Caring for elderly parents - major life changes?

[swimmermom3]

I will remove some of the following information, so please do not quote this post.

 

My parents are both 77 and live in their single-level home about a 5-minute drive from us.  My mom had breast cancer several years ago and we think the chemo severally hurt her lungs and the past year has greatly diminished her ability to do more than walk a few feet in the house.  She had a mild heart attack a couple of months ago and they placed a stent. 

 

My dad has been fairly healthy and he now does nearly everything around the house.  They have house cleaners every other week for two hours. Anyway, Dad was scheduled to have hip surgery last week, but a few days prior, he had chest pains. We got him to ER and in the cath lab they discovered two blockages, one on the major artery they call "the Widow Maker." We were very lucky. He just had another few days in the hospital due to a concern over a possible clot in one of the stents. There can be no hip surgery for 6 months, so he has chronic pain.

 

We need to make some major changes and I am feeling a bit overwhelmed.  My folks have acknowledged they need help and they would like to stay in their home for now. I spent four nights there over the past week and have a better feel for what my mom can do and what she can't do.

 

Any advice that those of you who have been there can offer would be greatly appreciated. I am working my way through the book, How to Care for Aging Parents.  Tomorrow morning I will meet with their house cleaners and see if we can change to every week and add some more items.  I will be working on meals and grocery shopping and laundry to start with.

[prairiewindmomma]

Meals, laundry, and travel to/from doctor appointments have been the other big 3 things my relatives have struggled with.

[EKS]

This doesn't address your question directly, but I highly recommend (when you have time) reading the book Being Mortal. 

[RootAnn]

Some communities have volunteers who help older people with some of the things prairiewindmomma indicated. Our area calls it, "Neighbor to Neighbor" or something like that. Others have "Angels" of some sort. Might be something to look into. Medical transportation, lawnwork, small handyman fixing, etc. Search for elder care volunteer & your city/town name.

 

I'll be honest that this is the time that discussions about medical & financial power of attorney are the easiest. It is SO MUCH easier to get paperwork done now than later. If they don't already have their bills on autopay, that's something else to consider doing now, if possible. Adding someone to a bank account is something to ponder, as well. Decisions on that will be family-specific, of course.

 

 

[catz]

I think you need to very thoughtfully ask yourself is how much do you are able to help?  Are you healthy?  Is caregiving highly stressful for you?  What are your other family obligations?  Do you have a job?  Are you their only local offspring?  Is having them live with you an option at any time?  Is their house safe for them as they slow down (single level, bathrooms, etc)?

 

Might they qualify for other services like meals on wheels, etc?

 

Honestly, with hip surgery coming for dad down the line, I'd start talking favorably about moving to an assisted living situation and doing the homework on that unless living with you or another sibling could work at some point.  The thing is if they can get into that situation when they're doing ok and lucid, they may never need a nursing home.  Many people do better both physically and mentally in those situations because they have a lot of social stimulation and engagement and someone checking their health every single day. 

 

Lining up paperwork for living wills, health care directives, finances, etc is a great thing to get done to be able to forget about it.

 

My mom is 71 and in pretty good health (a couple issues well managed by medications and monitoring) and my father died a couple years ago.  They had a winter home and a summer home (near my brother and I).  She is so much happier in their winter home in a senior community and has a lot more interesting stuff going on there.   When she slows down a bit and gets rid of one of their homes I'm going to encourage her to move locally to something similar.

 

I do think whatever you decide, take it in blocks of time.  If you commit to helping daily, try that for 6-8 weeks and step back and think about it.  Keep your parents informed about how you're thinking and feeling about it.  Them choosing to stay in their home is not just about them any more if they can't do it on their own.  

 

:grouphug: Having aging parents is hard enough and being a care giver just adds another dimension to that. 

 

 

Edited August 6, 2017 by WoolySocks

[mschickie]

You might want to check into Meals on Wheels for them.  My mother just started getting those this past year and loves it.  The cost is very reasonable and she gets so much food.  If she is going out for dinner or something like that she will just freeze what she gets from them and then have it on the weekend when they do not deliver.

 

 

Another thing you might want to do is check with their church if they have one.  Many times the churches will have ministries where someone will volunteer to come over and help with laundry or driving folks to doctors appoints.  This would be helpful for whenever you are not able to help.

 

[MaeFlowers]

I dont have any advice but I understand what you're going through. My parents will be moving down the street from me in one month. My Dad has had three heart attacks/episodes including the Widow Maker. My Mom is in rehab because she fell and broke her hip last month. My Dad is doing everything (and has been for a while).

 

Im looling forward to them being close. They currently live 12 hours away. But, Im also nervous about what I am taking on. There is no other family to help and my parents are very private people. I'll be following along if you dont mind. I would like to read everyone's input.

[swimmermom3]

This doesn't address your question directly, but I highly recommend (when you have time) reading the book Being Mortal. 

 

Kai, thank you so much for this recommendation. I've ordered it as it looks like it addresses some very specific concerns that I have.

 

[sassenach]

Here's the good news- it doesn't sound like you are dealing with dementia currently. That makes such a difference. Personally, unless they have a LOT of resources, I would not jump to assisted living yet. You're rationing for an ambiguous time frame. Be conservative while they still have their faculties.

 

My priorities would be

 

1) legal stuff- financial and medical

2) household help- housekeeping (you're on it), food, maintenance

3) medical- appointments and personal care. This is the most consuming. Can they still safely bathe? What kind of rehab care does their insurance cover?

 

Best wishes.

[Kim in Appalachia]

1 piece of advice that I just learned from a friend:

 

Make sure all personal information is kept secure.  ID's should be in a locked safe, bills kept away or all switched to online, checkbooks and banking information locked away, etc....

 

You may be having different people in the home for help, from cleaning services to any home heath care.  Identity theft is a real concern.  

[TechWife]

I highly recommend that you find an attorney that specializes in elder issues and take your parents to meet him/her. Some of them will make house calls. They can step your parents through making sure their wills are current, explain advance directives/living wills, medical power of attorney, financial power of attorney and can help them with asset management. Something that seems straightforward, such as how a house is deeded, can be a major financial concern should the need for nursing home care one day arise. If they have other assets, the attorney can let them know to protect them so that they can use them for their own benefit for the longest period of time possible. Doing this was the best thing that we did for my parents.

[TechWife]

Here's the good news- it doesn't sound like you are dealing with dementia currently. That makes such a difference. Personally, unless they have a LOT of resources, I would not jump to assisted living yet. You're rationing for an ambiguous time frame. Be conservative while they still have their faculties.

 

 

The timing for when to use assisted living is critical. As you said, rationing resources for an unknown length of time is an important consideration. However, it is not the only consideration. We all run out of money at some point.  I wish we had considered assisted living for my parents much earlier than we did.  There comes a point at which someone is too infirm to be admitted to assisted living. It is a window of opportunity that closes and it can close very quickly and without warning. Once in assisted living, often the resident can "age in place" as long as the facility is able to provide appropriate care. 

[Seasider]

What TechWife said above, plus make sure you are listed on the HIPPA paperwork at their physicians' offices.

 

Contact their primary care doctor abd/or insurance carrier and find out if the office or insurance company has a social worker available as part of their benefits. If they do, that social worker can come out to the house, meet them, look around for potential problems, figure out what needs may be or soon to arise - meal procurement, transportation, safe living environment, best way to activate EMS, that sort of thing. If no social worker is available, seek out your local council on aging, which should be able to help with these things.

 

Remember that you cannot do it all, especially while you have a young and growing family to take care of. You can bet serve your parents not by doing everything yourself, but by using your energy to seek out resources. That keeps you freer to enjoy their company in their remaining years.

[PinkyandtheBrains.]

Do they happen to have any kind of long term care insurance? I know many don't. If they do, check out the details. It may be possible to work out options for in home help. I am navigating this with my mother right now.

 

 

It's not my story to tell, but feel free to pm me with questions. The situations are similar.

Edited August 7, 2017 by PinkyandtheBrains.

[Minerva]

:grouphug: I am coming up on this time with my parents and listening in. 

[Guest]

1.  Meet with the lawyer and get the paperwork in place.

 

2.  Do some research on assisted living options in their area.  Some will take Medicaid IF the residents have been in place on a paid plan for 5 years.  Very few take Medicaid straight out of the box.  

 

3.  Find out what their insurance will cover for in-home care.  And all the other things like Neighborhood Helpers and so on.  Learn about options.

 

4.  Be very honest with yourself and with them about what you can and cannot do for them.  My dh is retired, but his mom lives "independently" in a low-income apartment.  She is "independent" because she can cook for herself and do personal care.  But DH takes her to at least 1 and often 2 doctor appointments a week, picks up all her medicine, comes over 2x a week and washes her dishes, does all her grocery shopping, and so on.  She has a housekeeper come in 2x a month.  He does all the grant applications for her co-pay assistance for meds she needs but can't afford.  It is a half-time job, and he is not complaining nor am I.  But it IS a half-time job.  He couldn't do it if he were still working.  Or if she lived 15 miles away.  And even so, when she got some infection in her private areas, he drew the line.  "I'm not doing that with my mom.  She's my MOM."  So that had to be paid for.  He had to be really honest about this with her and with the medical people (who will push everything they can onto the family...and I'm no help.  I just don't do medical stuff.  It seriously makes me throw up to do more than change a bandaid.  So I'm no good as a backup on that stuff.  

 

So there's "independent" and there's "independent."  My MIL is not in assisted living because my DH has a half-time job taking care of her.  But she is "assisted."  If you can't do these things, things that must be done, you have to have a plan for how they will get done.  And no one is better off for fooling themselves about the part they can play.  

 

6.  Acknowledge at least to yourselves that it probably not going to get any better than it is right now.  My grandfather was still talking on his deathbed (as in he died the next morning) about all the things he was going to do when he got home.  That attitude made it very hard for him to get a grip on the things that needed to happen a lot sooner than they did, and possibly shortened his life.  I know, I know...stubbornness maybe made him live longer too.  IDK.  But the mess left behind for everyone else...I also saw THAT.  KWIM?

 

Good luck to you.  This isn't all that much fun, and it is really hard because it is a role reversal and everyone has to learn to play a new part.  My mom and my MIL have been fantastic at doing this adjustment and it has made a world of difference. 

 

 

[Carol in Cal.]

Good advice so far.

Good for you for trying to help them age in place.  IME that is what most people are happiest with.

 

I would add--did either of them serve in the military?  Sometimes there is financial as well as medical aid that accrues from that when care is needed.  It's worth checking into if so.

 

Also, FWIW, my MIL took care of her aging father and step mother for quite a while, until she just couldn't anymore.  They lived close by.  She ran over with a noon hot meal daily and back again to clean up and get supper later on, plus they called her when they fell in the middle of the night.  She helped them manage in general--paying bills, going to the doctor, etc.  I don't know what finally made her decide that it was too much, but finally she insisted that they hire help and they got a day nurse and a night nurse, and were able to live at home for the following two years or so until they died.  But during the time she was over there all the time was when she got diabetes and high blood pressure.  It's very hard to be in charge of frail adults 24/7.  They are less manageable than babies and just as relentless in their needs. 

 

Another book you might read:  The 36 Hour Day.  That has to do with dementia, which you should watch out for. 

[Pawz4me]

So much depends on their financial resources and on your relationship with them. If the relationship is good and If they have enough savings that you can hire help as needed then IME caretaking doesn't have to be a huge life changer. The first step (other than seeing to immediate needs, of course) is understanding their assets (especially savings/monthly income from SS, pensions, etc.) and making sure you have some access to those funds. 

[Laura Corin]

Something that we underestimated was the emotional toll that it would all take.  Not only the increased busyness and worry, but also the changing relationship, any unfinished emotional business from childhood, dealing with other relatives, having tough conversations about end of life...   It has all been exhausting and there have been times when I was, honestly, resentful of the way that all this was taking over my life.  It's not an attractive reaction but it was something I needed to work through.  Somehow developing a sense of humour about how awful things sometimes were was key to keeping moving forward.  Good luck!

[catz]

The timing for when to use assisted living is critical. As you said, rationing resources for an unknown length of time is an important consideration. However, it is not the only consideration. We all run out of money at some point. I wish we had considered assisted living for my parents much earlier than we did. There comes a point at which someone is too infirm to be admitted to assisted living. It is a window of opportunity that closes and it can close very quickly and without warning. Once in assisted living, often the resident can "age in place" as long as the facility is able to provide appropriate care.

 

Yes, this exactly. It can take some time to get finances and paperwork in line and find some place if assisted living is in the cards. I have 2 grandmothers who definely would have done better in assisted living. The other thing is when one dies the other will already have a community in place. You only use the services you need. If you are independent it's just like living in an apartment.

 

Something that we underestimated was the emotional toll that it would all take. Not only the increased busyness and worry, but also the changing relationship, any unfinished emotional business from childhood, dealing with other relatives, having tough conversations about end of life... It has all been exhausting and there have been times when I was, honestly, resentful of the way that all this was taking over my life. It's not an attractive reaction but it was something I needed to work through. Somehow developing a sense of humour about how awful things sometimes were was key to keeping moving forward. Good luck!

This is a great way of saying this. No one should be a martyr 24-7 and not every one is good at care giving. The emotional and paper work end alone of this is difficult and draining. Stay in touch with your feelings on it. Don't be afraid to say no to a doctor or hospital because they always assume family can do everything. Edited August 7, 2017 by WoolySocks

[elegantlion]

My mom is healthy, but she has been doing some things to prepare for aging. Ds and I live here and we are really the only family nearby.

 

She is making sure her physical home is in order. Since we moved last year, she has upgraded most of the appliances, spent some time keeping the cars in good working order, and been very open about her finances (my dad was never that open until he really needed help). We are also going through and making her all of her assets have a co-owner or a POD. When we refinance in a few years, we will probably put me or ds or both on the house. 

 

We are easing into those discussions of what would happen if I can no longer care for her. I know she wants to stay in the home as long as possible. I'm not sure where my limit is, but we have sort of a mini-kitchen now set up upstairs (2 story house), which would be helpful is she couldn't do stairs well. 

 

If genetics come into play, I feel like her mind will fade before her physical health, which I can see having its own set of challenges. 

 

I know even living with a very healthy older parent has been emotionally challenging as Laura pointed out. There are weird childhood issues (my own) that come up. 

 

Thanks for the book recommendations, I should probably read up on this topic. 

[fairfarmhand]

One thing that never occurred to us is the ability for emergency services to get to typically used areas of the home. My FIL was bedridden in a back bedroom. He had several calls to the EMT and when he was in pain, scared, and suffering, he had to be carried to the stretcher. They couldn't make a turn in the hallway with a stretcher.

 

 

[Joules]

Something that we underestimated was the emotional toll that it would all take.

Everything she said. Set boundaries, get counseling, and take care of yourself and your nuclear family. You don't want to wake up one morning and realize your marriage is a casualty of the whole thing.

[MBM]

I took care of my MIL for about ten years. Some suggestions:

 

AARP has helpful advice.

 

Patients can recover at post acute care facilities that are designed to help them heal faster while being overseen.

 

If your parents want to stay in their home, start learning about visiting nurses. My MIL broke her leg three times. The first two times I stayed and cared for her. We lived in the same condo so it was relatively easy. By the third time we had moved 17 miles away so it took longer to get there especially since we were driving into a city. We ended up hiring a visiting nurse who turned out to be a godsend, just a super caring individual. She had just moved into my MIL's condo and could easily check on her. Because of her, we were able to go on a vacation knowing MIL had someone close by who was helping her throughout the day.

 

If your parents have assets, all of you should figure out how to arrange them with an attorney so that funds can be easily accessed for their care should that need arise.

 

I used to make diabetic meals for my MIL in my home which were stored in containers and were easy for her to fix.

 

It's also important to make the house safer if possible -- installing grab bars and ensuring they are properly fastened and can hold a lot of weight, making sure surfaces aren't too slippery, tripping hazards, night lights, etc.

[PinkyandtheBrains.]

Something that we underestimated was the emotional toll that it would all take. Not only the increased busyness and worry, but also the changing relationship, any unfinished emotional business from childhood, dealing with other relatives, having tough conversations about end of life... It has all been exhausting and there have been times when I was, honestly, resentful of the way that all this was taking over my life. It's not an attractive reaction but it was something I needed to work through. Somehow developing a sense of humour about how awful things sometimes were was key to keeping moving forward. Good luck!

This is huge, and such a struggle.

[dsmith]

I don't know if this was mentioned upthread, but have you thought about a Life Alert or similar device? We have a Philips Lifeline for my father-in-law, and it has fall detection. We share a house with our in-laws but we still decided we needed one of these devices after fil passed out and fell in the bathroom and nobody heard him fall. We will probably be adding a device for mil soon. 

 

We had an episode last night with fil at the dinner table, and he ended up vomiting at the table and being unable to breathe. For some reason it really scared the crap out of me compared to other episodes we've had with him. (mostly low blood sugar issues) It really made me worried about the future, especially now that I've been diagnosed with MS. They will be staying in the house until the end, and I'm realizing how difficult and stressful this is going to be. I know my sister-in-law will be able to help financially with caregivers in the future, but I'm on the floor cleaning up vomit and she's making faces about how gross it is, lol. 

[Legomom]

1.  Meet with the lawyer and get the paperwork in place.

 

2.  Do some research on assisted living options in their area.  Some will take Medicaid IF the residents have been in place on a paid plan for 5 years.  Very few take Medicaid straight out of the box.  

 

3.  Find out what their insurance will cover for in-home care.  And all the other things like Neighborhood Helpers and so on.  Learn about options.

 

4.  Be very honest with yourself and with them about what you can and cannot do for them.  My dh is retired, but his mom lives "independently" in a low-income apartment.  She is "independent" because she can cook for herself and do personal care.  But DH takes her to at least 1 and often 2 doctor appointments a week, picks up all her medicine, comes over 2x a week and washes her dishes, does all her grocery shopping, and so on.  She has a housekeeper come in 2x a month.  He does all the grant applications for her co-pay assistance for meds she needs but can't afford.  It is a half-time job, and he is not complaining nor am I.  But it IS a half-time job.  He couldn't do it if he were still working.  Or if she lived 15 miles away.  And even so, when she got some infection in her private areas, he drew the line.  "I'm not doing that with my mom.  She's my MOM."  So that had to be paid for.  He had to be really honest about this with her and with the medical people (who will push everything they can onto the family...and I'm no help.  I just don't do medical stuff.  It seriously makes me throw up to do more than change a bandaid.  So I'm no good as a backup on that stuff.  

 

So there's "independent" and there's "independent."  My MIL is not in assisted living because my DH has a half-time job taking care of her.  But she is "assisted."  If you can't do these things, things that must be done, you have to have a plan for how they will get done.  And no one is better off for fooling themselves about the part they can play.  

 

6.  Acknowledge at least to yourselves that it probably not going to get any better than it is right now.  My grandfather was still talking on his deathbed (as in he died the next morning) about all the things he was going to do when he got home.  That attitude made it very hard for him to get a grip on the things that needed to happen a lot sooner than they did, and possibly shortened his life.  I know, I know...stubbornness maybe made him live longer too.  IDK.  But the mess left behind for everyone else...I also saw THAT.  KWIM?

 

Good luck to you.  This isn't all that much fun, and it is really hard because it is a role reversal and everyone has to learn to play a new part.  My mom and my MIL have been fantastic at doing this adjustment and it has made a world of difference. 

 

I have found the above bolded to be very important regarding my mother's situation right now.  Due to her situation, she may need to move to assisted living.  In our area, most assisted living places are requiring a private pay commitment of 1  - 2 years of an average $4,500 per month if it is anticipated that the person will need Medicaid..  If the person does not have the assets, the facility looks to the family to pay or they won't take the person into their facility.  Medicaid beds/rooms are limited in number in most places and many places do not even take it so often there are no openings or a waiting list.  If no one can pay it is then up to the family to care for the individiual on their own, which may or may not be feasible.

 

Rationing funds becomes very important. For example, my mother could spend her money on helpers coming into her apartment to allow her to live in her home without going into assisted living but if she were to spend it down below the 1-2 years of private pay required to get into assisted living, she would be stuck if she then needed to go into assisted living.  So I can see that some elderly people could end up going into assisted living sooner than necessary, just so that they can meet the payment requirements to be admitted.

 

We are right in the middle of all of this now and are learning as we go. 

 

 

Edited August 7, 2017 by Legomom

[Guest]

I don't know if this was mentioned upthread, but have you thought about a Life Alert or similar device? We have a Philips Lifeline for my father-in-law, and it has fall detection. We share a house with our in-laws but we still decided we needed one of these devices after fil passed out and fell in the bathroom and nobody heard him fall. We will probably be adding a device for mil soon. 

 

We had an episode last night with fil at the dinner table, and he ended up vomiting at the table and being unable to breathe. For some reason it really scared the crap out of me compared to other episodes we've had with him. (mostly low blood sugar issues) It really made me worried about the future, especially now that I've been diagnosed with MS. They will be staying in the house until the end, and I'm realizing how difficult and stressful this is going to be. I know my sister-in-law will be able to help financially with caregivers in the future, but I'm on the floor cleaning up vomit and she's making faces about how gross it is, lol. 

 

THIS is me and my sister. I am the one making faces.  She is the one cleaning up everything, saying over and over, "Puppies and kittens, puppies and kittens..."  I fill another role, and it's not nothing, but I could not reverse the roles.  Just couldn't.  Things are this way because of decisions made in the past, but that gets hard to remember in specific situations.  :0(

 

The thing is, for YOU this will be important that you can get help when you need it.  Someone I love very much has MS and it is worrying to me to see the difference when her life is stressed.  

[Carol in Cal.]

When we refinance in a few years, we will probably put me or ds or both on the house. 

 

 

PLEASE talk to an estate lawyer before doing this.

 

There are some real disadvantages to it.  

 

Ask specifically about the implications of a 'stepped up basis' and how they play into this.  Run the numbers before you decide.

 

Also ask about putting the house into a trust instead.

[Seasider]

I have found the above bolded to be very important regarding my mother's situation right now. Due to her situation, she may need to move to assisted living. In our area, most assisted living places are requiring a private pay commitment of 1 - 2 years of an average $4,500 per month if it is anticipated that the person will need Medicaid.. If the person does not have the assets, the facility looks to the family to pay or they won't take the person into their facility. Medicaid beds/rooms are limited in number in most places and many places do not even take it so often there are no openings or a waiting list. If no one can pay it is then up to the family to care for the individiual on their own, which may or may not be feasible.

 

Rationing funds becomes very important. For example, my mother could spend her money on helpers coming into her apartment to allow her to live in her home without going into assisted living but if she were to spend it down below the 1-2 years of private pay required to get into assisted living, she would be stuck if she then needed to go into assisted living. So I can see that some elderly people could end up going into assisted living sooner than necessary, just so that they can meet the payment requirements to be admitted.

 

We are right in the middle of all of this now and are learning as we go.

There are a rare few places that will accept a resident "Medicaid pending," but that means that you have to have a Medicaid application ready to go. It can take many months just to nail down the information you need to complete the application. Start collecting that documentation now. Even if they plan to age in place, you cannot predict if a fall, developing dementia, or some other medical circumstance will arise that would require residential care (i.e., needs that are impossible for you to physically or financially meet in their home).

 

A great gift you (or whomever they select as POA) can provide is to get a firm handle on their financial situation. Medicaid does a 60 month look back and misspent funds can disqualify someone from benefit eligibility. To your reading list I would add Medicaid for Dummies. Yes, that's a real book title, the system is so complicated it needs that kind of explanation. If your parents were good stewards of their resources, it's still complicated but much easier. Sadly, many elderly people fall victim to fraudulent scammers, identity theft, using credit cards for high priced prescriptions, resorting to casinos as meal plans, bad reverse mortgages, all manner of things which really make a mess come time to prepare an application for Medicaid for long term care. Best to know what you're facing.

 

Bless you for your willingness to assist. Be aware that caregiver guilt is very real, know about it and how it can influence your emotions. Be willing to admit what you can't do when thinking about what you can. Be especially mindful that you have a responsibility first to your own children. They can learn much through your well-modeled compassionate choices, but they are the ones that will most feel the effects of your divided time.

 

ETA be sure to speak with someone in your own state about specifics. Medicaid is a federal program but it is administered at the state level, which means policies and practices are widely variable.

Edited August 7, 2017 by Seasider

[Seasider]

PLEASE talk to an estate lawyer before doing this.

 

There are some real disadvantages to it.

 

Ask specifically about the implications of a 'stepped up basis' and how they play into this. Run the numbers before you decide.

 

Also ask about putting the house into a trust instead.

And frankly I might not wait a few years. That Medicaid lookback period is often a deal breaker. If your mom is ready to talk about it now, might want to go with it.

[TechWife]

And frankly I might not wait a few years. That Medicaid lookback period is often a deal breaker. If your mom is ready to talk about it now, might want to go with it.

The sooner, the better, IMO. Elder finances are complicated. The less money a person has, the more complicated it can get, I think.

[Laura Corin]

Something that I have been very glad to have done is to talk about end-of-life care.  Mum has signed a living will/advance directive.  She was happy when I mentioned it and organised it for her.  She has reached the stage where, although she is amazingly healthy for her age, she has no interest in having her life prolonged if she has a terminal diagnosis or is not longer able to make decisions due to dementia or similar.  If we hadn't had the discussion, we might have prolonged things out of guilt.

[cera2]

We hired a "nanny" for my aging grandparents.  She is a local college student majoring in nursing and she truly is just like the babysitters I hired for my kids when they were young.  She stops in Tuesday and Thursday afternoons from 3-7 and helps with whatever they need.  She does the housekeeping things their house cleaner doesn't do (laundry, odds and ends of organizing that my grandmother directs), random tasks (helping decorate for holidays, etc), and drives them to appointments and errands (haircuts, bank, post office, grocery store, etc).  My grandparents love having someone they can ask for help of any kind without worrying that they are imposing on the family (though we would never feel that way they hated asking us for help) and she is pretty willing to do whatever they need and chat with my grandmother while she does it.  

 

We have also hired her boyfriend to come do handyman type chores that don't require any special skills one Saturday a month.  He has changed light bulbs, carried boxes to and from the attic, etc.  

[QueenCat]

A great gift you (or whomever they select as POA) can provide is to get a firm handle on their financial situation. Medicaid does a 60 month look back and misspent funds can disqualify someone from benefit eligibility. To your reading list I would add Medicaid for Dummies. Yes, that's a real book title, the system is so complicated it needs that kind of explanation. If your parents were good stewards of their resources, it's still complicated but much easier. Sadly, many elderly people fall victim to fraudulent scammers, identity theft, using credit cards for high priced prescriptions, resorting to casinos as meal plans, bad reverse mortgages, all manner of things which really make a mess come time to prepare an application for Medicaid for long term care. Best to know what you're facing.

 

 

What exactly do they look for? My dad is in  nursing care, mom is in assisted living. They have enough to last another 1.5 years at full cost, from savings. Mom will probably move to nursing care, though before that time is up. They have pensions and SS that can cover about a third. They do pay off their credit card bill monthly. Most of what goes on it are needed supplies (diapers, wipes, etc, that the nursing home/assisted living will provide but at a higher cost, so I use their credit card to order it all online). But what about things like assets they've gotten rid of? They gave me, not sold to me their timeshare about a year ago. They sold my brother their car for $1 about 6 months ago. He didn't ask them to do that but he couldn't have paid them for it, and it really helped him. Will these things be considered irresponsible? Or the supplemental groceries? Think along the lines of favorite snacks the nursing home doesn't have in stock. Or other odds and ends?

[Laurie4b]

Some things I don't think I saw mentioned: 

 

See if there is a doctor who specializes in gerontology nearby and if so, schedule a visit to see it it's a good match. It can make a huge difference in the quality of your parents' lives as opposed to a family doctor or internist because a gerontologist is more cued into to broader issues of aging as well as info like which drugs can have differential effects on the elderly compared to the younger population. (There is a list called the BEERS list that is put out by the American Geriatric Association.) My father was on prescription and OTC meds that he should not have been taking. The prescribing doctors were clueless about the effects on the elderly, particularly someone with a family history of dementia. Sadly, this is not uncommon.) 

 

I would follow up on why your mom can't walk very far. If it's breathing issues, that could be heart or lung . Since you think it's lungs, a pulmonologist would be the specialist. See if she can be referred for physical therapy. Your dad might be able to benefit from it too while he waits for the hip surgery.  The more your parents can exercise within whatever limitations they have, the better their quality of life, longevity, and cognitive health and the longer they will be able to function independently. 

 

An overlooked professional is an occupational therapist. They can do a home visit and evaluate ways to help make tasks of living easier and safer for your parents. It might be ways of doing things or some simple assistive technology or gadgets. 

 

I just read Being Mortal and it is really excellent. 

[Seasider]

What exactly do they look for? My dad is in nursing care, mom is in assisted living. They have enough to last another 1.5 years at full cost, from savings. Mom will probably move to nursing care, though before that time is up. They have pensions and SS that can cover about a third. They do pay off their credit card bill monthly. Most of what goes on it are needed supplies (diapers, wipes, etc, that the nursing home/assisted living will provide but at a higher cost, so I use their credit card to order it all online). But what about things like assets they've gotten rid of? They gave me, not sold to me their timeshare about a year ago. They sold my brother their car for $1 about 6 months ago. He didn't ask them to do that but he couldn't have paid them for it, and it really helped him. Will these things be considered irresponsible? Or the supplemental groceries? Think along the lines of favorite snacks the nursing home doesn't have in stock. Or other odds and ends?

The way I understand it, if they need Medicaid in less than 60 months from the time they gave you that condo, it will be regarded as a gift and you can be "penalized." i.e., required to contribute an equivalent value of private pay before benefits kick in.

 

But I am not qualified to speak with certainty regarding your individual circumstances. That's why a good elder law attorney, as suggested upthread, is vital.

 

Different agencies/physicians/facilities maybhave social workers available for the necessary applications on behalf of the truly destitute. But if any level of assets are involved, things get complicated very quickly. That lookback is a bear. Sadly there's a lot of fraud with people giving away assets then applying for federal aid, so it's not unreasonable that such a thing exists. It's just too bad that financial management is so important in the waning years when older folks are most likely to make poor decisions (for a variety of reasons).

 

So, while your parents have some liquid assets, use those funds for an attorney's advice. IME rates are around $250/hr and worth every penny.

[QueenCat]

The way I understand it, if they need Medicaid in less than 60 months from the time they gave you that condo, it will be regarded as a gift and you can be "penalized." i.e., required to contribute an equivalent value of private pay before benefits kick in.

 

But I am not qualified to speak with certainty regarding your individual circumstances. That's why a good elder law attorney, as suggested upthread, is vital.

 

Different agencies/physicians/facilities maybhave social workers available for the necessary applications on behalf of the truly destitute. But if any level of assets are involved, things get complicated very quickly. That lookback is a bear. Sadly there's a lot of fraud with people giving away assets then applying for federal aid, so it's not unreasonable that such a thing exists. It's just too bad that financial management is so important in the waning years when older folks are most likely to make poor decisions (for a variety of reasons).

 

So, while your parents have some liquid assets, use those funds for an attorney's advice. IME rates are around $250/hr and worth every penny.

 

It's a timeshare, not a condo. I now own one week a year of use. It's got a value of $2000-4000  but very difficult to sell. Closing costs would pretty much take up the proceeds. Which is why I accepted it, so they could stop paying the maintenance fees and I could start. It was the easiest way for them to not have to pay anymore. I'm more worried about the car, because it had a value of about $6k when they sold it to him for $1. He does not have the ability to give anyone that kind of money. He might be able to come up with a few hundred....... lol. They do have a good financial planner that has been helpful. I doubt I could talk them into seeing an attorney. They think their money will last a lot longer than it will. And that if it doesn't my sister and I can come up with the difference. I'd have to get a full time job to do that, and then I wouldn't have time to see them!

[Guest]

We hired a "nanny" for my aging grandparents.  She is a local college student majoring in nursing and she truly is just like the babysitters I hired for my kids when they were young.  She stops in Tuesday and Thursday afternoons from 3-7 and helps with whatever they need.  She does the housekeeping things their house cleaner doesn't do (laundry, odds and ends of organizing that my grandmother directs), random tasks (helping decorate for holidays, etc), and drives them to appointments and errands (haircuts, bank, post office, grocery store, etc).  My grandparents love having someone they can ask for help of any kind without worrying that they are imposing on the family (though we would never feel that way they hated asking us for help) and she is pretty willing to do whatever they need and chat with my grandmother while she does it.  

 

We have also hired her boyfriend to come do handyman type chores that don't require any special skills one Saturday a month.  He has changed light bulbs, carried boxes to and from the attic, etc.  

 

I have friends who have done this and it has been a godsend.  The "nanny" also takes the elder to the doctor appointments and so on.  I'm not kidding, that chews up half a day for my dh with his mom every week. 

[mschickie]

I would also agree that talking to an elder care lawyer would be a great thing to do at this point.  When my Aunt moved up to our area a couple of years ago we did not think about talking to a local lawyer.  She had a will, my sister had her power of attorney and was her health care proxy.  When her health started taking a turn we did get with an elder care lawyer.  It was expensive but so worth it.  They knew the ins and outs of applying for Medicaid and also had us set up a prepaid funeral plan for her.   I cannot even imagine doing all that paperwork on  our own, it was just too confusing.

[Seasider]

It's a timeshare, not a condo. I now own one week a year of use. It's got a value of $2000-4000 but very difficult to sell. Closing costs would pretty much take up the proceeds. Which is why I accepted it, so they could stop paying the maintenance fees and I could start. It was the easiest way for them to not have to pay anymore. I'm more worried about the car, because it had a value of about $6k when they sold it to him for $1. He does not have the ability to give anyone that kind of money. He might be able to come up with a few hundred....... lol. They do have a good financial planner that has been helpful. I doubt I could talk them into seeing an attorney. They think their money will last a lot longer than it will. And that if it doesn't my sister and I can come up with the difference. I'd have to get a full time job to do that, and then I wouldn't have time to see them!

As I understand it, any non-excluded asset divested at less than fair market value can cause a problem. Again, get real advice from a real attorney!

[Guest]

It's a timeshare, not a condo. I now own one week a year of use. It's got a value of $2000-4000  but very difficult to sell. Closing costs would pretty much take up the proceeds. Which is why I accepted it, so they could stop paying the maintenance fees and I could start. It was the easiest way for them to not have to pay anymore. I'm more worried about the car, because it had a value of about $6k when they sold it to him for $1. He does not have the ability to give anyone that kind of money. He might be able to come up with a few hundred....... lol. They do have a good financial planner that has been helpful. I doubt I could talk them into seeing an attorney. They think their money will last a lot longer than it will. And that if it doesn't my sister and I can come up with the difference. I'd have to get a full time job to do that, and then I wouldn't have time to see them!

 

BTDT.  

 

I got out a spreadsheet and put in the numbers and showed them to the people who thought their money was going to last forever.  I put in several scenarios in different columns:  assisted living, in-home care, and so on.  It was an eye-opener for *everyone*--including me.  It got kind of complicated because in some scenarios you pay utilities, in others you don't and so on...

 

I'm on the verge of doing another one of these to convince my 94yo mom who doesn't drive anymore to show her that she can sell her car and use taxis for less money than she is paying for INSURANCE.  Some people have to see black and white.  And to be fair, my numbers were not completely spot on, so there were some corrections they had to make...which got me some information I didn't have.  

 

One thing that got some attention:  in the "in-home care" column, it got interesting.  My dad needed someone to come put on his compression socks in the morning--it was killing my sister who has a bad back.  "Couldn't we hire someone to come and do this?"  Oh, yeah, and off again in the evening.  Well, alrighty then.  $18 an hour.  But a three hour minimum.  So when I showed them a *daily* expense of $54 in the morning and $54 in the evening, two things happened.  First, they started giving my sister a little more spending money (she was hard up at the time) and griping a lot less about things and second, my dad could suddenly put on his own socks.  

 

Black and white is powerful. Even for Depression Babies.  :0).   My parents are really decent people...don't think otherwise.  It's just that no one really signs up for this...

[fairfarmhand]

Just FYI, prepaid funerals are NOT considered an asset.

 

So if Grandma has a pile of money to bury herself, she should go ahead and buy the funeral. Otherwise, that money will be used up on care and the family will have to pay for the burial.

[Joules]

Just FYI, prepaid funerals are NOT considered an asset.

 

So if Grandma has a pile of money to bury herself, she should go ahead and buy the funeral. Otherwise, that money will be used up on care and the family will have to pay for the burial.

 

That's something that I never thought of...Thanks!

[Seasider]

That's something that I never thought of...Thanks!

Prepaid plans are an excluded asset, so you are right, they're not counted as a liquid asset when applying for medicaid. However, some states have limits, so find out what that is in yours before prepurchasing a full on jazz funeral or something equally spectacular.

[mschickie]

With the prepaid funeral you need to work closely with the funeral home.  From what I understand in many states if you do not use all the money in the trust then the rest of the money is turned over to the state.  Due to that reason you want to make sure that you get the numbers right.  Most funeral homes will put in a little padding just in case prices go up but you do not want it to be too much.  If you get a funeral home that is used to doing this they know how to do the adjusting.