Elder Care

People care , of course , must include elderly people . The word "elderly" triggers a train load of definitions and cultural references . Mick Jagger sang "What a drag it is getting old !" . I , for one , am looking forward to it . What is the alternative ? Die young and make a good looking corpse ? I am already past that stage . Might as well follow through with it . So , while we permies are planting our food forests and envisioning the first forest crescendo fifty years in the future we had best envision our human forest through the generations also .
A food forest or any sustainable project must by definition become intergenerational . The real yields with minimal inputs will be achieved by our children and grandchildren . Will they want to stay and continue our efforts ? Are we making that attractive to them ? Will your kids want to care for you when you are aged and less productive ? How will we care for our parents ? What kind of world are we making for ourselves to age in ?
At this present time our societies default system for an aged parent is the nursing home . Keeping an elder at home can be exhausting and impossible without a team effort from the extended family . By the time we reach middle age we our up to our necks in careers and income production . We cannot stop our overly busy lives without going bankrupt it seems . Obviously permaculture speaks to that . We will need wiggle room in our most productive decades in order to keep Mom and Dad within our own circle .
I believe I have something to share with you about this topic . I have been a long term care nurse for nearly 23 years . I know of some fine alternatives to the traditional nursing home . I would like to read of your efforts to keep your parents and grandparents well at home or integrated into the social fabric . What does your culture believe about aging and an elders place in society ?
The society we create today is the society we hopefully will grow gracefully aged in . The problem is the solution . Logically therefore , aging must not be a problem but a direction for all to go purposefully and fearlessly . What says you ? Onward Crew !

I and others have touched upon this dilemma under "aging in place". What your talking about is something which is derived from a culture's soul. Unfortunately the United States doesn't have reverence for the elderly as part of it's foundation. Here is an excerpt from a recent Bill Moyers program,interviewing David Suzuki:

BILL MOYERS: Don't you think that we hope to grow old but dread old age?

DAVID SUZUKI: Well, yes. I mean, no one, I called myself an elder reluctantly. But having seen the role of elders in First Nations communities, it's something that I now feel very proud to say I am an elder. Elders in a First Nations community, go to a feast or an event, when an elder walks in the room they're like rock stars, you know. They're the repository of all of that long traditional knowledge that's been again hard won over thousands of years. And that is passed on.


Contrast that with our main modern concern about aging - economics. People are worried about being able to afford the nursing home (if needed), let alone even beginning to think about what it,the nursing home, symbolizes and says about our society.

It's good you bring this topic up. It is a long evolving process which involves a sense of community and deep understanding of place as well. It will take more than a few generations to begin to take root here. If we don't strive to move the discussion into the realm of public discourse there won't be much of a chance for aging to gain true value.

As Wendell Berry was asked ( in a interview with, I think, Naomi Klein) about how do we Americans who live so much through our computers find true home. His reply was to find a place and begin the thousand year process.

This is one of about a million things which has drawn me to permaculture. Let me sound incredibly conservative here for a second. I think that the dissolution of traditional family structure has had major often negative effects on our society. I really don't like the idea of fragmenting family and outsourcing the responsibilities to others. From raising kids to taking care of elder family members. Its these sorts of social bounds which I believe have largely defined us (and many high order mammals) as a species. And I think it has been to our detriment that we've outsourced these and in effect estranged ourselves from our families, clans, and natural life cycles and basically turned quality of care into a commodity.

My mom lives just up the street*. And while she is still in her prime, each year the ages roll and she is less and less able to 'do everything'. For me being within walking distance to help out whenever she needs wood split, heavy lifting done, her dog watched for the weekend et cetera is a high priority for me. She certainly isn't in possession of a vast fortune which would make her capable of hiring a pool of servants to do it for her. And whenever I have a surplus of eggs or get a major score mushroom hunting she is always the first beneficiary. Nutrition is important to aging well I believe.

So I live where I always have lived and try to take care of those who have always taken care of me. This seems so simple and it seems like a model that has trationally worked and been successful, but in modernity the powers that be .... (rant rant rant rant rant rant rant)

Anyhow - This seems SO COMMON SENSE to me. I am shocked how many mechanisms our currant 'culture' has put in place to make this sort of thing excedingly difficult. In part, I think, of what has been a pretty successful (and detrimental) attempt to monetize everything.


Edit: *Our properties are actually contiguous, I can get there without even using the public road

A quandry awaits those of us who have chosen to live and heal ourselves outside the norm . Those choices we make may not be available to us if we slip into a delirium or become mentally feeble . Do you prefer to heal yourself with herbs and food ? Actually those choices are not readily available to cognitively impaired adults . Medicare and Medicaid , most or all health insurance companies do not pay for those alternatives . No long term care facilities offer wholistic treatments or diet . Your loved ones may be accused of elder abuse by withholding conventional treatment from you .

Here is a sample of an Advanced Directive . I have seen many of these , this one is very thorough . As you can see , it offers little in the way of communicating a desire for alternative medicine and therapies :


I, _____________________________________________________________, write this document as a directive regarding my medical care.

In the following sections, put the initials of your name in the blank spaces by the choices you want.

PART 1. My Durable Power of Attorney for Health Care
______ I appoint this person to make decisions about my medical care if there ever comes a time when I cannot make those decisions myself. I want the person I have appointed, my doctors, my family and others to be guided by the decisions I have made in the parts of the form that follow.

Name: ______________________________________________________________________________

Home telephone: ____________________________ Work telephone: _______________________

Address: ____________________________________________________________________________


If the person above cannot or will not make decisions for me, I appoint this person:

Name: ______________________________________________________________________________

Home telephone: ___________________________ Work telephone: ________________________

Address: ____________________________________________________________________________


______ I have not appointed anyone to make health care decisions for me in this or any other document.

PART 2. My Living Will
These are my wishes for my future medical care if there ever comes a time when I can't make these decisions for myself.

A. These are my wishes if I have a terminal condition
Life-sustaining treatments

_____ I do not want life-sustaining treatment (including CPR) started. If life-sustaining treatments are started, I want them stopped.

_____ I want the life-sustaining treatments that my doctors think are best for me.

_____ Other wishes _________________________________________________________________________

Artificial nutrition and hydration

_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.

_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.

_____ Other wishes _________________________________________________________________________

Comfort care

_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.

_____ Other wishes _________________________________________________________________________

B. These are my wishes if I am ever in a persistent vegetative state
Life-sustaining treatments

_____ I do not want life-sustaining treatments (including CPR) started. If life-sustaining treatments are started, I want them stopped.

_____ I want the life-sustaining treatments that my doctors think are best for me.

_____ Other wishes _________________________________________________________________________

Artificial nutrition and hydration

_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.

_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.

_____ Other wishes _________________________________________________________________________

Comfort care

_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.

_____ Other wishes _________________________________________________________________________

C. Other directions
You have the right to be involved in all decisions about your medical care, even those not dealing with terminal conditions or persistent vegetative states. If you have wishes not covered in other parts of this document, please indicate them below.

__________________________________________________________________________________________

__________________________________________________________________________________________


PART 3. Other Wishes
A. Organ donation
_____ I do not wish to donate any of my organs or tissues.

_____ I want to donate all of my organs and tissues.

_____ I only want to donate these organs and tissues: ___________________________________________

_____ Other wishes _________________________________________________________________________

B. Autopsy
_____ I do not want an autopsy.

_____ I agree to an autopsy if my doctors wish it.

_____ Other wishes _________________________________________________________________________

C. Other statements about your medical care
If you wish to say more about any of the choices you have made or if you have any other statements to make about your medical care, you may do so on a separate piece of paper. If you do so, put here the number of pages you are adding: _____________

PART 4. Signatures
You and two witnesses must sign this document before it will be legal.

A. Your signature
By my signature below, I show that I understand the purpose and the effect of this document.

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________

B. Your witnesses' signatures
I believe the person who has signed this advance directive to be of sound mind, that he/she signed or acknowledged this advance directive in my presence and that he/she appears not to be acting under pressure, duress, fraud or undue influence. I am not related to the person making this advance directive by blood, marriage or adoption nor, to the best of my knowledge, am I named in his/her will. I am not the person appointed in this advance directive. I am not a health care provider or an employee of a health care provider who is now, or has been in the past, responsible for the care of the person making this advance directive.

Witness #1

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________

Witness #2

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________



Obviously , this standardized form will need a little tweaking to assure you continue recieving your prefered treatments while temporarily or permanently impaired .

Many , many elderly people live their lives at home either independently or with family . However , the vast majority that live in nursing homes are there due to functional losses , not advanced medical problems . They need assistance with transfering from chair to bed , bathing , eating , incontinence . Families {or intentional communities} could certainly learn these skills in no time . Though ,as I said above , nursing homes are still the default choice available when a person is no longer able to care for themselves . These institutions are very generic with little variation in their models . Very little .
In the 1990's Dr Bill Thomas created the Eden Alternative . This was a model to change the psycho-social enviroment of nursing homes . There is no funding for this , and the nursing home can not be reimbursed for these changes . The model is inspiring but has not produced a revolution in nursing home enviroments . Here is a link :

http://www.edenalt.org/about-the-eden-alternative/

The Eden Alternative is a way to restructure existing conventional long term care institutions . Dr Thomas then created the GreenHouse Project . These facilities are the Eden Alternative built from ground up . They do not resemble a nursing home in any way . In architecture or management . They are intentional communitities for the aged . Here is a link to the wiki page :

http://en.wikipedia.org/wiki/Green_House_Project

And the youtube video :

https://www.youtube.com/watch?v=l4Ap1ByNgKE

If you tour a conventional nursing home for the purpose of placing your eldered parent or for yourself you will be greeted by an admissions coordinator who will steer you through the facility . That person will be promoting the services available and hoping you choose "us" . I am not condemning the nursing home as it is . It is an institution that presently provides a place that the rest of society does not seem to be stepping up to. However , a conventional nursing institution is an institution at best . A trade off occurs between the individual and the institution . "We" will meet many of "your" needs but "you" will have to surrender a portion of "your" individuality to the institutional process . This frustrating process begins from moment one upon entering the facility . Most people react to any insane enviroment in which they have no control over by becoming depressed , anorexic , agressive , agitated . The default method for dealing with these personality changes is to medicate the individual not change the enviroment . However there are a few shining stars { as in my post above } trying to create institutional changes .

Naomi Feil is a social worker who created Validation Therapy . A system of communicating with cognitively impaired / demented individuals with the intent to enhance their life . As opposed to making it easier for the institution to cope with your reactions to it . Here is an example of her at work:



Then a program using ipods to stimulate the mind and memories of a an elder obviously reacting to the effects of institutionalization :



Carry On , Crew !

I love the idea of taking care of elders in our homes but I do not condemn institutions either. My dilemma is that even though I would like to take care of somebody's parents, I sure wish I didn't have to take care of mine!

This is a difficult subject for sure, but I think in considering elder care options it would be unwise to forget that some people are abusive/ manipulative/ suffer from various mental disorders (that they may not even want to admit themselves) that make them extremely difficult to get along with even when they are young and possibly doubly so when they are old. But these people need to be cared for too. The question is: by whom? Their children may have struggled to get along with them all their lives and when things get even more difficult, they just can't deal with it any more. I'm myself about to reach this point. So sadly I think I'm about to come to the conclusion that I cannot live up to what I consider to be "ideal elder care".

Unless I could change the elders that is

I love the idea of looking after my perents however... My dad is obese so if his mobility goes I literally couldn't lift him. At all. No way.
Mum and dad are devoriced. Could I put them back in one house to look after them? Doesn't seem like a good idea...
My mother is a city girl who needs lots of social interaction... Do I ship her out to the farm to live with me in realitive isolation?
Both my parents have made the very serious request  that I help them kill themselves if they lose their mental faculties. I know if I put my devoriced elderly parents together in a house in the country they would both be insane in very short order.
Mum has complex health conditions that need regular doctors and hospital visits. Should I move her further away from her health care team?
Its a complex situation that I don't know a good answer to

No kidding!
Several times here in India I've heard people go on and on about how in the West people just boot their elderly parents to the curb or shunt them heartlessly to institutions, or how horrible it is that the elderly live alone and not with their adult children and grandchildren etc. It is so hard to explain that.... Often in the west, elders WANT to live alone because to move in with their kids would make them feel they were incapable --- and that so many elders are so difficult for various reasons mentioned above, or due to intense health care, they are living with more difficult care needs than a regular family or individual can provide (and Alzheimers and dementia don't seem to be known of as a thing of old age here). In India it seems verboten to say that one's parents are less than perfect, especially in permies. In private, I know many people who have various difficult histories with one or both p
arents, or as mentioned above, a manipulative or passive aggressive or just plain nasty parent. Etc etc. As with so many things in life, it's much easier said than done.

I have been lucky in the parent and in-law department, all were nice people, and aside from one illness, I was never called on for caring for an elder. But phew, I sympathise with those of you who are dealing with a difficulty!

So much of it is just cultural. I would like to take care of my parents eventually, but they don't want that. They have extensive long term care insurance, so that's that. My oldest child and I are buying property together, we will each have our own house. To me, this is the best of both worlds, together, but not too much. Despite being American, I don't like the way things are done here. I like more connection between extended family. Currently, all of my adult children still live with me. My oldest gets grief from others, judging her for living with her mother. She explains, we live together, it's mutually beneficial. Besides, the Bay Area is ridiculously expensive, most people live with lots of other people, family or not.

Anyway, I have made plans, so no nursing home for me.

We have yet to send anyone to a nursing home.

In the tiny home we are moving too, my Grandfather at age 72 breathed his last in the same home he breathed his first, my Grandmother and Great-Grandmother all breathed their last in that home, as we gathered around and said our good byes. It is just the way it is, when the time comes, we do the dreaded "death watch shifts", but such is life.

Sadly alheimer's runs in my family, but while I "babysat" my Grandfather as his mind failed to the point it could not support his body, I try to remember him the way he was, 10 years before he started to "get confused."

Even more sad is that my Dad just got the same diagnosis. It is a non-curable disease. He will never get better...it is fatal, and he is assured of dying of it. Yet as frustrating as it is, as we work on fixing up his old home (our tiny home...the family farmhouse), a house he was born in, he is fading. He cuts things 1/8 short, so every measurement I give him is 1/8th short. And some cuts are crooked that I either endure, or quietly fix later when he is not looking. I try to be patient because this is most likely our last project together, and while his sawing skills are questionable at times, the fact is, he can still use a saw safely. What he can do today he will not be able to do tomorrow, so we celebrate what he can do. It can be trying...when it took him 4 hours to wire a 3 way switch in the hallway, I quietly let him work through it instead of stepping in, as really it is like dealing with my daughters, threading the line between doing it for them, and being so stand-off-ish that they get frustrated.


My mother is not much better, dying slowly of conjunctive heart failure, just as my maternal grandfather did. But they have two daughters (my sisters) who have down-syndrome, so they will take care of my parents until their own special needs stops that, then Katie and I will step in and help out. We have to move because my sisters would be devastated and could never leave the only home they know. Its just how their affliction is.

Is any of this "fair"? No...I did not chose to adopt two down-syndrome siblings, but it does not matter. My parents made that choice, and my obligation to my family, to society...is step in and do my part.  Again it comes down to that backwards word: RESPONSIBILITY. It is backwards because I have the ability to care for my parents and two disabled sisters, and so...I will respond. That equals Responsibility

Travis Johnson wrote:I have the ability to care  and so...I will respond. That equals Responsibility

I also have the ability, even though, like you, I have my own problems (who doesn't?) . I have the ability to care for my dad with Alzheimer's, so I will.

Excellent posts and insights from everyone who has participated in this conversation!

I really respect Travis Johnson's way of elder care and that is exactly what I would like to do, but sadly don't think I am able to. Or perhaps I would be able to but what would be the cost of it to my mental health and thus my ability to be a hopefully-good-enough mother to my own children. I'm not sure.

The question of responsibility is indeed central to this discussion. I do feel like it's my responsibility to take care of my parents, but what about my responsibility to myself and indeed, my self-respect. I can't go into details here on a public forum and as this is a general conversation perhaps it would be a bit off-topic if I did. But the general point is that it's a difficult ethical dilemma, there are no easy answers and hopefully my case enlightens some of the difficulties.

I've often jokingly said (not because I think elder care is a laughing matter but because I find humour sometimes is the only thing that keeps me relatively sane) that I could swap parents with someone else whose parents are as crazy as mine. It's a joke, but there's still some truth to it: it is much easier to get along with difficult people who you are not related to. All the advice from various psychology/ self-help books I've read over the years seems to be so much easier to apply when there isn't the parent-child relationship on the background to mess things up.

I think part of the problem is the roles and positions we are caught up seeing ourselves in. From out society, they were picked up or applied for many different reasons, some not even having anything to do with life's realities. It may help a lot to try looking at the situation from different points of view - that is, try just for a bit, to lose some of the assumptions we incorporate w/out consciousness about what is moral, what is possible, what is proper, who we are, what is duty and what is ours...  I guess "who we are" would be the big one.

That's a little vague. How about this:  Authority plays a part in most "difficult" situations. How do you relate to authority? Exercising it? I think that is often a real stumbling block for children transitioning to equal-to and then greater-than their parents (in terms of immediate power, anyway). I'm not talking about authority being accepted by others (different topic), but rather one's own view of authority. As perhaps you can guess, my own opinion is that authority is _necessary_ and that _somebody_ MUST exercise it sometimes if all is go better than it might. I think for many exercising authority is _very_ difficult nigh on impossible to do because it disappears the umbrella of unthinking togetherness that soothes much pain and upset. The person in authority is alone in certain senses and that can be hard. Present public consciousness accessible to most people provides no roles, no good models, no good tradition, no underpinning for a person required to assume true authority. Well, perhaps  there is the military service which, while being an easy target for the morally superior, has traditions and practices and theory and understanding of authority the rest of this society does not. Mostly, authority in this society has little or no public tradition to personally aid people required to use it.

IOW, I think part of our trouble dealing with difficult people lies within ourselves, not with "them" and looking a little into ourselves may be a first thing to consider if we want to deal with certain inevitable life issues. It changes us to give up and grow up and that's not something most of us rush into willingly. We have to give up blaming the other. We give up trying to see through rosy glasses. We give up the pretense that the very best we can do isn't going to hurt somebody - it will, or at least they maybe won't like it in the loudest crudest and most violent way they can. When we assume authority, we reduce the number or people that we can look up to for "the right answer" - in the end, we're it. That's real hard, especially with "the parents".

You give up arguing with them. At some point, you need to manage the whole situation, including yourself and them. They're not your parents, not your friend, you're not their little child. They AND OTHERS are your responsibility. If we're going to try to speak in those terms. Although we are all many things at once, it's nigh impossible to keep a glowing holistic vision in place when struggling hard in the ruck and the muck. At some point we need to choose a path and proceed with as much hope and faith as we can. And a little help from our friends - _that_ one is BIG. We do our best and make a guess (choice(?)) and carry on, with some bit of "faith" that our best and truest sincere effort will "do good" or something like that, even though we can't see or imagine just how right at the moment.  In my experience, almost never will we know the true affects and wisdom of our actions, see proof, receive our "just vindication", etc. I think "faith" is, in the end, necessary.

Ah. Probably too much philosophy. Just a stab at saying sometimes it helps to look at root causes we can reach. I submit that our self conception, the one we _never_ think about or hold to light and can't imagine letting go of, can be one of those things which we can affect and and a look there might make many things possible.

Regards,
Rufus

I only have one parent left and if she goes the way of her mother, she may live to 95 or more. This would put me at 74.

My younger sister would only be 59 at that time. She gets along much better with my mother, partially because they share the same religion, and partially because my mother did a much better job with her younger children, than she did with the older ones. Although when I think of it, she had more help. I took Heidi and Jeff out all the time and it acted as their uncle. My other brothers and sister took up the slack when my mother was too busy with other things.

I don't think there's anything wrong with making a judgement of how good a parent was, and then dealing with their care as elders, accordingly.

My mother has some assets, so she's not going to be a financial burden. I would totally support seeing a much larger share of the inheritance, go to Heidi, if in fact she ends up caring for my mother. I'm sure that at least two of my brothers would be so keen to get their hands on the money, that they might not see this the same way that I do. My mother is of sound mind, so much as anyone in a religious delirium can be, so I've been encouraging getting something written down.

As the population ages, people who have looked after themselves physically, could easily outlive their children's ability to care for them. I met a nice lady at the Oak Bay Rec Center who is 103 years old. She's a regular. I inquired as to whether or not she takes the bus. There's no need for that, her 81 year old daughter goes there every day with her. But there are things that this daughter can't do, because of limited strength.

And here's another type of Elder Care. I am the healthiest one in my family, for my age. I expect to outlive my two older brothers, and several of the younger ones, because I haven't lived the way that they have. It is quite likely that one brother who is 9 years younger, will fail either physically or mentally, before I do. Again I come back to a simple value judgment. Has this brother done anything to bring this upon himself? He certainly didn't have anything to do with raising me. I changed quite a few of his diapers, but now he's headed toward being an old man, as fast as he can go. I don't believe that I have any responsibility to look after him, and since he has no assets and I seriously doubt that he ever will, he's going to be a burden on somebody. I think it will fall to the provincial government. And that's what happens in later life, when you've made a lifetime of bad choices.

I don't expect to become a burden on my daughters. And I don't think they would find checking in on me to be a burden. I don't think I will be one who fails mentally, since that hasn't happened with my parents or any of the grandparents. There's been no alcohol, drugs, obesity or other predictive factors for that in my life. But I suppose it could happen. If I get to that point and I am still functional enough to realize what's happening, then I think suicide is the best option. We have legally assisted suicide in British Columbia, so I guess we will see where that leads in the following decades. But I would really hope to be in a position to do it by my own hand. If it were publicly administered, I would prefer firing squad or hanging, but so far they've got much less theatrical options available. And I suppose doing it on your own can become limited according to how limited your body is. There's guns, and there's cliffs you could run a wheelchair over I suppose. I don't give this a huge amount of thought now, but I will plan for it sometime in the next 20 years.

A large criminal gang near here has a clubhouse, I suppose I could show up armed. That ought to do it. So if they are still around somewhere between 20 and 70 years from now, I might pay them a visit. :-)

It's possible that I've seen too many Bruce Willis movies.

One thing I don't see people talk about is: What do you do if your elder has a deteriorating mental condition that makes them violent at unforeseen times, and you have young children?

We always thought and planned that we would trade off taking care of my mother-in-law with my husband's brother. But, then she became violent with my nieces, and her mental condition is one where she doesn't have control of that violence. (She has Dissociative Identity Disorder, so litereally another not-very-nice personality takes over). She doesn't have a job, her physical health is deteriorating, and she is applying for government disability. She actually checked herself into a mental hospital and was there there for a few months and is now in a temporary shelter. But she can only be at the shelter for a few months, and then has to find a place of her own...

We don't know where she'll live! I can't imagine her disability check will be enough for an apartment, and we all have young kids and we don't want them endangered so we can't have her live with us and take care of her...and we're all kind of scraping by. My parents advice me we shouldn't send money or pay for my mother-in-law's support, since we're so tight on money ourselves. Our budget IS tight, but we can't just abandon her to the streets! My brother-in-law just kind of shrugs his shoulders and says she'll have to figure that out. But, she's not able to care for herself!

We weren't expecting to have to make these sorts of decisions, and especially not so soon! We didn't know she would get violent and be a danger to our kids. We figured we could have her live with us as she aged.... What do we do now??

Michelle, have you been able to get your MIL to a neurologist to see if there is some more aggressive treatment that can be done to help with her condition?  Treatment of mental and neurological conditions is evolving rapidly, so the physicians she sees regularly may not be aware of all options.

Many cities have public housing where low income folks can apply.

There are also some health related retirement homes that can be of assistance.  Usually the home knows how to work with medicare/medicaid to get the applicant in.  These are not nursing homes.  Sometimes they are church related.

Here in Canada, and I think in the us as well, the government will spend quite a bit of money on an older person, if there is no one else available. But if there is someone else available and they are a close relative, the government won't even spend half that much to support that person. So we see a situation where people are put in care even though they have a willing relative, because that person can't afford to quit work to dedicate so much time to the effort.

It would be much cheaper for society, to allow these people to live in private homes with relatives, rather than occupying hospital beds and other expensive publicly owned facilities. I think everyone would benefit.

Anne Miller wrote:Many cities have public housing where low income folks can apply.

There are also some health related retirement homes that can be of assistance.  Usually the home knows how to work with medicare/medicaid to get the applicant in.  These are not nursing homes.  Sometimes they are church related.

I've been trying to figure out public housing, but it's hard, because it's not something I'm familiar with, and she lives a state away, 8+hour drive away. The state she's in has a lower cost of living than mine. So, does she live in my brother-in-law's state, or our state? It's overwhelming thinking about all the possiblities. I don't even know where to start.

Tyler Ludens wrote:Michelle, have you been able to get your MIL to a neurologist to see if there is some more aggressive treatment that can be done to help with her condition?  Treatment of mental and neurological conditions is evolving rapidly, so the physicians she sees regularly may not be aware of all options.

I don't know who she saw at the various mental hospitals she was at. My brother-in-law tried calling and talking to her doctors a lot, and they won't give him ANY information. I don't think I'd have any luck contacting her doctors, as I'm not a blood relative, and it's really hard trying to get my husband to remember to call. He works nights, so by the time he comes home, he's ready to pass out.

I know she's seen counselors and phycologist. Can a neurologist do anything for Dissociative Identity Disorder? The identities are REAL, just as real as your identity is or mine...

Michelle Reasor wrote:
I know she's seen counselors and phycologist. Can a neurologist do anything for Dissociative Identity Disorder? The identities are REAL, just as real as your identity is or mine...

If she is violent it sounds like she needs help from a psychiatrist, not only a therapist or psychologist.  A psychiatrist or neurologist can give her tests such as CAT scans, MRI, etc to see if there might be some underlying physical reason for the disorder in addition to past trauma.  A psychiatrist or neurologist can prescribe medications which might help reduce her distress.  Unfortunately, for you or your husband to give her proper care, you will need for her to be willing to give you power of attorney so that you can legally speak to her doctors.  Powers of attorney are almost necessary for anyone caring for an elder who may be losing the ability to make responsible decisions.

My dad went through a battery of tests to determine for sure that he has Alzheimer's and not some other brain disorder.  Even before he was diagnosed he had given his children various powers of attorney so we would be prepared if he became ill or injured.

You might try checking your county first to see if they have something like "Aging and Disability Resources Office", if so they might direct you where the best place to start.

If not, try your nearest city and ask about public housing if it is not listed on their website or phone directory.  It might have another name though that is all I can think of.  I have seen these "projects" (sounds like New York City) in many small towns.

If they require that she be a resident, you might ask what is required to be a resident.  Our daughter looked into this when she was going to college so they might not require the residency though there maybe a waiting list.

I would do this as a learning experience then her sons should decide where they want her to live.  This might be the state where she will benefit the most, the one she can easily qualify for.

I hope this makes sense and if you have any other questions feel free to ask.

Eldercare locator:  https://eldercare.acl.gov/Public/Index.aspx

Michelle - An elder care facility will not be properly equipped to handle someone with Dissociative Identity Disorder. You really need a mental health care facility or halfway house and then a daycare facility, typically Medicare/Medicaid will pay for this.