Way OT: aging parents

[flydhest]

My parents are in their late 70s. We all know how life goes. Has anyone come across books that are helpful in having the conversations that have to happen? I am the youngest of four brothers and we are trying to figure out how to have the hard convos.

The collective wisdom is appreciated.

[thwart]

Start out with talking about setting up a power of attorney for healthcare decisions and a power of attorney for financial matters.

Your parents are likely to be receptive to that. Hope so, anyway.

And that may segue into a discussion about a living will, or their desires regarding terminal care.

For those of us whose parents are further along in both age and health issues, the tougher conversations come up about driving and also moving into a safer, perhaps more compact place to live.

[Louis]

I'll be interested in seeing what comes up here - I just spent a week+ with my parents down in Haiti (early to mid-80's between them) and they're going downhill pretty quickly.

In a related matter, I just sent an e-mail to my sister asking her if she thought we should get them one of these (see image below) My mother takes quite a few pills and is always worried about whether or not she's already taken what she needs to take at any given time of the day.

Bottom line: the combination of physical and mental decline is pretty scary.

https://www.forgettingthepill.com/sc_images/products/875_large_image.jpg

[El Chaba]

If they are still living independently and have all of their mental faculties, you are probably in good shape to just talk it over. Every situation seems to be as unique as the people involved. My mother is 87 and has dementia with a nearly complete loss of short-term memory. Her memory of events in the past beyond 20 years is excellent. After my father passed about 6 years ago, we had my mother living with us for about two years. She is now in assisted living and doing great. With the benefit of 20/20 hindsight, she should have gone straight to assisted living. We thought we were doing a good thing, but she is in a better situation for HER....

[El Chaba]

PS...The big hassle WRT the "Big Conversation" might not be with your parents but may be with getting your siblings on board with what steps need to be taken when the time comes....

[rePhil]

While books may give you ideas,no one knows YOUR parents like you and your siblings. Like a lot of things in life there is no one size fits all.
Life sneaks up on us. Every morning when i look in the mirror I wonder what happened to the 20 something me. Both my wife & I are collecting SS. We took in upon ourselves to see a lawyer, do a will, living will and power of attorney. The attorney provided insight into a lot that never crossed our minds. We shared all the info with our 3 sons and the two Daughter in Laws.
We know the day will come when it will be time to hand over the keys. Whether that includes additional assistance only time will tell.



My parents are in their late 70s. We all know how life goes. Has anyone come across books that are helpful in having the conversations that have to happen? I am the youngest of four brothers and we are trying to figure out how to have the hard convos.

The collective wisdom is appreciated.

[eddief]

If they are still lucid and ambulatory, why is the burden on the kids? I am not saying aging and handling it are not important, but it is a giant, wide-ranging subject.

I just finished this book: Atul Gawande - "Being Mortal."

It is an in depth overview of the medical, health care, and cultural issues around aging and what to consider when death seems to be closer to knocking at the door.

[Climb01742]

My own life taught me the importance of talking through what each parent’s wishes are regarding ‘do not resuscitate’ protocol. It’s just one detail among the many things to discuss, but it can be key. I was hundreds of miles away when my mom was in a car accident. The clarity of her wishes made the final hours and minutes less wrenching, particularly from afar where each detail was by phone, when seconds mattered. It’s not easy getting there but clarity now makes later better than it might be. Good luck.

[djg]

I'll ask my wife, who has been helping her folks with some transitions these past few years. Downsizing -- out of the family home to an apartment in a senior community (which raised the question what kind) -- some planning, streamlining of finances, etc. She's close to them, and they think the world of her (and her capabilities), so all of that helps. Still in all, some things are complicated and some things take time.

There are some standard things that trusts & estates lawyers recommend -- some for folks my age too, but additional ones for people in their '70s -- but I gather that you are asking for another kind of guidance. My wife can be pretty relentless about researching such things . . . darn near anything, really -- I'll see what she says.

[rounder]

Best wishes Flydhest, hope that all goes well.

I have no books, but my mother died about a year ago at age 93. Father died from cancer at 65.

My mother died from old age, she knew that she was losing it, but still did NYT crossword puzzles daily. She did not complain about anything, but hospice care was provided at the end.

Everyone is different, have no idea what your parents are going through. You seem pretty capable. My guess is that your parents also capable also and will do well.

Best wishes and good luck.

[flydhest]

Dad is getting more and more forgetful. It has gone beyond standard absent mindedness. Mom is feeling the strain more and more of caring for them. Dad has never been good about communication openly and the defensiveness has grown.

Mom wants a continuing care place, she is pretty eyes wide open. Dad is pretty resistant.

My brothers are in a reasonable state on this. We did a conference call tonight, but the interactions with the folks are not uniformly shared.

I used to be local. Moved away a year and a half ago. Still dealing with a bit of guilt about that.

Just hoping that some books on how to have the convo have been written and been useful to folks.

[bigbill]

My dad is 78 and in poor health. He almost died a few months ago from a leg infection. He's lucky he still has his leg. But it aged him tremendously. He is struggling with diabetes (hereditary, but I'm good) and can't climb stairs. I don't figure I'll have him around in a year. His wife is ten years younger and in better health, but they live on their social security checks in Sun City, AZ. I'm just as concerned about his wife after he dies as I am him. They have two children together but they live paycheck to paycheck as well. It will all be on my older sister and I to take care of things. The only upside is that I'm <3 hours away.

[Ralph]

My suggestion.....Make sure their affairs are in order. Wills, directives, Transfer on death and Power of Attorney papers...financial and health care, where needed, know place where the important documents are kept, insurance policy beneficiaries how they want it, etc. get them prepared (bet they already are).

Make sure they are seeing a (at very least) a primary care Doctor on a regular basis.....blood work good (glucose levels?). How about Dexascan (sp).....bones fragile? Aging folks have some special health care things they need to monitor. Eyes healthy? Dental care? How about hearing? Driving skills? Personal hygiene still being attended to. Keep an eye on these things.

But.....if their health is good.....late 70's not so old especially if basic health is good. Only you know their condition. I'm 77 myself...notice my oldest son asking questions, etc.

[Louis]

But.....if their health is good.....late 70's not so old especially if basic health is good. Only you know their condition. I'm 77 myself.

Don't worry Ralph, the Forum will be there for you and Dave Thompson when you need us. (Especially since his bikes are "just my size." ;) )

[Ken Robb]

I'll be interested in seeing what comes up here - I just spent a week+ with my parents down in Haiti (early to mid-80's between them) and they're going downhill pretty quickly.

In a related matter, I just sent an e-mail to my sister asking her if she thought we should get them one of these (see image below) My mother takes quite a few pills and is always worried about whether or not she's already taken what she needs to take at any given time of the day.

Bottom line: the combination of physical and mental decline is pretty scary.

https://www.forgettingthepill.com/sc_images/products/875_large_image.jpg
Anyone taking multiple pills more than once a day NEEDS a system to keep track.

[Ralph]

Bigbill hit on something....for two folks living on SS, when one dies, a check stops. Usually the survivor gets to continue getting the larger of the two checks.....but for two people living on two checks....many times one cannot live on one SS check.
Medicare only pays about 80%, and a secondary policy is expensive for a one SS check person.

In Florida.....for folks with less than $2000 of financial assets, and less than $2000 of monthly income....can qualify for Medicaid....which can pay everything. Usually can keep a house and car. Then estate sells at death. Check out for your state. Many too proud to apply.

[parris]

I can't speak to extended care as both of my parents pretty independent until a fairly short time before they passed. I CAN speak to the importance of a will and such.

Will's and such are VERY important. Something/someone that's almost as important as the will is the executor/executrix. In our families case my dad had his will spelled out pretty well except for small household items. His executor one of my uncles "thought" he was doing well but due to issues screwed parts of the proceeding up badly. His failure was compounded by other aunts and uncles that felt they had to protect one of my sisters from herself.

One of the things that a good friend told me the last few months that my dad was alive was "Parris don't be surprised by what you see once your dad passes away. You'll be blown out of the water by the vultures that come out in your family".

If your mom and dad aren't thrilled with downsizing and getting rid of their small household items if they offer them to you and your siblings it may be good to accept them. Even if you have to store them because often times it's that small stuff that carries meaning to the person that's giving it away. Good luck with things.

[wasfast]

I agree STRONGLY about having a Will, Power of Attorney and Health Care directive in place. If their situation is relatively straightforward, you don't even need a lawyer. There are free online options, this is one:

https://www.doyourownwill.com/

The POA and HCD are really important with potential health issues if they get serious.

My Mom had lots of health issues the last 6 years and finally passed in July this year. I know I struggled with decisions at every juncture about what steps to take for her care. The challenge is you only do it once and thus have no prior experience. All that to say that it's not easy but you can do it.

[gasman]

Great advice here. My Dad died 26 years ago and my Mom died last year. Because they had all their affairs in in order the transition was made much easier for both my sister and my self. My wife had a completely different experience with her parents. It's really a different conversation for every family depending on the personalities and relationships.
It sounds like you are keeping the lines of communication open it will go much better and there will need to be many more conversations. The hardest one for my Mom was to stop driving, but when my sister and I said it was time she accepted it after about a week.

Best of luck. Don't feel guilty because you moved away. I lived across the country from my Mom though my sister was only 1/2 hour away. We both supported out Mom.

[cmg]

"Medicare only pays about 80%, and a secondary policy is expensive for a one SS check person. " medicare pays 80% from an approved rate for services. if your doctor is above that approved rate then the % that medicare pays will be less. getting a secondary policy to pay will practically take a miracle. the 2nd insur co. can't make a profit if they pay.

[Veloo]

I'm north of the border so this may not be apples to apples as far as protocol and such.

I started with a visit to the Alzheimer Society of Toronto. That was good one on one talks to understand behaviour and how to deal with it.

I was also lucky to have a friend who's wife worked in the hospital specifically on the floor that deals with mental illness so I checked my mother into that hospital when things went downhill.

Since we weren't going into a private retirement home, we got on the public waiting list for a nursing home as she got treatment in hospital. My friend's wife wlaked me through the process.

When we did get into a home a month later, one of the first things I was told was to protect myself - from my family. The guy registering us told me how family doesn't always take on this stuff very well and things can get ugly. I wasn't expecting to get that as my first bit of advice.

Since we didn't have power of attorney and she was already diagnosed with dementia and alzheimer's, my understanding is there was no way we'd get it since she was not of sound mind anymore. So I highly recommend you get it now if you haven't already to save yourself a lot of headache.

I have friends that manage to keep parents with dementia at home but I don't know how they do it, especially if they both work. I know guilt is a big part of why they can't do the nursing home thing but I've found the homes to have pretty good staff and lots of activities and programs. Much better place than the senior's apartment building she was in that was not equipped to handle anyone with mental illness.

That's what I can recall off the top of my head for now. For me my information came through direct talks with people vs books as being in a metropolitan city, there are just lots of resources for this stuff but it helps when you have someone directing you.

[el cheapo]

Been a caregiver to both my parents since 2010. A lot of great info on this thread that's right on target. One thing that hasn't been mentioned is one of the greatest resources I utilized... local government aging services. These folks were a gold mine of info. When my mom was diagnosed with ALS I knew we were going to need help. County Aging Agency pointed us in the right direction with attorneys (financial trust and capital preservation) and helped with Medicaid spend down rules and application. Forgot to mention that my mom was 77 and my dad was 86 when this happened. I was correct in protecting my father financially because my mom ended up in a nursing home after a year. Spent $70,000 before Medicaid kicked in. They didn't have long term care insurance. Mom died after a year. Five years later my dad is almost 94 and still lives on his own with daily help from me. I live a mile down the road. He doesn't drive so I take him everywhere he needs to go. Last year we had 57 medical appointments. I pretty much plan my day around his needs. I'm still able to get out and ride but have cut the mileage down considerably. I'm always on call for his unexpected needs so I can't be physically wiped out. One sad note to all this is the non participation of my brother. He does live in another state but has all kinds of time off (retired) and plenty of money. He comes once a year for less than a week on vacation. Not once in eight years has he offered to give me a break. I haven't had a vacation since this all started. We use to be close but no longer. He doesn't know this but I dropped his family from my will. I'm single and he would have gotten everything. You learn a lot about your family when the chips are down. I knew he wasn't going to be any help when my mom was diagnosed and it took him almost four months to get here. When he arrived he stayed for a few hours and left with his wife to go sightseeing in another part of the state. My mom was in a wheelchair and unable to walk or speak. He returned for another two days and left for good.

[54ny77]

If you've never had a conversation with parents and/or siblings about life stuff, I would suggest compartmentalized conversations. One specific topic only at a time, at each setting. Then shut if off, forced stop. Give yourselves an hour or two hours, tops. Then stop.

Do this several times over the course of a few months.

It will help isolate the wild tangents. 'Cause there will be plenty of those later on....

Good luck to you and hope you have terrific & memorable remaining years with your aged loved ones. :)

[Peter P.]

I don't know about printed material, but most towns have a senior center, and the town government can usually refer you to a local Council on Aging, either of which should be able to steer you in the right direction. Call your local town hall.

Same goes for a lawyer who specializes in "elder law". I'm sure they'd give you free literature or steer you in the right direction.

That was my experience.

[biker72]

I'm 80 and most people I know that are my age don't want to have the "talk". Maybe tomorrow....maybe next week.

I've brought this up with my kids and have everything pretty well set up.
My wife bugged me for years to get a will so I finally did. Of course she never got one and when she passed 3 years ago it was somewhat of a mess. Everything got worked out eventually.

[NewDFWrider]

There were a lot of good ideas posted. I don't have any suggestions about books, per OP's request. However, being that both of my parents have passed away, my grandmother passed away at home in front of me, and my wife's grandmother recently passed away, I can offer you some advice based on personal experience.

1. Make sure that your parents have a health care directive / power of attorney. They are two different things. The health care directive lays out what your parent wants to do at end of life if she or he isn't capable of making decisions. Health care directives vary by state, so although you don't need a lawyer, you do need to do some careful research. The power of attorney lets someone else handle financial and other affairs. As a lead-up to both discussions, you and your brothers should try to get some agreement on what everyone thinks the right answer should be (and who should get to make the final decisions). Then you guys should go to your parents and explain to them that you want to understand and respect their wishes. Sometimes, this is a difficult, or impossible, conversation to have in a direct manner--so you could approach it as--I'm really worried about what happened to Uncle Charlie, or my friend's dad, etc.

2. Make sure that you or your siblings fully understand your parent's medical history and have a list of all medications (and dosages) that they take, particularly if your parents aren't good with English and live in the US. It will make emergency room visits and doctor visits A LOT easier.

3. As mentioned earlier, a will isn't necessarily important--it just depends on what assets your parents hold and whether they want it divided in a particular way. In most states if one parent dies without a will, the spouse gets everything. If both parents die without a will, then the children get everything. A corollary to wills are trusts and probate: for most people, trusts are a waste of attorney fees and accountant fees, and probate isn't a big deal unless someone needs money fast. The easiest way to avoid probate and wills is just to set up pay-on-death beneficiaries with respect to bank accounts and brokerage accounts.

4. Some people are into this--it might be worth talking about what they want for a funeral. Funeral expenses can get really expensive because everyone is emotional (sorry, lots of value judgments embedded here)--but if your parents don't care, then it can be done in an inexpensive, but respectful manner.

5. Even if you don't want to talk about downsizing their house, or moving to assisted living, or moving in with the kids, it is worth taking a hard look at your parents' house and figuring out where accidents might happen. And then talking to your parents about how to senior-proof their living area. Is there something in the bathtub or shower for them to hold on to? Are there stairs they need to go up and down every day (and is there a way to live on just one floor)? Can they get in and out of the house easily, or must they negotiate stairs? Is there a list of emergency contact information in a very obvious location? (And sorry to be ghoulish, but does everyone know where the health care directive is?)

Good luck.

[paredown]

The best thing we did was get my MIL set up with a good financial planner shortly after my FIL passed away. He had looked after everything, so this took the burden off us for the short term.

From their advice we took steps to set up a living trust, got my wife listed as executor, POC for heatlh care issues and all that stuff.

More recently we were able to convince her to hire professional downsizers which takes the acrimony out of the situation, so we are not accused of wanting to get rid of her stuff.:mad:

Next round (which is coming soon) will be to address her living situation. She has coped and been pretty self-sufficient, but several changes--the illness of the one friend who reliably checked in with her, the institutionalization of her gentleman friend (so they no longer go out together) and the difficulty in dealing with just the day to day of house upkeep, cleaning etc have all combined to leave her in a situation where she is no longer coping.

I consider the conversation with my siblings about what to do about my mother a total failure--one sibling has taken over, and no one is allowed to have an opinion, no one else does anything (in his view) and we have been unable to take any steps to keep her safe and comfortable. So no advice there--but as has been said--be prepared for a lot of weirdness.

As has been said, the local Office of Aging (or whatever) is a great resource. We were able to get her access to County transportation to and from doctors at low (or no) cost for my MIL by signing her up.

[josephr]

Dad is getting more and more forgetful. It has gone beyond standard absent mindedness. Mom is feeling the strain more and more of caring for them. Dad has never been good about communication openly and the defensiveness has grown.

Mom wants a continuing care place, she is pretty eyes wide open. Dad is pretty resistant.

My brothers are in a reasonable state on this. We did a conference call tonight, but the interactions with the folks are not uniformly shared.

I used to be local. Moved away a year and a half ago. Still dealing with a bit of guilt about that.

Just hoping that some books on how to have the convo have been written and been useful to folks.


I work in a geriatric-psych unit of a hospital--- dementia, alzheimer's,and other age-related mental diseases are no joke...they can get worse, much worse...and the nicest, most gentlest people can become quite aggressive and physical. Early diagnosis can be time consuming too as physicians generally want to rule out all medical causes before and/or all of the symptoms are too obvious to dismiss. That being said, its a hell of a lot easier to obtain PoA now, while they're still within their mind, than later when you have file a court petition to acknowledge their diminished capacities.

There's no 'easy' way to have the conversation either...but you have to have it. I'm the youngest and my parents are/were very patriarchal and my 1st born oldest brother has been very reluctant to participate in this assigned role. Getting my dad to stop driving was the worst 6-8 months of my dad's decline. His eyesight was failing, his legs were swollen that he could hardly walk and a myriad of other health issues. Of course, my mom certainly wasn't dealing with the realities very well which complicated things and it took the doctor to say 'hell no he shouldn't be driving' before we could get him off the road.

Start now. Don't wait. Be persistent and work with your brothers and sisters....as the youngest, I've learned that sometimes its not what's being said, but who is saying it.

Edit: 54ny77 makes some great points about these conversations taking a long period of time...there's lots of emotional and cognitive processing going on...you can read books all day long, but going thru this isn't easy as you make the actual decisions to get to where you need to be.

[Seramount]

luckily, my parents had the foresight to have wills, POA, DNR directives etc in place long before they were in poor health.

they lived on their own until their early 90s, but once my mom had a serious fall and broke her shoulder, her condition plummeted dramatically. she never returned to their home...two weeks in hospital, a few more in a nursing facility, and then she passed.

immediately afterwards, my dad then went from fairly healthy to wheelchair-bound in two months and had to be placed in a nursing home where he lived for three years.

as the only relative that was interested in being involved with their care situation, the amount of effort required was staggering. was the most difficult challenge of my life.

not sure you could ever get the information needed to handle these things from a book.

[yngpunk]

You should also check with your state to see if they have a standardized form that you can "fill in the blanks" with your desires and get it notarized. Some states will even let you "register/file" the document with them and then it becomes accessible to health care practitioners to whom you give the record locator #

[buddybikes]

One more thing not mentioned - how well do your siblings get along? Where are they located? How will assets be split up? This of course will go into their will. In my case, I have bit of resentment with my brother and perhaps my father as they had 2 pieces of property, one cabin on a pond and another 10 acres in the country. They were both given to my brother as the oldest, with their thinking it wouldn't matter who got it as we would all use. I haven't been out to the lakehouse since, and his kids basically own it.

Wife and I said screw it, and bought house on the ocean which is better anyway, and small so we are already downsizing significantly (age 63/61).

[johnmdesigner]

All advice here is excellent.
The most important thing to do is sit down with your sibilings and determine who is going to be responsible for what.
If you are all in agreement it will go a long way when you have discussions with your parents.
Dissent among children is always a monkey wrench in the works.

[djg]

I asked -- my wife did copious research but blanked on the sort of thing that you are looking for. Her folks are in Nashville, but she did look into some DC-area places and has friends who've done the same. You can contact me off-line, of course, if you want any of her observations, but I gather that this isn't the main sort of advice you are seeking.

One thing that helped with her dad, who is compos mentis but has complex health problems, including physical limitations, and who was somewhat (at least) resistant, initially, to the move, was an idea that occurred to him first -- Susan and others helped reinforce it. That is, that he was doing it for his wife. She was, generally speaking, much more able, but she has vision problems, including poor nighttime vision, and he/they/everyone worried that she'd lose her ability to drive at some point. Better to transition before it's really necessary -- before a hasty grab for what happens to be available at a particular time. You have many more choices over time than you do when there's a health crisis or breakdown. Basically, considerations that were real but not-so-pressing for my mother in law provided a good emotional hook for my father in law. I don't know if that's an angle that can be used in your case or not.

These things are hard, and every family has its wrinkles. Some of the conversations take some time, and revisiting, and maybe some of them have to be in-person. My own parents are gone, I'm sorry to say, and never spent extended time in a seniors or assisted living facility. Difficulties helping them were ameliorated by the fact that they trusted me and my brother, and the fact that my brother and I were close and trusted each other. Relatively few people, all in the same metro area, and siblings working more or less as partners, makes hard things less hard, but it doesn't make them easy.

As a practical matter, do you (and/or one or more siblings) have access to your dad's doctor(s)? Consenting to the sharing of information can be a much easier step than handing over the reigns, and it can give you important information (and, depending on the doc, a useful sounding board).

Folks have said sensible things about, e.g., health care power of attorney, durable power of attorney, a will, etc. There are basic packages that lawyers offer, and customize. One thing being an executor helped me do was realize what I should have known for years. That is, that I needed such things for myself, as an adult with a family, including kids. Lots of people with resources and dependents put this off as something for old age (or at least not now, and then later), even if they know full well that stuff happens. Documents can be revisited and amended as people and circumstances change, but starting with something is not -- at least not in my view -- something that should wait for AARP eligibility.

I'm rambling, and not really to the point of your question. You've gotten some good advice, and probably have better people to talk to, but feel free to get in touch if you want.

[TBLS]

Great advice. My parents were very organized and I took steps while my mom was in good shape (has dementia now) to share the power of attorney form with critical resources - social security, pension, VA, health insurance companies so I can easily access her information Time consuming but easy while she could id herself and answer questions, impossible and more complex now.

Never easy but things happen quickly so need to be prepared