Mom refuses help living at home, and I can see how this ends.

Dear Grassflower: Mom’s declining mentally but still lives at home. She accepted my help with finances, but refuses help with cleaning the house, yard, etc. She says it’s too expensive or “I don’t need help!” Yes, she does! The inside of the house is a cluttered mess with 3-day-old food on the kitchen counter and the yard is full of weeds, tall grass, rusted lawn furniture, and garbage. She’s been cited for local code violations multiple times, and neighbors complain about the rats. Mom also refuses in-home care. I know dementia care is expensive, so I want her to be able to live at home as long as possible. But not like this! It’s filthy and she’s going to fall and hurt herself unless I force help on her. But she won’t pay for it! What do I do?

~Chloe, Nebraska

The train has already left the station.

I appreciate that you’re trying to keep Mom as independent as possible, and it probably IS cheaper to keep her in her house—as long as she’s safe.

But she’s not.

You mentioned the clutter, which is most definitely a trip hazard, especially a cognitively impaired elderly adult. If Mom’s got dementia, she’s 15% likelier to fall than most other elderly folks. You also mentioned food sitting out for days, which is a health risk and may insects and other pests. The unattended yard, rusted furniture, and garbage are also a risk—though more indirectly. Properties that are perceived to be abandoned often attract graffiti “taggers” and are likelier to be cited by municipal code enforcement officers.

The truth is that despite your help, Mom can’t really continue to live safely in her house. So the only question is: what next?

Get POA or Guardianship.

It’s doubtful your mom’s actually doing okay, so talk to her attorney about what’s going on. Make sure after you talk to her lawyer that he already has Power of Attorney paperwork prepared and ready for Mom to sign. Meanwhile, talk to Mom about having you OFFICIALLY take over looking after her. If Mom agrees, stop by her attorney’s office and get her to sign POA papers.

Once you’ve talked to Mom’s attorney, talk not to just her normal doctor, but to a geriatric psychiatrist. Have Mom tested for dementia so you know FOR SURE what’s going on. If Mom’s sane, then something else is going on, but you still probably need to step in and take action whether she wants help or not. If she has dementia, you don’t want to know that BEFORE she signs the POA paper, because it will risk voiding the paperwork to have the signature of someone who is not mentally competent to sign. That’s why you want to do the POA paperwork first.

Regardless of what happens at the lawyer’s office, once you have Mom’s dementia diagnosis, you are in position to, if necessary, have a judge declare her mentally incompetent to care for herself, and appoint you as her guardian (providing there are no obvious conflicts of interest that would suggest otherwise).

The above steps should make it easier to move Mom to a dementia care facility, and most likely, sell her house to pay for her care. Perhaps you could even take the citations she’s been issued and tell her that she has to move into an apartment while you work on the house so that the city doesn’t keep sending her threatening letters.

Get Mom to assisted living/dementia care…however you can.

Your desire to preserve Mom’s independence is well-placed, but it’s also limited by reality.

What you decide to do for Mom’s care will depend on how well Mom can still carry out what are called “activities of daily living.” That means stuff like bathing, getting dressed, remembering to take her meds, walking on her own, and going to the bathroom.

If Mom’s still somewhat able to function semi-independently (on good days, at least), there are many senior homes that provide whatever help is needed—usually very little at first, typically a daily health check-in—then allow residents to age-in-place to more dependent care.

But she can’t continue to live at home. Moving her to a place where she can feel settled in isn’t going to be easy, because as you said, Mom doesn’t want any help and probably doesn’t want to move. But you can “temporarily permanently” relocate her.

For instance, when it was clear my Mom’s dementia prevented her from being able to live at home, I suggested spending some time in Dallas, where we lived. She hadn’t been there before and wanted to see the town. I eventually found a place for her that had maybe half a dozen residents who lived in what had once been a large 1970s single-family home. It looked a lot like her old house. I told her it was a rental home and that the others (residents) were just company who were also renting rooms. She never said another word about her old house and didn’t even ask about moving back. The truth was that Mama was already in the habit of getting lost in her own house, and it had become a confusing, strange, and cavernous place with many rooms she didn’t recognize.

Review Mom’s finances and plan for her new setup.

Now that Mom’s in dementia care or some other kind of assisted living, physically looking after is no longer hit-and-miss or dependent on your noticing something is “off.” But as you will discover, assisted living is expensive. You’ll need a thorough review of Mom’s assets, including her savings, retirement funds, and the house. Don’t forget that if Dad was in the military, your mom may be entitled to survivor benefits as well. Once you’ve got a handle on how much money Mom still has, work up a plan for how to make it last 6-8 years, because that’s the most common estimate of how much time people with dementia live after diagnosis.

Tend to the house and yard.

The first thing I would do is call the city and tell them that you’re moving your elderly Mom out of the house and that you’ll be calling a yard service within the next day or two. Leave the rusted lawn furniture out for bulk trash pickup, and do what you can to clean things up.

Chances are good that Mom won’t EVER be coming back to the house, so the next thing is to go through Mom’s possessions and decide what can be moved to her residence at assisted living, what to give to family members, what to sell at a garage sale, and what to throw out.

It’s all a very tedious, heartbreaking thing to do…I know that firsthand. When my husband and I moved my Mom, she barely understood what was going on. Then while she was getting settled in, we drove back to her old house and began an intense week of cleaning and clearing things out. You’ll probably be amazed what 60 years of accumulated living produces—and most of the physical stuff is NOT sentimental treasures. We collected a few things that really mattered, but most of it was old mystery novels she hadn’t touched in 40+ years, dusty closets full of old shelves, appliances she never used, and coats she hadn’t worn for decades.

Unfortunately, making Mom’s house look fresh and attractive to whoever lives in it next is one of those things you have to do—especially if you want to afford good care for Mom.

Remember why you’re doing it.

I had to tell myself over and over again that I was NOT liquidating Mom’s life as if it had never happened, but closing a chapter on it and opening a new one.

It was also a lesson in taking inventory of what actually matters: health, safety, and being able to share a loved one’s remaining moments without fear that they’ll come to a bad end as a result of neglect. You have to remind yourself sometimes that what you’re doing is actually the best choice for Mom, and one you wouldn’t make unless you had to…but you had to.

Be kind to yourself.

Give yourself a break for doing the Really Hard Stuff and being the grown-up you never wanted to be. You’re taking care of Mom, you’re doing your best, and that has to count for something. Mom’s not going to get better, but you can keep her safe and content, and that matters.