Hi everyone, I’m seeking advice on how to navigate a complex elder care situation involving my 91-year-old mother-in-law. She has multiple health issues, including mobility loss, cognitive concerns that the doctors and family aren't addressing, atherosclerosis and recurrent UTIs that are antibiotic resistant. She has fallen at least eight times in three years, and just got out of a two month stay in rehab facility after she fainted on the toilet and her legs wouldn't work. She returned home worse than when she went in and can't take care of her cat, let alone herself. When I called 911 after she fell and split her head open on another occasion, she screamed at me the entire call and just wanted me to call my husband home from work to pick her up off the floor and refused to go with the ambulance, waiting for her son to leave work to deal with it. He is in his late 60s and has fainted recently from pure exhaustion. We are done setting ourselves on fire to keep the rest of the family warm in their denial. We contacted the SNF to advise we are not agreeing to discharge plan but my SIL and the caretaker/friend brought her home anyways. She’s currently living at home but refuses to accept the level of help she needs. A friend (not licensed) has been helping part-time, but often ignores medical advice (e.g., enabling double diapering, bringing fast food despite dietary restrictions, and not preparing meals). My MIL has been sitting in the same diaper since July 4th after my SIL left to go home. This can lead to sepsis, she's on antibiotics now for a bladder infection she had while in SNF and they sent her home with the infection. When we told my SIL we'd be calling APS, she laughed and said they wouldn't do anything, mind you she's a social worker heading the department in Sacramento. I've witnessed and reported to family and doctors that my MIL hides dirty diapers in her bed, reusing dirty toilet paper she hides and nobody is concerned about her cognition/dementia or has realized this is why she has recurrent UTI. She hasn't showered in two weeks because she can't get upstairs, she's bathing in the sink. When we brought it to my SIL, that she's been in the same diaper since she left July 4th, she advised we're not to confront my MIL because she doesn't like it when we do and has enough stress. She said she'd get on her about changing it but isn't here and MIL doesn't listen. I'm constantly expected to look the other way and keep my mouth shut. My sister-in-law, a social worker, has stepped in as the point person and legal decision-maker but has no POA, is largely absent (lives in northern cali and we are in southern cali) and avoids difficult conversations. My husband and I live in the home and have made it clear we are not available for the day-to-day support after seven years of her narcissistic abuse. We are only willing to deal with medical emergencies. Everyone says, if we don't like it, to leave but she'd be dead already if we had left. We are trying to pull back so we’re no longer the default safety net, but I’m concerned about neglect happening when others don’t step up, and what that means legally and ethically.Here are my main questions: Do I have any legal obligation to intervene if I witness unsafe or unsanitary conditions but am not the power of attorney or designated caregiver? How can I hold the designated family caregiver accountable when she avoids taking action, and I don’t want to become the fallback? How should I navigate mandated reporting or Adult Protective Services if I’m trying to step back but still witness medical neglect?If we live in the same home, but I’m trying to set boundaries and not be her primary caregiver, what are my rights or risks?I’m documenting everything now and trying to protect my health and marriage while ensuring she gets appropriate care. We are also working on moving out and worried about the foreseeable harm coming. I’d really appreciate any advice.
This part of your post jumped out at me, Tknox. A stressed-out man in his late 60s being expected by mama to jeopardize his employment to come lift a dead weight off the floor, who has also recently fainted from sheer exhaustion, is a very worrying scenario in my opinion. Is he able to take any care of his own health and wellness needs or are they getting subsumed into all the elder care drama? How is his blood pressure, cholesterol, blood sugar, weight, sleep, etc.?
To be very blunt, I hope you and your husband can make some drastic changes to ensure this harridan doesn’t outlive him!
She will either be dying in home or in care. As a near-83 year old, the older I get the more I know it little matter which. A few more unhappy years in care is not necessarily preferable.
You cannot force someone competent into care.
And you cannot/should not be attempting to jump onto the burning funeral pyre. It may be a slow burn.
As you describe this, the lack of entering care and the lack of proper assessment of mental health, and a full POA operating to place MIL is very much at risk. I would call APS and tell them that you, for one, will no longer be intervening in this situation. I do not know where your husband is in his own choices about what has been going on all this time with his own mother, but none of that is within your own control.
Finally, to be clear, you cannot dictate and manage care without the power to do so.
Step away. Let all family members know you are doing so. Leave this to your MIL's family. Tell them whether she lives or dies is likely entirely in their own hands, and encourage them to meet about all this WITHOUT your presence and WITHOUT your input.
Not all stories have a happy ending. I see none likely here. This has been going on for at least the three years you mention. It is very unlikely to change without strong state intervention by APS.
Your MIL obviously belongs in a managed care facility where she will receive the 24/7 care she now requires and where you all can get back to just being her family and advocates.
And most definitely you and your husband need to move out as far away as possible and if your MIL isn't placed by then, call APS again, and report an elderly adult who's not being properly looked after, and let them take over her care.
That's the least you can do to try and right this very wrong situation.
This situation is layered, and I came here for advice on how to protect everyone involved, including myself, not to be accused of neglect or elder abuse when I’ve been the one calling it out. We’re trying to do the right thing while everyone else disappears. My SIL still hasn't called to handle the diaper change and the caretaker/friend was here for less than an hour today and did not make her change it. Didn't even notice, I'm the one who noticed and immediately brought it to the person in charges attention. I'm documenting it all to report to APS because I don't know what else I can do.
Document. Document.. Document.
Document everything that you see that would be "reportable" as abuse or neglect.
If you can get video that would be even better., (check your state you might not be able to legally record audio, some States require 2 party consent)
When MIL goes to the hospital again make it very clear that you and your husband are not caregivers and you and he are not responsible for her.
YOU can report the situation to APS. make sure that you inform APS that there is NO ONE that has been appointed POA and no one has been appointed Guardian. (That is probably what should happen here. If your husband wants to tackle this and see an Attorney to obtain Guardianship then he will be in a better position to make decisions)
I hate to say this but your best course of action is for him (and you) to step back, refuse to get entangled anymore and let things happen as they will.
and he should not come home early from work, he should not be putting his health in jeopardy to appease his mother and the rest of the family.
I’ve been documenting everything, including specific dates, text messages, behavior patterns, and care failures. We’ve also made it clear to hospital and SNF staff that we’re not her legal caregivers, and that there’s no POA or guardian in place; which, like you said, is likely what’s needed.
You’re right, my husband and I are at the point where we have to pull back. It’s not neglect, it’s survival. Your grounded advice helped me feel seen and validated while stuck in the middle of a very layered situation. Thank you again.
Your SIl and your MIL have decided they know better, so all you and your poor husband can do is walk away.
Can the two of you take a week or 2 vacation?
If anyone calls with a crisis, say, “oh no, what do you plan to do about that?”
Detaching with love is all you can do here and it’s the best thing to do so you don’t help propping her and everyone else up and so they will be forced to deal with reality. EVEN IF A POOR OUTCOME IS THE RESULT.
Detach with love. They are entitled do it their way but you and your husband are not required to participate in their farce so MIL doesn’t scream.
You and DH need to move out and you and he need to call APS and report all of this so that they know you tried to change things.
This should trigger the following:
1. Acknowledge and receive the written statement – they cannot legally ignore or discard it.
2. Transcribe or summarize it into Maryann’s chart – typically in the daily nursing notes or as an incident report. Even if the exact paper isn’t inserted, the content must be documented if requested.
3. Assess and/or report the wound immediately – since the note involves a sore on the vagina, it becomes a skin integrity concern, triggering mandatory wound assessment or escalation.
4. Escalate the concern internally, likely to the charge nurse, wound care team, or facility administrator, especially since neglect and sepsis risk are explicitly stated.
5. Document the plan of care or initiate investigation, if they don’t, it becomes liability for the facility, especially since its been documented as reported.
+ You & your husband have clear ideas of your boundaries.
+ You are in agreement.
These are 3 very strong foundations to start from.
If you say no, mean no, act no..
What is stopping that from changing the situation? What or who is blocking the natural consequences?
I have LO with tendancy towards self-neglect. I have spoken up to Case Manager & LO's Doctor. I was then able to *detach with love* from care tasks & become a visitor. This was possoblww because there was that physocal space. Me in my home, LO in own.
"We are also working on moving out and worried about the foreseeable harm coming."
You have every right to move out. Take a job 4 hours away, take a holiday etc.
Is it MIL's home or yours? That may help planning?