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My mother is 86, she has always been very independent and has lived alone since my father died more than 10 years ago.

Recently she has passed through a severe health problem and, though she will be discharged from hospital soon, she is considerably weakened, to the point of needing help to walk some steps to the bathroom. Doctors state that she absolutely cannot live alone at the moment, that she is going to need, not only home help, but also (almost) permanent attention, by someone able to perform elementary nursing care and ready to call emergency if needed. In particular, some episodes of shortness of breath are alarming.

She has already suggested that I can live with her, which is out of the question, not least because I like to live alone. So, there's a need to hire someone to live with her permanently. It's an affordable option that will mean a much less radical change of life for her as e.g. a nursing home.

Now, I'm struggling with how to have a conversation about this with her. How to start "the" conversation that ends with "we are going to hire someone to live with you permanently"?

  • How will the home help be paid for? What does her doctor say? Is there a hospice program where she lives? Have you scoped out how she might realistically get the home help you are envisioning? (It's a lot easier to get someone to follow your advice if you can lay out realistic options. It's so much less overwhelming for the person, that way.) I've voted to close because I don't see how we can answer the question without knowing more about the situation (see my questions at the beginning of my comment). – aparente001 Jan 26 '18 at 3:46
  • @aparente001 She has a pension and, even if she refuses to pay, it would be affordable, at least temporarily. Doctors absolutely state she cannot live alone for the moment. Hospices are an option, but I see this a second step: more expensive (or publicly subsidized places with a long waiting list) and a more radical change of life. Of course I have envisioned the response, just I want you to expand my view, isn't that the whole point of SE? :) – Miguel Jan 26 '18 at 6:26
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    Are you sure you mean 'hospice'? My understanding of that term is an institution primarily providing relatively short term palliative, end-of-life care for the terminally ill, when your description of your mother seems to be that she is frail but recovering from a health issue? – Spagirl Jan 26 '18 at 11:58
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    @Spagirl Thanks! English is not my mother tongue and I copied the word without looking in the dictionary :( – Miguel Jan 26 '18 at 15:36
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    A retirement home or, more probably, a nursing home might be what you intended to say :) – walen Jan 26 '18 at 22:24
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Don't use "I like to live alone" as a reason for why you aren't going to be supporting your mother. That communicates that your likes supersede taking care of your mother.

Instead focus on how you're (probably) not a trained medical professional, how it's unfair to your mother to receive anything less than the best in medical care. If you're employed you're already going to need to hire someone to keep an eye on her while you're at work even if you are living with her and are doing nothing else besides taking care of her.

Start by getting her to accept that she needs care. Express a willingness to be involved with this care, perhaps by committing to attend as many of her doctor's visits as possible. Only after she's bought into the idea of constant care should you begin to discuss the logistics of this. You can't put your life on hold to care for your mother and if you can afford to pay a medical professional to be there for your mother her quality of life will greatly improve over what she would experience in your care.

Forcing medical care on someone who isn't in immediate danger is a great way to damage your relationship. Approach the conversation by asking your mom what she thinks is best. Be clear with her that you aren't comfortable being her primary caregiver, and that you aren't qualified to provide medical care. It may help if you offer to live with her for a predetermined amount of time (like a month or two at most) while you find a caregiver she gets along with.


This is obviously assuming that you are fortunate enough to be able to afford to pay a professional for 24 hour care and aren't a medical professional yourself.

  • I am sorry I misled you towards medical care. The hired assistant would perform some rudimentary nursery care (e.g. feeding through gastrostomy tube) and call emergency if needed. The argument that she would be more qualified than myself is probably false. – Miguel Jan 26 '18 at 6:14
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    @Miguel that seems unlikely. Have you received training on how to properly care for an elderly person? Have you received training on the kinds of health problems an elderly person might experience? Don't underestimate the value of the training that even a "rudimentary nurse" has received. – Cronax Jan 26 '18 at 10:30
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    While your first paragraph is understandable, isn't it okay to be 'selfish' in this kind of situation? Doesn't the OP have the right to simply say "As much as I love you, this is not something I am prepared to do"? Focusing only on 'external factors' feels like finding an excuse in order not to have to say "no"...I agree that those concerns are all valid too, but I strongly think the OP should communicate their wishes too. – Cronax Jan 26 '18 at 10:34
  • @Cronax The OP has a right to say whatever they want and deal with the consequences of their speech. I see nothing wrong with saying this is not something I'm prepared to do. I think I was getting at that in P4 where I said Be clear with her that you aren't comfortable being her primary caregiver. If these suggestions fail OP may be forced to put their foot down and say I'm not taking care of you but I'd strongly suggest trying to keep the refusal as impersonal as possible. – sphennings Jan 26 '18 at 14:28
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This is tricky. She's used to her independence, change is hard, and it's a tough reality for her to face that she needs extra help. She needs to get used to the idea,and it makes a big difference how you present it.

It's perfectly reasonable as her son for you to be concerned about her health and wellbeing. And that's a good place to start. The best thing to focus on is your concern for her health.

  • you want to ensure her needs are met
  • you want someone there all the time
  • you want someone experienced with her condition who knows how to help her
  • you are concerned about your ability to perform this role.

"I'm worried that I won't be there when you need me due to work/obligations/etc and I don't have the medical training to be able to help you, what if I don't know what to do?"

Give her a chance to get used to the idea, and then perhaps have a few potential candidates come around and meet her to help her for a morning and see how she feels. She may realise that having someone around to help her all the time isn't that bad. By getting her involved in the process she feels like she has a bit more control.

  • Good answer, just the argument about medical training is dubious, as I said in another comment. – Miguel Jan 26 '18 at 17:58
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I've worked with the elderly and you're talking about one of the hardest conversations you'll ever have. I've noted in Assisted Living that there are 2 kinds of residents: the kind who move in themselves, and the kind who are told "Mom, this is where you live now". The first are pretty happy with the arrangement, and the second are absolutely furious for anywhere from 2 weeks to until they have a medical emergency.

Unless you are a trained medical provider, you shouldn't be providing medical care. Shortness of breath can lead to all kinds of complications to someone not trained in caring for that.

The best start to the conversation is to simply ask "How do you with your activities of daily living? Are you still having a hard time taking a bath/dressing/going up stairs? How do you feel on a daily basis?" That will help gauge her level of denial and set the stage for the harder conversation.

Then is when you can lead into "I understand you want me to live with you, but you need care from someone who is trained in medical care - which I am not. I will keep visiting you, but we both know that we need someone who knows how to handle your shortness of breath (and other conditions, if any)." If she says "But you can do that", say in no uncertain terms that you are not a trained medical professional, not equipped to handle her condition, and that you could do the wrong thing, leading to her injury or death. And you can't live with that. (Which I suspect is true)

It may also be the time to approach the idea of Assisted Living with her. If she's lonely, that will give her a bunch of others that she can spend time with, as well as Activities personnel, day trips, and other benefits. She may fall into that second group I mentioned above, but they all did eventually turn over and realize that they had a good arrangement with people who could help them at any time of the day or night.

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