Sister with depression and worries about caring for elderly Mum

[magsbags123]

My sister V and I are in our 50s. I am the older by a couple of years. Our mother is now 85 and her health and strength are failing rapidly. I live a 5 hour drive away from my Mum and sister. We are not a super-close family but up till now my sister and I have always tried to back each other up when it came to crunch issues.

V has now decided that she needs to move in with Mum but will not contemplate any help from anyone except me. V suffers very badly from depression and can barely cope with her own issues let alone being solely responsible for a very frail and ill parent. V moved Mum in with her for a few weeks when she became ill earlier in the year. I came up every other weekend to help but it wasn't enough. V did her best and I truly admire her for that but she missed signs of Mum's deteriorating health (V is convinced she fakes symptoms such as breathlessness to get attention) and Mum ended up in hospital for 10 weeks.

Things are made more difficult by the fact that she and my Mum have never got on and V has told my Mum many times to her face that she hates her. To be fair, Mum is not an easy person to get on with either and they have a history of stand-offs over the years, which has got worse since my Dad died.

Things have now come to a head as it seems V would ideally like me to give up my small business to have Mum live with me 6 months of the year. My partner has a very well paid job and we could live off that easily but I have on/off mental health issues and basically my business is what gets me up in the morning. It's my 'thing' and gives me a lot of self-respect. I feel I could cope with Mum in my home so long as I had help from carers but V is adamant this isn't good enough and is now planning to give up her own job to look after Mum 24/7.

For me the worst thing is that the last two times V and I saw each other we had terrible fights, and she told me I was selfish, heartless and cared more about my dog than about our mother. I was urging her not to give up her job and possibly her sanity to devote herself to Mum's care. She is barely speaking to me now and won't update me on Mum's progress, telling me to ask Mum directly. Mum is often too tired or feeling too ill to tell me anything in detail though and I am reduced to messaging V on Facebook once a week and I get one word non-answers if I'm lucky and 'I don't want to talk' if I'm not.

In short, I'm afraid my sister will endanger the health of my mother and/or herself if she goes ahead with her plan to care for Mum 24/7. She will not compromise and now totally blanks me if I try to talk about it. I feel I am losing my sister over this.

Any advice or insights, please?

Seems obvious you need to take control of your mothers' care or you will be taking an unacceptable level of risk, when you take the drama with your sister out of the equation (not that this isnt a problem in itself) then this is purely about making sure a vulnerable woman gets the right care. It seems you will need to sacrifice at least partially your job in order to improve the health of your mother which sounds like it should be a top priority as she is very ill. Hopefully with better care her health will improve and everyone will have better relationships. If she moves in with you then I think it should be full time, would be very unsettling to your mother and her access to NHS care to be constantly swapping addresses, you'll need to build up relationships with GPs and get familiar with your local hospital - obviously this isn't a must but I think it will make everyone's lives easier, plus if she is with you I am sure you would be able to work perhaps less hours than you do but still keep your job going, not sure what would be on offer in terms of extra support too. I see this as a safeguarding issue and would do whatever it took to get her to your house, can you accept her demand that you would not have carers in initially at least, just to make the initial move acceptable to her? Seems also you need to speak to your mother and find out if she would be happy with that plan. It is unfortunate your sister doesn't sound well enough to deal with this so you must, but hopefully you will find it rewarding and things with your sister will improve and you will still carry on with your job, perhaps you could take on extra staff either for your business or to do cleaning\cooking to free up more of your time? Good luck

Hmmm
I am the same age as you with similar aged parent/in law situation.
The six month thing just doesn't work. Nobody wants to feel like a travelling fair and accidents happen when older people are out of a familiar environment.
If possible, you need to make decisions with a cool head, without blame and without the views of one person trumping those of another.
What does your mother want?
Why can't your sister live with your mother but still use carers?
What are the actual physical needs of your mother? How mobile is she? Is she continent? Is she of sound mind?
Think of five years hence. What will happen if she has died. Will your sister remain in her house? What if she is in a home. How will care be paid for.
Please ignore any emotional blackmail by your sister. Your mother's interests will be better served by clarity of thought and planning rather than broken promises.

Would it be worth talking things through with someone like Help the Aged? They might have some ideas and will certainly have knowledge of safeguarding and legal issues which you might not have considered.
You poor things - all of you - caring for elderly parents when you have poor health yourself is incredibly difficult. Often compromising is the only possible way through. What would your mother like? Is she able to tell you?

You are in an unenviable situation.

I think you need to get the health care professionals in to do a needs assessment, and find out what care your mother needs, and what she might be entitled to.

eg would sheltered accommodation be an option? Or respite care at a home near you so that you can carry on with your business?

Also, has your mum got the legal stuff in place, such as power of attorney?

Regarding your sister, her suggestions seem incoherent - why say she needs to move in with your mum, and then say your mum needs to move in with you?

YANBU to not want to live with your DM and provide, rather than organise (and help finance?) the care.

If you really feel your sister isn't capable of looking after your mother safely and you don't already have power of attorney then there are some difficult conversations to be had and decisions made.

It's sad but your DM's health might not improve but might worsen.

The fact that your sister has argued bitterly with your mum, has said that she hates her, has deliberately ignored your mum's symptoms in the past, and is refusing to have anyone outside the family in the home, point to abuse of a vulnerable adult.

Adult services at your mum's local social services should be informed of this. The situation at the moment is extremely unhealthy and is putting your mum at significant risk.

You are under no obligation to give up your job and haul your life across the country because your mum is ill. You say your mum hasn't been easy to get along with; I assume that's code for her being abusive, bullying and toxic.

I don't think you should give up your business (especially if you're not married), but is there time to visit your DM and talk things over? When visiting you could find contAct details for her health and care providers.

Thanks everyone for your replies! Lots of good points. A few more details for clarification. Sorry if long.

Mum is currently in a respite bed after leaving hospital and is being given physio etc to try to improve her strength and mobility. She is due to be discharged in about a week and is being provided with two weeks help 4 x a day for free by the NHS under their Independent Living Team scheme. They will supervise Mum as she settles in and will continue to assess her needs. It's after this two weeks that we will have to decide how things should be managed on a long term basis. Mum is not going to recover her health as she has a heart condition that is steadily deteriorating. Her lack of mobility now means it's difficult for her to get to the toilet on her own, or to make herself a drink. She does not suffer from dementia but sleeps a lot and is sometimes a bit groggy. A cleaner, a gardener/handyman and Meals on Wheels were already in place some time ago. Legal stuff (power of attorney etc) and finances are all in order.

V and I agree 100% that we don't want Mum to go into a home. My preference is for Mum to have live-in care and nursing in her own home instead. She can afford that for a few years at least. It would be easy for my sister to keep an eye on the standard of care and I would be happy to visit as often as I can to help out and to check everything is OK. The sticking point is that V will not contemplate carers from outside the family. She has had dealings with care agencies through her job and the experiences have been bad enough for her to come to believe that 90% of carers are lazy, uncaring and dishonest. I am aware that you do get bad carers but my MiL for example was looked after by some absolutely lovely people who genuinely wanted the best for her.

V recently lost her old job and is now working part time on very low pay. It was really difficult for her to find a new position, partly because of her age and partly because it's a rural area and there aren't many opportunities. So if she gives this up to look after Mum, the chances of her getting another job after Mum dies will be almost nil. This is why it's absolutely crazy for her to even think about it. I don't understand why she would sacrifice her future for someone she says she despises when there is a perfectly workable alternative solution. I don't think my Mum would enjoy being looked after 24/7 by my sister anyway but would be probably be happy to have her move in or to stay overnight so long as there were other carers involved.

I agree it isn't ideal for Mum to be shuttled back and forth between us either. It's a 5 hour journey for a start, and also all her friends and other family members are in our home town. My partner and I live in the middle of nowhere with no near neighbours so she would be quite isolated here. I am pretty sure Mum would not want to live with us full time if there was an alternative that would keep her in her own home. I am visiting next week so will try to discuss it properly with her then.

I suppose I am afraid I will lose my sister completely if we fall out over this. I was very upset at the thought of that a day or two ago but I can see now that there's very little I can do about it if she chooses for whatever reason to cut me off so I'll have to live with that possibility and just think about Mum's needs for now.

One other point: Mum does not know V suffers from clinical depression, only that she is a bit reclusive etc. Should I inform Mum of my sister's true state of health and my opinion that it is way too much for V to take on?

You absolutely need to visit your mum and over several conversations work out what she wants to happen. Would a flat in an assisted living community work? Carers can definitely work although there will be blips and difficulties along the way. Care homes can be good and can be a disgrace, really serious research needed there. The best ones will be identified by people without dementia who have chosen to give up their homes to lived there.

Your ds is sounds as if she is a little desperate and this works on some level as a solution for her own problems rather than your mother's. She is being very childish in refusing to speak and frankly I would have grave concerns about her caring for your mother. You say she has screamed that she hates her...this would be a dangerous situation, almost a disaster waiting to happen.

After your mother is discharged hopefully it will become clearer how things should move. There should be a meeting to discuss long term needs. Make sure you find out and attend. Could you stay for a while to assess and get involved? You say LPoA is sorted but do you share this with your sister? Another idea is to speak to your mothers GP if you really feel your sister is putting your mother at risk.

All very tricky and I wish you well.

Thanks, MTC. I'm afraid Mum is past the stage where assisted living would be appropriate. I have seen her every 2 or 3 weeks over the last few months and she definitely needs regular help at home now, and in my opinion probably someone to stay overnight as well as care visits during the day. I have discussed some of this with the Independent Living Team who are doing a continuous assessment on her for at least another two weeks, even after she gets home. They have my number and are updating me directly as my sister refuses to.

It's really hard to say whether my sister would put Mum at risk again. She did at one time believe that Mum was exaggerating some of her symptoms for attention. However she realises she was wrong and I don't think it would happen now. I do find it hard to be optimistic about the prospect though, as it's hard enough caring for someone you love, let alone someone you profess to hate and have a history of falling out with.

Who has power of attorney, you and/or your sister?

I don't think you can avoid conflict with your sister sadly.

We have joint and several I think they call it? In other words we can make decisions independently of each other. But it only kicks in if Mum becomes incapable of making her own decisions. She's not at that point yet.

I am resigned now to the conflict with V. I'm sad about that because we have always looked out for each other up till now.

There are two types of power of attorney:-

1. health and welfare
2. property and financial affairs

Which do you have; joint and several simply means the two of you can operate independently of each other. Its not a type of power of attorney.

Re this comment:-
"V and I agree 100% that we don't want Mum to go into a home. My preference is for Mum to have live-in care and nursing in her own home instead. She can afford that for a few years at least".

You'd be surprised at how quickly funds can be drained.

What does your mother want?. She may well not want to be in a nursing home but she may well have no choice. Realistically your sister is in no good place herself to do this task either.

Why not a nursing home?. The alternative currently being presented is not going to work.

A nursing home may well be now the best place for your mother to be in given that her other daughter hates her very being as well and she does not sound at all suitable to be caring for her mother in any event. Live in care, particularly private based care, is very expensive and the savings may soon run down very quickly. It may well be that her home will have to be sold to pay for her care. You are certainly under no obligation to uproot your own existence (no one will say thanks for you doing that anyway) and the six month thing is completely unworkable in any case. Live in or overnight (particularly that type) care can also be hideously expensive so may well be unworkable; who is going to pay the bill?.

What if anything have the independent living team said about the possibility of your sister caring for your mother. Do they know what your sister has commented?.

Difficult decisions are going to have to be made and you may well end up being "the bad one" here but your sister caring for your mother in my opinion is a complete non starter. I think her best option would be for her to be placed into a nursing home

Good question re powers of attorney. I will double check.

I realise that the house may well have to be sold at some point whatever we decide to do now. However Mum is lucky enough to have a good income from pensions and various investments, as well as substantial savings. I have costed live-in care and it's do-able for some years without selling the house especially if V moved in or was there overnight. It would mean she would not have to give up her job and the pressure on her would be a great deal less. Obviously if Mum's condition deteriorated to the point when she needed someone to be awake all night to look after her, we'd have to think again.

I feel we owe it to Mum to at least try an alternative to a nursing home. We are certainly not going to 'place' her anywhere until all other avenues are exhausted. I do not plan to leave her in my sister's hands on a full-time basis though as I know it's a recipe for disaster.

Given her personal circumstances as well, having V care for your mother at all (or particularly without any outside carers coming in) is a complete recipe for disaster. She is already suggesting that mother lives with you for six months; this is not workable at all already. You are five hours away and live in a rural area so what you can do yourself is itself limited. That's not your fault.

Your mother needs a risk assessment. A carers assessment for your sister should also be done.

Her home will likely have to be sold to pay for her care. If she substantial savings then she will get minimal or even no help from the council and be expected to pay for care. That amount of money will go down very quickly. Live in care is expensive in any case. Overnight care is hideously expensive as well and may not actually be feasible. You may well be badly underestimating how much this is going to cost financially.

I fully realise you do not want a nursing home (who really does want to put a parent into a home, no-one really but sometimes it is the only and best way for all concerned) but I think its something you really need to look at and discuss sooner rather than later. Arranging a place at the last minute is something no-one should ever be in a position of having to do. Also there is always demand for places in good nursing homes and the first one you look at may well be unable to place her. You should visit several in any case.

My late Nan never wanted to go into a nursing home either but she did also because she simply could not manage at home any longer even with carers going in. Overnight care was not feasible, she was a danger to her own self at home.

She did manage for some years with carers but it was a huge strain on my parents all the same (and relationships between them were sometimes fraught as well even though they mostly got on. Your sister clearly does not get on with her mother already so there are problems there too).

I have done my sums thoroughly Attila, honestly :)

As I said Mum has an excellent ongoing income which will pay for a high proportion of her care, topped up by her savings. It will be at least 6 years before her capital runs out. This is the one area I feel confident handling as I've did it previously for my MiL towards the end of her life. Money is only a side issue here. I'm just trying to prevent my family from falling apart.

I have of course looked at care homes as a back-up plan but haven't yet found one I'd be remotely happy to leave my Mum in. I believe my sister could cope with care for my Mum so long as she's not the primary carer.

Thanks so much everyone for your advice. I have had to ask for the thread to be deleted as I have discovered that my sister reads Mumsnet and obviously I don't want her to see this. I will update in a new thread at some point (with fewer personal details) if there are any developments.