A rock and a hard place with in-laws

Sametal · December 2023

Good morning everyone.
We have felt so lucky to have found this site and this group of support.
My wife and I have been together almost 22 years and I have been part of her family for the same amount of time. After losing my own father to cancer just less than 2 years into our relationship, her parents have always been there to support us.
We have spent nearly as much time with them as we did with our own family.
We have spent many holidays with them, dinners, family vacations and a variety of house projects with them over the last 20+ years.
They had been very active in their community, with friends and their church.
Until pandemic hit.

They spent so much time together alone for such an intense amount of time and most of their clubs and hobbies got pushed aside during that time.
Friends either passed away or moved closer to their own children. My FIL just turned 92 and MIL 88.
They live over an hour from us in their own home within a 55+ community.
As the youngest of the kids, my wife and I have been dealing mostly with them and visiting as often as we can. I am dealing with my own mental health issues which is also a burden on my wife and her family.

We have been talking with them since last year about moving to an a continuing care community closer to us where they could start in independent living and progress from there. We have even toured several but they have come back with it cost too much and maybe in a year from now.
They can afford it but insist that they are better at their house which is mortgage free.

My MIL is very reluctant to be seen as getting old and or losing any control of her faculties. My FIL was just diagnosed with ESA. He is very receptive to help and welcomes our visits as well as wants to learn more about his own illness. He even allowed my wife to call in and listen to his appointment with his doctor- something my MIL has been quite reluctant to allow.
She is his primary caretaker, and is not a very patient person with him and seeing him decline. But more than that, she herself is showing decline, at a much more rapid pace than my FIL and she is completely denying it.
She is also so adamant that she is not losing her abilities, often by doing something to show she can still read, see and walk just fine.
But we feel she may be hindering our FIL in his own journey, she does not let him use his cane in the house, she keeps the lights low because she can see just fine, she even argued for months not to allow us to install grab bars because she did not need them- even if my FIL was getting stuck on the toilet!

We are sure the idea of losing control over her own abilities and cognition is very frightening and all we want to do is help, but she is so resistant and believes she is still capable of making all the decision.

We have been coaching their kids to be more firm with her and not let her just wave them away or stop the conversation.
And now we need to get her to see the doctor about her own possible decline and no one wants to do that with her, none of the kids.
We are fine being the bad guy in the story of their lives. We just want them to be safe and stay healthy as long as they can.
How do we help someone who does not want the help?
Their kids keep saying we can’t make them do anything- yet. But when is that yet? How will we know? My wife is their HCP and my sister-in-law is their financial POA.
We don’t want to wait for an accident to happen.
And also we don’t want to make things worse. I would love to have them in an apartment near us, we are also near many hospitals, senior programs, family & friends. But our MIL wants to wait until they possibly will have to go to Assisted Living.
We are at our wits end. Any advise?

Thanks for listening.

WIGO23 · December 2023

I am sorry I have no advice to offer. We do have a friend who went through a similar situation though. The family did an “intervention” as a group with the reluctant Mom and better decisions were made.

fmb · December 2023

Can you get your FIL's doctor to discuss this with them? They can explain how unsafe it is for FIL to continue to live in their current home and appeal to MIL's love for FIL to help keep him safe by moving. It was a wise, insightful doctor who convinced my DH to move to a care facility when I could no longer safely care for him. Is your sister-in-law (the financial POA) familiar enough with their financial situation to show them how to make things work financially? DH was adamant that we could not afford a care facility until I crunched the numbers and showed him exactly how we could make it work without reducing me to poverty. Even if you can get only your FIL on board, it may tip the scales toward both of them moving.

amishamy73 · December 2023

Merry Christmas to you. My advice is to be the "bad guys" and see if you can make some moves. Like another commenter said - get a doctor involved. Otherwise more often than not it is a tragedy that winds up making the change/decision for them. And that compounds grief with trauma. Best of luck to you & your family.

Emily 123 · December 2023

Hello sametal,

You and your wife are spending a lot of time with your in-laws, and that lets them preserve the illusion of independence. It may be that FIL has to be the driver here, since I'm assuming that the POA's for MIL aren't active unless he passes. In that case you may indeed have to wait it out until a fall or something else helps expedite a move.

At their age you might want to see if monthly rental at an AL (that has a good MC on site) would make more sense. Not trying to be gruesome, but the older they are the less ROI they may get from a CCRC, given the price of some buy-ins. Either way, it really sounds like at least mom needs to be in assisted living, and it would be easier to get her her moved in somewhere while she can still develop a routine. While not definite, I suspect that if you move them to independent living you will be looking at another move to meet their increasing needs. (Also-if MIL is having memory issues, a move into a new place when she can't retain a memory of the move, the new home, or new people will increase her needs for support.)

It also sounds like MIL has anosognosia, which isn't unusual. It's an incapacity on her part (due to the disease) to recognize that she's having problems. When this happens, it's important to understand that the disease has progressed enough that she isn't retaining current information. The memory she's drawing on to make decisions may be at least several years old. In that case she'll see no need for help for herself or your FIL--several years ago he didn't need grab bars, etc. Her reality is not current, but it is very real to her. Knowing that, often the best thing is to de-escalate the situation by stopping all discussions around the changes you see, or trying to force her to understand that she's having problems. She cannot see the need, that ship has sailed. Because the disease affects more than memory, her judgement, reasoning, emotional control, and executive ability will also be affected.

1.) Trying to reason with her is ramping up her resistance and making her angry. This makes it harder on the family. Don't argue with her. The goal is to make the move happen using whatever reason she'll accept, not make her see reality (she can't, anymore).

2.) She isn't going to be able to make logical decisions, and so the family will have to come up with plans while allowing her to think she's in control. Tricky, but can be done

Have everyone step back and look down the road in a year or two--where do the in-laws need to be at 90 and 94? I'd say in a supported environment.

You might be able to get her to the doctor by fibbing that an office visit is a new Medicare requirement, making sure that the physician knows in advance that it's for a cognitive assessment--list the behaviors you see, share your concerns about how it endangers your dad and that she's likely not able to be an efficient primary caregiver.

These helped me--please share with your family if you think they might help!

Understanding the Dementia Experience:

https://www.smashwords.com/books/view/210580

Tam Cummings assessment tools/AD checklist

https://tala.org/wp-content/uploads/2019/04/Tam-Cummings-LLC-Handouts.pdf

Tam Cummings-Stages: https://www.youtube.com/watch?v=tansVVDM0fE

Teepa-10 early: https://www.youtube.com/watch?v=pqmqC-702Yg

Teepa-multiple videos: https://www.youtube.com/playlist?list=PL2E2lPBsUeBjA1Utglo8q6yANAijEf8cX

5 other losses besides memory: https://www.youtube.com/watch?v=awBm4S9NwJ0

Anosognosia https://www.youtube.com/watch?v=5nw3YUDQJuY

Careblazers-How To Convince Someone With Dementia They Need Help: https://www.youtube.com/watch?v=ncKhXQtnyfI

Careblazers-5 mistakes to avoid: https://www.youtube.com/watch?v=rO50pVUOlbE