FMIL was diagnosed with S4 non-hodgkins (rare subtype) in September. FFIL suffered a hemorrhagic stroke in November. They are both in their 70s. There are no memory issues.
Since then, they have gone to the ER on almost a weekly basis. Both have had repeated UTIs that did land them in the hospital. They are now both periodically incontinent.
They have hired a night/weekend indy, and they made Brother's Wife the day-shift person/manager. Most of the falls/wet diapers/etc. happen under the family member.
SO talked to his dad's rehab caseworker, who believes it is imperative there be another person on days besides the family member. But neither Brother's Wife nor they want to hear it so we can't do anything.
A lot of people have been involved for way more time here, and there are people who do this professionally.
If you're one of them, how long do you estimate it'll be before they need more help in-home or elsewhere, and what are the signs that this needs to be acted upon?
My step MIL was diagnosed with stage 4 Non Hodgkins Lymphoma about 18 years ago, she was in her early 50's and died earlier this month from a different cancer. My Uncle was diagnosed with the same last month and at 83 has been told he will not live out 2021.
My Dad had a massive stroke 5.5 years ago. I got the call, the doctor's did not think he would make it. He is alive and well at almost 92. Dad is getting frail, but does his exercises daily, and is only up to one or 2 outings a week, and it takes 2 days to recover.
As far as signs go, each care giver will have their own breaking point and or boundary beyond which they can/will no longer provide care.
Some examples:
Parent can no longer physically navigate their home.
Incontinence
Behaviour changes
ADL's are no longer managable
24/7 care is needed.
Caregiver burn out
There are more, each situation is unique.
Then there are people like me, who refuse to provide any degree of hands on care or provide any funds to my parent's care. They have plenty of assets to pay for their care.
I see so much frustration from people who say their siblings/other family members aren't helping.
All I can say about that is we tried. We used to spend the night there. The thing is, Brother's Wife is extremely bossy. She's also the only family member getting paid (she gets about $65K annualized) but when it comes to her own PTO or needing an extra hand to help one of them into the car, she'll call last minute seeking volunteer help as it's "just for a minute."
Yesterday, SO cashed out his 401(k) early as his unemployment will soon end. After that he had to prep for an event with his top job prospect. He has told his parents, and DIL, that this was coming for a month.
He went over there shortly before noon to relieve Brother's Wife for her medical appointment for an hour. This turned into DIL demanding that he perform or assist with half her shift. Meanwhile, he had to go cash out his 401k early and prep for an extremely important job interview.
DIL's reply was, "So did you GET the job?"
FMIL herself had to step in on that one.
So with the siblings/family member situation, it's not always that other family members are just being inhumane or selfish.
So Bossy Britches Brothers Wife is paid 65k by HIS parents to caregive & oversight of other caregivers, is that right? $ 65,000.00
Just how is she - let’s call her BB - being paid?
Is BB working under a drawn up by an atty caregiver contract & with full FICA, IRS, state filings done? BB does time sheets for hours of work performed? Payments match up to invoices BB submits to her inlaws? Someone other than BB or her husband writes out and signs the checks for BBs 65k? Is BB getting other in kind benefit by being their caregiver, like she drives her in-laws cars or uses their credit cards?
Who is DPOA for your future in laws? Is it BB or her hubs?
Just how much $$$$ do you think your inlaws have?
Do they have fully paid off home very well maintained & combined income of $3-5k a mo (like SS $ plus investment $ or other retirement $ each mo) and have 700K-1M available liquid? There’s 2 of them, they are going to ea need 24/7 oversight. Whether this is inhome or in a facility it is horrendously expensive. Right now BB is $5400 a mo plus whatever else is paid to other caregivers. If home health agency is getting hired in addition to BB this should be easily $20k a mo if it’s legit agency being used as there’s 2 of them. The average NH stay is 2/2.5 years so if we used that as the standard for being alive and needing help.... do your future in-laws have 750k to private pay for all this plus pay their regular property costs???
If not, they are going to need to apply to Medicaid for care either for LTC in a facility like a SNF or some cobbled together inhome care between Medicaid and private pay. Medicaid not Medicare.
Medicaid is going to require 5 years of future in law’s financials. That 65 large paid to BB will be considered “gifting” and make them ineligible for a period of time for Medicaid unless Whomever is stuck as DPOA is able to document legit contracts and FiCA for payments to BB. Ditto for any other $ that seems to not have direct benefit to in laws. Like if they paid for stuff for grandkids. Medicaid caseworker will have bank statements and all other financials, it’s easy to look for stuff that flat doesn’t add up.
I’d be real REAL concerned that BB is well aware of Medicaid rules & 1 of the reasons she’s so defensive on time & $. And when the sh*t hits the fan in caregiving for both of the future in laws as their needs gets way way beyond what family can do, that BB will bail, leaving you & your SO and other family to deal with all this.
If they don’t have serious serious cash on hand $ right now, if they live long enough they will run out of $, family will run out of ability and elders will file for Medicaid. And their application will be huge red flags for the caseworker. Put on your best Veronica Mars and start to find out just what their finances are. You don’t want to get stuck with all this; you don’t want your future hubs to get stuck with this if at all possible as well either. This site is littered with bad siblings & their spouses who view their folks as lil cash registers and then exit when Medicaid is filed (as the last resort) and the good sibs are stuck with a transfer penalty for $ elder gave to the bad sibling & their spouse. Just word up to you, ok.
They aren't just paying bb for days. They are paying an indy for nights and weekends--which comes to $105,520 annualized for the aide for over 120 hours a week. They are paying her over the county minimum for her time, but are frankly ignoring SS, Medicare and other tax obligations let alone state wage rules, which include at least a half hour on lunch (which is unpaid). Which include 15 minute breaks every two hours on the clock. Which include time and a half after 8 and double OT after 12. Seriously, she spends six months there, she's an employment lawyer's dream if she decides to sue.
They are multimillionaires who can pay for whatever they want. Money isn't the issue with them.
The issue is the Brother's Wife, who's assigned herself to be their Pit Bull/Martha Stewart. She can't handle diapers, esp on a male. Let alone fall risk. The SIL is like this martyr type who's like "I'LL HANDLE IT" because, after all, this has been the first f-t employment let alone position of authority for her anytime in the 21st century. At least.
What'll happen is a crisis, maybe dual, involving syncope or falls or something else sooner or later, probably sooner with SIL.
The day FFIL came home from stroke rehab, for example, his two sons had to lift him at which point SO noticed a gigantic wet spot. SIL's position? "He has a Depends on."
See the problem? I don't have kids but at least I babysat enough to know if it's leaking it needs to be changed.
I'm not part of this bio family, but I understand that an elder might not want to be changed by a daughter-in-law, especially if she doesn't even do it when it's obvious.
And, SO's already seen that his dad can't get up. He crashed into an end table when he tried and narrowly missed the lamp, b/c SIL was off on one of her personal errands and expected SO to be there early.
SIL is 65, has been a pack-day smoker for half a century, and is clinically obese. No way is she going to be able to pick him up after a fall like so did four days ago.
So bluntly, I'm just waiting. There's nothing else to do, really, until they want to listen to SO, or their aide, or someone other than her.
She did go into remission for five years. When the cancer returned it came back with a vengeance. No one can predict the future.
As has been said before, one of the first issues that the WHOLE family has to understand is the financial issues that may or may not be looming. Igloo572 nicely laid out things that need to be addressed so that people can make good decisions on care for your In-laws. Payment to your sister-in-law MUST be done legally or not only do are you potentially in a situation where the medicare look-back is looming but it also impacts gift filing paperwork for IRS.
My other question is why the rehab counselor thinks there needs to be an additional caregiver on-site when the brother's wife is in the home and supposedly providing care. Do they need actual medical care that she cannot provide? Do they suspect that appropriate care is NOT being given? I think that anytime there are weekly ER visits that is a big red flag that something is not working.
My advice is to have a family meeting using the rehab counselors insistence that there be additional help as the excuse for the meeting. If possible have a professional mediator and a real agenda to keep it from becoming a shouting match with the bossy sister. Make certain to include the financial implications of their long-term care and get everything out in the air. What is currently happening is not sustainable for the long term and they could live a very long time. Your sister-in-law is not likely to want to give up or share her $65K to get the necessary help.
Your final question was how long do I estimate before they'll need more help and I think that the answer is that they already DO need more help. You've had a professional tell you they need more help. Your sister-in-law asks family members to provide help on an ad hoc basis. If you didn't know the answer to this question you wouldn't be here asking it.
That rehab counselor probably is a mandated reporter. Weekly accidents might could happen. But constant accidents and regular ER runs suggest something is seriously amiss. Especially if there supposedly is a caregiver getting paid 65K who should be doing oversight of other caregivers. If someone is a mandated reporter there are going to have to report their concerns to APS. Plus intake RN & ER doc at the ER will notice the pattern too and they too are mandated reporters.
Sissy BB may have already has a talk with rehab counselor & hospital staff on their concerns and why she’s defensive.
(one of them will be posting in a few months wondering why no one is helping!)
If the brother is POA or the parents are cognizant this is their decision.
Is suggest that you step back.
You can support your future husband.
What you can do is make your feelings known to your future husband. Will you be willing to "take a shift" when it comes to caregiving? If necessary would you welcome them into your home? If this is even a remote possibility you need to tell your intended what you're willing to do. ("hands on" caregiving or have parents pay for a caregiver?)
I am also guessing that the thought of Assisted Living is out of the question so the above may be a reality at some point...
At the beginning, "we" were supposed to go over overnights, seven nights a week, according to Brother's Wife. SO went to his mom and said, look, I'm unemployed and need this to be my job. Mom agreed and also said she'd pay DIL for her time.
DIL didn't even ask me if it was cool to volunteer that kind of time, which it isn't. So I told SO I'd be going over maybe every 2-3 days.
DIL proceeded to tell SO that he had to take over all of her daytime shift so she could have a break, without offering him a reciprocal night one. Oh boy, did the f-bombs fly on the phone fight, and I had to take the phone over and say to her look, both of you can't work a combined 168 hours a week, some overlapping, without a respite person in there.
That night, I told FMIL what was going on. She had a giant hissy and next day reported it to SIL. SIL got infuriated and assigned it to Brother to tell SO to tell me that I'd been inappropriate in bringing up the home care discussion. SO told his brother to fk off for probably the first time in 15 years. SIL promptly persona non grataed me for that offense, did not sign me up for the lift training, and therefore I am out of it.
Thankfully.
SIL royally screwed up with the family she grew up with. None of them speak to her now. She's kinda like how grandparents are with their grandkids when they don't have to raise them.