View Full Version : Aging Parents
Dear forumites, I could use your advice. My parents are mid-80's, and still live alone - mostly independently. That needs to change, though. Mom is legally blind, due to macular degeneration. She still has some vision - she gets by ok. Dad now seems to have dementia of some sort (not sure of actual medical terms here) and has little to no memory or cognitive function. Now, this is actually not noticeable if you don't know him.
Dad is still driving. They can't do much more than prepare meals and do their own laundry / clean up after themselves. I stop by about every other week, and there's a list of things to be done - minor tasks, like change the batteries in a flashlight - between the two of them, they can't even do that simple task.
But honestly, I have concerns.
As with many of the aging population, they don't want to give up their independence. Additionally, they don't want to be a bother or a burden to anyone. And then we add finances, and oh boy! The ideal situation is that they sell their current home and move into an assisted living residence. That's just a pipe dream, as there are tons of arguments against that. So, we are trying to piece together some sort of plan that lets them stay in their home. ERGH!!!
Challenge #1: Time. I live locally along with my hubby. We both work full time outside the home. My brother and his wife live 1500 miles away. Hubby and I also have the grandkids every weekend. Did I say EVERY?!?!?
Challenge #2: Money. Mom and Dad live on a fixed income. They own their home, but it's a condo and there are quarterly fees that - along with normal living expenses - are near their income level.
So - to stay in their home, they need someone to drive them to appointments and run errands. Most all appointments will occur during my working hours. I NEED to work, not just want. We have to have two incomes at this time. There is no option for me to reduce hours at work. Actually, my boss would like me to work more hours. I can't work flex hours - someone must cover the core hours of 9 - 4 (I work 8 - 5).
To move into a care facility would require the sale of their condo to have the money to do so. The condo likely will not sell, as there are 6 out of 25 on the market now, some of those for more than 3 years.
Can anyone give me any creative ways to address this?
Also, your prayers are greatly appreciated. This is keeping me up at night.
Just one idea, but how about a reverse mortgage that would cover an aide that could do those little chores, take them on errands and keep an eye on them? I don't know how much they cost, but it might be worth it.
I know reverse mortgages aren't the best thing (someone more knowledgeable than I could talk through the details), but it might provide some means for hired help. My grandfather had "Mrs. Debeck" come to his home every day when he was losing his faculties.
There are agencies in our area that help with assessing client needs and exploring the options available with the older parents.
Ultimately, it will be their decision. Repeat this to yourself and think of the lifeguard who must wait until the struggling drowning victim calms down before going to assist.
Talk to the family doctor or write your concerns to him/her if that is possible.
Driving with dementia issues is very complicated (and unfair to the general public) to sort out but the family doctor is essential in this. Once the assessments on both are done, there may be $$ support for the choices that must be made.
Some of my friends are going through this with their neighbours and friends and it is very hard to be on the sidelines but that is where you must stay for your own sanity.
They made their choice to live where they do and must live with it and whatever unfolds in their lives.
Sorry if I sound harsh or unfeeling because I am neither but the law is very clear that it is their decision and it needs to an informed decision based on an objective assessment of both and the exploration of options.
Do they have clear power of attorney? Do they have regular health care? So many questions can be covered by a knowledgeable interviewer of a support agency who knows the legislation in your area and the services that are available to residents.
It is a very difficult time to go through so hugs to you and your parents.
Miss Cellane
1-24-12, 4:10pm
To add to the good advice given above--make sure that your parents have durable powers of attorney for both financial and medical issues.
Check with the local council on aging or whatever their town/city has to offer. At the very least, there should be some sort of dial-a-ride available to take them to doctor's appointments and the like.
Also check to see what resources your state has to offer.
To be blunt, your brother is getting off easy--he's too far away to offer practical assistance. Can he chip in some money for a housecleaner or home health aide? If you have enough money, there are many organizations out there that are providing services that allow the elderly to remain in their homes safely.
If one of your parents becomes ill or incapacitated, you would qualify for FMLA leave, if your company has more than 50 employees. You can take this leave in big chucks of time, like weeks, or you can use it a few hours at a time, say for driving them to appointments and such.
You could try pointing out to your mother that while she values her independence, she cannot retain that without becoming a burden to someone, most likely you. It would be to everyone's advantage if you and she started touring the available assisted living facilities, so that she can see what they are like and state a preference. If she finds one she likes, it is sometimes possible to be put on the waiting list with an option to defer entering the facility. What that means is that when your parents' names hit the top of the list, they can decide not to go there at that point, but their name will remain on the list, in case they want a future vacancy.
When my dad was in a similar situation, I got a lot of help from the social worker at the hospital, after he fell and broke his hip. I don't know how you would contact someone like the social worker if your parents aren't hospitalized, but the social worker had contacts for things like home health aides and home physical therapists and the like. She also had lists of all the nursing homes, rehab centers and assisted living facilities in the area, which saved me hours of research. I'm not sure what to look for, but you need to find someone like the social worker who has this sort of info for your area.
Friends of mine who are dealing with the same problems found a nursing student who wanted a part-time job. She visits their parents three afternoons a week--she does some light cleaning, all their food shopping, checks that they are taking their medications and plays a lot of gin rummy. I think they pay her $10 a hour for 2-3 hours a visit.
Do you have room in your home for them? If so, you could have them move in with you and sell their place to provide money, along with their incomes, to hire a person to stay at home with them while you are at work. Or someone part time to stop by for an hour or 2 to help them. Someone to not only watch them, but help with grooming, taking meds, doing errands, etc.. Your parents may even be able to help with chores around the house and cooking meals to give you a break and make them feel useful and independant. You could still have the grandkids every weekend, and I'm sure your parents would love that, and wouldn't have to disrupt your scedule too much. If they have their own area in the home then everyone could have some privacy. Not an ideal choice for most but a workable one. My Mom lived with me for awhile before she passed on and it made my life soooo much easier then having to deal with the alternatives that were available.
I would make absolutely sure that your father's dementia/confusion isn't being caused by depression, dehydration, drug side effects, drug interactions, or any one of a number of often-overlooked factors confronting the elderly. It may be reversible.
When my mom was dealing with care issues for her parents she learned that there is a franchise in many cities called Home Again. They provide a van and driver to take elderly clients to appointments. It's not cheap, but it is a lot less costly than hiring a person full-time, and I understand that the employees all have training and insurance.
I would second the idea to ask around for what free services might be available. I would probably start with country social services or any senior resource center. In my community there are free driving services to get seniors to doctor's appointments and other transportation. Our super markets have grocery delivery for a small fee. I have a friend who does volunteer work with Volunteers America (I think that's the name). They do free or voluntary donation work for seniors and will fix household things like simple plumbing leaks, do grab bar installations, and the like. My mother also had macular degeneration and got some assistance from one of the non-profit organizations that help the sight impaired, though I can't remember the name of the organization.
You could try pointing out to your mother that while she values her independence, she cannot retain that without becoming a burden to someone, most likely you. It would be to everyone's advantage if you and she started touring the available assisted living facilities, so that she can see what they are like and state a preference. If she finds one she likes, it is sometimes possible to be put on the waiting list with an option to defer entering the facility. What that means is that when your parents' names hit the top of the list, they can decide not to go there at that point, but their name will remain on the list, in case they want a future vacancy.
This is how a close friend of mine got her 94 year old aunt (who did not drive) to move into an assisted living facility. My friend is a SAHM with three children, the youngest two who are teenagers with very active schedules of sports and music lessons. She was also the only living relative left. Her aunt lived on the far opposite end of our metro area, which meant a 1:15 drive with no traffic. Yet aunt expected my friend to drop everything whenever she called, and come help her with things. My friend finally told her aunt that it could not continue. Aunt's condo was sold and she moved into an assisted living facility 15-20 minutes away from my friend. Things only happened when my friend was very blunt and very honest, while very loving, to her aunt.
Maybe if you take your mom to some assisted living places she can see that they aren't all that bad. She can cook if she wants, most have a small kitchen, but there is a dining room available if she doesn't want to cook. They almost always have a bus going somewhere everyday, shopping, malls, whatever.
You say they are in their mid eighties. Is your father, by any chance, a veteran? Did he serve in WW2? If so, there is a wealth of information out there for you, for free. Call the local VA and tell them you want to talk to the Veterans affairs person who deals with WW2 veterans. Keep at it as it might take you a bit to find this person. This person can tell you of your options and your father just might be eligible for some benefits. You might need to go through his personal papers to find record of his service, but this person can tell you what you need.
I don't know where you live but chances are there is an office of senior services that can at least point you in some direction.
Good luck. You are not alone. So many, including myself, are dealing with these issues now.
Please test for B-12 deficiency...trying to get it for my MIL can account for some fuzziness. Google B-12 and seniors and see what you get. Hugs to you about getting your dad to stop driving. I've heard some people use the "you can't drive on your medication" and take the keys until they forget to ask. We're now living with my 92 year old MIL who is doing pretty well with us but is very stubborn about being independent.
I have a friend who worked for a company that provided some basic help for seniors like driving to appointments, light cleaning and stuff like that. I remember looking into it and although I don't remember how much it cost, I remember thinking it was pretty reasonable considering the cost of other kinds of care.
Also, do they have any good neighbors around that might be willing to check up on them? Both my sister and I have, at various times, given neighbors rides to doctor's appointments, picked things up at the store for them and stuff like that. My neighborhood actually has a lot of people who do that kind of thing for each other. There are a couple of ladies around here who are retired, but relatively young (late 50s, early 60s) who have made the elderly neighbors (80s and 90s) their pet project. They check in with them once in a while and just see what they need. It just makes them feel good to be able to help. If they attend a church you might be able to find someone who would be willing to do that too. I know there are some people at my church who do that. It's not an official thing, just a neighborly one.
Also, I don't know what kind of area they live in but here in the Twin Cities and also near my Grandma-in-law's house there are busses that specifically help handicapped and elderly people get where they need to go. Grandma-in-law is 99 and lives alone in a walk-up apartment. She uses that bus to get groceries, go to church and go to some doctor's appointment. I don't know any details about it at all, but it might be worth looking into.
I don't really have much to add, other than to give you some support. I would look for free services.
It's really tough. My hubby's maternal grandmother had buckets of money and moved into assisted living (her own apartment). That was great.
His paternal grandparents had a house and SOME money, but wanted their independence. So that meant they expected my MIL and FIL to do their laundry, clean their house, etc., even though they could afford to hire someone. It may be something with their generation wanting to keep the money they saved and pass it to their kids, and not have to pay it out to a home. But they also were getting belligerant in their old age and would say they'd do something - but not, and laugh about it. Now the grandma is in a home, (grandpa died).
My father lived alone until he died at 81, but he was losing his memory and shouldn't have been driving.
My mother just died recently, and she couldn't walk, wouldn't eat, etc., which was very hard on my stepdad as her caregiver.
I wouldn't say that your brother is getting off "easy". Maybe yes in the expectations. Occasionally my SIL will make comments that she'll take in my MIL and we can just send money. I love my MIL and would help her in a minute, but I don't have the same relationship. Years of family dinners, free day care, etc. etc...it's not an even comparison in the slightest.
IF your parents need more money to hire help THEN for sure you should share in the burden with your brother. Or rather, he should share in your burden. HOWEVER, if your parents can afford it, they should spend their own money.
domestic goddess
1-24-12, 11:43pm
I'm going through some of the same things with my 86 year old mother. My brother lives with her and provides a lot of help, but he doesn't "get" the little things, like how she wants to get out of the house once in a while and "shop". She gets tired very quickly, and it rarely occurs to him to take her wheelchair. Since I am nearly 500 miles away, my assistance is somewhat limited, but I do what I can.
Can you talk to your parents' dr. about getting therapy for them? My mom recently completed physical, occupational, balance, memory and speech therapy, and the therapists came to the home. Some of the results were better than others, but they all had some value. PT and OT can help them figure out new ways to do old things as arthritis makes it impossible to do things in the same old ways. If they are taking daily medications, you will need to help them find ways to make sure they remember to take them every day.
They may not want to move, but there may really be no option. Assisted living communities are not like they used to be, and it might be a good idea to start visiting some. There will be people to do the cleaning, and some errands, too, and transportation is often provided for shopping trips and doctor appointments. Adult day care centers offer the chance for socialization, as well as someone to check up on them. My mom's litttle town offers transportation for seniors to go anywhere within the city limits, for any reason, for a nominal fee ($1.50) That can substitute for driving. In some places, there are homemaker services, which will be paid in full or part by Medicare. This isn't available in my hometown, but it may be different for your parents.
In the meantime, if you can put some tasks on a schedule, you can be sure they will get done. Change flashlight batteries and smoke detector batteries on the same schedule, for example. See if you can arrange with their pharmacy to have prescription refills ready automatically, for example. Maybe you can hire someone to do grocery shopping or other errands for them, or drive them to doctor's appointments. You don't have to do everything yourself, but your responsibility is to see to it that these things get done, by someone else, if necessary. If your kids are old enough, they can do some things, too, and should. Care of our elders is a sacred trust, and we should all be willing to help out.
chrisgermany
1-25-12, 5:37am
Do they have a spare room? Could they take in an au-pair girl or boy or exchange with a student one room for some hours help?
I thought of another service that might help your parents while they are in their current house. I know a lady who is an organizational expert and, I think, occupational therapist. She consults with elderly people in helping to, as much as possible, "seniorize" their homes.
She says there are a lot of things elderly people do because they have always done them that can be dangerous or just more difficult as they get older and sometimes they just need someone to point these things out and help them correct them. Sometimes it's putting railings in the bathroom or moving things around in cabinets so they are easier to reach or putting grippy mats in places that get wet. Having observed my grandparents, I think that would be a useful service. They are definitely creatures of habit and wouldn't necessarily think of things like that on their own. I think she said her average visit is a few hundred dollars.
There are retirement facilities which are tri-level: independent living > assisted > full care. My husband works for a facility which is fully independent, meaning they can come and go as they wish. Their meals are included in the rent. But they don't have the upkeep of a home to worry about, and there is transportation to appointments provided.
You could call some of these types of facilities. They have management who are experienced in talking with seniors and their families, presenting the options in a non-scary way. Some of the most reluctant seniors end up being the most content in the long run.
Indianapolis has apartments for seniors that include a daily bus schedule to nearby facilities like shopping, library, grocery, RX, etc. These are really nice places and I have gotten brochures and toured plus talked to residents. Each building even has a resident advisor. All utilties are included for around $550 for studio and up to $800 for a big 2 bedroom. There is also a new service where for additional cost additional servicesllike nursing and housekeeping can be arranged thru an outside service, if needed. They have an active social program too.
It is a safe and easy to maintain place to live and looks just like any other apartment building with the added benefits of inside garbage deposit, inside mailboxes and individual safety features. They even allow dogs and cats.
It takes some investigation but there are a wide variety of housing situations out there. Some advertise and some do not.
I understand the issues involved since we are now in the situation of having an 80 year old 650 miles away. She is recently widowed and right now wants to stay in the house. We are waiting for the crisis to occur that will mandate she move here.
I would second the suggestion to look into VA assistance if your dad is a veteran. Thankfully I didn't have to force this decision to move to a facility on my father. At 81, 2 years ago, he decided on his own to move to an assisted living facility, mainly because of the stress he felt about feeding himself, which he had been doing with moderate success in the 3 years since mom died. He picked the facility on his own and it seems to be a good place so all is good for us. But I remember reading on their website at the time that there was assistance available through the VA for vets of limited means through a specific program.
For the OP's parents getting them into a facility now so that they get comfortable with being there would probably be a lot easier transition while they still have each other for support then it would be once one passes away and the other has to move to a facility alone and scared about the unknowns of moving to a new place and "starting over.
I definitely can empathize with you. I will be the one who will take care of my parents since my brother is in another state. I am not sure how you feel about moving them in with you...but that is something I would do. That way you can work, have someone stop in to see them during the day, and they will have the loving interaction with the grandkids as well. However, this situation can be very stressful for you and your husband.
I also agree that you should reach out to the Senior Center in your community and see if they can be signed up for some classes/activities for during the day. They also have buses that will take the seniors to their appointments as well.
Each state has local "Area Agency on Aging" offices. These offices can help you identify what local, state and federal resources may be availble to your parents. Also, depending on their insurance, probably Medicaid, they are likely to have access to home health aides through a Home and Community Based Services (HCBS) program. These programs provide for trained aides and certified nursing assistants who come in to a senior's home for a couple to several hours a day to assist with the "activities of daily living." These are things like dressing, showering, laundry, meal preparation, supervision of medication administration, light cleaning, etc. You would start to arrange for these services first by having a conversation with your parents' physician. If they don't already have a gerontologist, you might consider finding one to serve as their primary care physician. Gerontologists are specially trained to treat the elderly and can guide them, and you, through the maze of applications for services that are potentially available. Hope this is helpful.
I wish there were more support services for the elderly here in China. My MIL has been struggling with depression and diminishing physical capacity (kind of a chicken and egg situation) for the past couple of years. During our most recent visit, my DH and I suggested some basic stretching and muscle building exercises she can do, which seemed to help both her mood and her mobility, but I really wish there was some way we could bring in a physical therapist for her to help her practice and build more confidence with it. Does anyone know of good online resources for such things? Would have to be video or heavily visually based as she doesn't read English.
Thanks for any suggestions...
lhamo
Contact the Council on Aging. They helped with a ramp, handrails in the bathroom, transport chair, hospital bed, cleaning service and Meals on Wheels for my dad.
When he started falling and was diagnosed with a degenerative neurological condition, we hired (with my dad's money) home care helpers (more expensive than a nursing home) while we looked for a nursing home for him. It took about a year to find a good place, so I would start looking now.
The home helpers can dispense pills, make sure they eat, give them a bath and so forth.
When the car starts showing up with mysterious dings and scratches, that's the time to take the keys away. Or if your dad gets lost while driving.
We had an elderlaw attorney handle the will, trust, durable power of attorney etc.
There is a person called a geriatric care manager who can help with a lot of this. We didn't hire such a person, but chose to do it ourselves (there were 5 kids to spread out the workload), but just letting you know that this option exists.
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