O.T. - Elderly parental care?

[Cantdog]

First off, this is a really tough situation that many folks find themselves in but don’t often talk about, so you aren’t alone.

I’m a palliative care physician so navigating these conversations is a big part of my work. I’ll first echo what was said above, it’s really important to have your parents name a health care proxy, begin to have some conversations about ‘what matters most’, and if there are things they don’t want done if their health worsens suddenly(not wanting CPR for instance) completing a Physician Order for Life Sustaining Treatment form or POLST form is a protection that they won’t have these things done to them.

For the next step, I’d strongly look at having your parents seen by a geriatrician instead of a regular internist. The ways that we manage medical problems when you’re 80 are often different than when you’re 50 or 60. Geriatrician would be able to help deprescribe some medications that aren’t helping(and may be causing harm), help navigate care and make recommendations for what’s next, connect your family with local resources, etc.

Are either of your parents Veterans? If so that gives a lot more options I’m happy to speak about.

If you have other questions feel free to PM me and we can talk further.

[oldpotatoe]

That's a tough one. Elderly care in the US is awful or expensive, and some of the expensive ones are awful. My mother-in-law went through this..My wife(eldest daughter) was the main care giver and the brains behind getting her into a managed care/memory care center(she had Alzheimers).

Safe to say your parents are going to need help. They cannot live independently any longer. Either live in help(BIG $) or a managed care facility(also big $)..My Mother-in-law's tab was pushing $7000 PER MONTH(yep, you read that correctly). Luckily, her financial status allowed her to apply for and receive Medicaid...so her last 2 years or so was paid for.

YES, there are counselors who can guide you througt this whole thing withut selling you something but the bottom line is
-they are going to need external care
-their financial status will determine what that care will be.

Unfortunately.

[paredown]

Sorry to read this Dave--it's joining another of those 'clubs' that no one really wants to join.

My mom just passed away this spring at 96--but because I live somewhere else my other siblings did all of the hard lifting.

A couple of small take-aways for me--the Occupational Therapists are usually pretty good at assessing whether or not someone is still able to live on their own. In Canada (where Mom was) assessment by one was required before the hospital would release her to return home, or to recommend a nursing home.

The second small thought is that often cognitive decline can be from medication (or combinations of meds)--and that can be hard to determine. It can also (especially with women) be the side effects of UT infections--we saw the second with my Mom, where we would think she was off her nutter, but it was just the infection(s) speaking.

The meds problem we saw with my MIL, who we also thought was also declining mentally--and a bout of illness and a doctor who took her off all but the bare essential meds (and then carefully checked as they were added back) made a huge diffence. Once that got sorted, she was much sharper. She will still have better and worse days, but she is functional enough that she could (with a little help) travel to visit us for Thanksgiving.

The real issue is that advocacy. finding a nursing home, helping to shepherd someone through the cycle of appointments and check ups--all take a lot of work. And being close/having them nearby is the only way that works,,,

[TBLS]

Just put my mom in memory care last month. Great commentary so far but a few items ( sorry if I missed in earlier posts)

Try to get authorized on accounts, insurance, social security, VA, etc. if parent can still confirm their identity can be handled over phone but more difficult later if have to provide POA, etc.

Make every attempt to review financial situation, bills, accounts, etc. Hopefully so surprises

Any living arrangement is a business decision. Get things in writing and if you go with external arrangements visit unscheduled. Trust your instincts and review their state registration, reports, etc. When budgeting think of other items needed such as haircuts, etc as can add up.

My mom and I are lucky as she has great insurance and while not rich has resources for a nice place.

You are not alone - I am 60 and this is a common conversation with my peers

[yngpunk]

As additional food for thought, I'd suggest reading Being Mortal by Atul Gawande

[biker72]

Being an elderly parent I actually looked into his last year. I got a case of sticker shock!!!!

I'm sure there must be less expensive options in the area but I was looking for just a place to stay...no special care...etc.

For something that would work for me and two cats;
$250k deposit and $1500 per month for the first year. One meal per day included. Got a car??? Parking is extra.
If I were to die one week after I moved in my survivors would get MOST of the $250k refunded.

Looks like I'll stay home for a while....

[David Kirk]

Thank you all so very much for your thoughts and for sharing your info and stories. It means a lot to me. I have a lot to process and lots of research to do but you all have helped give me some direction so I can get things started.

It's Thanksgiving today and one of the many things I'm thankful for even on a day where things in our family are dark is the light that this wonderful community brings to us all.

Happy Thanksgiving and cheers to you all.

dave

[steelbikerider]

Where in Texas? My brother and I just moved my parents into independent living with home health care after selling their TX Hill country ranch. You can PM me if you need TX specific info. Some of the in home care groups like Visiting Angels can take care of the grocery shopping, doctor visits and errands etc. if they want to stay in their home. Visiting Angels also gave us detailed reports about behavior and called when they had concerns which was often.

[Kirk007]

Hi Dave,

Been there twice over now, lots of good advice here. A couple that I haven't seen mentioned or that deserve emphasis. First, understand what your parents want and get that down on paper in, as others have mentiioned health directives etc. now even if they may not want to face it. Do you have siblings or other family members close to your parents? If so, the legal documents like power of attorney etc become doubly important. Getting the family on the same page can save a lot of hard feelings down the road. You don't want to be fighting over end of life decisions. They may still come up even with legal documents in place but a frank discussion about your parents' wishes and desires now with other family members rather than down the road when emotions will be running rampant may help. Finally, nothing can substitute for proximity. Again, any other siblings or family near them in Texas? If not then a move, even temporary for someone might be in order. I moved my parents from Florida to Pennsylvania so they were in same town as my sister and other relatives. We left Eugene and returned to Seattle to be with Cindy's dad. It's a lot of work and disruptive, but you do what you have to do. Best of luck, and Happy Thanksgiving to you and Karen.

[Bostic]

My mother passed about a year ago after going through the full cycle of dementia. It started a decade ago with sun-downing. I knew something was up with all the yelling in the evening and read up on the symptoms and what to expect as it progressed.

My sister and I moved her to Nevada where the cost of living and care was much cheaper than California. When my mother could no longer live on her own we moved her to an independent living community. That was difficult as nothing was ever good enough. Food, living arrangements, the other seniors. I'd call and check in each day and assure her how much she earned the right to not have to work, drive, and enjoy her golden years. Then her memory would lapse and she would get ready for 'work' in the morning and even try to leave the premises to catch an imaginary bus.

After a lot of research we found a nice home in northern Reno where we moved my mother to live with several other seniors and a couple of full time live in assistants. We really lucked out from a monthly price as the care was first rate. The cost of memory care will give anyone a shock when they see it.

She fell a few times and broke a hip and had to go through recovery and rehab. She would forget why she had to rehab and would get upset, then a half hour later would be fine and zipping around in the wheelchair. That's the part of dementia that is ready tough to cope with. I would not know what to expect every time I would drive up from the Bay Area to visit. A couple of times she did not recognize me at all.

The later stages of dementia, she could not communicate properly. Thoughts would get jumbled and long past memories would get mixed up with events that never happened.

Please get all the paperwork done well ahead of time. You want to make sure you have complete control of the finances. My sister and I took ownership of the bank accounts, closed up every credit card, made sure medical was covered, etc.

The credit cards got me beyond angry. I was patient at first but after a few different calls where they will do everything to prevent the card from being closed I said forget it to tact and discipline.

[Dekonick]

Originally Posted by Cantdog

First off, this is a really tough situation that many folks find themselves in but don’t often talk about, so you aren’t alone.

I’m a palliative care physician so navigating these conversations is a big part of my work. I’ll first echo what was said above, it’s really important to have your parents name a health care proxy, begin to have some conversations about ‘what matters most’, and if there are things they don’t want done if their health worsens suddenly(not wanting CPR for instance) completing a Physician Order for Life Sustaining Treatment form or POLST form is a protection that they won’t have these things done to them.

For the next step, I’d strongly look at having your parents seen by a geriatrician instead of a regular internist. The ways that we manage medical problems when you’re 80 are often different than when you’re 50 or 60. Geriatrician would be able to help deprescribe some medications that aren’t helping(and may be causing harm), help navigate care and make recommendations for what’s next, connect your family with local resources, etc.

Are either of your parents Veterans? If so that gives a lot more options I’m happy to speak about.

If you have other questions feel free to PM me and we can talk further.

Everything listed above. Especially the MOLST / POLST. The transition from living independently to assisted living is a big life change. Something to consider is to respect their wishes as much as possible. I see it all of the time where adult children do not respect these choices or are at odds with one anther. The time to discuss advanced directives is before you need to make the choice - when there is no pressure. An informed decision now can prevent controversy at a later date. I hope you figure out a solution that works for your family. If you would like more information from the nursing perspective, I would be glad to answer any questions you may have. After my mother passed away from Alzheimer's, I changed course and began working with geriatrics part time. For the last year and a half, I was a charge nurse in an assisted living with a high population of residents who had Alzheimers or other forms of dementia, as well as the typical loss of mobility. By far my most rewarding and enlightening job experience to date. All of the suggestions given by others are good - it just might help to talk to someone from the 'inside' who isn't trying to sell you anything and can just answer questions. Just PM if you would like to talk.

Best

D.

[Dekonick]

Originally Posted by oldpotatoe

That's a tough one. Elderly care in the US is awful or expensive, and some of the expensive ones are awful. My mother-in-law went through this..My wife(eldest daughter) was the main care giver and the brains behind getting her into a managed care/memory care center(she had Alzheimers).

Safe to say your parents are going to need help. They cannot live independently any longer. Either live in help(BIG $) or a managed care facility(also big $)..My Mother-in-law's tab was pushing $7000 PER MONTH(yep, you read that correctly). Luckily, her financial status allowed her to apply for and receive Medicaid...so her last 2 years or so was paid for.

YES, there are counselors who can guide you througt this whole thing withut selling you something but the bottom line is
-they are going to need external care
-their financial status will determine what that care will be.

Unfortunately.

7,000 a month isn't even all that expensive.

[mg2ride]

One of the early options is Non Medical Profressional Care Givers. They are effectively companions that can help with bathing, feeding and general daily tasks. Some will even help with light cleaning.

In very general terms, the people providing this service do truly care for the people they are involved with and often have years of experience. We used them while caring for my mom before she passed. Even though me and 2 sisters were local and involved with my moms care on a daily basis, these providers offered great insight and advise to us.

It is a relatively cheap option with very flexible hours. Of course this assume a certain level of health.

Along with their care, you really need to spend as much quality time with them as you can.

[MerckxMad]

Your father in law will probably be discharged from the hospital to a rehab facility. The hospital social workers will be your primary resource in this process. While your mother is not their patient, you might want to discuss her situation with the case manager since your mother will be unable to care for your father in law post-discharge and will therefore figure into the rehab recommendation. This will probably be your introduction to the world of elder care. A live in aide or assisted living facility sounds like the next logical step. Best wishes.

[Dekonick]

Originally Posted by MerckxMad

Your father in law will probably be discharged from the hospital to a rehab facility. The hospital social workers will be your primary resource in this process. While your mother is not their patient, you might want to discuss her situation with the case manager since your mother will be unable to care for your father in law post-discharge and will therefore figure into the rehab recommendation. This will probably be your introduction to the world of elder care. A live in aide or assisted living facility sounds like the next logical step. Best wishes.

If your parents do choose to remain at home, it would be prudent to have the house evaluated for safety and perhaps make some modifications. Ramps, railings, removing throw rugs, safeties on the range etc...

Find out what their local 911 EMS uses for charting and see if they have a paper copy of a 'stat pad'. I find almost no one does this and it is one of the most helpful things you can do to make a 911 call much easier for everyone. You can pre-populate the form with essential information (name, birth date, known medical conditions, known allergies to medications) and hand it to EMS when they arrive, with a POLST, (In Maryland, it is called a MOLST) along with an up to date list of medications, physicians and their contact information, and family contacts + insurance info. Kept together this makes everything smooth... and ensures wishes are respected.

best,

D.