her.
Started with just bed linen and towels and gradually got up to everything but her underwear, she was not comfortable with anyone but herself/family dealing with that.
Might be a practical idea to free up your FIL's energy for cooking/tidying things a cleaner wouldn't ordinarily do.

That's a good idea M0rT, thanks

For transport is there a community transport service available, so not run by the hospital but a local charity? Google their local area. This is run by volunteers who use their own cars, or there maybe a minibus service available. You usually pay the volunteer the cost of petrol, so usually works out cheaper than a taxi. DM uses the community transport service when she needs to attend medical appointments eg doctor, dentist etc if I am not available to drive her there. She sometimes uses them even if I am available as I think she feels she is still being independent (can no longer drive) by organising it herself, and also not always having to rely on me (I assume it is that rather than she doesn't like my driving!)

Would they consider wheels on meals once in a while to reduce the burden of cooking? There are various services available to suit different budgets. Also many restaurants have branched out doing takeaways/delivery services during COVID times. I know many of the residents of the retirement flats where DM lives have taken advantage of this in the last year and the chippy does a roaring trade on Friday lunchtime with a delivery of fish and chips!

What may be more of an issue is when one of them is left on their own.

Your MIL is not that old in terms of being in need of care. (Fewer than 10 years older than I am!) I wonder if you and your DH need to start talking to them or each other about what will happen when your FIL dies or your MIL dies as the other is far more likely to find it hard.

I don't know what her health is like, but at 75 she ought to be able to order food online, so maybe teaching her some skills to help her become or remain independent are needed? my mum's friends who are that age and even mid- late 80s are able to use the web and order food etc themselves. I have a friend aged 75 who is very IT savvy so it's not purely a generational thing.

I think what's needed are two plans - one for the immediate short term of the next year, but one looking beyond that at the next 5 years and beyond.

Leila, you're right. 75 is really not that old. MIL however is proof that being 'old' has nothing to do with your age and everything to do with your attitude. She absolutely refuses to have anything to do with the internet - believe me, we have tried. She's not interested in solutions, she's not interested in making life easier for herself. We do need to have a conversation about what will happen if FIL is not around anymore. She has said that she doesn't want to stay in the house, and she wouldn't manage it anyway (steps down to front door, stairs to bedroom and bathroom) but we need a more focused conversation about what her options might be. She has said that she wants a ground floor flat, but also that she wants to go into a home. She's very passive, but also very awkward - nothing is ever good enough. Wish us luck!

This all sounds a bit familiar! We also had the 'sigh, well I'll just have to go into a home then' thing although in my dDad's case it was even more passive aggressive, whenever things weren't exactly the way he wanted them (ie his daughter/DIL doing everything for him) it was 'I'll be put into a home' as though he had no agency or say whatsoever, it always gave me visions of a social worker with a huge 'childcatcher' style net chasing him around and bundling him off kicking and screaming .

The reality of course is that (unless they are wealthy enough to self-fund in the kind of nice care home you'd actually be happy to live in, which will be £££) social services will absolutely not want or be willing to fund residential care for your ILs unless it's absolutely necessary, IME both social services and the individual (if they have capacity) resist until the last possible moment because care homes, even the basic not very nice ones are so so expensive - thousands of pounds a week! Carer visits at home are much more likely if they'll accept, carers can assist with daily living tasks as well as more personal care, but round our way the most you are likely to get is 1 or 2 daily visits for 10-15 minutes a time (my Mum went up to 4 daily visits, 2 x 30 mins and 2 x10 at one time but her mobility was very bad and she needed a lot of help with showering etc). In our area (it may vary from council to council or agency to agency) they will do quick jobs like put a load of laundry on (but obviously in the time available it won't be finished so if DPILs aren't then able to get it out and dried themselves that will have to wait til the next visit), make a cup of tea, microwave a ready meal or put together a sandwich, wipe down the counters, change the bed, that kind of thing. 'Proper' cleaning is tough because how much can they realistically do in 10 mins with everything else, so I would investigate a weekly cleaner (ideally one that will do laundry as well) and doing online shopping for them (I think places like Wiltshire Farm foods do 'meal on wheels' style frozen ready meals that the delivery man can unload direct into the freezer, a carer could then stick on one for them of an evening so they have a hot meal at least once a day - they may then be able to manage their own cereal and sandwiches for breakfast and lunch?).

Longer term would they consider moving to a sheltered housing/retirement type complex? The modern ones are very swanky and not at all institutional (my Mum's honestly could be mistaken for a high end hotel), you live in your own self-contained flat but there is usually a degree of 'assistance', so things like a canteen or restaurant for meals, bills and maintenance included in your service charge or rent so you don't have to worry about anything extra, a manager on site at least some of the time and in 'extra care' facilities you can pay extra for laundry services, cleaning, care etc. It's usually not that cheap in terms of the size of flat you actually own/rent, but I think they're a really really good thing. You can choose to just treat it like an apartment block with extra services, and keep yourself to yourself if you like but a sense of community usually grows up as well and it's easy to make friends, often there'll be bingo nights or seated yoga or other activities going on in the communal areas, a mobile hairdressser visiting, that kind of thing... it's really surprised me how much previously quite isolated and low people, who've maybe been through a bereavement or ill health, perk up when they're somewhere they feel safe and supported and where there is a ready made and 'easy' social circle, I've witnessed even quite curmudgeonly, proud folks prepared to participate in group activities or going down the pub with their new mates (sometimes this is tactfully framed as 'to help the older ones') or whatever - it takes such a burden off their children who might have been their whole social world previously!

How much money do you have to throw at the problem? If a lot then get a at home caterer in to make food at home, a cleaning service twice a week, and just organise an account with a taxi firm like Addison Lee for your mum.

We are comfortably off, and ILs have fairly substantial savings - whether they are willing to spend them is the big issue!

Your MIL does sound a lot older than she is. My ex colleagues, friends and relatives of her age were using IT at work or for personal reasons 10 years ago just pre-retirement.
As PP says, the care you will get from SS is minimal . My late MIL had carers in 4 x a day- to get her out of bed, to help her into bed ( at a very early time, to suit them) and then a quick visit at lunchtime and mid-afternoon.

Care homes are a minimum of £1K a week for something very basic. So that's £50K+ a year. Do they intend to sell their home?

Is your DH the only child?

Would they consider moving closer to you and buying into a retirement flat sheltered accommodation?

Yes DP is only child and feels a huge amount of responsibility. No, they definitely wouldn't move any closer to us. I think they will stay in their house until FIL is no longer with us and then MIL may need other arrangements, but I agree with previous posters that we need to actually have this conversation with them, and hope to get some clarity