Difficult Decision Concerning Elderly Parent...Options?

[M.D. Holloway]

My Father is past the twilight of his life. While he has good days and bad days he is no shape to take care of himself by himself. He has had visiting nurses spend almost 18 hours a day with him as well as my siblings checking in on him. He made some good investments in the past but spent a lot of money on my Mom when she was alive in private care facilities. Several years at $8000/month starts to drain the wallet. He has been burning through the rest paying for in home nursing as well. Been doing it for over 4 years now. Its expensive but we see the only alternative is the nursing home. We all saw what happened to my Mom in that. Even the best ones are a galaxy away from what you get at home.

For over 10 years I pleaded with him to live with us but he all out refused. He is about 3 to 4 months away from running out of money then its time for the nursing home under title 19 or medicare or what ever it is. I talked to my siblings about paying for in home nursing - while he has good days and bad he is very a wear of his money situation and has told us that in no uncertain terms are we to spend money on him. He would be supremely insulted if so. I say we just tell him the state will take care of it...but then I started looking at the cost. I'm not certain we could afford it either. I want great care for the guy but don't know how to get there.

I have put off getting the Turbo thinking that I will have to contribute at least 1K a month maybe 2K. I would do it. My twin might be able to match me but my older sibs are retire on a fixed income so they are not gonna be able to do it. The in home care is roughly $6K a month. Not sure what to do.

Wondering if title 19 or Medicare would cover in house care instead of a home? Anyone any any ideas?

[id10t]

Got a community college near by that has a nursing program? Room/board/little cash in exchange for care may work.

[jcommin]

First, let me say I a empathize with what you are going thru. I have lived thru this as I'm sure other have too. We become our parents parent. Both of my parent were in nursing homes. My dad for about a year - he was lucky. My mom had dementia and lasting 5 years before she died.. Allot of money was spent, care is very costly and the quality of care varies.

I'm lucky because:

I have a brother who was vested in our parents well being. We never fought over anything and we shared the process as painful as it was.

We had a supportive family, As often as I felt alone, my extended family supported our decisions.

I retained a lawyer - I straightened out their estate and made changes. My mom and dad never imagined senior care. They thought they would stay in their home and die of old age.

I got an investment adviser. I made no financial move until I got consultation. He also changed investments that suited my situation. He knew about medicare, ss, and what we could/could not do.

I made a burial plan for the both of them. I did this early on because I anticipated there would be nothing left and what the government allows isn't much.

In the 90's the financial look back was 3 years - I believe it is now 5. If you want to move money, valuables, antiques, etc - be careful.

When my parents became ill, Medicare did not cover in home expenses. We could no longer take care of my mom. It wasn't safe for her or us. She would wander at all hours of the night, turn the oven and stove on, get lost in the bathroom. Short of just tying her down, we were drained. If hurt to finally give up.

Since your dad does not have a spouse, everything he owns can be used to pay bills if/when you come to the decision to put him in a home.

Mike, all the best. I'm sure you will make good decisions.

[craigster59]

Advice from someone who has worked for over 14 years in helping families apply for Medicade/ nursing home benefits. (not me, a friend):

First, check with the Medicaid Long Term Care office in your father's town to see if Medicaid LTC offers in-home care (it varies from state to state. Some states, like Arizona, do. Others don't, like California).

If your father is approved for Medicaid LTC in a nursing home, the State will pay for the cost of his care. Your father will have to help pay for his care and that is called a share of cost. The State will look at his gross income to calculate his share of cost. He will be left with around $35 for spending money every month (for ice cream or hair cuts or whatever your father wants to spend it on). A patient's family is NOT responsible to help pay for his care, it will all be covered by Medicaid.

There is also a PACE program in Texas that covers long term care. You should find the office in your father's town and see what they cover and what the eligibiity criteria is,

The worst mistake you can make is listen to other people. Please let the Medicaid LTC office and PACE office staff tell you what's what and then make your deicision. People who don't work in this field can put you on the wrong path and possibly cost you thousands of dollars. It's best to get all the info "from the horse's mouth" so to speak.

Well, there you go Mike. PM me and I'll give you my cell and you can speak with her directly if you have any questions. Good luck!

[wdfifteen]

Originally Posted by M.D. Holloway

SIts expensive but we see the only alternative is the nursing home. We all saw what happened to my Mom in that. Even the best ones are a galaxy away from what you get at home.

I'm sorry things didn't go well for your mom. But "Even the best ones are a galaxy away from what you get at home" would depend on what you consider the "best" and what you can provide at home. The level of care at the place my father played out his last 8 years was head and shoulders above what anyone in our family could have provided, short of one of us having 10 years of nursing experience and quitting our job to care for him.

Every family situation is different. I'm glad you have the training and resources to take care of him in his home. In my father's case "the home" was far better than the family could have provided.

[Rusty Heap]

Let me gather my thoughts, and I'll post again.


I've been running in your shoes for the last 2 years with my Mom, dementia / brain cancer.


till you wear those shoes, you have no idea.

my heart felt hugs sent out to all those with these responsibilities.

[herr_oberst]

Mike, sorry about your situation, I, too have gone through all of that fairly recently.

I wholeheartedly agree with Cragister - "Please let the Medicaid LTC office and PACE office staff tell you what's what and then make your deicision. People who don't work in this field can put you on the wrong path and possibly cost you thousands of dollars".

Good luck, brother!

[M.D. Holloway]

I remember when I was young, I had a great aunt who was in a home. My folks would visit her and sometimes bring us along. My great aunt wasn't a nice person when she was young and got meaner when we got older to the point of being down right disrespectful to anyone around but my parents still paid her visits. She may of cared or maybe she didn't. My folks would always say we are the only ones she has - no one else wants her. I remember one visit we were leaving and my Mom looked to me and said "no matter what, don't ever put me in a place like this." I promised her I wouldn't. Funny thing is, my great aunts place was actually very well respected and she received excellent care for over 15 years.

Flash forward 17 years ago when my Mom was showing signed early signs of dementia. My Dad took care of her until she got so bad he couldn't anymore. She was put into a very good home as well and he would visit her from 8:00Am till 9:00PM every day - he did this for almost 4 years with out ever not being there with her. She may have known who he was at first but in her last 2 years she had no idea. I remember the last time she seemed to have a sense of her surroundings. I visited her, held her hand while she was in her wheel chair. We went outside to the gardens and she looked over at me and said "you promised...you promised..." That was the last thing she said to me...

Ya, not feeling good about it but not that there was anything I could do...

My Dad referred to those places as 'The Dying Places" and repeated told me he would never want to be in those places. After my Mom died he would spend sometime going back and seeing some of the other people he met there. He didn't like it but he felt for them because no one ever visited with them. He referred to them as 'the forgotten'.

I guess I don't want my Dad to be a 'forgotten in a dying place..."

[biosurfer1]

Nursing homes were a place to go and wait to die, at least thats how the older generation sees them. My grandmother really needs to be in one and she did for about a month. She did it to appease my parents and I'm 100% sure she decided to move out before she even moved in. She didn't give the place nor the people there a chance. Funny thing is she had to stay there 30 days since it was pre-paid and I think towards the end she was meeting some people and possibly somewhat enjoying herself, but of course she would have never admitted it and moved out. Claiming she would never go back. Talking her, you'd think it was the worst place in the world but in fact, I'd move in if I could. They cook for you (good food too, ate several times) provide tons of things to do, outings, games, movies, etc. You can have as much assisted living as needed, otherwise they were completely independent.

The best way I can describe it is you live in a much nicer dorm room, just don't have to go to class. I'm sure some are worse than others but sign me up when the time comes!

[Noporscheform]

Craigster advice is very good. Also check with the states department of aging and the Alzheimer's association for good info on what facilities and resources are available.

[Seahawk]

As always, some very good insight on this thread.

My father lives in a continuing care retirement community in California and loves it. He is 84 and told me many times he didn't want to be a burden to his children, especially living with them. Just not his thing.

Nor mine, frankly.

He is extremely active and, more than once, has told me over the phone when we chat, "got to go!"

He may be a bit of an outlier, but my wife's grandfather had a similar run. He moved from here to Florida, bought a house and planned to see his children a bunch. Never happened. He got so lonely, even with daily care givers, that he asked me to move him back to Maryland and into a local assisted care facility.

Which I did. He was 87 at this time.

We settled into a bit of a routine. It is probably important to mention I really loved Jack, named my son after him and enjoyed his wit, right up until the end.

My wife would handle the mid week visits, groceries and visits to whatever he needed. Since we had Au Pairs in those days, they would pinch hit with the kids.

On weekends, I'd drop a bottle of Ten High off on Saturday morning, yap a bit and then go.

I'd pick him up every Sunday afternoon and bring him home for dinner. After dinner he and I would go for a drive in the local area. What great stories he told. Jack was a bit of a rouge so there was color in all the back roads we travelled.

After about three months, Jack made friends, a lot of friends. He would ask if he could bring a buddy to dinner once in awhile. He even managed a late in life romance after he turned 90. She was his age, a former teacher and the bomb. She loved the Sunday drives.

I guess my point is that nursing homes vary. Jacks place was nothing special...assisted living since his income was modest. He really enjoyed being in the mix, not living day to day with a care giver in his own hootch. He had his own apartment, kitchen and access to an elder bus. Every time I showed up he was playing elderly grab ass with his buds.

It was clean, well managed and we showed up at least twice a week. That matters. Don't fear nursing homes, at least good ones that know you are interested in how things are going.

Good luck, Mike.

[Porsche-O-Phile]

I know more than I should about this subject - a very close personal friend who I see at least 2 or 3 times a week is a hospice nurse. There are some woefully crappy situations that people can get into when it comes to end-of-life care. I saw one happen first-hand with my deceased grandmother (moved in with us, costs were supposed to be shared between my mom and her two brothers - she got royally screwed and never saw a dime). My dad's mom was the victim of flat-out senior abuse (his sister bled her estate dry when she contracted dementia and by the time my dad realized what was happening she was destitute - over $100k pissed away in about four years on vacations, designer clothes, manicures, etc.). There wasn't a damn thing the DA could do by the time the light was shone on it.

The stories can be way worse than that. Assisted living is a good way to go but it's not cheap - though cheaper than a nursing home. They will NOT do anything for you though - especially involving medications - so a person needs to be reasonably functional there. Nursing homes range from good to downright scary. They ALL will absolutely bleed any senior's estate dry. Their stated goal is often to ensure that they get every last dollar out of a person's estate before Medicaid kicks in. Yes they're that blunt about it. They can and will leave heirs with nothing if they are given any chance.

In home care is absolutely the best but it's damn expensive. If you can make it work at all, do it. I strongly recommend everyone over 65 setting up a Medicaid trust - my parents did it to protect what they worked for their entire life. They want it to go to charity, to their kids and grandkids as THEY want - not as some sleazy probate court decides or worse still, gets all seized and liquidated by a nursing home. That's the game. It may sound nasty and sleazy but you're up against institutions that are orders of magnitude more nasty and sleazy - and much more experienced at it. If you care about what happens to your estate at all, set one up and do it before you get too old (yes the look-back is now five years for Medicaid "impoverishment" so the difference between doing it when you're 65 and 70 is huge).

All the best Mike. It totally sucks and I hear about how it can and does go bad for too many people far too often. Makes me want to blow my life's savings on hookers and blow, then go drive off a bridge.

[MadameButterfly]

20 years ago I became friends with an elderly woman - very frugal and independent - with distant relatives about 3000 miles away. Over time I found myself doing more and more for her because there just wasn't anyone else.
In 2006, when I couldn't reach her on the phone, I asked her neighbors to check in on her. They found her on the floor too confused to even push the lifeline button around her neck. She ended up in a nursing home for a limited amount of time with the intention of leaving before they started charging her.
Since she'd given me her Power of Attorney, I used that time to make her home safe and sanitary, and hired this wonderful young woman with elder care training to live with her, for room and board and a modest salary. I hired the neighbor to provide respite, and for everything else, I filled in the gaps.
From the beginning I involved Hospice. They are such a wonderful resource. They visited several times a week and were very pleased with the quality of her care.
Emeline died where she wanted to - in her home - in July of 2007, surrounded by Hospice, her beautiful young caregiver, her wonderful neighbors and me.
After she was gone, per her instructions, I divided her small estate between 20 charities and distant relatives of her choosing. An exhausting experience, but great peace of mind.
If you can find someone trustworthy with elder care experience....maybe I was just lucky....

[Bill Douglas]

My Granny ended up in a place with excellent care, card games, heated swimming pool, drinking sessions - the works. She loved it.

I'm not afraid of growing old (unlikely I will, but anyway...) and I'll check into this place. Staggering drunk and naked around the swimming pool, why change the habits of a lifetime I say.

[craigster59]

Originally Posted by Porsche-O-Phile

...... They ALL will absolutely bleed any senior's estate dry. Their stated goal is often to ensure that they get every last dollar out of a person's estate before Medicaid kicks in. Yes they're that blunt about it. They can and will leave heirs with nothing if they are given any chance.

The gal I had post on here about Mike's predicament worked for 14 years in Arizona helping seniors apply for Medicaid benefits and helping spouses get into nursing homes. These people were destitute, some having had no AC in their homes for years to save on costs, going without meals, etc.

California is much different. She now works part time for an attorney in Tarzana helping clients apply for Medicaid who have already gone through the process with the attorney of hiding millions in assets so their heirs will have an "inheritance". Meanwhile, the taxpayers shoulder the costs of these peoples care.

I see no reason why someone's assets should not be diminished for long term care before Medicaid payments kick in.

[wdfifteen]

Originally Posted by craigster59

I see no reason why someone's assets should not be diminished for long term care before Medicaid payments kick in.

Me either. Taxpayers should not be left holding the bag because someone wants to leave the kid's a nice inheritance. If the kids want an inheritance, they can take care of mom and pop.

[wdfifteen]

Originally Posted by Porsche-O-Phile

They ALL will absolutely bleed any senior's estate dry. Their stated goal is often to ensure that they get every last dollar out of a person's estate before Medicaid kicks in. Yes they're that blunt about it. They can and will leave heirs with nothing if they are given any chance.

I'm sorry you've had such bad experiences. As for the above, it's the law, not the nursing home's policy. You are not eligible for Medicaid if you have assets to call on to take care of your expenses.

[porsche4life]

Some very good advice here, I'll just throw in what I saw in my days as a pill pusher....

Spend some time looking around the different facilities in the area, you can tell pretty quickly which gives the best care, and I could tell which one I would want family in after I was in them all.

Visit often! Its a shame to say this, but our customers who seemed happiest and who got the best attention from the nurse had frequent family visits. Get to know the nursing staff, bring them small tokens of appreciation etc. Remember its a tough job, and nursing homes are pretty low on the nursing pay scale. If they like you and your loved one, you will get the help you need.

And if you see ANYTHING of concern, speak up. Talk to someone about it. Again, the most attentive people got the best care.

Hope it all works out for the best Mike. There are good homes out there, and I had a family member in one for close to 20 years due to alzheimers. Someone visited her DAILY, and she got top notch care.

[Laneco]

Originally Posted by MadameButterfly

20 years ago I became friends with an elderly woman - very frugal and independent - with distant relatives about 3000 miles away. Over time I found myself doing more and more for her because there just wasn't anyone else.....If you can find someone trustworthy with elder care experience....maybe I was just lucky....

I think she was the lucky one to have found YOU. Thank God there are people like you out there. Thank you for the wonderful thing that you have done.

angela

[Rusty Heap]

May I slightly tangent this thread with this insight.


Get your own lifes' paperwork together, now.


everyone really needs:

A Will.
Medical Power of Attny
Financial Power of Attny.


final wishes of personal effects.



whether your 20 - 30 - 50 or not acting your age regardless, you need your own papers in order.



I've had to make some serious health and financial decisions with my Mom, and thank god her working in the legal field for 35+ years, she had me and my sister documented legal with POA and Wills established and such..............


so many people don't really think of it, but yeah, we all check out some day lights out.