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. firstname.lastname@example.org.
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.
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. 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. She can barely communicate so she is at the mercy of those who attend her.
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!
THE AIRPORT WHEELCHAIR – HOW TO NAVIGATE THE SYSTEM
The other day, while running in Crandon Park, I came across my friend, Lilian, whose elderly Mom is in pretty good health. Every year she and her Mother go to Santa Fe, New Mexico for mother-daughter time. This means, she, like me, needs to utilize the wheelchair services provided at airports. We’re both experts on the do’s and don’t’s and have compared notes. So, although I’m writing the column, Lilian is a great source of research. She, like many of us, is living it.
Eulan the wheelchair provider at Miami International Airport, has no competition — this means they don’t have to try . . . and it shows. When Dad first needed a wheelchair, I used to drop him off at Door #3, walk him in and sit him down in the wheelchair area. I’d make sure his name was in the book with his flight time. Then I would leave. Big mistake — basically, wheelchair dependent travelers are at the mercy of strangers. It’s as if they are cows in a pen being led to slaughter. OK, I exaggerate . . . but only a little! Too many times, a person is forgotten and are raced to the gate in a cart. Think of how stressed you are when you might miss your flight and double that feeling for someone who has no control and elderly.
That’s not all, the Eulan workforce, i.e. the wheelchair drivers, are paid minimum wage and expect tips. They don’t care about your family member, they want to transport as many people in the shortest amount of time and make money. I remember one particular scene I created when the wheelchair driver left my father alone to retrieve other passengers from other TERMINALS (not gates) to place them all in one cart! This means Dad is sitting in a chair for 20 to 30 minutes. Luckily, I was with him and that didn’t’ happen. BUT, it does happen and it happens more than it should
This is the system and although I don’t like it we must live in it. Here are my suggestions:
Ensure that you have $5.00 bills, $10.00 bills and $20.00 bills in your pocket/wallet;
Get a pass from the airline to escort your loved on to his or her gate;
If you’re a member of the American Express Centurion Lounge or an airline club, have the wheelchair take your loved one there by wheelchair then arrange for a guest services cart to take him or her to the Gate at an appropriate time — these clubs specialize in customer service. Whoever the driver is give him $10.00.
If you’re not a member of a club then escort the wheelchair and the attendant to the gate and tip the attendant well. (I do it on length of transport – the more distant the gate the larger the tip with Gate 60 being $20.00.) Give your family member the $5.00 bill and tell the attendant that it’s for him after he takes the family member to the door of the airplane. This is a little extra security — it mightn’t always work but it usually does.
For connecting flights in other airports stay with your family member. They will take them off the plane and leave them in the wait area to go get more folks off the plane. That’s when you pull out the $5.00 and tell them you have a connecting flight and need them now — ask them to call a peer to retrieve the other passengers. When you arrive at the gate — another tip.
Yes, it costs money but its the best way to work within the system and have peace of mind. If you have other suggestions please let me know. If you can’t don’t have time to do this for your family members, call us at Parenting Your Parents — yes, a little more expensive but you still have peace of mind!
This occasion has been in the making for over a year . . . family is coming together and it’s a happy, happy occasion. The entire time your parents have been part of the plans . . . where they will sit, what they will wear . . . And now, it’s a month away and Mom is unable to travel because of her dementia and Dad a little weaker from a hospital stay. Often the kids make the decision — they cannot come. But wait, why not??
Again, we as the children have to ask the question, is it because we don’t want to be bothered or is it because Dad simply cannot handle the travel? Our company says: ask Dad! If he says yes, here are a few suggestions:
You want to avoid having your parent travel alone. We say, hire a traveling babysitter. Depending on your parents health, the person can be hired for both or one.
Why a babysitter? First, the airport mania is overwhelming. There are wheelchairs available but someone must supervise the attendant. I’ve seen seniors left by themselves while the attendant goes to pick up more passengers to fill up a terminal bus. That is not how my parent is going to be treated and nor should yours.
Secondly, the airplane ride. Will they need help getting to the restroom? Are they in an aisle seat where it’s easy to get up and down? What about getting those headphones in the ears so the show can be watched?
Thirdly, landing. Yes, the airline will have the wheelchair waiting but it’s a strange airport with all the chaos of any large meeting space. The babysitter adds calm to the chaos and supervision to the wheelchair attendants.
Lastly, the party! No one family member wants to go to take Dad to his room and skip the rest of the party. Nor is it fair to have a family member in charge of dinner, getting the elderly to their table . . . etc. Think of how much you’ve already spent on this party. What’s a few more dollars if it means your parents/grandparents can be in the photo? The memories last you a lifetime.
So yes, there are options. The babysitter costs money but helps to prevent resentment. At Parenting Your Parents that’s what we do — make certain that your family event is a family event with minimum trauma.
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.
NOTHING prepares you for your parents aging. Our company can assist with the financial scams and pitfalls but you’re the one who has to watch Mom, Dad, Grandma or Grandad age and weaken. It’s heart wrenching! I write this column as a daughter who has a demented mother (87) and a weakened , non-driving father (93).
Mother is in a nursing home. This nursing home has an excellent reputation and a low employee turn over rate but it’s still one of those places where the halls are filled with moaning people in wheelchairs or portable beds.
This home charges close to $7000.00 a month but accepts medicaid. This means we had to impoverish Mom. By “impoverish” I mean I had to do the paperwork to make her medicaid eligible. We now pay a little over $700.00 a month. I do not have the words to detail the pain . . .humiliation that I felt in using my legal education to make my mother poor enough so she could live with other poor people in her old age. This is not what she wanted nor is it what we wanted. However, Dad is lucid, Mother is not — we couldn’t afford both and neither could they.
Each time I visit Mom I cut her nails, take off the old nail polish, pay for a weekly hairdresser. rub Lubriderm on her skin and place vaseline on her lips. It kills me to leave her although I know in five minutes she won’t remember I was there.. But, there is a silver lining, Mom and I were oil and water as I grew up. We simply didn’t get along. Today however, it gives me great joy to minister unto her — to do little things that allow her to feel special and loved. She always has tears in her eyes when I say goodby and so do I BUT (and this is important) I know when she dies I’ll have done all I can. For that I’m grateful.
I am a “Daddy’s Girl” so watching him weaken is difficult. On one hand I’m so grateful that he has a quality of life that allows him to live alone in an assisted living facility but I still have to cut his nails, hire a barber, and cajole him to use his walker. I accompany him to the 3:30pm weekly Happy Hour when I’m in town but I see his failure to thrive. Who can blame him? He lives in place with lots of old people all of whom are simply trying to get through the day. I know Dad is ready to leave us — I don’t want him to but I know he’s tired of growing old.
And let me end this column by stating that as hard as it has been for me I am once removed. My father chose to live in Atlanta where my brother and his family reside and Matt has had to deal with the day to day. Matt is more stoic but he’s also the baby of the family — and this is a true role reversal for him. He does a phenomenal job and I’m grateful.
To make it a bit more personal I’ve added a photo of Mom and Dad before dementia took hold and we had to take over.
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.