Parent has always spent most of their time with step-parent's family, but now we need to have unity on what comes next. Any advice?

Blended families can add a unique wrinkle to issues such as yours. Let's get some clarity first:

- did your Dad give someone (or more than one) durable Power of Attorney? You won't be able to make any decisions beyond what your Dad actually wants and what the PoAs decide. Hopefully they will get consensus from others who care about his future, but they don't have to. You can request to be kept in the loop regarding what transpires for his care, but you won't have any real power, except the power to be a fly in the ointment.

- Having discussions about long-simmering issues, like feeling "out of the loop", needs to maybe wait as this will only add drama to an already emotional time and suck people's limited energy. My husband is from a blended family and I totally understand what feeling out of the loop is like. Just play nice for your dad's sake and get his current issues solved.

- Why do you believe in "keeping loved ones at home as long as possible"? Please go to the Caregiver Burnout postings if you want to know what reality is. Sounds like your step-mom may already be there, so don't judge her unless you know how much she's been doing for your dad.

- Be the adult in this journey. This is the most loving and practical thing you can do for your dad.

Your stepmother has been caring for your father. She has reached the end of her rope. Her children want her to admit him to a good facility, where she and they and your father's own children can visit him.

You, meanwhile - the one person who come what may will not be doing the heavy lifting - believe in keeping him at home for "as long as possible."

As long as possible appears to have passed by. Do NOT get in the way. By all means call a family meeting, where you and your siblings can offer whatever in the way of moral support you are each comfortable with, but don't "volunteer" your stepmother for either more hands-on caregiving or more guilt.

I just want to say that as long you remain hands off and aren’t taking physical care of your dad, you really have no say in whether or not he is placed. You aren’t obligated to step up and help believe me, i know it must be hard to want to, all things considered. But forget about your belief that he stay in his own home as long as possible. Its really up to your step mom and your dad to decide how long he stays home, unless you are willing to take him in to your own home. Yes you should have a family meeting with your siblings to see what the consensus is and who is willing to do what. But again, if dad coming to live with any of you is not a possibility, then it’s really going to be he & his wife’s decision to put him in long term care.

This is a tough situation with many old hurts and emotions in play I'm sure but I wouldn't "air" my hurt or frustrations at this time with Dad or step-siblings if I were you, you may even find that by simply expressing willingness and desire (if you have it, sounds like you do) to be a part of and help with their (they come as a package) care moving forward the misunderstandings or interpretations of the past will be corrected naturally. But that aside I would suggest exactly what you are thinking about in a family meeting, maybe start with what forms naturally when you are there and not just come in with what could be interpreted as trying to control things or take over. When you go for a visit spend a day or two first getting a feel for what happens day to day, who is doing what etc. Then when one or more of your step-siblings who have been doing the lions share of the support are around ask questions, I imagine because you are visiting one or both of your sisters will be around too for visits so maybe 2 of you can have an impromptu conversation with one or two of the steps about what you can do to help or what they are thinking needs to happen next. Then if the opportunity presents choose the person or timing to suggest the siblings all get together and then the siblings and parents should get together to chat about all of this. But throughout all of this try to recognize and make sure they know you recognize, right or wrong, that they (steps) have been the ones most involved in your shared parents lives and now care, they know your dad's marriage best and have been giving the support children do for years. Not because you and your sisters didn't want to or weren't willing it's not a dis on you or something to blame them, Dad or his wife for, it's just the way it worked out. But recognizing that and your place in that chain right now may put everyone including Dad and his wife more at ease about how this can go and allow them to speak more freely, include you and your sisters more freely in the big picture and that's what I hear you asking for.

You are right when you say your assumptions about what aging should look like and what your dad wants may not be the same as his so try not to go into this with preconceived notions but do talk to him about it, listen to what he has to say one on one as well as interacting with the rest of his family. I don't think I saw how long he has been married to his current wife but my impression is it's been a while and he really entrenched into that second family even though they aren't his biological kids but you didn't all really live together. I lived a similar situation so can kind of relate, anger and hurt included but I can also tell you that in particular the medical needs of aging and medical crisis have a way of presenting the opportunity for changing all of that and giving you all the opportunity for a second chance at being family. In many ways I think the fact that we are older with families of our own helps this process but that's a whole different tangent. I encourage you to find a non threatening way in, a way to contribute your unique skills which by your very question here include the will to plan in advance which is key here, without stepping on the key players position even if it means taking a back seat or helping them come up with ideas, plans rather than it being your idea (if you get my meaning) and find your new place in the bigger family. Hopefully your step-siblings aren't at the place where they want to split your parent's and make Dad your problem because this could become very sticky especially given the fact that they have had so much involvement over the years and your dad's kids have not because then you are looking at assets and financial division, medical expense and qualifying for help. As a couple they are entangled and if that is the feeling you get with no bites to work together you need to get an Elder Care/estate attorney involved to consult with.

This decision is your stepmother's, as his wife. Especially if she has POA. You should be included in her decisions especially if her children are. But the final decision is hers.

I would not say anything about always feeling "out of it". I get the impression that you were raised by Mom and Dad remarried. Did he raise his step children or were you all grown when he remarried. It really has a lot to do with how ur question is answered.

Stepsibs may be more in tune to what their mom can/cannot do physically at this point. If you are already aware she is under a lot of stress and is overwhelmed, the stepsibs are even more aware than you.

Go talk to s/mom as soon as you can and make your offer. At least she will know how many hours you intend to pay for (and you make the arrangements so she doesn't have to deal with that part) and how much relief you will be offering. Your other siblings need to give you a calendar of committed hours that you can share with her at the same time...siblings must in in agreement that if their name on calendar for a certain day and can't go, they find replacement ahead of time. Do not leave s/mom hanging when she expects you to be there. - If you all can't provide this sort of promise to her, don't make the offer.

If you and the siblings don't want him in a facility, which one of you can take him into your home? Or which one of you is willing to go to their house to provide her with 24/7 coverage so she can get out of the house to get a break...for several days, week, month, etc. A break for a caregiver needs to be substantial - not just giving them a couple of hours to run all over town to pick up groceries, misc items for the house. If no one is willing to step up, then your belief of keeping loved ones at home lacks the hard work it takes to accomplish that belief

Sorry your "I believe in keeping loved ones at home as long as possible," does not count in this situation.

Your step mother is his wife. The bulk of caring is falling on her. She is the one, who gets to decide if she can no longer cope with her husband at home.

Family meeting is definitely needed.

1 - Focus on what kinds of tasks dad needs help with at this moment.

2 - Also focus on who is willing to help meet these needs and in what ways. Nobody can tell another what he/she should do. Each person should volunteer for himself/herself.

3 - If there are needs that nobody wants/able to address, its time to look for other resources: Adult Day Program, home or health care aides, sitters, etc.

4 - Get dad an appointment for POAs with a lawyer while he is still able to give consent. Then, that person or those people can "take over" with decision-making when dad is unable to.

Family meeting is in order.