Articles:

Elder Care for a Loved One

“Life is a Bitch, You Get Old, You Die”

But, Who Provides For Your Care Between Old and Death?

Introduction

This document is not meant to be all-inclusive. It is meant to raise awareness, so the right questions could be asked and to lessen the total shock of the entire situation of caring for elderly loved ones.

When I was growing up my life followed this chronology:

· Born (1st of 8 Children, good Catholic family with parents who got the rhythm method backwards)

· Moved 14 times before I turned 16 (Father was an Electrical Engineer)

· Mother died of a heart attack when I was 16

· Moved out at 17 after graduating high school (got the hell out of a house with 7 siblings)

· Got married at 18 (the first time)

· Had two daughters (first one at age 20, second one at age 23)

· Divorced after 15 years of marriage

· Remarried after 5 years of being single

· Lost my oldest daughter at age 24 (car accident)

· Inherited two step kids (boy age 7, girl age 3)

· Father died from a heart attack at age 67. He had raised all 8 kids on his own

· Currently married to wife #2 for 24 years and retired

So, you might think at this moment; why do I give a crap about this guy’s life? What has it got to do with taking care of our older loved ones? I am getting to that. In the chronology above, where do you see anything about OLD or Elder Care? You don’t, and that is the point I am trying to make. And I will wager that most of you will experience what I did unless you get some education about the facts first. It is always better to know a truck is coming at you before it hits you.

I am sure you’ve all heard about the tradition of elder care with the Native American Indian tribes. The old Indians went to a top of a mountain and just died. Or if they couldn’t pull their weight, they just died. As time passed in the early United States life was rural. People had lots of children, so they could help on the farm and because the mortality rate for children was extremely high. They needed to have a lot of children. Most adults were dead by the time they were 40 or 45, so there wasn’t much need for elder care.

So, why am I writing about taking care of your elders? My folks were long dead and gone before they were old enough to require any care. Two words answer the above question: (Mother-in-law and Father-in-law).

Now we have finally arrived at the real issue or PROBLEM portion of this article.

To continue my life’s chronology from above:

· When I remarried I inherited (the only thing I ever inherited), two older in-laws.

· They lived in a different state, we lived in California.

· Over the next 20 years all holidays of any consequence were spent in Nevada.

· My mother-in-law died at age 84.

· My father-in-law died at age 92.

Before we actually get into the meat of the PROBLEM, I would like to share some facts about dealing with elderly parents:

1. If you buy them a gift, you own support of that gift FOREVER.

2. All gifts MUST last 30 to 40 years otherwise they are crap.

3. All gifts must be easy to understand or the (support- forever- contract) becomes a living nightmare.

4. If you live a long distance from your parents (or in-laws) make sure you keep copies of all operations manuals (from the gifts you gave them) at your house, otherwise you will be making many more visits to their home.

5. Generally the closest sibling (in miles from the in-law house), inherits most of the parental support.

6. Get used to constant reruns of Mash and other old shows, you will know them by heart soon.

The Problem

(How to Take Care of Elderly Folks)

The PROBLEM is more clearly defined due to these inevitable facts of life:

· Modern medicine keeps people alive longer.

· People love their independence and will fight for it.

· There is physical and mental decline as we age.

· Eventually older people will loose their car driving privileges (thank God!).

· The ability to see and hear diminishes.

· Bones get more brittle and break easily.

· Skin gets thinner and the slightest bump will cause a bruise or bleeding.

· The ability to control bowels etc. diminishes (incontinence and diapers).

· At some point a walker and eventually a wheel chair will be required.

· Prescription medicines increase as we age and they have to be regulated diligently.

· Eventually managing your finances becomes a large issue.

· Only certain types of people (Care Givers) are suited for supporting the elderly (this doesn’t mean that your personality isn’t compatible to be a caregiver).

In other words the problem is simply stated:

How do I take care of elderly loved ones, in a way that they get all the love and care that is needed, without driving everyone crazy? And, can (we/they) afford it?

Before proceeding with possible solutions I’ll bet you might have some questions, just like I did. Some of these questions are listed below:

1. Why didn’t someone share these issues while I was growing up?

2. Why don’t they teach you about this in school?

3. Do my older loved ones have enough money to support themselves?

4. Can I, or my spouse, provide this care at my home by ourselves?

5. Can I provide this care at my home with outsourced support?

6. If I can’t provide this care at my home are there decent facilities that will provide the required care and how much do they cost?

7. Are there different kinds of elder care facilities and what are the differences?

8. Will my loved ones hate me if I have to move them into an elder care facility?

9. How much Government support is available for this care?

10. If my loved one is close to death, what are the options?

11. What is Hospice and how does it work?

12. What do my loved ones have to do to ensure that their financial house is in order and the correct care is provided?

13. Where do I find resources for assistance with these situations?

14. What happens when my loved one dies?

15. How do I get on with my life and plan for my own possible elder care needs?

I will provide my answers to each of these questions in the solutions section of this article. My answers will NOT be all inclusive. They will contain the information that I have discovered through my life experiences and research. I wish someone had provided information like this for me before I had to experience it on my own. I think my life would have been much more at ease, had I had something like this article, and I hope it will help you as well.

Solutions (And Answers to Questions)

1. Why didn’t someone share these issues while I was growing up so I could be somewhat prepared?

I am a Baby Boomer and in the 59+ category. I went to regular Catholic and pubic schools and obtained undergraduate and graduate degrees. All my grandparents either died at an early age or died quickly at an older age with all their faculties (mental and physical).

So, I will bet many of you have had the same life experiences and thus, there was never any thought about elder care. I must be right or you would not have obtained this article in the first place.

2. Why don’t they teach you about this in school?

The real question is why elder care is not part of normal pubic school curriculum? At least if there was awareness, there would be far less trauma when the fact of elder care hits you in the face. I hope someone in my audience is part of Academia and takes the hint to build some curriculum.

This article will at least raise that awareness and help with the education process for this subject.

3. Do my older loved ones have enough money to support themselves?

This is a touchy question. Most elderly loved ones are very tight lipped about their finances. The only way to obtain this financial information is to ask them or if you are lucky, you are the appointed administrator of their Will and/or Trust. Someone has to have access to this information eventually, so the right financial decisions are made for the eventual elder care. There are even new Attorney specialties out there now just dealing with elder care finances.

Eventually most elderly can’t control their own finances. There are a lot of unscrupulous people out there that take advantage of the elderly and fleece them for all they can get. I hope someone in the family can gain control of the finances first, before they become prey for these terrible people. By control, I mean some sort of legal document (like a power of attorney) that allows the writing of checks and opinions about their investment choices.

There are at least two ways that I am aware of to accomplish this required control. Both require attorneys, physicians, and legal documents.

Generally the person that gains financial control is also the administrator of the Will and Trust. The easiest way to gain financial control is through a Power of Attorney (POA)

A Power of Attorney can be obtained from an Attorney and your loved ones granting you this capability must sign it. The POA will allow check writing, making investment decisions and generally the ability to take over your loved one’s finances. The checks and all accounts will have your name on them as the POA.

If the elderly loved one is unable to grant you the POA or is unwilling, there is another legal route. First you must determine that the elder are incompetent to handle their own financial responsibilities. This can be done through documents or testimonials from doctors and psychiatrists. These documents must be given to an Attorney and the Attorney will take it to court. The end result is a legal conservatorship stating that you have complete control over your elderly loved ones’ life and finances. This route is sometimes very expensive, time intensive, and can cause hurt feelings.

It is much better to go the POA route if at all possible.

4. Can I provide this care at home by myself?

The short answer is yes. The long answer is much more difficult. As I stated earlier, it takes a certain type of personality to be a qualified caregiver. Not many people have this personality. If you think that you have that personality ask yourself these questions first:

· What type of personality does your loved one have? Mean, demanding, abusive, loving?

· Can I manage a regimented medical prescription schedule and get it right? One wrong dosage could be the end of your loved one.

· Can your spouse or other relatives handle the new demands on your time?

· Do you have other support (respite) so vacations, other chores, and appointments for yourself can be accomplished?

· Can you handle giving your loved one baths, changing diapers, etc. as their age progresses? It really takes a lot of physical strength to accomplish some if these duties.

· Can you get up in the middle of the night, several times, to take care of bathroom calls, etc.

· Can you afford to provide this support? (a spare bedroom, food, household expenses, transportation, medical appointments etc.)

· Do you want to provide these services because of guilt feelings (no one is going to put my relative in a home), or because you really want to do this? The reason had better be the latter and not the former.

· If something bad happens on your watch (a fall, broken bones, death) can you handle the guilt?

· When you take your loved one out can you put up with embarrassing moments such as (passing gas, drooling from the mouth and nose, food mishaps, foul comments to strangers, and numerous other accidents too numerous to mention here)?

· What if your loved one has less than desirable personal cleanliness habits (refuses to bath, wash hands, etc.)? Can you be forceful enough?

· Can you handle their depression and the things they may say about wanting to die and this is no life for a human (because they have felt like their independence is gone)?

5. CanI provide this care at my home with outsourced support?

This solution may appear to be the best at first glance.

But, there are many considerations here also:

· Do you have room for a live-in care and your loved one? Remember eventually you loved one will need 24 hour care.

· The care could be one person 24 hours a day or 3 people 8 hours each per day.

· How do you know these people are qualified for elder care?

· You will need to provide liability and disability insurance for in-home care workers. Can you afford it?

· What do you do if a hired caregiver is abusive?

· What do you do if this person is dishonest?

· If the hired caregiver is injured what are all your responsibilities? Can you be sued?

· Is this solution cheaper than a fully managed out-sourced home solution?

6. If I can’t provide this care at my home are there decent facilities that will provide the necessary care and how much do they cost?

The answer to this question is yes there are decent facilities. They will vary vastly in cost and that cost is generally based on where you live and what services are required. A personal example is my father-in-law. He had moderate dementia, required a walker, can not handle any financial responsibilities, has severe depression, prostate cancer, and is generally hard to get along with. We first placed him in a home in the Bay Area of CA. The cost of his room and services was $5800 per month in 2008. This was the ala-carte cost for just room and board. Any additional services were extra. It was a nice home. Due to job changes, we moved him to another facility, with similar services; in the foothills of CA and the charges were $3600 per month.

So you have to check around and be diligent. Talk to the management staff and all the caregivers. Watch how your loved one is treated. Visit several times per week.

7. Are there different kinds of elder care facilities and what are the differences?

Yes there are several types of facilities to choose from and it depends on your loved ones requirements to determine which one you choose:

· Assisted Care: This type of facility is for someone that gets around pretty much on his or her own. They can feed themselves and make bathroom calls. They may need assistance bathing, getting their nails cut, making the bed etc.

· Dementia Care: This could be the same type of person as mentioned above but they have memory problems. They could forget their entire family and not remember from day to day what they ate an hour ago. They generally forget about bathing, exercise or sometimes where they are.

· Nursing Care: This is generally for a person that is no longer ambulatory and needs help with just about everything.

· Hospice Care: This is for someone who is going to pass away very soon. The main purpose of Hospice is to keep the patient comfortable with no pain until they eventually pass. The people that provide this care are very professional and compassionate people and they know what they are doing. Hospice care can be performed at any location the patient resides in.

The first 3 types of care mentioned above get more expensive as the requirements change. So Nursing Care is the most expensive, Dementia Care is second, and Assisted Care is the least expensive. I should also mention that most of these care options don’t take Medicare patients they are private pay facilities.

8. Will my loved ones hate me if I have to move them into an elder care facility?

This is a tough question to answer. It really has too many variables. It sounds terrible, but if something bad happens (a broken bone, starting a fire to the house, getting ripped off financially, etc.) then you will probably not be hated by suggesting some type of care facility. In my own experience, my mother in law (84) was diagnosed with brain cancer. My father in law (89 at the time) had moderate dementia and almost burned the kitchen and bedroom down on different occasions. When mom got sick with the cancer it was a FAIRLY easy job to convince them to seek some help. My wife and I were the closest relatives (although we lived in a different state). So we moved the folks closer to us and into a very nice assisted care facility after they voluntarily let us sell their home and vehicles. At the time my wife and I were both working professionals and could provide no help ourselves to the situations besides frequent visits to their home whenever possible. My mother-in-law passed away 2 months after entering the care facility from the cancer.

If, due to circumstances beyond your control, a loved one can’t move in with you when required, a care facility must be considered. If the loved one is a danger to themselves or people around them, due to illness, then it is your duty to talk them into what is best for them. If they will not volunteer to go for help, then it is your duty to force the issue legally. You will probably need physicians or other professionals signed statements before contacting an attorney. Your final goal is to become the legal conservator of your loved one. This whole process with takes time and costs money to accomplish.

If your loved ones cooperate, a simple Power Of Attorney will suffice. This allows you to sign contracts and take care of all their financial and health related matters.

9. How much Government support is available for this care?

This is a very complicated area, but basically there is no government assistance until your loved one is essentially financially broke. The government agencies want your loved one to be down to their last $2000 before assistance is offered. Some states also allow the loved one to own a house. The government agencies will check bank records back 60 months. If gifts were given such as cash to relatives, the agency (Medicaid) will not provide support until those gifts were given back as support costs for your loved one. So, as an example; if your loved one gave you $12,000 as gifts over the past 60 months and their care facility was $6000 per month, the loved one is stuck for the support for the first 2 months of care.

There are many tax laws that forbid the distribution of loved ones assets up to 5 years before a care facility is needed. See a certified public accountant or tax expert for the federal and state rules regarding this subject. In other words, a loved one can’t give away their estates to try and go on government assistance. They must spend their savings first. Otherwise government assistance will not be available. If the government determines that the estate was distributed prematurely to try and retain the money within the family, then your loved one will be without any hope of government assistance if it is required.

When or if government assistance is obtained it is very minimal. There are no private rooms, but at least life-supporting care is still provided. There is an additional area I must raise your awareness of concerning this topic. Some assisted care residences are NOT required to keep your loved one, even with government assistance, after they run out of funds. Some facilities ARE required to keep your loved one after they run out of funds. It is important to ask these questions before initially placing your loved one in a facility.

Your next question might be; how much are these assisted living facilities? The answer is: it varies. The closer to a large city you live the more expensive the care facilities become. When I lived in the Bay Area of California the facility we chose was close to $6000 per month for assisted living covering one person. I moved to a rural community and the costs were reduced to $3700 per month covering the same services.

So depending on your loved ones financial abilities it really pays to shop around for a reasonable facility.

10. If my loved one is close to death, what are the options?

If all goes well by the time your loved one is close to death, they will be in a full care nursing home facility. The facility will help you determine the next steps for care. Some assisted care facilities also have dementia and Alzheimer units at the same location. If a doctor in the nursing home or hospital determines the patient can be helped being hospitalized, that is another option. If the doctor determines the patient is going to die within 6 months they may suggest Hospice care.

11. What is Hospice and how does it work?

Quality hospice care can make the difference between overwhelming stress, symptoms that may be unbearable...and living peacefully and meaningfully up to the very end. Hospice is about living, maintaining your dignity, and most of all, about caring for one another. "Hospice is not a place; hospice is a way of caring for one another." That is a direct quote from the Hospice website. It is a covered Medicare benefit.

The Hospice benefit covers all services, medications and equipment related to the illness. These include:

Physician services

Nursing services

Home health aides

Medical appliances and supplies

Spiritual, dietary, and other counseling

Continuous care during crisis periods

Trained volunteers

Bereavement service

In my opinion this is a service sent from Above. The professionals providing the service are top notch.

You can visit the Hospice site at: http://www.hospicefoundation.org

12. What do my loved ones have to do to ensure that their financial house is in order and the correct care is provided?

The best way to ensure that a loved ones wishes are met after their passing is to make sure they created the following documents at a minimum:

• A Will

• Revocable Trust

• Advanced Directives

These documents compliment each other and will save many dollars in Probate costs. An administrator (executor) must also be appointed to ensure the wishes contained within the documents are carried out. Tax laws (Federal and State) and the various amounts they tax are moving targets and literally change every year. Talk to an attorney or look these documents up on the web for in-depth definitions.

13. Where do I find resources for assistance with these situations?

AgingCare.com is a leading online community that connects people caring for elderly parents to other caregivers, personalized information, and local resources. AgingCare.com has become the trusted resource for exchanging ideas, sharing conversations and finding credible information for those seeking elder care solutions.

http://www.n4a.org/ An excellent website with resources for individuals and caregivers.

Check with your local senior center as they provide many more services than just bingo and meals. They often collaborate with Federal, State, and County agencies designed to assist seniors and their caregivers.

14. What happens when my loved one dies?

If you were able to ensure all the documents in question #12 were created this question will be answered. Some of the items included in these documents are:

· Who are the administrator(s) of these documents?

· Where do the remains of your loved one go?

· What happens to their remaining assets and personal belongings?

· What bank accounts, stock accounts, and savings accounts, etc. exist?

· Do they want to be cremated or buried or both?

· What life support is to be provided during their final hours/days?

· Do they wish any religious services?

· Who will be invited to the services?

· Will any body organs be donated?

A number of certified death certificates would need to be obtained. One can arrange for these at the mortuary that takes care of your loved ones remains. The certificates are sent to creditors, IRS, State Tax Institutes, Social Security, Medicare, pension plans, etc. An obituary can be created and published in the local newspaper and sometimes the local newspaper where the loved one was born or was raised. Remember, unless you were married to your loved one that any financial obligations left behind is not yours. Creditors will send you threatening letters, but you are not responsible for the debts. Ignore the letters and just send them a certified death certificate.

15. How do I get on with my life and plan for my own possible elder care needs?

There is only one cure for grieving and that is the passage of time. Cry when needed, have a tantrum, scream, yell. But don’t hold your grieving inside and bottle it up. You must experience the full force of grieving in order to begin the healing process. Stay busy.

If you are younger, Elder Care insurance can be purchased for a reasonable amount. The premium usually stays the same as you age. If you are older (over 45) the premiums are very substantial. If you can afford it buy it, the younger the better. If not, just do your best to build your retirement nest egg and hope your money outlasts your life. If you have substantial assets remember the probate tax laws are evolving yearly. Start gifting or giving away your assets to the people you love far (at least 7 years) before you become in need of assisted care. How do you determine this time? Your guess is as good as mine. The worst that could happen is Medicaid determines that you gave away all your assets so you could qualify for government assistance.

In summary, I hope this short article raises awareness to some unsuspecting people that will be burdened with care for a disabled or elder loved one.

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