Concerning family situation. Advice welcomed!

Share information, support and advice on all aspects of caring.
Hello Til and welcome to the forum :)

Firstly your Mum should NOT be trying to lift Nan (even with your help) when she has a fall; it's likely she could do more damage than good. She should dial 999 and get the paramedics - they are quite happy to come out to lift an elderly person who has fallen and will also check them over to ensure that no damage has been done.

It does sound as though now is the time to start considering what Nan 'needs' as opposed to what she and your Mum 'want'. Caring for someone 24/7 is definitely not a one person job and certainly cannot be sustained in the long term.

There are various options from having care workers come in to help with Nan's care to full time residential care in a care home. I would suggest you and Mum start by arranging a Needs Assessment for Nan and a Carers Assessment for herself. You'll find more information on both here:
http://www.carersuk.org/help-and-advice ... assessment
http://www.carersuk.org/help-and-advice ... assessment

Is Nan in receipt of any benefits ? If so Mum may fit the eligibility criteria for Carers Allowance - see here:
http://www.carersuk.org/help-and-advice ... -allowance

It also sounds as though Nan would be eligible for Attendance Allowance, more on that here:
http://www.carersuk.org/help-and-advice ... -allowance
I have casually raised the possibility of getting help to my mum, but I think that my mum sees it as a personal failure or unkindness to do so, and my nan has previously refused to allow other carers to come in and help her around the house.
It is NOT failure to admit that you cannot cope single handled in such a situation - if your Mum burns herself out looking after Nan and becomes ill herself, who will then care for Nan ? Anyone in a caring situation comes to realise that there comes a time when outside help is necessary and essential for all concerned.
Frailty is the price you pay for living a long life.
It is NOT up to Nan to choose who cares for her, and for how long. She has no right whatsoever to tell others what they should do. The only power she has over others is the power they let her have. If she cannot live alone at home without help, then either she accepts outside help, or moves somewhere it is available.
It is time for your mum to stand up to Nan. From what you say, it sounds like she needs to be either in hospital or a nursing home (a care home won't accept her if she can't walk), until her leg has healed and she can move round independently (Was this a problem before the leg bleed?)
Mum needs to talk to the GP and Social Services today and stress the urgency of the situation, that something needs to be done TODAY.
Next time Nan falls mum MUST ring 999 - paramedics are highly trained and will be able to assess whether Nan has just fallen because her legs are weak, or whether something else is going on. Maybe a mini stroke, for example. They will be able to give her a thorough check over, including blood pressure etc.
Tell mum to stop being Superwoman (and endangering her own long term health) and start yelling Help very loudly.
Sadly, many elderly people can live alone happily for many years, until there is some sort of crisis, then everything changes overnight. There is a "life changing moment". Nan may recover, but you must all accept that nothing may ever be quite the same ever again. This was the case for all four of our parents, I know from personal experience how devastating the realisation can be. From the way you write, I suspect Nan is 80+?
From what I have explained, do you think that hospital is the best place for my nan to live temporarily, at least until her leg can heal? If so, how would we go about putting this into action? Obviously hospitals don't accept anyone who rolls up to the front door and says they think they need to stay. Should we be looking to get a GP referral?
When the paramedics came after Nan had her fall did they recommend that they took her to hospital to be checked out ? As you rightly say you can't just roll up to A&E and ask for a bed ! It will depend on the severity of her wound but I'd suggest talking to her GP who can set up visits from the District Nurse if they don't think Nan warrants being an in-patient.
Refusing outside help wherever possible is a very common problem. It's really moral blackmail, they know if they refuse outside help that means family must do it instead! Nan probably doesn't really appreciate that she is getting so old and frail and how much that is affecting others.
It really helps if the GP is seen to be the one making the decision, about whether to stay at home or go to hospital or into residential care, rather than family members. Certainly the GP should be taking an active role at the moment. When did he/she last visit? How long will the leg take to "get better". Is the District Nurse doing regular check ups/dressings? Have you been offered a hospital bed to make nursing easier? A commode?
Welcome to the Forum, Til.

Can I just add that nan's own wishes, assuming she has mental capacity, are essential here. Nan cannot be put into a home against her wishes, unless it is determined that she does not have the capacity to make her own decisions. If she needs a care home for respite purposes, to allow her leg to heal, it is then a question of who pays for that respite. Social services would need to do a financial assessment to see if nan's assets total sufficient to make her self-funding.

A good first step would be Nan's GP although he may quote confidentiality and refuse to discuss it. This happened in my mum's case but he did not refuse to get a letter from me and discuss it. You would then need to contact Social Services, as Susie mentioned before, to get a care assessment done.

Good luck, it will take some struggle to get a good care system in place,
Anne x
Have you considered a community O/T assessment. You can make a self referral although a referral by a G.P. would be much quicker. You could contact your local adult social services team. They may have suggestions and can sometimes make quicker referrals. You need access to perhaps temporary equipment.
It's good that your nan does seem to feel that her daughter, your mum, is doing a lot for her. Can you build on that yourself? eg, can you talk to her and say 'Look, Nan, mum is finding this all very, very exhausting and stressful. If she can't manage it at all, and you really don't want outsiders coming in to help her, then you'll end up being in a home, because there won't be any other option!'

What I'm getting at is to make it clear to her that UNLESS she accepts outside carers coming in to help your mum, then the alternative is NOT 'mum does everything' (as she is doing now) but 'Nan goes into a care home'.

Many elderly people consider that having outside carers coming in is the least worst option compared with going into a home.

There are several ways to 'introduce' outside carers into the situation .What's been rcommended on this forum in the past have been, for example:

- tell your nan they are 'cleaners' not 'carers'
- the first time, have them arrive WHILE your mum (or you) are there so they are there AS WELL
- next time, you/your mum says something like 'While Mrs xx is here I'm going to make your supper' (or whatever)
- then it's 'while Mrs X is here I'm just popping to the shops'

etc etc....the idea is that it isn't, at first 'either/or' but both family and careworker simultaneously, and then as your nan gets used to the carers, family can 'sneak out' more and more.

Often, members here report that it is question of the caree getting used to having outside carers, and, as I said at the top, of realising that unless they accept outside carers AS WELL as their family, family alone just can't cope AT ALL, and a care home is the only option left.

Wishing you all the best - but I think you will need to both talk to your nan AND try and 'be firm' with your mum as to how much she does. One way forum members approach this is to say that when there is a professionial carer doing the 'drudge work' of caring, the family members can spend 'quality time' with the caree - maybe, for example, your mum can now spend time talking about her childhood, gathering as much information as possible about your nan's youth etc etc.....getting out old photos, going through them, saying who they are and just 'gathering memories' for the future....
Hi Til
I would suggest, in the interim before other things are arranged, that you get a commode and a touch sensitive light for your nan's room. When my mum takes to her bed I move the commode closer to her so she can almost fall into position! The bedside light we got her has three touch settings so she isn't blinded and she really likes it.
I hope this helps and you can get some help your nan will accept before long. Maybe the doctor could suggest it to her if she has a good relationship with him/her.
Take care
Tracy
Just to say that whilst of course your nan cannot be 'forced' into a care home if she does not want to go, and she has mental capacity, the corollary of that freedom not be forced into a care home is that, equally, no one can be 'forced' to care for her!

Not a single one of us has any legal 'duty of care' to look after another adult person, whoever they are, and each of us is legally free to walk away, and 'hand over' the person to the state to look after (whether that person wants that or not!!!)

So in a way, it cuts both ways. Your mum could 'walk away' from her mother, and your nan could therefore be left with only two options - have outside carers come into her home to look after her OR go into residential care.

I know many people would never 'walk away' from a relative needing care, but knowing that you CAN if if things get really tough and unbearable, is a great mental freedom I think.

When I 'inherited' my 89 y/o MIL with incipient dementia, and found it unbearable to be her 'only carer' (no one else around but me, sigh), I used to think that if I really, really couldn't cope, I'd simply phone SS and tell them there was an 89 y/o with dementia all alone in her flat and it was up to them what to do next.....

(Luckily, she did agree to go into a very nice residential place near me - not that she liked it, sigh.)
The first meeting I had with a Social Worker in connection with my two elderly aunties,

She implied that if any accident befell them, that it would be my fault, despite me living 45 miles away. She gave me the impression that if one of them had a fatal accident at home, that she would give evidence to the Coroner that it was my fault.