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My parents are getting too old to be able to care for themselves. They live in a tiny home in a rural town with few services. They should be in assisted living, but can’t afford it. They have some money in the bank but my mother is secretive about their finances. My father has better cognitive abilities, but my mother controls everything. She is starting to show memory issues. What do we do when they can’t afford care? The house is too small for home care, not that they would be willing to pay for it. I’m too old myself and unable to provide the level of care they need. They have no long term care ins.

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Call your state's elder protective services. Do it anonymously or ask a friend to do it. Tell them you are a concerned neighbor and are worried about their safety. The goal is to get a social worker out there to assess them and see if they are a danger to themselves.
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You asked this same question back in November 2022, and got a number of responses. Did you ever follow any of the advice that was given to you in that thread?
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Brokenalone Jul 2023
You are right that I asked this before. I spoke with several organizations but the truth is that I get overwhelmed. My mother got breast cancer and I got her through surgery and radiation. I took my father to the ER and by going through the results (me, not any doctor) saw his pancreas is atrophied and I found an enzyme supplement and his VA doctor has been getting those sent. Now they are staying with my sisters in CA and they realize how feeble they have become. We can’t bring ourselves to have the state elder services come and they appear better than they are so might be no help. The horrible truth is we keep thinking one will die and then it will make it easier to help the other. I can’t get a POA. My mother won’t sign one and she bully’s my father. I didn’t even know there were responses last Nov. as it didn’t notify me and then the cancer happened and I was too busy.
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As CTTN55 noted, here's the 17 answers you got when you first posted this question in Nov 2022:

https://www.agingcare.com/questions/what-do-you-do-when-your-parents-need-more-dare-than-you-can-provide-but-have-no-financial-resources-478389.htm

If you are not the PoA or legal guardian for your parents AND they aren't cooperative with any help AND you have no idea what their financial resources are... then you don't really have any power to help them or get them to help themselves.

Call social services for their county and report them as vulnerable elders. This will start the process.
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Brokenalone Jul 2023
I went back through those answers. I’m not ready to call social services and have them hauled off against their will. I’m not certain they would think they need to be taken. They appear more capable than they are. There are no caregivers or in home care services near them. Their house is 399 sq ft. Not enough room for a caregiver. I researched Medicaid only to be told there are virtually no assisted living places that take Medicaid.
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You profile says you are 65. As you say you contemplate being able to help them I assume that you live nearby them.

You are correct in your surmise that while they may need more care either now or soon, few ALFs will take them due to their low income, and that they may be becoming rapidly more in need.

At this time I think you walk a narrow line here. You don't want to do so much that they are enabled in their poor decision making. But it may not yet be time for them to sell their last home and enter care; their small savings will be gone in seconds and they will be on Medicaid.

I would first decide for yourself what you can and can't/won't do. Get a clear picture of their needs and which of them you can help with. Decide whether you want POA for them or not.
Perhaps you can shop with them once a week. Get them to appointments. Visit once a week and call daily.
WHATEVER you decide you can/are willing to do, the next step is a "sit-down" with them to calmly explain that. To tell them that it will soon become more difficult for them to remain independent and you cannot pick up more than you describe.

I can't really think of more you can do. While they are competent these are their decisions to make. At the point they make bad decisions someone will be hospitalized or the home will need wellness check by APS and decisions for placement made. As you are looking at nursing home placement basically, I wouldn't jump the gun on that one. I also would not want them remaining where they have inadequate care and I felt forced to do more than I can.

Tough decisions ahead for the three of you and I am so sorry. I am wishing you luck.
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Medicaid has an "in home" program. See if they qualify. But then, Mom will need to reveal their finances.
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Brokenalone Jul 2023
Their house is too small , 399 sq ft. The town is too rural and no caregivers nearby.
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Broke, I very much doubt Social Services would cart them away, as you put it.

They, and the local Area Agency on Aging might be able to offer some advise or services--cleaning help, repairs, heating/AC, food assistance . If nothing else, it gets your folks on their radar.

The thing to remember is that if either of your parents ends up in the hospital, you should confer with the social workers and discharge planners there. Make sure they understand that you are not the on site help and that your parents aren't safe living alone any longer.

Often, if the "healthier" parent is hospitalized, EmS will transport BOTH to the hospital because it's clear the other will not be safe living alone.
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