Question: My 75 year old mother is at a skilled nursing facility (SNF) getting rehab after falling down and breaking her arm. Mom also has diabetes, kidney disease, heart arrhythmia, a torn rotator cuff in the arm that's broken, chronic urinary tract infections and skin wounds, and mild dementia. One and a half years ago my parents were in an accident that killed my father and put mom in the hospital/rehab for four months. Now, we three daughters have to decide if mom returns home with more care or goes to assisted living. Two of my sisters live near her but I do not. My youngest sister insists she can temporarily move in with mom to give 24/7 care while working part-time, and piece together home health care, outpatient rehab, adult day services, transportation etc so mom can stay at home. But my other sister and I suspect that sis is high functioning BPD or has Narcissism. Her caring for mom seems to be all about sucking my mom and us into her drama, while alienating and demeaning mom's caregivers. Mom just wants to go home, so she just goes along with sis (who a few months ago wrangled herself into being health care POA, even though mom initially wanted to name my other sister). I am financial POA, so I worry that allowing my youngest sister to take over care is not looking out for mom's best interests. I believe sis has taken advantage of mom's finances in the past. Can I do anything to set boundaries or even prevent an unsafe in home situation? SNF health care professionals won't give their true opinion, saying the family has to come to agreement. Working with the lawyer to name a POA over the summer was expensive because mom refused to pick anyone.
Dr. Amy: Caregivers sometimes tell me that they find managing the family dynamics to be more work than actually caring for their loved one. It sounds like you are in this situation. One of the best ways to resolve the issues you face is to hire a geriatric care manager to assess your mother and the family situation, and recommend the best options for your mother. Skilled Nursing Facility staff do not have the mandate to play this role. The advantage of engaging a geriatric care manager is that he or she has no vested interest in the situation and will offer impartial advice. These are professionally trained people who have a lot to offer. The National Association of Geriatric Care Managers can help you find a geriatric care manager in your area (see caremanager.org and look under “find a care manager”).
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