Caring for Elderly Parents

[bivenator]

Time marches on and about three weeks ago it was my Father in Laws time. He passed suddenly due to a massive stroke. Ex Marine, nice guy, terrific father, he is missed.

His wife, (my MIL) has early Alzheimers aged 74, has come to live with my wife daughter and me. I welcomed her and could not see putting her into a home.

My wife is a stay at home mom, daughter is in fourth grade. My wife was looking to rejoin the workforce this year but with this event that will not be possible. Mrs bivenator had some medical issues last year and it is imperative that she work as much debt has accumulated.

Mrs bivenator has 3 siblings, all married and all successful.

MIL estate will be only a few thousand dollars after all debts are settled.

I want the siblings to pay my wife for providing 24/7 care but am unsure of amounts. Any amount would be in addition to the social security that the MIL will receive.

This situation is creating lots of friction between one sister (lawyer with the power of attourney) and my wife.

Any Pelican advice or experience with this type of situation will be much appreciated.

[BRPORSCHE]

Man this is no fun. This is how family's are destroyed.

I wish you the best of luck!

[Seahawk]

Originally Posted by BRPORSCHE

Man this is no fun. This is how family's are destroyed

Agreed. Very important insight since this is when the fabric of a family unravels.

Much more back story needed. Why you guys, why the sister with POA, etc.

This is going to sound heartless, but get the siblings together, face-to-face, and lay it all out, nuts and bolts: The difficulty of Alzheimers, how much the estate is worth, what you are willing to do, what they should do, etc., expressed in time and money. Be frank and specific. Get real world quotes from providers in the field.

You guys need a business plan, with detail and dollars.

Then be prepared to do the right thing because so few people are.

[wdfifteen]

It is totally unfair of the sibs to expect Mrs B to shoulder this load while they skate. Caring for an alzheimer's patient is physically demanding and emotionally devastating work. You do not sit around eating bon bons while they sleep.
What do the sibs think the alternative is?

Seahawk is 100% on the money.

[MotoSook]

Agree with Paul and "wd." Get it all out there and have a plan.



Sounds good, but it will probably fail...the plan. Sorry, but the family factor that should ensure the plan's success is already missing. But it's still worth trying.


And the arsehole in me says...go dump grandma on the lawyer SIL with POA.


I know from where I speak. I am the only son, and probably the most successful of my siblings (6 sisters). I've taken on the care of my parents who are in good health now. I know the day will come when I will have to deal with failing health. It will not be easy, and I will not be able to count on my sisters for financial support.

Right now, my parents are living in my guesthouse, and I pay all the bills including catastrophic insurance for my mom (step-mom) who isn't at Medicare age yet. Having them live with us will be easier to care for them, but I fear there will come a day when I need to provide at home nursing care. My folks have no savings nor pension (dad has a very very small one), so they pretty much live on Social Security now. When the bills get too much for me, I will hit up my sisters. I already know the sad stories I will get most of the time, and it willl likely lead to me banning them from my property. Call me heartless, but I don't have the patience to deal with such things.


I wish you luck with your MIL. I hinted at this before in prior threads, but this type of elderly care is ignored by our goverment. I don't ask for much from Uncle Sam, but I do wish they would start considering legislation and relief for folks in our position. We care for our elderly parents like any of our other dependents, yet we are penalized for it without any consideration for the expense and effort when it comes to taxes.

[john70t]

I would suggest a family meeting and put all the cards on the table.
-Nursing homes are extremely pricey.
-Part-time nursing assistance will not be cheap either. You will occasionally need this to have a life of your own sometimes and ensure her care.
-A lot of work will be involved as dementia patients can be mobile and smart.

If the sister wants to have mom live in some sterile nursing home, or with her (requiring home care 24/7), then her irrational control issues.....ummm....I meant 'concerns'......should be discussed in front of the whole family.
Perhaps another POA be appointed, so a solution can be agreed upon.

I'd suggest you all attend local Alzheimer meetings and talk with other people.
Get references.
Find options.
Make schedules.

Also, the house should be safety-proofed:
Stairs/rugs/thresholds and other tripping hazards should be fixed. Glass and other items should be out of reach. Stoves might need switches. Doors might need buzzers so she doesn't walk across town. Toilets and tubs will definitely need handrails.

[RANDY P]

Opt for a nursing home, on paper- Medicare (or medicaid).. Honestly, you may wind up there eventually. Alzheimer's will get to the point where you need FT skilled care, it's degenerative and it will wreak havoc in your household. I know you want to keep her there, etc. etc but it will wear you out.

A nursing home isn't as bad as it seems, you can visit as often as you wish without the disaster and liability of having it at home.

Believe me on this one.

rjp

[Flat Six]

Originally Posted by bivenator

Time marches on and about three weeks ago it was my Father in Laws time. He passed suddenly due to a massive stroke. Ex Marine, nice guy, terrific father, he is missed.

His wife, (my MIL) has early Alzheimers aged 74, has come to live with my wife daughter and me. I welcomed her and could not see putting her into a home.

My wife is a stay at home mom, daughter is in fourth grade. My wife was looking to rejoin the workforce this year but with this event that will not be possible. Mrs bivenator had some medical issues last year and it is imperative that she work as much debt has accumulated.

Mrs bivenator has 3 siblings, all married and all successful.

MIL estate will be only a few thousand dollars after all debts are settled.

I want the siblings to pay my wife for providing 24/7 care but am unsure of amounts. Any amount would be in addition to the social security that the MIL will receive.

This situation is creating lots of friction between one sister (lawyer with the power of attourney) and my wife.

Any Pelican advice or experience with this type of situation will be much appreciated.

Sorry to hear this, but good on you and the Mrs. for stepping up. Karma dollars won't work at the grocery store, but will get you lots of goodwill here.

Depending on where you live, an assisted living facility will run what -- $6k - $8K a month? I'd suggest you also reach out to your local Home Instead Senior Care franchise to find out what it'd cost for them to provide in-home senior care for your MIL.

I'm very, very familiar with Home Instead and they have some of the best care in the industry; they specialize in care for seniors with dementia or Alzheimer's. Get an estimate from them of the hourly rates they'd charge.

Armed with these two pieces of information, work out with your siblings-in-law some fair and equal amount of support for their mother -- whether that support is in the form of coming to your home to care for her while the Mrs. is working, while you're on vacation, or just need a break; or if financial support is more appropriate.

At the end of the day, you can't force anyone to assume responsibility for their family's well-being. But starting with a reasonable and rational basis for providing context (e.g., what it'd cost if a 3rd party were to provide) should help. I suppose you could/should also consider whether your MIL would become (for tax purposes) a dependent and work that into the calculations.

Good luck; hope this helps. Let us know how it goes.

[scottmandue]

We are in the same boat.

My mom and dad are hitting there 90's and still in their house.

I married my lovely wife three years ago and she moved from Portland OR into my home here in sunny SoCal last September.

I work full time and the plan was for her to get a part time job.

My older brother has the POA and he and his wife are local and retired.

We have three part time caregivers (@ $15 hour) however my wife has got sucked into working 20-40 hours a week (@ $15 hour) driving then to med. appts., checking their prescription (a full time job), scheduling the caregivers.

I will divert from going on a rant about how much this is sucking all the life and energy out of my new wife and our new marriage...

So basically to answer your question, not sure what the going rate ion your area is but around here caregivers run $20-$25 HR (my parents are too cheap to pay that so we have hired friends/family for $15 HR)
Assisted care, again check in your area... around here $2600-$6000 a month.

[RANDY P]

With those types of assets she'll probably qualify Medicaid- she will also qualify for VA care facility- she's the spouse of Military. Start the process now, it's gonna be a while.


Find a GOOD VA care home that will do Alzheimer's, and go for it.

rjp

EDIT: Start HERE. http://www.dads.state.tx.us/services/faqs-fact/nf.html

http://www.dads.state.tx.us/news_info/ombudsman/financing.html

How this deal works (in NV at least) is MIL geet put in the care home based on the anticipation that you WILL qualify- so, the nursing home people check you out, and figure you qualify for medicaid, and let you in.

Fast forward a few months, your MIL will be recieving huge medical bills for the care, while they wait for Medicaid approval- medicaid doesn't kick in until AFTER you are admitted to the home, when it does kick in, it usually retropays to the first days, after CONTRIBUTION- whatever they figure your MIL has to pay to "spend down" her assets to qualify.

So, start looking around for a VA care home that does alzheimer's, talk to them, they check out MIL and then they forward you to a Medicaid specialist who slams the paperwork through so the nursing home gets paid. Medicaid won't talk about paying for long-term care until AFTER she's been diagnosed, need established and she's been admitted and technically personally liable for the care bill, since she's admitted already.

You will get bills, but don't pay it- Medicaid is officially approved and will take care of most of the balance and the amount you need to pay is established then...Be ready, it's gonna come out of MIL's estate.

It's a load of paperwork too, they want all kinds of bank statements, proofs of deposit, all kinds of stuff to establish need. Be ready, start saving all bank statements, cancelled checks both paid out and payable to her, etc. etc.

NOTE: this is just my experience with the process in NV, it could be different in TX.

[bivenator]

Sibs initially wanted to put her in a nursing home. My wife was very close to her father and was devastated by his death. We both could not stand the idea of her mother going into a home. We had the ability, time and desire so it is not viewed as a burden. It is sometimes not easy to do what is right.

She still has a fair amount of cognition but is understandably depressed after losing her husband. She is not aggressive or loud and has made a lot of progress since her husband passed with her mood and interactions with others. Wife and I are encouraged by a neurologist visit that indicated no progression of the disease since her last visit six months prior.

My FIL gave power of attorney to his oldest daughter who is lawyer. She has got a bit of a cold heart and was pushing the others to put MOM in the nursing home.

Lawyer sib wants to have the estate pay my wife, use a long term disability insurance policy to bring an in home assistant. This looks like a way for her to minimize her amount to pay.

My idea is to have social security payments and money pitched in by the siblings pay my wife an amount close to 30k. Leaving the long term care insurance for the almost certain eventuality of my MIL needing more skilled care than we can provide. Any money in the estate would supplement the LTC insurance.

Lawyer sib wants to drain the estate so that the MIL is then eligible for Medicaid. I am aghast that 4 sibs with dual income households and one child per would allow their mother to enter the Medicaid program.

Hope this adds some backstory, thanks for the reply Paul.

[craigster59]

Draining the estate for Medicaid eligibility is the new norm. Your MIL needs to be in a facility first and then apply for the Medicaid. Sounds like lawyer sib has brushed up on her elder law and is trying to take the quick/ cheap way out while preserving the inheritance.

[john70t]

(I correct myself.)
SIL may be entirely correct for the long term strategy, depending upon your circumstances.
a). Some facilities provide great care and are a better environment than 'busy home' for the elderly.
b). Many are definitely not.

If MOM is coherent, she should be involved in that conversation....

[RANDY P]

Of course, we want our parents to be around instead of a nursing home, but there comes a time when it's better for THEM as well as you. A good nursing home has the experience and is set up for special cases like Alzheimer's and Dementia. They have staff who monitor them all the time, and keep them out of trouble.

Imagine having to supervise every single thing that goes on in the house- childproofing things, locking the doors at night so they don't wander out in the street, or let the pets loose.

Even grocery shopping is a PITA, don't even think about vacations. A fading patient is a tough commitment, that's the ugly reality of it. Would your MIL want to be a burden on you?

My Mom is a retired RN, and threw the towel in on my dad after 2.5 years, she knew it was over, and my Dad wouldn't want to be anyone's PITA, he'd be OK with it.

rjp

PS the nursing home is what you make of it- I visit several times weekly, because it's just has to happen.

[john70t]

Nursing homes may eventually end up to be the best solution, but it is obtusely neglectful and inhumane to just dispose of parents out of personal convenience.

OP's situation is unique, and best left to his family consensus.

In the meantime, pot is believed to inhibit the brain-plaque buildup causing dementia/parkinsons.
It is an anti-depressant, painkiller, and appetite stimulant.
The legal but entirely synthetic version of pot is Marinol pills, which don't contain the additional 60+ 'inactive' ingredients.
Ask your doctor.

[Hugh R]

I took care of my MIL for 4 years, and the wife's siblings didn't do squat until she died, then they were all over the finances. I had a BIL handle all her bills and finances from the day she moved in so there was no question whether I'd been skimming off of her accounts, which I saw as a real challenge from one SIL who drained her mom's accounts dry before kicking her to the curb.

Try and keep finances separate from you, so that you don't run into those types of allegations.

[Tobra]

Lot of good advice here.

Sad to say, you will soon learn what sort of people your in-laws are.

Good luck, don't get between your spouse and her siblings, but don't let them abuse her. Walking the razor's edge you are. Do Paul's suggested come to Jesus meeting soonish.

[Jeff Alton]

Lots of great advice hear.

What typically happens, as you are seeing, is as soon as one sibling steps up, the others resume normal life... Pretty sad, but happens all of the time.

Like others have said, have a family sit down and lay it out...

[Lothar]

Agreed, good advice here. It makes me appreciate being an only child when I went through my parent's last years.

I will offer one bit of advice. With dementia/Alzheimer's, you will need to continually assess any risk of wandering from your home, if she is going to live with you. Some are predisposed to take off and will get lost, while other will not. This is a serious safety issue. It only takes a quick trip to the grocery store to have a real problem on your hands.

[vash]

good luck. sorry for the loss.

any State funding available for family home care?