During the journey many of us will take with an older family member there will come the juncture of whether to have in-home care, a move to a smaller place or a move to an assisted living facility.
On an emotional level, we all think it’s better for everyone if they stay in their home with in-home care. That works if family members are within a 15 minute drive. If this isn’t the case then one must really begin to think about “the best care.” Best care means the best for everyone concerned. These are tough issues and we tend to put off these decisions until you need to make them. That is the wrong time — you’re under an amazing amount of pressure, emotions are swirling and not all family members agree on the definition of “best care”.
My father always said he was going to die in his home. That he would only be taken out “feet first”. The children always went along with him because there was no need to rock the boat. Mother, whose dementia was getting worse, would agree with Dad. In order to accommodate Dad, we hired a caregiver to come in three times a week to “entertain” Mom. The bad news – caregivers don’t stay forever. (In this case 6 months which is a long time in the caregiver world.) We hit the jackpot with our first one but then the next three simply didn’t do the job. They were late, wouldn’t’t show up . . . all the usual employment issues.
In our opinion, several questions must be asked:
How many family members living in the home?
Do both need care?
How mobile are they?
Does anyone drive?
Do they need 24hr care or will 4 to 6 hours 3 times a week suffice?
Does anyone have dementia/alzheimer’s?
Once these questions are answered then it’s easier to come up with a solution. Following are some practical things to think about:
How much money is there?
Is there Long Term Care policy?
Does one need more care than the other?
Is it only one family member?
Do you need to be “medicaid ready”?
Are there other benefits for which your family member is eligible?
In the case of Mom and Dad we had a catastrophic event and we had to move them from their home to a totally new location (see my first article). This experience is how I know that asking your parents what they want done in their ‘final chapter’ is easier said than done. It’s an extremely difficult conversation and we tend to avoid it. DON’T! If you don’t think you’re capable of having this discussion, hire someone to assist – sometimes our loved ones hear bad news better from outsiders. If you’re emotionally wrung out because you’re in the middle of the “journey” — you are not alone.
Parenting Your Parents has mental health professionals who are skilled in family matters as well as move managers (a person who manages the entire move — from sitting with the person and deciding what to keep, to selling/giving away the surplus and hiring and managing the move) — all of whom assist in making any transition as easy as possible . . . and none are easy.
It’s a good news/bad news scenario. The good news, you have enough money to have in-home care. The bad news, it’s implementation time — finding the right company or person. This is a slippery slope — especially in South Florida.
Most of us reading this article have never dealt with caregivers —for ourselves or other family members. Questions to keep in mind: Is there a license necessary for this type of work? What happens if the person harms my family member? Is there a background check for the caregiver?
These questions are easily answered if you use a reputable bonded company. A “bonded” company is one who has a “surety bond” and if anything happens to your loved one like theft, maltreatment, or injury, the company cannot hide behind bankruptcy — the bonding company is responsible for payment.
In south Florida many people hire caregivers because a friend recommended him or her or the person had worked for another friend’s family member or its someone just in from Latin America and they need a job. It’s less expensive but it’s dangerous. If there’s theft or maltreatment you have no recourse — these people do not have the means to compensate for their conduct. We’ve all heard stories of stealing, maltreatment of the patient and overall sloth behavior.
One very well known man in Key Biscayne had in-home care for him and his wife. She died and it was just him. The home care folks started taking advantage — eating his food, taking his “change,” purchasing his food (and theirs) and only tending to him when his out of town daughter called to say she was coming to visit. Luckily, his neighbor became suspicious when he found the man disoriented and walking the halls. He took him back to his condo only to find the “helper” watching television and eating — totally unaware the patient had left. He chastised the employee, called the daughter and put an end to the in-home care.
Bottom line – you do not want your family members in the care of people who don’t care. The safest thing anyone can do is call a reputable company and pay the extra $2.00 or $3.00 an hour that a bonded company would charge.
Parenting Your Parents partners with ComforCare — not only do they have well trained caregivers but, if you qualify, they can find you free in-home care! Contact us if you need us. email@example.com.
BORING BUT USEFUL:
MEDICARE – MEDICAID — THEY SOUND ALIKE BUT ARE VERY DIFFERENT
Many of us think if we’re eligible for Medicare then we’re also eligible for Medicaid — although very few of us understand the difference. I am going to attempt to explain that difference without putting you to sleep.
MEDICARE: Medicare is a federally funded insurance program for “seniors.” It is available to all US citizens and green card holders from the age of 65 and higher. There are two parts: Part A (Hospital Coverage) and Part B (Medical Insurance). If you choose a simple ‘medicare’ then you also have to choose doctors and hospitals that accept medicare. (Please see my article, “Choosing Good Care Within the Medicare System”). In 2017 the Part B premium average is $134 but if you have a higher income it can go as high as $600.00/month. If you live on or close to your social security income it’s $109.00 on average.
For hospital insurance you usually pay a deductible — this can go into the thousands which is why many people choose to have a “supplemental” plan. These plans are run by insurance companies and often are free — which is an HMO. As you know, we at Parenting Your Parents, recommend PPO plans which is an out of pocket cost.
MEDICAID: Medicaid is a state administered program with some funds coming from state taxes and other funds coming from federal Medicaid grants given to needy states. (In other words, the poorer the state the more federal funds.) The benefits are intended for low-income patients who cannot otherwise afford medical assistance. To be eligible for Medicaid, you must meet a mandatory list of standards that are partially enforced by the federal government.
Again you must be a US Citizen or Green Card holder to be eligible. For the purposes of seniors, they must be in a nursing home facility or receive “home or community-based care.” Bottom line, a senior cannot have assets or income over the poverty level if they want to qualify for medicaid.
Here is the kicker – qualifying for Medicaid triggers a five year look back to ascertain that you (the senior or the child) have not recently transferred a home, bank account, and/or other assets to avoid paying for nursing home care. And this is the tricky part — when do you begin the asset transfer to children, a trust, and/or a power of attorney. And that is where Parenting Your Parents is a resource.
This is a very tough subject. In our experience parents don’t want to give up control and the kids are the prime suspects, i.e. “they want to take our money away and use it for vacations!” For the kids the hardest part is that one parent is going to go into a nursing home and you have to be prepared (unless you have more that $10 million in assets).
Bottom line — ask yourself — do you want these homes to get your money or do you want the money used for the greater good — whatever that might be. Once that question is answered, you can move forward in either direction . . . protecting your assets now or letting fate take her course.
MONITORING THE MONITORS –
HOLDING THE ASSISTED LIVING CENTERS ACCOUNTABLE
That dreaded phone call — the one where you don’t know the person at the other end of the line and he or she says, “we’re calling about your Mother.” In this case, Mother, suffering from dementia, had pulled the fire alarm and the locks on the “locked facility” had released. She walked out onto a busy street in Atlanta, GA and tried to flag down a car and escape. Luckily, a concerned motorist called the Police who called the facility. They walked two blocks and found my mother. Until that moment no one knew she was missing. That was a wake-up call.
Dementia does not mean stupid — it simply means that the mind is forgetting. Mother, a summa cum laude graduate of American University, wanted out! She took a look at her surroundings, saw the fire alarm and pulled the lever. The problem, as you can see, is that her “protectors” are not as smart. Needless to say, we moved her out and found another place for her to live. That was three years ago. Today, she has forgotten how to walk, cannot move her wheelchair and is no longer a flight risk.
If one of your family has dementia/alzhiemers it is incumbent upon you to visit the facility regularly — this alerts the staff and the person receives better care. It’s the old axiom — the squeaky wheel gets the oil. Mother is now in a Medicaid nursing home and we are more vigilant than ever. The stories we hear of horrible abuse might be rare and extreme but they’re true. Each time I go I check her legs, arms, feet, cut her nails and toenails because no one else does. Mom always has new scratches and I ask about each and every one Once she had toenails more than an inch long and the entire foot was placed into tennis shoes. (That has been corrected.) She can barely communicate so she is at the mercy of those who attend her. When you visit your family member, choose different items to inspect. Also buy moisturizer, print the family name and room number on it and place it in a drawer or shelf. Sometimes these creams go walking but I note that each time I’ve mentioned a disappearance the item is found. Inform the nursing home of any issues verbally and follow up with a written document. I always email what I stated verbally.
Dad is in an assisted living facility. He has his wits about him and can communicate his needs to the staff. Still, we’ve had to watch the little things — are they washing his clothes on time, changing his sheets weekly, doing the deep cleans in his room and treating him with respect. As Dad has aged he has also lost motor skills, he is a fall risk and weaker – hence the heightened vigilance. If your parents live together this becomes much easier. They watch out for each other. However, this is an exception, not the rule.
In conclusion, the workers at these facilities care about their residents but are human. It really becomes an issue of time. In a nursing home each attendant has 16 to19 patients a day to bathe, dress and feed. The private-pay locations are more vigilant than the Medicaid nursing homes BUT they also have more employees and better paid employees. I do my best to be “understanding” but, at the end of the day, it’s my Mother and Father and no one messes with them!
You walk into the lobby and take a deep breath. How did you get here? Why is this necessary? How did my very competent ‘elders’ all of a sudden need assistance living? Other questions pop into your head, will they be happy here? Will they be fed well? Will they like the people here? Whether you’re 40 years old or 80 years old — these are real moments. Change is coming and it seems to be screaming down the train track right at you. Do you jump or simply lie down? Before you decide ask:
- Do the elders want to live near family or friends? If both are in the same location the question is moot. Otherwise, this question comes first. It’s not about YOU as the child it’s about your parent’s quality of life. We all think Mom and Dad should be close to us, family, but that’s not necessarily what THEY want. If they have a life in a separate location and want to stay, keep them there. Today, with UBER and LYFT the ability to drive is not a necessity.
- What is your budget for a senior care center? Certainly this makes a small difference in the food or housing (food and maintenance are fairly comparable) but the big difference is location. You ask yourself — how long will it take to get them to their synagogue or church? How far is it to their favorite restaurant? What other bills will need to be paid?
- How much money is there? Can Mom and Dad afford this on their own or are will the kids have to assist financially? What other sources of monies can be tapped? Are there VA benefits? Widow/widower benefits? Can social security disability come into play?
- Can this facility be trusted? We’ve all heard those horror stories of badly treated seniors and none of us want that happening to our parents. There are many resources and most of them are online. You can look up assisted living centers and many will pop up — most with ratings right next to the name. There is also AARP ratings, YELP ratings and Facebook.
Bottom line: You will have to do some searching — online and in person Peace of mind is what you want in any location. As the children you want your parents well treated — as the residents you, too, want options in food, activities and people. The most important aspect of this is that you and your parents feel comfortable and secure.
Our company, Parenting Your Parents takes no fees from assisted living centers. Our concern is you and we want the option of defending you against them — which can sometimes happen.
By way of introduction, I became an advisor to families dealing with “aging parents or grandparents” after dealing with my own. The amount of legal work, CPA work, and residential home issues, facing Dad at the age of 90 as his wife’s mental health declined, was staggering. My father, like many husbands and Dads, hid the severity of Mom’s dementia for several years. Finally, the kids realized he was being hit, scratched, screamed at by a person who looked like his bride but no longer was. We stepped in.
This is not an unusual scenario. Mom and Dad had lived all over the world, They were respected members of their community, church and neighbors. None of the children lived in Houston, Texas – the city Mom and Dad called home so they built a life there without us. I would fly in about once a month to check in on them and my brother would visit about once a quarter. We both realized Mom was “slipping” and at first ignored it. (My bad). Then we began by hiring an aide to give Dad a break two or three times a week for 3 to 4 hours each time. We thought the situation had stabilized.
The kids threw Dad a 90th birthday party and family members arrived from throughout the USA — it was a great 2 day event and Mom was on top of her game. As different family members said goodbye, Mom asked who was taking her home — as she stood in the middle of her living room. That is when it hit me — she honestly had no idea who she was, where she was and why she was there.
My brother and I sprang into action. First we had to face Dad and tell him they were moving. He had a choice, Atlanta, GA (brother) or Miami, FL. (yours truly). He chose his son. Now, we had to go find an assisted living center convenient for my brother and his wife. No easy task. They move in and it becomes apparent that mother is in no way cognizant. She needs 24 hour care — this means Mom and Dad will live apart. Need I go into the gut wrenching sadness of placing them in separate places — not just for them but also for their children.
Meanwhile, back in Houston, I am flying in weekly from Miami, going through a home that was lived in for over thirty years and deciding what to keep, what to sell, what to throw away. The house also had to be placed on the market. Another gut wrenching experience . . . looking at clothes your parents wore to fetes, church, weddings . . . reviewing photos of Dad as a young sailor in WWII, Mom and Dad leaving the church on their wedding day . . .tears form as I write this.
Bottom line – it is HORRIBLE! Yet, in many ways the ‘gut-wrenching’ feeling was cathartic – we know Mom and Dad raised terrific kids, each with their own strengths. None of us live close to each other but when needed we rally together to become an indefensible scrum. Mom and Dad are now as good as they can be but it’s only because we did not allow ANYONE to abuse them. I don’t believe people don’t WANT to abuse seniors but the process allows it and many take advantage.
Finally, my brother took my father into his home while we were dealing with Mother’s many escape attempts and bad nursing homes. Today, Dad is in an assisted living center (his idea) where many WWII vets live and mother in the best possible nursing home environment for her situation.
Aging is not an easy path and one fraught with crevices and scammers. Those pitfalls are what the ensuing columns will be about. I beg you to ask as many questions as possible — my expertise is finding the money you’re owed, an analysis of what is needed for an easy transition, holding hands and holding on the phone for 45 minutes to an hour to get the answers needed. Let me know your concern — none is too trivial. I hope many of my columns will be answers to your questions.