Advice needed

[charliehungerford]

My PIL are becoming more difficult to deal with. They are 90 and 91 and live three hours drive away. They clearly have dementia but don’t really engage with the doctors. They are effectively house bound. We organise all their home delivery shopping, liaising with the surgery and pharmacy re medications on a weekly basis. We hadn’t visited for six months as my husband has not been able to drive long distances or be in a car for more than an hour or so following surgery, he also has prostate cancer which was diagnosed earlier this year, and has a lot of medical appointments. We haven’t shared this diagnosis with them.

we visited recently and the house is in a state, mould on the inside of the windows as they don’t ventilate, disgusting fridge full of mould and stagnant water, filthy toilets that had to be cleaned before using, unchanged bedding, dirty clothes and poor personal hygiene.

We are trying to get them to accept a weekly cleaner, but my MIL refuses to have any stranger in the house. She’s very obstinate and doesn’t like to spend money and think everything is a ‘rip off’. They have a considerable amount of savings and a good income, most of which is not being spent.

My husband has POA and does manage their finances.

Does Anyone have any idea how we can encourage them to accept help, my FIL thinks it’s a good idea but she’s totally against it. We can’t leave them in the deteriorating squalor, but if she refuses what can we do. My husband offered to spring clean her room and change the bedding but she refused.

The situation is very stressful and my husband really doesn’t need this while he is dealing with the worry of a fairly aggressive (although not immediately life threatening) cancer with the associated treatments.

Can you contact the GP and ask for a referral to social services ?
There is a form at the GP that allows them to share information with you - would DPs complete this form?
It sounds v stressful.
I think social services assessment could be an option. Or reach out to the social care team.

In all honesty your PILs situation is beyond a cleaner going in once a week. It would be a start, but they need more than that. I had POA for my mother and I looked at it this way, she gave me POA so I could do what needed doing in her best interests.

Almost all elderly people with dementia 'refuse to have a stranger in the house'. What you/DH need to do is simply to do things and tell them what is happening. Don't suggest it or ask because the default answer is no.

I lived a couple of hours away and I organised a carer from an agency (Home Instead). They provide 'companion care' which includes things like preparing a meal, housework, laundry. They will also do personal care like dressing/washing if needed. Basically anything which needed doing, they did it.

I organised it and told my mother the day before someone was coming to help her.

Your MIL may grumble but you have FIL onside so the carer/cleaner should be able to get in and doing what needs doing.

If you do go via a care agency, the manager will want to visit the PILs to see what their needs are. DH (or you) really need to be there for that meeting, but after that it will make DH's life a lot easier.

This may help

https://www.ageuk.org.uk/information-advice/health-wellbeing/relationships-family/worried-about-someone/

Does your husband have both financial and health capacity poa?. If he has health poa then he can simply talk to their GP. If the GP agrees that they don't have mental capacity to make decisions about their health then your husband can make those decisions on their behalf.

Sadly this is a situation that so many of us find ourselves in. There really is no solution until a crisis happens. Usually this is a fall which prompts a hospital stay.
Social Services will only intervene when your parents agree. I am sorry to be pessimistic about the outcome but I have lots of experience of this.

Sadly I have to agree. I can see in my situation - not dissimilar to the OP's - that we are all just waiting for a crisis which in theory is avoidable but in actuality is not. It's very sad and very hard.

My husband has completed this form. The mere mention of social services will result in anger and tears from mil. They did let a practice nurse in recently to take their blood pressure, we thought she might have raised a concern, but she didn’t. I’m not sure SS would et involved as they would be self funding. They have the funds to pay for help but she won’t accept that they need it.

I agree, they really need a daily visit, but she said they are fine and are not wasting money on help. I think a visit from a care agency when we are there might be possible, but even if she agrees at the time by time the actual help turn she would have forgotten she’d agreed and won’t let them in. Apparently if they have ‘capacity’ then we can’t force it, even with the POA.

The actual GP hasn’t seem them for ages. We did have a capacity assessment last year regarding some changes that had to be made to the POA, they were deemed to have capacity to make the changes at the time, but I think things have deteriorated since then.

Op could you contact the doctor with your concerns ? Its very difficult dealing with stubborn parents. Luck x

This is what concerns us, especially with my husband’s health issues. He’ll be having extended radio therapy in a few months and we won’t be in the position to visit them even in an emergency situation as he’ll be at the hospital every day bar weekends for seven weeks. This takes priority over his parent’s health and well-being, especially as a future crises could possibly be avoided if they acknowledged they need help and accepted some daily assistance now.

The answer is that they do not have capacity and therefore poa comes into force.
As per pp, I arranged a care agency that was paid by the hour to do what was needed. They did housework, cooked meals and took mum out for coffee etc. She actually took to the carers well once she realised that they were nice people I guess they stopped being strangers. With Mum, I had to say to her that it was eithers help at home or help in a home to get her to agree

You need to get a dementia assessment done first it will be easier for social services to help with that in place .. start looking at assisted living / Care options in their area .. Is the POA in place for financial & health ?

You have two options; just stop engaging with the situation, reduce contact to a minimum until they see sense so you can concentrate on your husband’s health OR do what you need to do, and what they need done. This would mean engaging some agency to go in daily and help them, and inform social services what’s happening. Also inform the GP. There may well be some flak at first but you will know you have done the right thing for their physical well being.
Your husband’s health has to take centre stage and pussyfooting around with this is detrimental to both of you.
Choose your route and stick to it.

If your FIL wants help then you can get the help for him even if MIL doesn't want it. As others have said, once she gets to know the carers as people the likelihood is that she will accept it as well.

@charliehungerford
You only have two options. You either try to get carers in, or you wait until one or both end up in hospital.

You're right they cannot be forced to accept care. But good carers will have a way of doing what needs to be done. I had another relative with dementia who was very resistant to help and would try to turn carers away at the door. However her husband did want to let them in, so generally they got in.

You could ask Social Services to visit for a needs assessment. But there is little chance of your mother cooperating with them. And if PILs are self-funding SS would expect your DH to organise the carers so you would be no further forward.

To get a diagnosis of dementia MIL would need to visit the GP, then accept a referral to the memory clinic, and an MRI. She is not going to do these things. My relative very obviously had dementia but never had a diagnosis because she refused to see a doctor. But we still got her to grudgingly accept the carers.

They are adamant they want to stay at home so forcing the issue re help and mentioning alternatives (residential care) might convince them .

I have been writing letters to my DF GP along the lines of
Name DOB
Dear Dr X
I am Ritaskitchen the daughter of DF who is your patient.
I visited DF on date. I observed
a
b
c
I am raising a safeguarding concern.

GP did the referral to social services.
So you don’t have to be involved too much. Or get blamed.