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You must remember that you were not chosen by your stepdaughter, her mother chose you. When you entered your stepdaughters life she still had her real father. She would have felt a range of emotions from her mother sending her father away to your displacing him. The truth is irrelevant, it’s what she felt that is important. From your question I assume she was of reasonable age when you came into her life. You will have formed a relationship but how close it is and was is only known to you and those in the familyA child is not bound to to look after a parent in old age and whether they want to or not depends on how the parent treated them as they grew up, how they see the actions of the parent towards them as an adult and what calls are being placed on the child by their own life and responsibilities. A bond to the real parent is usually stronger than that to a step parent.I have only the very limited information of your question to work with but just it’s tone implies you are both needy and demanding. You say your son has hired a private nurse for a once a week visit so your actual needs aren’t high, and their is no mention of your son visiting so he may be paying to salve his conscience. You expect your stepdaughter to treat you like she did her real father……are your honest needs what his were? Did you treat her as he did? Who is doing all the stuff the nurse doesn’t do like laundry, shopping etc? You?I make no judgement but in my experience people in need tend to have folk step up to help if they can, but they seldom ask. Those who try to demand are seldom in the need they portray to others.At the end of the day, your step daughter has the right to care or not for you or any other person who asks. As an RN she is used to assessing care needs and has the ability to offer advice as to how those in genuine need can access the services from organisations outside the family. Her RN status is her job, not a solemn oath to rush to the aid of anyone who demands it.Good luck. Perhaps now might be a good time to ask yourself the question “why should she” rather than “why won’t she”? Reflect upon how you helped your parents in their old age. Many older folk believe they are owed everything because they are aging and their bodies are starting to fail. Many expect that they will be helped even thorough they have done little in their life to earn it. When there demands aren’t met they play the victim, the martyr, bemoaning how no one will help them whilst they stop helping themselves even though they are capable of doing so. Others just grit their teeth and get on with it. Only you know in your heart where you fit int this scenario. If you truely can’t cope you have the option of going into a nursing home.

I feel very fortunate because I had someone who backed my corner and took it upon himself to push to make sure referrals were received and processed.It took ages, months each time, from speaking to my own GP, then phoning to see where this referral was sent, then phoning other organisations to make sure it was received and so on. This was just on the run up to the diagnosis for autism. The PTSD wasn't diagnosed until I spoke with a psychiatrist which I didn't get to see until I'd received the diagnosis for autism.Since then, I am pleased to say that in the UK, nationwide there are centres that have sprung up specifically in responce to the crisis we had in this country prior to 2009, when an act of Parliament was pushed through (predominantly because of parents who were concerned about the lack of support for autistic adults) that puts a responsibility on local authorities to offer support and adult autism support services.I was ascribed a support worker who was going to help with any issues I have, starting with therapy for the trauma because I am highly avoidant when it comes to dealing with the outside world and before diagnosis, I put myself in danger, nearly ended up homeless and I had warrants for debts, stopped eating, lost so much weight and didn't reach out for help.The adult autism centre is in lockdown and has been since March.My autistism support worker, got poorly, had an operation and apparently isn't returning to work, so I've had to wait and the centre is a new organisation with staff shortages of peopLe trained and so on. But It did give me access to services specifically for autistic people and adults with learning difficulties, such as a mindfulness course and regularly we had meetups arranged with special “cafe’s” which were themed around special interests or problems we might have such as finding driving tutors with autism awareness or dentists that will knock us out rather than give a local anaesthetic.I have felt a need to complain a lot, I am gifted at complaining via the written word and my letters of complaint querying services seems to get results, I've felt largely ignored and that's prompted a few scathing emails that have been dealt with, I sent a few when I felt they forgotten about me and questions weren't answered but overall, I feel safer now, I know they have a duty of care for me and there is support in place that I feel makes it much easier for me to speak to people in charge of my medical care.The one thing I have noticed that is often at medical assessments, I need somebody with me who who understands me and medical professionals tend to address that person instead of forcing eye contact or even an exchange with me.I had a medical assessment to apply for a disability benefit we have here in the UK, PIP (Personal independence payments) and I had to appeal their findings when they said that I showed no signs of mental impairment partly because Id managed to fill the forms for the application without assistance. I won the appeal with the help of CAB (the citizens advice bureau, a charity) so I am officially disabled with a severe disability because of autism and PTSD and the way that affects my daily living and mobility.I've not had any other medical health issues aside from a boil in my armpit and that was easy enough to explain, the GP didn't speak to my support worker on behalf of me, with regards to that.I'm not sure if that answers your question or not, or whether that might be useful for folks outside the UK but the 2009 changes in our law certainly helped and ongoingly helps us access services when we have medical needs.I don't think that doctors seem to learn much about autism and I know that ten years ago, when I first starting shutting down and I had awful sensory issues after my son was born that I really needed help to understand and my then GP had the attitude that I was just depressed and referred me for CBT, I went to hell and back in that time and he was extremely callous in saying “you don't look like an hysterical woman to me, you must be fine but we will send you for CBT and not listen to anything else you say because you are probably neurotic and not hysterical”I suspect alexythimia didn't help me when it comes to talking about emotions and even pain, I can dissociate from a lot of pain and I had a really wierd experience when I cut my hand and needed stitches.As soon as I cut my hand, I saw the blood and started to go into shock, but not so much that I didn't follow procedure and compress and elevate the cut above my heart, to slow down the blood loss.So by the time I was sat in A&E I was lucid, not panicking and my hand was stuck up in the air with a tea towel wrapped around it.The doctor and nurse who both saw it, were highly suspicious of why there was no blood and why I was so calm. I actually think that they thought I'd done it to myself, on purpose, for reasons that I can't imagine. It definitely changed something in the way they perceived what had happened.I felt that if I didn't explain that I was carving wood and I am wood Carver, it's an occupation and my cut was an accident.It just so happened that I was dissociated, I was freaking out inside because I darent look at my hand, I feared that I flayed it and so sitting and looking blank was the best I could do, to hold myself together so yes, I looked spaced out and couldn't communicate very well, I definitely didn't want to talk about it, I just wanted to be sewn back up, so that I could go home and cry.Feeling emotional and physically hurt, don't go hand in a way that doesn't severely affect my communication - when I'm in a lot of pain, I can't talk about it which is explainable now we all know I'm autistic, when my medical records didn't show that, I think I had a very close shave with not getting sectioned under the mental health act for self harm, because my emotional responces and communication looked “off” to medical people who worked with me and it did unnerve them.But then it unnerved the midwives who helped deliver my son, because even mid labour, my heart beats per minute was less than theirs and they weren't in labour having contractions.I personally think that dissociation and alexithymia both come naturally for me, any pain, phusicak or emotional and I shut it out and become detached - so I actually find it very hard hard to acknowledge that 1. I am really hurting and 2. A way of expressing that with emotion so that other people believe me. Instead of screaming or showing the pain of emotion on my face like other people, instead I probably show flat emotional affect.I think that makes it easier for doctors and medical professionals to look at me and dismiss what I'm saying, unless my leg is falling or my hand looks like it's flayed, unless it looks obvious to them as medical professionals, it is a worry that I have, that things will get overlooked just because i can't show upset and distress in a way that they can identify in other folks without autism.

Wages are lower but that is a unidimensional analysis. The overall cost of a family living well is, in most cases, lower in France at the end of the year, and the quality of life is considered so good by average Frenchman that they forgo the possibility of higher nominal wages elsewhere in most cases.I. Real-life calculation of the cost of equivalent services and quality of life. Let’s go through each major expenditure calculation.Accommodation - Paris as the most expensive location in France, but accommodation is 3 to 6 times cheaper elsewhere.Cost of 1-bedroom rental in centre (Numbeo)Biggest city: Paris vs NYC $1335 // $3150Middle size city: Lyon vs Philadelphia $775 // $1550Higher education. Apart from private business schools, education in France is public, excellent and very inexpensive. In the US, even a State (public) university would cost at least $10k-$35k per annum in tuition (depends on the university and then the tiered fees concerning the student’s State of residence and choice of subject); private universities can be $40–80k per annum. Most Americans end up with student debt that take decades to pay off from $50k-$500k!Medical School tuition:France $1,100 per year.US State (public) school for in-State residents $35k per year;US Private about $60–85k per annum.Law Degree : France $500 vs USA Public $17k vs USA Private $35kUrban transport. Most urban areas in France are compact with pedestrian-compliant layouts, have excellent urban transport and so car ownership is unnecessary in many situations. In the US, even a modest car would cost about $8.5k per year to own, insure, maintain, fuel and associated tolls/parking.Greater Paris yearly transport Pass : $815 (Forfait Navigo Annuel 5 zones - RATP)Metropolitan NYC 30-day Metrocard: $121, so annually $1,452Average annual cost of car ownership USA: $8,500 (Nerdwallet)Healthcare. In the US, unless it is a perk of employment, it would be about 9% of gross income AND subject to limits, exclusions and gaps. A single 55 year old can easily spend at least $10k per year JUST for premium in the US; heaven help him if he were to get a devastating, chronic illness (Breaking Bad is quintessentially American a phenomenon; in France, cancer care is fully assumed by the State.)France: Average annual cost $5,500 (indirect via taxes; direct via optional - but chosen by 87% of French - add-on private, usually non-profit, insurance)USA: Average annual cost (premium + out of pocket + public insurance like Medicare + public funding of “free” clinics and emergencies) $10k (CNBC)Retirement care. In the US, you have to take care of this yourself unless you are a public servant or a company employee that will have a solvent pension fund when you retire. In France, pension funds are largely handled by independent third-party organizations and decoupled from the solvency of former employers.Senior Community: France $600 monthly rent vs USA Avg month of private ALF $3700Long-term Care: France (EHPAD) vs USA (Nursing Home) $1,135 // $5.8–12.5kAvailability of a social benefits net throughout life. Benefits for maternity leave, child care, unemployment etc. are much more comprehensive and longer in France and not subject to budgetary crises with each political mandate. Even the long-term unemployed are provided a living stipend and free healthcare!Wages per hour worked.In France, 47 weeks a year x 35 hours per week => 1,645 hours annually; In the US, 50 weeks a year x 40 hours per week => 2,000 hours. In addition, many employees are accorded a “13th month”, a bonus equal to one month’s nominal salaryThus, to calculate the per hour wage equivalency from an annual wage figure: [French annual wage] + 21.6% = [equivalent US annual wage].$40k French annual wage = $52.7k US annual wage, based hourly wage and a 13th month bonus to salaried French employees.A more in-depth calculation would take into accountpublic holidays (France > US) ++paid leaves of absence [France > in the US). ++++income tax and sales tax (France > USA) ——Housing tax and common expenses in multi-family buildings;In France, the occupant (lessee, friend or owner) pays for a) housing tax (taxe d’habitation) for living in the housing and associated municipal services and b) also a monthly service fee (charges communes) for upkeep to the provider in a multi-family building; this means that rental agreements are longer with indexed increases only but the Taxe d’Habitation and “Charges mensuelles” vary for which the occupant is responsible.In the US, the renter only pays the rental charge, while the owner pays “property tax” and the common “monthly maintenance fee” in a multi-family building, both of which are subject to wide variation from year to year; for that reason, rental contracts are usually at most 1 year and a renegotiation occurs every year; it’s a monumental waste of everyone’s time.II. Quantitative cost-benefit calculation, the average employee with family would likely be out ahead in France. So, while the gross wages of a French job is less nominally than for an equivalent American posting, at the end of the day, you end up with more free time and possibly more disposable income, especially if you have a family, and your pension is not subject to the vagaries of a company that may go belly up or even reduce pension payout. If you are an average wage earner with a family, or if you have a chronic or devastating illness, your financial life is much less stressful and predictable in France than in the US.III. Qualitative Assessment of aspects of life in France.Things just work in France (except during the pre-summer strikes) and infrastructure is excellent with a government civil service that has 25 year planning cycles; even Japanese come to France to learn of this process!The urban environment is excellent in most parts of France with laws to preserve and maintain historic buildings; urban embellishment includes Paris’ own nursery so that flowers are in all green spaces as soon as spring arrives..Vastly varied countries are hours away by train or car.Food (OMG!) is superb. Farmers’ type markets are the norm. Good wine can be very cheap (€5 a bottle at an estate!) Real champagne starting as low as €13 (the one from Champagne region with ordered lines of fine bubbles rising in the glass vs other sparkling wine made in “méthode Champenoise” that fizz like pop/soda and taste like nail polish mixed with grape juice, guaranteeing a nasty headache).Security is usually not an issue save for spectacular isolated acts.The cultural, architectural and natural attractions of France are astonishing, ubiquitous and profound.Privacy is sacrosanct in France. It’s refreshing not to feel compelled to tolerate “group think” (i.e. irrational strong opinions shared by Joes or Jennies Average). No one cares what you do at home, as long as you are a good neighbor. They don’t pry. They don’t understand the concept of “sex scandal”; Paris Match was pilloried when they published photos of Pr. Mitterand’s adult daughter by a mistress. They even have unmarried ex-Presidents with parallel families, sequential partners.People actually tend to have independent thought, and conversations at best are enjoyable art forms. This could be their culture but it is reinforced by making Philosophy a compulsory high school subject. Every teenager is taught to deal with an issue through observation, gathering of relevant data, weighing different viewpoints and then drawing a conclusion that they have to defend! My god! What do French teenagers think of some leaders across the Pond?The climate is temperate (It almost never goes below freezing for extended periods in most locations and you don’t often need air-conditioning for more than a few weeks in summer).Lastly, with 5 weeks of statutory paid vacation per year, plus all the national holidays, your family and private life is given priority compared to the maximum of 2 weeks in the US, for example.Final ThoughtsIn some ways, French wages are lower as the financial/well-being risks are also lower.In France, it is unheard of that a family is bankrupted by a serious, chronic illness or long-term unemployment. In the US, one almost has to have a “reserve savings” for such an eventuality and many are devastated if they aren’t well insured or wealthy.In France, pensions, even for company employees, are managed by autonomous quasi-governmental pension funds, the solvency of which is decoupled from the future of the private employers. In the US, for example in the car industry, many retirees have had their pensions reduced or disappear when the former employers go bankrupt.In the US, if one has children, one has to plan decades ahead to finance their higher education (“college”) that would be annually, at a minimum, some US$10–35k tuition, plus living expenses. Some private universities would cost over $80k in tuition. Medical education can mean $500k of debt after 4–5 years in a private medical school like Harvard or Stanford!In France, if one is unemployed, benefits buffer those affected from the extreme pressures that Americans face.The French system is designed to be best for the majority of its citizens, on average. The US system is not “designed” but runs under a mish-mash of philosophies that vary from place to place; it makes managing one’s finances and well-being much more complex and risky.However, the US has a much more dynamic capital economy and, for the successful entrepreneur, the business environment and monetary rewards are far more than one could expect in France.