What is the best way to approach my mother needing help?

I don't blame people for not letting strangers in their home, neither do I! However, what you can do if home healthcare is necessary is have someone from the family there with her. That way, there's less chance of anything happening to her. Another advantage of having someone sit in for the duration of the health care aid is to make sure nothing is stolen, because people do tend to steal from the elderly. Sometimes it's someone they know, (but not always). People often see our elders as easy prey. That's how our elders are taken advantage of and some of them who happens to be blind or sometimes robbed blind. I once heard a sad story about a blind judge who needed assistance. He had very expensive furniture in his home, if I recall right some of it may have been antique. The furniture was strategically placed where he could feel around as he was navigating through his home. At some point, the assistant started switching the furniture for much cheaper versions. This went undetected for a while because the table which was later noticed by the blind judge one day noticed that something about the table just didn't feel right. The table was the same height as his original table, and the cheaper one felt similar, making it harder for the blind judge to catch. Then one day the judge happen to notice something was off about the cheaper table, which is how the assistant was caught. The assistant used clever tricks to keep the judge from finding out what all of his furniture was being secretly switched and substituted with cheaper versions of the same thing. I don't recall whatever happened to the judge's original furniture, but I think he got the right kind of help and cracked down hard on the thief who may have sold all of that expensive furniture to clueless buyers who didn't know about the theft or the situation behind it. There are cases where you can get things back when someone has (unknowingly) bought stolen property. This would involve going to whoever bought all that furniture and buying it back from them after explaining the situation. Any conscientious person would comply, but at this honest person won't. Knowing this story is only one example of why I don't blame anyone for not wanting strangers in their home because things like this (and worse) can easily happen. This is also why I highly recommend someone the patient knows very well and trust to sit with them when home health care aides come in. I don't recommend being alone with an in-home aide after hearing what happened to that blind judge. Hire in-home healthcare yes, but don't let the patient be alone with them when they come in because you just never know what kind of person is walking through the door to your vulnerable loved one.

What kind of help does she need? If it cleaning and washing, perhaps you can hire someone on a day when you take her out for a few hours. When you bring her home it will be done. You can contact the DMV and her primary care doctor about taking away her driving privileges. They can require a vision text and "fail" her, for example. At some point you have to give some tough love and let her complain for a short time until she gets used to needing certain kinds of help. Congrats on your mother living so independently into her 90's! But it's past time :)

If no one has health care power of attorney and financial power of attorney for your mom, it is high time to get that established. Even she knows she will not live forever and someone else may need to be able to take over for her. You can probably down load those forms for your state off of the internet. In Minnesota, the health care POA also included end-of-life treatment options--under what conditions to use tube feeling, etc. These forms need to be notarized. When I was given this authority for my friends, who had no children or close relatives, my friends' bank was used for the notary stamp. Get several copies stamped because certain places want an "original" before they recognize the POA. Her doctor should be doing a mental evaluation at each check-up. In Minnesota, it is required after age 65. Here it is to draw the face of a clock and a particular time, also remember 3 words and after about 5 minutes, they ask what they are. The POA forms I got gave me the authority to make decisions for them even if they disagreed with them--that was one of the choices. She needs to do this while she is still considered able to make such decisions for this to be "legal." Best of luck on this journey. My goal was to honor their way of life and wishes as long as possible. In the meantime I researched other options for when it was no longer possible for them to live independently and ended up with a great memory-care apartment in an AL with excellent care and medical supervision when that time came. I also had them put me on their checking and savings account as a signee so I could monitor their expenditures and then take over paying their bills when the time came for that.

I strongly agree about the mention of stubbornness in old-age, both people I helped in any way were both stubborn, and this is probably pretty common among many people who are all too familiar with independent living and doing things on their own timing and not someone else's. When someone else steps and to try and help, isn't it funny how it's often not well received? Therefore, I strongly agree on this one! I found that what helps me is to just be neutral and let the person ask me if I could be of help to them, and as much as I really love helping people I always jump to the occasion, (but only if they ask). I think this has a lot to do with getting past the stubbornness because forcing yourself on someone who doesn't want help is only going to cause further problems until they don't trust you. This is why I let people initiate and let me know if they want or need help, I don't just step right in and take over. You just basically have to be a neutral party like I was, and it helped an awful lot, and I think it had a lot to do with my ability to break the ice but only when the person felt ready. All I really have to do is not even be looking to go in and help, all I really did was just visit the person and I respected them just like I would any one else I visit. To me personally, the elder is no different than anyone else, just another person. It may not sound like much to you, but it meant the world to both of the people I got the honor of helping with whatever they asked as long as I was able to do it. If it involves running an errand and I had a working vehicle to go across town, I did it. If there was no car, all you have to do is explain that you can't go because there's no car or if the car broke and down. I noticed that just letting elders come to you really works wonders! If you let them come to you, chances are you could actually end up making a really good friend. I found that when you make friends, you can actually team up and actually helping each other as a team looking after other teammates. Let's say the car is broke down and but you don't have the money to fix it and it will take a while to save up that money. Now, let's say that the person wants to send you somewhere bad enough and they choose you over anyone else. This is where they may secretly surprise you one day by helping you get that car fixed because in some cases they are better financially set when you are. This actually happened but with a motorbike and the person really wanted me to go on errands for him since he couldn't drive. We actually pulled together and we got the bike fixed at a reasonable shop, but they initiated it, not me. The other surprise? This all came from a stubborn person! Yes, you never know when a stubborn person may actually left down their guard and team up with you and you too can actually do things together. It's kind a like a bartering system when someone helps you, but you turn around and return the favor in exchange for the favor they did for you. The bartering system actually works out very well when you have other team members working together, and working as a team is actually a far better and easier than trying to do it all alone, because sometimes you really do need help from others, just as much as others need help. When you have a bunch of struggling people who just happen to find each other, this is where the bartering system is very handy because you can all pull together like a team and you can all work together just like a family because they become kind of like your family, (and family's not always blood). It may come as a surprise to you, but you must start off as just a neutral party and let the person come to you as they wish, (if they wish). In many cases this can be a very high success rate even among people who are normally stubborn. Sometimes this is really all they need is just a neutral person not looking to take over what to come alongside them up and become a team member with them. There's a right way and a wrong way to approach people, and you always want to give them what they need by the right approach and not force yourself on them. I've noticed that things will go a whole lot smoother, are there are no hard feelings. Yes, just treat your elders just like you would any one else of any other age group and you might be surprise what comes your way! It really pays to be a neutral party, especially when you come and check in on them regularly (if it works out this way). It may surprise you to know that one of the stubborn people who reached out to me is someone I long since forgot many years before he actually reached out to me and initiated contact. This is where the discovery of being a neutral party began. Sometimes someone must get lonely enough to actually reach out to a long lost friend who long since moved on because the other person has also moved on. Much to my surprise, it turns out we live pretty close

My dad is all resistant to me "doing too much" but I handle it by doing whatever I see that needs doing with some combination of ignoring his complaints and giving him back humor. Somehow he seems to like it. I'll tell him I'm bored watching him nap in his chair so the sweeping and vacuuming just happened. I bring him food because I "accidentally" cooked too much, again! I plant flowers in his yard, and keep up the yard, telling him my mother will haunt me if I don't since she loved her yard. I drive him to doctor's appointments when he says not to, and tell him I have to because otherwise I won't hear about his health, but only get a rundown of the personal business of the nurses (he always finds out where they went to school, where they live, how many children they have, where they go to church, etc.) He gripes about what I do for him, but I've also overheard him telling others that "my daughter looks out for me" I've also insisted, despite protests, that he have a device that alerts me to falls, and the box on the front of the house that lets in first responders in case of emergency. Good luck, stubbornness is a tough condition of old age!

The biggest problem with elderly home alone and doing all for themselves, is the FALL, and no way to get themselves help. If you could talk with your Mom about the dangers of falling, and suggest an in home eval to go over safety in home, it might be a way to involve that third party. Some home health agencies will send an RN or social worker to do a safety check. Short of dying in your sleep, there are very few elderly who stay in their own homes until they die, without some type of care giving help to do so. At 98, she is very fortunate to have done so well, but all it takes is one fall to end up in a nursing home or dead suddenly. Does she have a life alert necklace? Home alarm system? Are you there daily to assess? Even if you are in the same town, though, falling in middle of the night and laying alone on a cold floor in pain can cause demise. I convince my parents, by getting an agreement to 'trying' a part time care giver for 30 days. My dad had dementia and was getting worse, but Mom didn't want any stranger in her home, though she could not deal with him alone. We sort of convince him, the helper was for her, and her that the helper was for him....for a trial. At the end of 30 days, both could see how much it helped them and so she stayed for over a year, and next time we needed helpers, Mom didn't argue. A care giver, can gradually get involved with the driving too. With my parents, it was being able to show how just one fall would almost, for sure, end up with them unable to stay home as they wished.....And, in the end, Dad had to be placed in Memory Care. Mom was home alone for two more years, some with caregivers, and some with in home monitoring, life alert necklace and even, eventually video cameras so I could monitor from living 5 hours away....but now, after 4 years of me being responsible, Dad has died, Mom has accepted (sort of!!) assisted living close to me, and the home has been sold with all belongings in storage. However, the past 4 years have been, by far, the worse in my entire life....with serious strains on our marriage, my health, our home business and more. IF you do not have a plan, or POA, advanced directives, an elder care attorney, and other support in your life for what is coming, get it together now....all the while praying that the end for Mom comes by dying in her sleep some night.

My Mom was the same way several years ago when she was taking care of my Dad. She was insistent that she could still do it all, but I could tell things were really slipping. What I ended up doing was giving her a "gift" of a housekeeper. I told her it was my gift to her and that all she had to do was try it for the 5 times I paid; then if she didn't like it we wouldn't have to renew. You have to give your Mom an "out" so she can save face - she is dealing with issues of autonomy and pride. My Mom balked a bit, but once she experienced the help that the caregiver provided, she was all-in and it was never an issue afterwards. What I had to do was make it easy for her to accept - and told her it was done - already paid for, couldn't be canceled, etc.
Do your research on senior caregivers in the area; get references; try to be there with your Mom when the caregiver arrives; be willing to go through a couple of different caregivers before you find the right "fit" - that's really important. Go with a reputable agency, Also remember that once you begin this, routine & predictability will be important. My Mom currently lives with me now - she turns 96 this fall - and I have a senior aide come in twice a week. She is thrown off when the schedule changes. So be aware that consistency is important. I hope this helps you. I had to realize that the roles we are playing have changed and that getting help for Mom was the right thing to do. It sounds like you instinctively know this for your Mom, too.

At 98--she is still driving, living alone and able to do so? When you say she is showing "signs"--good heavens, one would think so!

I am constantly amazed at the varying degrees of "neediness" on this board. We have 60 yo's needing constant care and someone nearly 40 years older seems totally independent.

I worked for an Elder Care company for several years. My client asked me to call her by her first name and called me her "personal assistant" rather than what I was, which was an elder care companion. I never wore the "assigned" uniform, I wore regular clothes and we just did whatever she wanted/needed. Her family couldn't get her to do things I could--simply because I was her employee and though she treated me with the utmost respect, and I, her, everyone KNEW she had this "paid assistant" and she LOVED it. I worked 3-4 days a week for her and we ran all day long.

Because I WASN'T family, and because I didn't bring the family dynamic into our work day, it worked out very well. I don't know how her family facilitated this--they had to take her keys away, yet she still wanted to be independent. This way, she was, and somebody besides family was handling "messes" and her very demanding schedule of places she wanted to be.

Ask your mother if she would like that. And if she's amenable, try to hire someone who has had some life experience under the belt. My client had fired 3 people in the 2 weeks before we met. They were young and were not respectful. (Elder care is NOT a job in which you will make much money.) Give that a try and see how she handles it.

And congrats on having a mom who seems to be doing so well so late in life!

Bless her heart for living so long. Let her be, but maybe she would take help from others. Parents do not want help from their children most times, so have some agency come in and make an assessment. All you can do is try, and if she hasn't been deemed incompetent, that is all you can do. Talk even though it is uncomfortable about her wishes (funeral, etc.)

There are some good suggestions here. It seems to me that accompanying your mom to the doctor is number one. She may not need to go often, but she needs a yearly checkup if nothing else. You could write the doctor ahead of time and say that she is still driving and won't accept any help. The same letter could list the negative changes that you see. He or she may have some suggestions for you such as in-home help.

Your mother has lived a long time in what seems to be remarkable health. While I don't believe in numbers as an indicator of when to quit driving, I'd say it would be exceptionally rare for someone 98 to be able to drive safely, so a doctor should back you up there.

A care manager is also a good suggestion. Often older people respond better to a third part than to their own "children." I really can't blame them. They want independence and why wouldn't they? If a third party offers suggestions, a few changes may be more welcome than the same changes coming from you.

This may seem unfair but to her you’re still her kid. There are family dynamics involved. A care manager would be an “official” who could help her with decisions and then your input may be much more welcome.

If you haven't already talked about to your mother about what a quality life is to her, then you need to do that. I've seen people in their late 80s denied their one cup of coffee in a day when that was one of the few things that the person still enjoyed. The coffee may or may not be good for the person, but if there is nothing that brings pleasure why fight to live?

You, punkjean, sound wonderful and respectful of your mother's rights so I have no doubt you'll do well in compromising. Her safety is important, but living her life as she chooses is also important. If these changes you are seeing are dementia, you may have to get more forceful in the future. For now, work with a third party and see how far you can get with keeping her happy while you protect her from the worst of the issues that could cause harm.

Babalu suggested the book "On Being Mortal." I think every caregiver should read it as well s their aging parents. Our culture has much to learn about quality of life vs. just existing.

Take care and keep being such a great daughter,
Carol

I don't know how safe your mom is still able to drive at 98, but something just dawned on me about something for refusing to give up the keys. There are some situations where people insist on self transport and in some situations there may not be any help for some seniors who may not otherwise be able to go anywhere, and would otherwise be housebound due to no other transportation. Though not true in all cases, it is true for some people who happened to have be alone with no outside help. I don't blame certain ones for not wanting to give up their independence, and sometimes self transport may still be necessary (for some people). It really all depends on the situation at hand because situations vary. I think some people know that if they give up driving that they will have no transportation, and this is true in some cases. Of course, you could look at another dilemma of having to depend on other people only for them to not show up (without warning). Having to depend on other people is definitely an inconvenience, especially if you happen to have a doctors appointment where your ride doesn't show up or in some cases even cancels the ride on the day of the appointment. There are downfalls to having to depend on other people for transportation. I think this is another thought that goes through peoples minds when they insist on still driving. Not every elderly person is going to be dangerous behind the wheel, some are clearly not. I even knew a man who ran a 16 acre horse farm well into his old age, and he still drove. I rode with him many times and he was safe on the road. I was amazed by how well he took care of himself, and he was an example of how people should stay busy to keep themselves fit and sharp, (and he definitely did). What amazes me even more is how he used to manage hay and straw bales, and he would even sling them all into the barn loft by himself. I will continue to carry his story as an example because this is a perfect example of staying busy well into your old age, because back in history people stayed busy on farms to stay well. He was also a World War II vet, so this also worked very well in his favor. Sometimes people insist on remaining independent, and there are just some cases where you just can't force your help where it's not wanted. If the person is trying to stay busy and is actually still competent, I'm not sure there's going to be much you can do because you don't want to force yourself into a situation where you're not wanted. This will only make the person more stubborn and even combative to the point they may physically fight you. There are some people like this and you don't want to tangle with someone who says no, because it can become a very dangerous situation. That's because big surprises often come in unexpected packages. This is why I would never force my help where it was unwanted, because I don't want to be on the receiving end of a big surprise! If your mom has mobility issues, you may get her a power chair or even just a manual wheelchair to help her get around her house. That would help her to be able to do more around the house if she can't stand or walk. Sometimes arthritis for instance can interfere with how long a person can be on their feet, which is why I suggested either a power chair or a manual wheelchair for mobility issues. This can make a huge difference in some cases where this is really all the person really needs. All you do is make sure there's enough room to navigate in the chair if a chair is needed. I'm not really sure of the whole situation, but more information would probably be very helpful in helping to address the issue. However, you're still looking at not forcing yourself into a situation if she already said no

Sometimes bringing in a third party like a geriatric care manager will facilitate the conversation. Most geriatric care managers will do an assessment which always brings about recognition of the limitations in most people. Sometimes a uninvolved person coming in can hell vat art the conversation.

Have you ever been to a doctor visit with her?

I agree with Pam that she probably shouldn't be driving, but I'd endeavor to get to accompany her to her next checkup and establish a relationship with her physician. When she says that everything is fine, vigorously shake your head "no".

most elders are quite capable of "showtiming"; putting on a good show for their doctors and their visitors. Heck, my dad, the day before he died of leukemia, convinced two RNs from a rehab that he was all set to do several weeks of vigorous physical therapy. My mom says he should have gotten an Oscar.

You might also want to make sure that mom has appointed a power of attorney, Medical Power of Attorney (or whatever it's called in your state) and has an advanced directive in place. None of us lives forever and some of the saddest stories on this board are from folks who are at a loss to know what their parents' wishes are if they can no longer communicate them.

In his recent book On Being Mortal, Atul Gawande reports that a woman had this all important conversation with her dad before he underwent life-threatening surgery. He said that as long as he'd be able to "watch TV and eat ice cream" he'd be content. When the surgery didn't go as planned and the surgeon asked her to make the call whether to continue in a life altering way, she was able to use that information to make a decision that sustained her dad's life, not as it was, but in a manner that would allow him to continue to enjoy those two activities.

Giving your mom that book, or maybe Roz Chast's Can't We Talk About Something More Pleasant? might be a conversation starter that is non-threatening.

For god's sake take the car away before she kills somebody. It will give her more time to do things at home and the world be a lot safer.