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My mom has dementia and has had a couple falls that have taken her to hospital. After each time my brother and I were told she needs 24/7 care. Neither of us live close to Mom. My brother, who has POA, has hired someone to come in mornings to clean her and get her food and meds. Then recently added an evening check. For most of the day and night mom sits in front of a TV. I believe Mom’s social security money pays for this help. She’s recently fallen at least twice since last hospitalization and needs 24/7 care. I do not understand why he doesn’t sell the house to provide money for this type of care. Any advice on how to convince him that Mom’s living condition is not safe and she needs around the clock care?

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As it’s your “sister in law that actually hires them and coordinates my mom’s care”, could you go out with SIL for the coffee and chat about the future, next time she visits? It would almost certainly be best to find out where she stands (and from her more about brother’s ideas) before you report the whole thing to APS. That's quite an aggressive move, last option rather than first option.
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Is mom sitting in her waste between times caregivers come in or is she capable of cleaning herself? Is she wearing a pendant that alerts family members or emergency services when a fall happens, or must she just lie in the floor until found? Is she prone to wandering? Can she be trusted to not make mistakes with her medications? Or a stove? Or trying to bathe alone? There are endless possibilities for harm to happen if you’ve been cautioned she cannot be alone. If your sibling won’t listen, call Adult Protective Services and let them know what the medical professionals have told your family needs to happen. Your sibling is being short sighted and selfish, time to help him see the light
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You won’t convince brother of anything because he obviously thinks he’s doing enough. Call police and ask them to do a welfare check. If that doesn’t produce the right agencies to take care of her, call adult protective services. Express your concern for mom.

She needs to be in a care facility. Don’t even think of moving her in with you. Caregiving is very difficult.
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These conflicts with siblings are so depleting.

For your consideration:

Falls are terrible but may not be the worst thing that can happen to a person.

You write: "But for most of the day and night Mom sits in front of a TV." That's basically what she'd be doing in a facility. (I know there are "activities"; but unless it's an especially good facility these are likely to be silly or just not a good fit. Not all older people are the same. The "activities" my mother was offered in an SNF were absurdly inappropriate.)

What about borrowing against the house to pay for the care? Maybe current rates make that not a good idea... Much depends on how long the money needs to last. 

If brother is trying to preserve an inheritance, you are right to object. But yanking mom from her home might not be the kindest option either. Unless you're certain brother is motivated by greed, maybe try to hear him out. There might be some sufficiently-sustainable way to draw income from the house to fund more home care.

But it does seem to be poor strategy to deplete all assets if this is heading towards Medicaid, since apparently it's easier to get into a nicer place (one that allows a transition to Medicaid) if one begins with private funding.

Other folks on this forum know this stuff better than I do. And of course I don't know the specifics of your situation.

Good luck to you.
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Birdie12345 Nov 9, 2023
Thank you for your response. I did not know about the “easier to get into a nicer place” with private funding and then transition to Medicaid.
My mom has always said she’d never forgive him if he put her in a nursing home so I think guilt rather than greed is the motivating factor. I’d be happy if he found a live in person to care for her or just hired a team for 24/7.
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"My mom has always said she’d never forgive him if he put her in a nursing home so I think guilt rather than greed is the motivating factor."

Are you on good/ok terms for phone calls or visits with your Brother? Go out for coffee for a chat? A relaxed, non-judgemental discussion on what's up.

Being curious to your brother's motivation & point of view may uncover things?

Maybe he could get curious to your motivation & point of view too??

Like you, I was battling for more assistance & supervision - but other family members were opposed.

My motivation was to increase safety (they viewed this is restrictive).

Their motivation was familiarity (I saw avoiding change - even denial).

They wanted to promote free choice - I saw decision making powers were .. dodgy.

I still wish to plan for the next stage.
They still wish to just plod on.
Planners vs Plodders.

However, despite coming from polar opposites we did both agree on *staying home as long as possible*.

Birdie, maybe you can find common ground also?
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Birdie12345 Nov 15, 2023
Beatty,
I really liked how you described Planners vs. Plodders. I’m definitely a Planner and my brother is a Plodder.
Thinking about it this way is helpful but I see so much that can be done to improve safety and when I mention it the response was “thank you for your opinion”. Sigh…. I’ve been shut out of all decisions regarding my mom. I should feel blessed I can at least still be allowed to visit her. Of course when I do visit all care takers are told not to come and I’m expected to do the caretaking. This angers me not because I I don’t want to care for my mom but because I had no say and when I leave there isn’t someone there which makes me feel like I’m abandoning my mom. Again to me the decisions made are irrational. I do however take the liberty of doing things like installing hand rails for the stairs, unplugging the oven, and installing safety latches.
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Calling APS is the nuclear option. It will END any relationship you have with your brother and his wife. Things will get ugly and no one will benefit.

That said, why not call your SIL and talk to her? I think cameras are a good idea. There are cameras that allow you to talk to the person and listen to their response.

Does your mother use a walker? What medications is she on? When was the last time she had her meds reviewed? As people age, some meds need to be adjusted to lower dosages. This is all to say that there are many questions you can ask your SIL that will enable you to have a conversation with her. You want to be able to have conversations with your SIL as your mother's needs are only going to increase!
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Tell him that the two of you should visit and assess how this is going, that the medical team believes it is no longer safe and that offhand you share that. That if he doesn't agree with you that placement is needed, and it clearly IS needed, you will be forced to contact APS and may have to seek guardianship if Mom is no longer competent in her own decisions, so that she can safely be placed.

He is POA. If he doesn't agree with you, then you may need to seek the advice of an elder law attorney. First step is an honest BEING THERE assessment of how Mom is doing. Falls aren't the only indicator, as elders WILL fall, wherever they are. But if you are THERE you will have clear indicators I am thinking.

I hope you will update us on your worrisome situation, and I sure do wish you the best of luck.
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Wow! What a tough situation for you to be in. I’m so sorry. Your hands are tied since your brother is mom’s POA.

Has your brother seen your mom with his own eyes lately? Could you suggest that he make a visit to see her in person?

Or at the very least have cameras installed so that he can see moment to moment what is actually going on.

Living far away certainly does make this situation harder for all of you.

How much contact does he have with the caregivers that have been hired?

You would think hearing news from a hospital staff would convince him to make plans for your mom’s future care. Has your mom ever gone to rehab after a fall?

What do you think his reasons are for not wanting to sell your mother’s home to help with paying for care in a facility?
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Birdie12345 Nov 9, 2023
My brother was the one who found my mom with her last non-hospital fall a day ago. I only know this because the caregiver told me. I can only talk with my mom if I call during a time a caregiver is with her because she no longer knows how to answer the phone. I live 3 time zones away so I have to call very early in the morning for me.
After each hospitalization (2x)she’s gone to rehab. After fall 1 (18 month ago) they advised 24/7 care. After fall 2 (2 months ago) they not only said she needed 24/7 but strongly advised it be in an AL.
My brother has very little contact with the caregivers. It’s my sister in law that actually hires them and coordinates my mom’s care. They own a home nearby that they stay in when in town but my brother’s job is 1000 miles away. So my sister in law travels between the two homes more often than my brother.
You are very correct when you say my hands are tied. For about five years I have tried to be a part of my mom’s care but have been shut out. I tried to get mom to move close to me and even arranged a month in an independent living facility as a trial run (three years ago). My brother said I had to send her home. When I said I couldn’t send her home with no help he said he’d get help. Sadly, she now needs that help to increase to 24/7 not a couple hours a day.
Hence I thought asking for advice in this forum might be helpful as I know others have difficulties with aging parents.
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Hate to be cynical, but he’s trying to keep the house as an inheritance. Alas, she should have put the house in a trust a long time ago. Or, he could be playing the “good son”, and doing exactly what Mom tells him to do, and being conveniently oblivious to reality. Something’s gotta give, and it will eventually. Oh that thud when the other shoe drops.
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Report this situation to the local authorities. They will investigate the situation and may remove POA from your sibling. The courts could appoint a guardian ad litem -not you - to manage her affairs.
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