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My mother has lived with my sister out of state for about 5 years. Recently her health has taken a turn and she’s moving to assisted living. My sister is completely burnt out, but spends a month away every year while we cover for her. Sister is unhinged right now and even though I’ve offered all the help I can think of, it’s never accepted and she just is so angry. She thinks we’re absent siblings because we don’t live there. We have two separate trips planned to go there in the next 3 months, but we do have full time jobs in another state. She thinks we should quit our jobs and move to the state where she is. I’m honestly more concerned for my sister at this point, as she has clearly been harboring resentment and is not herself. Does anyone have any creative ideas for helping from out of state? I’ve offered to have groceries/meals delivered, pay for a skilled caregiver to give her a break, schedule appointments and drivers, keep a family Google doc of all of her info so everyone is on the same page, set up family conference calls… it all gets shot down. I’ve tried talking it out and it goes nowhere. I’m trying to keep the lines of communication open, but it’s hard when she doesn’t respond. I’m worried about her. Suggestions?

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I think you’ve done all you can do
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Spuncrack Mar 2022
Thank you, @PeggySue2020
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She can't keep doing it.

Support her in placing mom or move mom to your house.

Giving her solutions to keep doing everything with more breaks isn't being helpful.

Doing 11 months for years is wearing, she wants her life back, that is reasonable.
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Spuncrack Mar 2022
@Isthisrealyreal
Agreed. We’ve tried for a couple of years to gently push assisted living, but she’s always resisted (my sister). She is finally going along with it, and honestly, for both of them, I think it will be so much better.
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The "absent" children often can be beneficiaries of underlying resentment even when absent ones have made offers that could make a difference, no matter how small or large. It goes with the territory.

Maybe your sister is declining offers to be, and use this word with care, a martyr--would that sound like her at all? But, caregiving certainly can change a person, too.

A heart-felt letter, perhaps, to her that lets her know she's sacrificed, how much it's appreciated, and the only way you can help is by (filling in the blank), and to please let you help lighten her load in these small ways.

I say small b/c offering for meal delivery, for example, while expensive and convenient, is a blip on the screen of a caregiver's day.

When I lived in a different state going to school--long before my mother became ill--I was told that when my brother referenced me it was with a bitter "she's not here" kind of thing. Resentment. And with no one ill. Just a mother who could be difficult.

As someone already said, you've done what you can do.

I'll further add...and that's all you can do.
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Spuncrack Mar 2022
Thank you!
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PeggySue2020 Mar 2022
Lisa, to every single person whose heard you since March 14, 99 percent think your leaving would be the be the responsible and rational thing compared to what you’re doing meddling in your bros business. And you, miss privacy, just dropped another dook on how rich your brother is. Your presence there is simply antagonizing him and your father.

Do not think your and the ops situation is the same at all. For one thing, this op didn’t ride in on a rail, and second, they’re actually offering to pay for things. This op has already offered money for aides and shopping help. If this op got put on dads favorite store lists, they probably would welcome it as opposed to starting another thread here about how it’s so distressing that the caregiving bro would transgress your privacy.
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Hey spuncrack,
I suspect your sister is feeling some displaced anger and grief, perhaps irrationally thinking that if you’d just all moved back, mom could have stayed home.

Not really. When it is time for al, it’s usually past time.

Someone in AL will typically require at least 300 in “optional” expenses, more if dentures or hearing aides are involved, but even if not, even incidentals like shampoo, tp, Kleenex, depends etc rapidly add up. You can offer to set up and fund an instacart that sis is in charge of, and perhaps even a 1 on 1 aide.
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Spuncrack Mar 2022
This is a great idea!
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Your sister is going to need time to recover now that mom is placed before you see any difference. And I mean a lot of time. In fact I just hope she can recover.
Even if your mom is at the appropriate level of care, it doesn’t mean your sister is getting the kind of help that allows her to walk away without worry or concern or follow up etc.
I am in your sisters position. I may be transferring a bit here but what I would like is to step completely away. I would be happy to send my DH aunt to someone else to care for her or to turn her care over to. She isn’t difficult. In fact caregivers enjoy her. I love her dearly but I am bone tired. I am not angry at anyone. Aunt has no children. When I am with her, I enjoy her. I feel happy to be with her. We read so much on this forum about difficult parents. Often caregivers give that as a reason they are burned out. But I am burned out with a pleasant LO and no shared siblings to be angry with. Perhaps it is the same with your sister.
You seem like a pleasant, well balanced person. I mean no disrespect. I only want to make a point based on the limited amount of information you have given us.
If your sister became unable to care for your mom tomorrow, what creative idea would you come up with? That is what your sister needs. No, you aren’t going to quit your jobs and move there but what would you do? Do that.
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Spuncrack Apr 2022
No disrespect taken. I posted here to get advice from people who know, but are not personally invested in my specific situation, so thank you. Our mother can definitely be difficult and has mastered the guilt trip. Unfortunately, for my older siblings there is a lot of stigma around mental health and they need for help. I do my best to normalize but I know that decades of thinking one way is hard to undo.

There are four of us that are able to help. My brother had my mother for a year before she became too difficult for he and his wife. He didn’t kick her out, but the sister that currently cares for her didn’t like it, so moved her in where she’s been living since. My other sister and I have both offered to put her in assisted living near us, but the sister currently caring for her doesn’t want to be that far from her. She did finally agree to letting me set up a zoom call with my siblings last night, so that’s positive. :)
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If mother has finally moved to AL after 5 years with sister, perhaps what you could do for sister is a money gift. She can decide how to spend it. She can’t have been earning much recently.

Sometimes what’s offered feels like it’s really offered to the person being cared for, not the caregiver. Her world is probably collapsing now – so much less to do, what comes next? A gift to HER may be the simplest and best way to appreciate HER and what she’s done. Worth considering?
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Spuncrack Apr 2022
I’ve thought about this. I’m just not sure she’d take it. When I visit I tell her to go and get away, but she won’t. I’ll continue thinking about how to make this a reality. She’s going away for a month in a couple of weeks and none of us are planning to contact her about Mom at all during that time.
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I am very confused.
Your first sentence says that your Mother lived with your sister for five years, but that she has now, due to health problems, moved to ALF.
Then you go on to say how overwhelmed and angry sister is, and how you are doing all you can from your distance, but Sister remains angry?
Mom is GONE to ALF now?
IF Mom is gone from Sister's home, how is any of this relevant?
What am I missing?
I went through all the responses and your response to them below and I still cannot figure where the problem is if Mom is already placed in a facility in your Sister's area? If Sister has placed Mom and is STILL upset and overwhelmed it kind of indicates that this is her default setting....she is perhaps in the "habit" of having problems and complaining, perhaps having trouble moving on.
She is, I think you say, going on vacation for a month. That's great. The answer is not to NEVER MENTION Mom during that time. The answer is to REASSURE her WHEN and ONLY when she asks to be filled in, and reassure her before she leaves that you will keep close contact with the facility, and will let her know if there are any severe problems.
Five years is a long time to care for someone. We are a bit like those middle aged folks who have the children leave the nest. Not yet comfortable that they will be OK.
Best out to you. Not even certain I understand your question, but hope I got this right.
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Spuncrack Apr 2022
I’ll try to make background clearer. Mom moved out of her home (her choice) after my dad died, and moved in with my brother. It wasn’t the greatest fit, and my sister was bothered by it so asked our mom to move in with her. She has lived with my sister for 5 years, and recently has had declining health issues enough that we’ve all decided (my mom included) that assisted living is best. Right now we have a move in day of June 1st, because of my sister’s preplanned trip and application for financial assistance. The anger comes from, I’m assuming, being the main caretaker for 5 years. She REALLY dislikes being called the caretaker though.
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My sister passed in 1996 leaving a 7yr old son. At that time I had 2 daughters home with a grandson, oldest going to Nursing school me babysitting. After her passing my brother took my nephew to live with him after my sister asked if he would since she felt I had enough on my plate. Nephew is special needs. Well, my SIL said yes to my sister without talking it over with my brother. My SIL took over my nephews care and on an off would complain about. She assumed alot when it came to "everyone else turn my sister down". I told her my sister asked them because she felt my plate was full. I had no idea she did this until it was done. I assumed we would take him. Then it was we never sent money. There was no need to, he received my sisters pension of $500 a month (this was the 90s) and had a market money acct with my sisters life insurance in it to draw from. Plus, we were never asked. We had him 2 weeks out of the Summer. Would have taken him the whole Summer but she felt my parents spoiled him and it took her a while to get him into shape. We got him at Christmas for a week or two. We would have taken him whenever he was off but...she wanted that control.

So, what I am saying is some people like being the Marter. The person who saves the day. Like my SIL, they have assumptions. You tried to help out, sister's thinking you would all move back is her problem. Her assumption. It would have been nice if my brothers had visited more often but I would not have expected them to move back home.

When Mom is in the AL sending things are so easy now. Depends was a big expense and I always looked for sales. You can get Mom new bed stuff. We took Mom down to a Twin so needed new stuff. Tell sister to give u a heads up when Mom needs something personal. Mom needs new clothes send them.
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We had this with my SIL MIL moved out of state to be near her daughter, leaving 2 sons, DILs and grandchildren. We tried everything to not have her go because MiL and SIL had never really had a relationship. They whole thing was weird….MIL said SILmaaked her to move and helped with finding her a home, etc. SIL says that is not the truth. 10’years later we get emails, letters, texts saying she is done, it is time for her brothers to step up. None of my husbands siblings had close relationships, but my husband and I stepped up from afar. We sent groceries every week to MIL, We took care of her finances, whatever she needed plus traveled there every 6 weeks to spend a week to give SIL a break. Things got real bad last year and we stepped on and moved MIL to a MC facility in our state. Have not heard from SIL 8 months.
not sure there is anything you can do except give your sister time. Now that mom will be in AL, that will give your sister a break….however….there is still things for her to do when mom gets to AL. Can you get the furniture,
get everything she would need, pack etc while your sister is away…this will ease the burden. Then do not forget to still give your sister a break when mom is in AL, maybe from afar manage that.
best of luck
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Spuncrack Apr 2022
Yes, I will be there for a couple weeks during the move in period, along with my other sister. :)
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Spuncrack, it sounds like you have done all you can: Offered practical help + kept communication open. All you can *within reason*. I add that as obviously quitting your jobs & moving interstate is NOT reasonable.

Yes, Sister may be heading to or already is burnt out.

Sister will need to face facts. In a nutshell: Being a lone caregiver only works for so long. She has been like a protective wolf - a LONE wolf - but she needs a wolf PACK.

Can she 'magic' a pack of sisters into reality to share the load? No.

Can she let go of some tasks, outsource, hire help, use delivery services? Yes. But she won't. What is stopping her?

This situation happens aLOT.

Reasons behind it vary. Some have people pleaser personalities or see it as their duty. Some won't ask for help due to pride, or have a wide perfectionist streak & won't tolerate other's different standards. Some actually lack trust from all non-family helpers.

It's a little like the process of sending your kids to school. That process of letting go a bit. Letting others outside the family (teachers, sport captains etc) have influence in their lives.

Sadly, sometimes it really does take a breakdown, their own physical or mental health crises to change their behaviour.

You can't do this for her.

What you CAN do is stay on message. Keep repeating it is time to rethink the plan. Make it work for Mom AND Sister. Add extra help. Moving to AL does not mean she *failed*. It just means she is ADDING a lot more help.
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Leave her alone at this point. What more can you do? You've offered all of the help that you can up to this point, and it has all been rejected. Some people want to play martyr and refuse help when it is offered.

Do not quit your jobs and move to where your sister lives. If you want to help further, try suggestion counseling to your sister so that she can balance her life between caretaking and self-care. Sometimes self-care could mean giving up that caretaking role for good. Assisting living and nursing home care may be the best move for your loved one. There are trained aides and nurses around the clock that can help with their needs.
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I’m going through this after my mother’s death actually. But, in my circumstance, I had a narcissistic mother, who triangulated us: I was in my mother’s life, like an only child, for decades, but my mother became so narcissistic, she gave my sister the early inheritance of the house up the street from her, in large part, to let me know that nothing I’d ever done for her had any worth. I’ll skip the rest.

I don’t know that there’s anything you really can do. Because, sometimes, it’s a strategy or game, to get you to give up everything for your parents. It also doesn’t matter if your sister was as codependent, as she was a caregiver. My sister is wailing like a martyr. But, the probable truth is that it was easy for her to afford to live in that house — because she was dependent upon our mother’s SS check, which is now gone. So, you may need to read between the lines and think about what might’ve been going on behind the scenes.

If it creates a hardship, for you to quit your jobs and move and your sister and mother are not willing to move closer to you, you must consider the consequences, long after. Pretty sure this “come to the mountain” scenario plays out over and over. A parent and also a caregiving sibling, can sometimes take a great deal of pride, in making other siblings uproot their lives, lose their own homes, give up job security, healthcare, and retirement, to care for someone, who might pass away shortly. In this market, that can be permanently crippling. This is particularly so, if it’s a less successful sibling, who is looking to even life’s score and paint the picture that you’ve never done well.

Ultimately still, you may find that you could’ve never done the “right thing” and you need to prepare yourself for your sister to entitle herself to whatever your mother may have left behind, even if your mother only needed care, for a brief period of time. For me? That is part of the reason why I’m starting probate right now.
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CTTN55 Apr 2022
I read your previous posts. After giving your sister an early inheritance and you went no contact decades ago, did your mother then live with your sister?

Good for you for getting out of that situation!
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Part of the problem is that usually: Mother will pin the responsibility on one child (always a daughter, when there is one) and we get caught in the conflict btw new world responsibilities & old world expectations. It IS completely unfair and IS changing, if too slowly. I was right where your sister was, and the resentment nearly did me in. At least siblings are offering & occasionally giving her a break? I alone took care of Mom for 10 years, and my take on this from then on is this: one person cannot do it all without paying a the price of declining health or worse. Sister probably wants to live up to her mother’s expectations - she cannot & should not! Parents have a right to some care & consideration <which should be borne by all siblings to the degree that it’s possible.> Be aware of what you can do realistically and the rest should be taken over by paid help.
Good luck. Be strong.
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I have a similar situation. My sister never got angry and provided care for my mom, who lived near her, for many years including several years of accelerating dementia and her final death at my sisters house in February. My mom complained that my sister didn’t do enough (that would have included quitting her seasonal job and moving into her house). Like your relative my sister and my mom persistently refused any and all offers of care. I actually did relocate 2 1/2 years ago but nothing changes. Occasionally my sister would ask me to come down for a few days or buy some enfamil but that was it. I gave up offering after letting her know that I was available whenever she asked. Turns out what she needed was to call and vent when things got too much. In my sisters case, she is a caretaker and pleaser by nature. She will take on another project now that my mom is gone. We actually became closer during this period and has willingly handed over the job of closing my moms house. I also had to consider the possibility that my own presence was difficult for her. She is non confrontational to the point that she avoids difficult questions. I suspect that my ahem, decisive personality, combined with my moms demands, was just too much for her. I would say ignore her requests to relocate, ask “what else could I do” and give her as much moral support as she can tolerate. This is her journey, as hard as it is to watch.
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"So... *apart* from resigning our jobs and moving in next door, what can we do to help?"

You wouldn't get a polite answer, no, I'm afraid not.

I think all you can do is carry on with your existing plans and try to keep your head down. Let this pass, letting more immoderate demands and remarks wash over you.

Your sister won't feel okay until:
your mother is fine
the stress has abated
she's healed from the last few years, bearing in mind that many of the emotional injuries won't even have been noticed or understood so far
she has perspective
reality is different.

She may appear to blame and resent you. She may even actually blame and resent you - hint, by the way. Taking over for a month IS a big deal and a credit to you; but it isn't wise to say so (or appear to think so) to someone who handles the other eleven months of the year. - which isn't rational but isn't something she can help.

You're just going to have to hold tight and let things move forward. How are the ALF plans developing, is there a moving date yet?
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Even if you were to upend your whole lives by quitting your jobs and moving to where she is, she might still reject all offers of help. I'm not sure this is only about help, because if it were, she'd accept the offers you've already made. It sounds like she's gotten into an angry, stuck place.

As others have said, keep the lines of communication open, continue to listen, continue to be an available shoulder.

Also, what if you just took action on something helpful instead of asking for her to tell you what's needed? Something like arranging a meal delivery service or a family newsletter and saying, "I'm going to do X, is that ok with you?" Rather than "how can I help?"

Or even just send her a care package or flowers just for her, with a nice note?
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I have a similar situation. My sister never got angry and provided care for my mom, who lived near her, for many years including several years of accelerating dementia and her final death at my sisters house in February. My mom complained that my sister didn’t do enough (that would have included quitting her seasonal job and moving into her house). Like your relative my sister and my mom persistently refused any and all offers of care. I actually did relocate 2 1/2 years ago but nothing changes. Occasionally my sister would ask me to come down for a few days or buy some enfamil but that was it. I gave up offering after letting her know that I was available whenever she asked. Turns out what she needed was to call and vent when things got too much. In my sisters case, she is a caretaker and pleaser by nature. She will take on another project now that my mom is gone. We actually became closer during this period and has willingly handed over the job of closing my moms house. I also had to consider the possibility that my own presence was difficult for her. She is non confrontational to the point that she avoids difficult questions. I suspect that my ahem, decisive personality, combined with my moms demands, was just too much for her. I would say ignore her requests to relocate, ask “what else could I do” and give her as much moral support as she can tolerate. This is her journey, as hard as it is to watch.
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I'm that sister. For perspective (and it may not relate to your situation)...I have one sibling who I consider toxic and she openly tells people she will not help Dad if it means helping me. My other sibling is out of state and makes definitive offers that are NOT what I want or need. I live in Dad's home, and brother says "I'll come for a month and you can just have a getaway". I do not want to leave home for a month by myself, nor am I in a financial position to do so, nor am I in the mood for a vacation!! I have not cared for my own personal needs in years, do not know myself, have been sequestered in a dismal environment for years and I don't even know how to interact with the outside world. When I tried to explain, I was dismissed. I requested he stay with Dad and just let me BE ME without the responsibility of Dad. The trip turned out to be a week rather than a month. He was very busy with outdoor chores at Dad's, and wasn't tending to Dad at all. So yes, he came, he whipped the outdoor areas into shape. It was a nice visit and it was appreciated. Did he care for Dad? No. Did I get a psychological break? No.

I'm certain he means well but truthfully if you are a sole caregiver, especially when dementia is involved, you become a shell of a person and you need consistent RESPITE or you will go insane. Which I really sorta have. My siblings are living their best lives and I'm very resentful. I'm not a martyr. I have gone to great lengths to beg for help, to be very specific, etc. One sibling won't help ever. One sibling helps in his ways and that is appreciated, but I feel very unheard and alone, and yes resentful.

It's very likely that my brother feels he made a huge & generous offer to allow me a month-long getaway. That is so far from what I need, and I have expressed my needs. Just perspective from "that sibling"....
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Lost313 Apr 2022
I feel this. I was a caregiver for my grandad and the one time my sister offered to help, it was horrendous. You don’t get any rest because you can’t let go.

However to the original poster I WISH I had a family member offer anything for me. Someone who cares about my well being. Your sister probably has anxiety. Sometimes asking for “what can I do?” And really listening can help. I really feared hiring a caregiver and my siblings were against it because they would “steal everything” but the one we had was amazing and went above and beyond. My grandad had to go to MC and she still texts me weekly to see how he is.
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Offer to put mom in a nursing home in your state. If she accepts great. She’s off the hook. My begt is that she will not allow it or want to move her … but the the decision should be equal although she is the main care giver .
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I think you are doing everything you can. There is little you can do when someone isn't allowing others to help in ways that they can based on their circumstances. I do everything for my mother as my brother is in a different state, I have no expectation he will help as I live in the same state and am POA so manage all the finances.

Having your mother in AI will help, especially if your sister sees it as an opportunity to start rebuilding her life, if she chooses to do so. However, she may chose to remain "unhinged" and continue to refuse and support. That isn't your problem, it is hers.
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I found when I was taking care of my mom, even though I had a pretty strong support system in place, I felt like since my mom was residing under my roof, the majority of the responsibility for her care was on me. It wasn't anything that was expressed to me, either directly or implied, it's just the way I felt. That wasn't anyone's fault, but it still sometimes made for some feelings of resentment, which were then compounded by guilt, because I knew those feelings weren't "fair" of me. I think maybe I was just better at masking those feelings than your sister is.

Sometimes, you just gotta feel what you feel until you don't feel it anymore. Give her some time, she'll come around.
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albleich Apr 2022
Exactly. I have brothers that are supportive, offer what they can with their limitations. I get SO resentful because it’s my life that has been altered for the past 10 years, not theirs. But I also volunteered and felt it was my place since I’m the lone daughter. Just wish I got a few more calls to check up on how I’m doing, not just Mom. Such a roller coaster of emotions. Glad I have these groups on which to gain strength and, for lack of better terminology, ‘camraderie’.
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First off - it is not easy making decisions for our elderly parents solely - and it sounds as if this isn’t the case for your sister ?? - but only you would know that
- but in my experience my siblings who are for the most part absent and my mother lives with me -they thought this was a gravy situation - because I am retired etc - older than them- caretake for a granddaughter so I am the chosen caretaker ?!
- I am also my mothers POA - and Executor and I do believe that plays into alot of caretaking situations unfairly with family members who then think oh okay your handling everything !
I am resentful at times because caretaking is much more than physically being there - decisions - planning - etc. your situation sounds like a communication breakdown and I know all about that too -
i recently have thought how sad to have all these negative feelings at this stage-
start the conversation with your sister - does she not want any assistance unless her terms ?
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You have offered to do what you can from a distance.
I kinda sorta get where your sister is.
When you are a caregiver you get the idea that you are the only one that can give the type of care that (fill in the blank) needs. It is difficult for a caregiver to ask for help and to accept the help that is offered.
Your sister is burnt out. That is a difficult thing to admit. In the back of your head you think if admitting that you are burnt out it means you do not love (fill in the blank).
If mom is moving to Assisted Living that will help your sister greatly BUT she has to allow the facility staff to do what they are supposed to do to help mom. Your sister can not continue to still do all that she has been doing.
From a financial point of view where is AL less expensive? Where your sister lives or where you live? Would it be advantageous for mom to move to an AL where you live?
Does the AL that mom is moving to have a "sister community" near where you are? Is it possible for mom to spend some time in the AL in one and take a "vacay" near the other? Some communities will allow this, others will not.
The other option would be to have mom move in to an AL that is near you on a permanent basis and you assume the role of "care manager / caregiver" for mom. If you do that you also must allow the staff to do what they are paid to do.

Getting back to your sister, there is not much you can do for her if she will not accept any of the offers of help that you have given her.
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If she wants you to quit your job, that should tell you everything you need to know about her state of mind. She is wallowing in self pity. If you can't reason with her, then she can't be helped.
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When a parent can no longer manage life for themselves. 

Don’t think for one minute putting a parent in assisted living or memory care relieves a family member of ongoing stress and ongoing care. 

Finances, doctors and more doctors, bills, insurance issues, prescriptions, getting proper care in assisted living, monthly product needs, emergencies, and on and on I can go all need to be managed by the POA/ Health Surrogate. The consistent review of legal documents and keeping yourself out of financial liability creates a huge stress in itself. 

The hard part for siblings is to understand the POA/Health Surrogate is the fiduciary to the parent and takes on a huge liability and is the person who makes the decisions no matter what family opinions are. 

If your sister called you and told you I need this, this, and this done? Would you just do it or would you inflict all your opinions and put walls up so the work can never get done? A POA needs a worker not someone with a bunch of opinions or disagrees with what or how something should be done.

 My two sisters made my life more miserable because they expected me to tell them what to do, and then when I told them what to do they wouldn’t do it. I got a long list of bull and opinions just to make a doctors appointment for my mom not to mention a laundry list from them of what I should do. Visiting mom in assisted living/memory care is their idea of helping. HA HA. 

You will be the most help if you realize your not running the show or have the liability. Each day things can change and what was needed today is no longer needed no matter how hard you worked on a task.

I would like one of my sisters to take over the POA/ Health Surrogate so I can get back to my life. If you really really want to help take over the POA/Health Surrogate and let her live her life now.
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PeggySue2020 Apr 2022
My in laws had another crisis, and I explained to him what poa is. Good explanation
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She is playing a burnt out martyr. You can't help a martyr. I'd stop helping. And when she finally calls ready to explode, I'd say we tried to help. You refused everything. Nothing I can do. You don't have to move states to help her. She doesn't get to dictate your life. Why would you let he? She won't stop playing the martyr if you moved next door.
Id tell her when she is ready to ask for help, and take it, you'll be ready to help.
Id love someone to send groceries to me, or have respite care. A normal person would take that help.
What does she expect you to do? Move in with her, where she can control you too? It still won't be good enough. I'd take a step backwards until she finally wants help. Part of her is freaking out mom has to go to assisted living and she can't control that. It sounds like she is a control freak and if she holds on tight enough, nothing will change in her mind.
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Did I understand correctly that not until this moment, now that mom's moving into an assisted living facility your sister has just become "right now" unhinged. In addition, only now that you mom's going into an assisted living you and your other out-of-state sister are planning trips to go there in the next 3 months?

Boing.

Okay. Might be me.
At any rate...

Could be that she was so much in-the-thick-of-it that only now she can take a breath and acknowledge her rage. Think of someone putting every molecule of thought and physical effort into holding up a monsterous leaning retaining wall and it suddenly disappears. That person can now take an emotional breath, to take stock on how matters and she was supported, to refocus on her own bad decisions, and the good (haha) intentions of others, and may need to explode. Give it time. It may heal.

You had very good ideas, and you're correct under normal circumstances to think that every good effort starts with discussions and planning, but this is not an workplace environment, this is family, were there any efforts? Forgive me but I can only go by what you said -"I've offered all the help I can think of". Think of, think of, think of.

Please what were the efforts? Did you need permission. I am currently the only caregiver of my husband. Twenty years ago, 4.5 hours and 2 states away from my parents, my sister was the primary caregiver/overseer of them. Once a month I'd take extended weekends and told her not to show up and take a break, no discussion. When my parents needed care for extended periods of time I took family leave, or sick leave, or vacation time. My sister had a P/T job, a husband and family to care for to boot.

Your sister is 100% to blame for not taking you up on your offers. I have been guilty of that. I'd sometimes think, "How can people not see the obvious? How can people (family) not imagine themselves in my place and just do?" Equally I also wondered why I couldn't say, "I'm fricking drowning here to people or myself".
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You are a good you. Keep trying. Chin up. Your sister, as you say, is burnt out, and rightly. But the thing about being a primary caregiver is that you are bound by life to fail. Those you are caring for will, eventually, well... die, despite all that you do. That's mostly what drives caregivers over the rails. I would suspect it would be good for your sister to see a therapist about this, so that she can get her perspective back.
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Two things came to my mind: asking the sister what she wants from you as help and then just listen. Do what you can of what she asks. Since it sounds like moving back is a no go for you, tell her that is not possible and no further explanation. And, Send her $100. cash or check every month in a nice note or card saying Thank you. Ask her to use it on herself or whatever she needs/wants. It may help her realize what she has been doing, is doing, has sacrificed for, has Value to you and your other sister.
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