O.T. - Elderly parental care?

[David Kirk]

It seems I've seen some here talking about caring for their elderly parents so I hope this isn't too far off topic -

I live in Montana and my parents live in Texas. The are in their late 80's and have been living independently.

My mother is going through a serious and obvious cognitive decline and I don't know how to define it....I assume it's dementia but I don't know. My step-father had a hip replaced about 7-8 years ago and just yesterday fell and broke the 'good' hip. He has surgery later this afternoon. He walked with a walker before this and was very unsteady and I'd be surprised if he ever really walks unaided again.

I feel like this is a turning point in their care and living situation. My father will need care my mother won't be able to give even if she remembered to give it. They will need help of some sort and that's my question - how does one know the next step in this type of situation?

I feel like what I need is a professional who can assess their situation and advise the best path forward. I've found some people that claim to be in the advice business but in reality they are trying to sell their in-home health care service. This does not feel objective at all.

Has anyone here gone through this and found a way to get pro advice on what type of living arrangement should be next? Are there folks out there who's job it is to advise for a fee but not try to sell you on their other services?

Thanks so much,

dave

[ORMojo]

Working through some of this right now for my 87-year-old mom, who still lives independently and alone in the same house she has been in for about 50 years. But, together, we are researching other options for her. Fortunately, she only lives about 100 miles away from me, in the same state.

The one piece of advice I have is to start with the state/local area agency on aging (at least that is what they are called here in Oregon). Here, that resource assigns a caseworker to assess the person's current situation and needs, and advise on & even line up options, including in-home and residential center care of all types, from meal delivery, to transportation, to nursing & other assistance. As a government agency, they are not financially vested in your choices, and also have access to track records for the care providers.

I hope Texas has a similar arrangement that can be of assistance to you. If you are having trouble determining if that is available in Texas, I have a personal relationship with the Executive Director of one of the area agencies on aging here in Oregon, and perhaps she could provide a lead in Texas.

Good luck!

P.S. - Try starting here: https://txregionalcouncil.org/region...cies-on-aging/

[donevwil]

Probably of little help to you but:

With my mother her Dr was the person. My brother (in Texas) and I (local to mom) knew something was wrong, but things made more sense after a formal diagnosis (tests and scans to rule out Alzheimers, etc.). We'd let her dementia progress too far before acting, the earlier this is started the better. There are meds that can slow the progression.

My mom had voluntarily moved into an independent living facility (no care) after my dad died years earlier, but now needs care to monitor meds, go to Dr and lab visits (she also has cancer), remember to eat and drink, keep track of time, etc. Local hospital ER gave us recommendations on outside care options they've had good experience with. She now has a care giver 8 hrs a day, but probably needs closer to 12-24 ($$$) and is very resistant to a move to an assisted living facility (last year we tried, gained her approval only to have her back out the day before, we were not prepared). A couple years earlier her Dr had recommended we make the move to assisted living ASAP because making the move before it's needed is FAR easier and less stressful than after. We procrastinated and, well, lesson learned.

It's a tough process and, unfortunately, only gets tougher. Multiple incremental changes, as we did, only make it harder.

Best wishes to you and your family.

[eddief]

not there yet but i can't hide. anyway, i know you can google as well as i can. here are a couple of things i found. the second link, while not in MT or TX, sounds like a group devoted to assisting in situations like the one you are facing. also your university extension has / had a unit on the economic side of the equation. i bet someone from that program can direct you to the resources you need.

https://www.seniorhousingnet.com/adv...-help-families

https://www.longtermcarelink.net/lis...-Connor-CT.htm

http://msuextension.org/publications...MT199324HR.pdf

[Kingfisher]

Hi Dave, my sympathy goes out to you for this situation.
Mine was a little different. My wife developed early onset alzheimers 4 years ago and I made every effort to take care of her as long as I could at home.
When I could no longer provide the care she needed I contacted an Eldercare attorney in my area. It was the best decision I could have made.
They know the system in and out and guided me through the next phases of our life...which meant she went into an alzheimers unit at a nursing home.
I would imagine if you could find someone in your parents area that specializes in this they would be invaluable navigating next steps for your parents.
Feel free to contact me with any questions
Good luck
Bob

[Ralph]

Dave....Can't help with advice...but can describe what we went thru with both my mother (in NC) and my mother in law (in FL).

My mother was living in NC, and she had enough assets and income to go to a nice retirement community where she lived independently for a while, then had to move to the assisted living area when she needed help with daily activities, and then moved to the skilled care area where she lived until she died. If she had been diagnosed with dementia, she would have been moved to the memory care section. At any rate, Medicare paid none of this (and they didn't take Medicaid)...except for the 20 day benefit you get when they need some rehab for a broken bone, etc. She went thru a small fortune.

My mother in law lived independently in a small apartment until recently.....and she almost immediately went straight to skilled care at $9000 per month....went thru her savings after a while.....then qualified for Medicaid (a state and fed program), and at 93 still lives in an OK place that takes Medicaid. She seems happy.

So much depends on the kind of assets your parents have, and how much Federal and state money Texas makes available for the elderly. Some elderly have a home they can sell to help pay for some of this. Medicare does not pay for nursing home care in a facility, Medicaid does if they qualify, (or spend down and qualify), but each state is different. Dementia doesn't usually get better, so she may need to go to a facility along with your stepdad.

In Florida.....there is usually a sales staff in these nursing homes that help with getting them qualified (after all.....that's their business). And their asset level will determine what kind of place they live in.....pay their own way, or go to a place that takes Medicaid.

You have some work to do. Your parents may not be able to continue taking care of themselves. One of your options may be to move them near you....or a brother or sister. So much depends on how much Texas spends on elder care. it's a sad thing....people work all their lives, doing what they are supposed to do....living a responsible life....and so many outlive their resources. Good luck to you. If me....I would find a nice retirement community for them....and go talk to the person responsible for admissions. Medicare probably has some in home services....but sounds to me like your parents need more than that.

People who have lots of money can pay for this, people who have none can qualify for Medicaid. People in the middle are kinda screwed.....IMHO. Again....good luck.

[verbs4us]

This is always tough. My 93-year-old mom took a fall and needed 24/7 home care until she got her grouch back to take care of herself. I was complaining to a friend that we had gone through five agencies so far and none of them are acceptable. Her reaction: "Only five? you're just getting started."

The business model is designed for the business owners, not the clients (surprise!). That is, minimum-wage jobs attract minimum-wage employees and you get what you pay for. Maybe 1 is 8 aides was a caring person with any emotional intelligence or sense of enterprise. Honesty was also an issue.

We just went brute force through agency after agency until we found one that was barely acceptable, and there's where we ended up. I think it may be better if you can go outside that ecosystem and find someone who knows someone. Friends who have done that have faired better.

[gasman]

Dave -
Lots of good options listed already. You might also contact the social worker at the hospital where your father had his surgery. They can give you many different options.

One question to answer is are they going to stay in Texas ? Is there another family member that lives in the region ? They are at a point where they can’t live independently and even if you find a facility for them having a family member in the area that can check up on them, evaluate whether they are getting good care and generally keep an eye out.
It’s hard to check up on them when you’re 1,500 miles away. Would they even consider a move to Bozeman and would be okay with them nearby.

When my Mom was in the last couple years of her life I flew across the country to see her and help out. Luckily my sister lived 20 minutes from her so could see her weekly. That helped a lot.

Be sure they have a will , a durable power of attorney , etc. it makes everything much easier.

Good luck with this transition.

[572cv]

Dave, It's great that they are still together, in many ways. I have been involved in this stage of life - older parents- for a few years. I'm not a medical person, not even very social, so I'll just relate a few specific thoughts.

- My mother, now 92, fell and broke her hip last winter. Her 'statistical' prognosis was to never walk again, and to pass within six months. What made the difference was that my son was down visiting, and swung into action, monitoring what the hospital did, the surgery, the post surgery PT, and keeping everyone on the same page. He encouraged her to move through her pain, and to try, when she didn't feel like it. She's using a walker, but feels good and is enjoying the days. Conclusion: If you can find a patient advocate to be there for your stepfather after the surgery, it can make a difference.

- Your mother's cognitive decline is not necessarily Alzheimers. My mother and my wife's mother, both still with us, have on going cognitive decline, especially with numbers, but they are still themselves, they still have longer term memories. It is the short term memory that seems to deteriorate. And that reduces their ability to function independently, but not totally.

- My wife's mother moved a year ago to an independent apartment in a senior living community, an interesting one. It is called Eastview, in Middlebury, VT. Generally, its residents can stay independent until they can't be independent. Someone looks in on them every day, they have meals communally in a nice dining room, and have a community around them. Its a pretty good situation. Not all of these 'progressive care ' communities have the same model, so it is good to go there, check them out and see what you think. My dad lived to 90, and was in his home to the end. Mom is still in her home, but needs 24/7 care, so we have found some nice ladies who provide that care. We've gone through a few different folks to get the right mix, but in the end have a satisfactory situation. It took a couple of years to get to this point. My siblings and I feel very, very fortunate.

This is not any easy task, to make these judgements, but one does the best one can, knowing that they cannot. I don't think there is any right answer. Doing it from a distance is harder. If you have any family to help out, that is a big bonus. I tip my cap to everyone in this situation who steps up in any way. My best wishes to you and your family, and hope you can find a good path for your parents.

[donevwil]

Yes, thank you for the reminder gasman:

Durable power of attorney
POLST
Advanced Health Care Directive

... and so many more as moves are made.

[johnmdesigner]

I’m sorry to hear of your difficulties.
I went through this with my Mother and Father (Ohio) while I was living and working in NY. It is not an easy process.
First, make sure that everyone in the family is on board with the process and what is going to happen. If you have siblings you need to sit down and come to an agreement on who is going to do what. I was lucky in that regard being an only child. That means a legal check list of your parent’s situation and who will be their Power of Attorney and their Health Care POA. If that is to be you then you need a crash course in their finances, assets, insurance, whether they have health care POA’s etc. An Elder Care attorney can help with this if your parents haven’t already made these arrangements.
If your Father is of sound mind you need to sit down with him and discuss these things.
My Mother fell and needed rehab after her surgery. The rehab center was helpful in finding her an assisted living situation after her release.
Depending on their financial situation you may have to liquidate their assets in order to qualify for Medicaid. I had to relocate my Mother 4 times in 3 years because of her finances and availability in homes that would accept Medicaid. It was a very difficult process to do long distance. I was lucky to have a cousin in my hometown who was able to help with a lot of the day to day problems.
The law is different in every state so I can’t help you there. But understand you can’t begin to help them until you get their legal consent. Being able to make legal decisions for them is the first step.
You will find that you have to do a lot of the information gathering on your own. The biggest help was the attorney who laid out a plan of action to preserve their assets while allowing them a comfortable life.
It’s a long process. PM me if you like and I will share my experiences with you.
John

[saab2000]

Having stuff in writing is important. Others have mentioned this as well. Make sure they have their wishes in writing and verified. This includes end-of-life wishes and funeral arrangements. Not to get ahead of myself, but this is actually important.

Most important thing is the wishes of the people involved.

Hope that helps a bit.

Thankfully, my folks wrote this stuff all out long ago. It makes it easier when times get tougher.

I think many of us are facing this, so you’re not alone in this endeavor.

[Ken Robb]

I have been through this with both parents, maiden aunt, and mother-in-law plus we have watched friends from our church family deal with it too.

There has bee LOTS of good advice and I didn't even read all the responses. One thing I really recommend is to try for a place with progressive levels of care so as their a needs increase they can stay in the same facility. Sometimes one needs more care than the other and it is a blessing if they can still get together daily even if they are in different wings of the facility due to their different requirements. I agree that moving them to where you can visit frequently and monitor their care is very important for everyone's peace of mind.

[Black Dog]

Dave, it sounds like you need a solid starting point before you let the potential complexity of this situation run you over. Start with the hospital social worker as gasman suggested. They will often be able to connect you with people and agencies that can lay out the local options. Managing this from a long distance is challenging but not impossible. One step at a time. I have been where you are and less than a month ago got my father with advanced Alzheimer’s into a good nursing home a thousand miles away from me. You have a good calm and positive way about you and that will make all the difference as you move through this. Anything I can do to help, just ask.

[Peter P.]

The Bozeman Senior Center or Department on Aging can help steer you in the right direction. There's always a city agency (check your town hall) that can refer you in the right direction, even if your parents live in another state.

You'll probably need power of attorney to assist in making decisions.

Some lawyers specialize in elder care issues. Typically, an initial consultation is free and that may be all you need.

I don't know if your parents have the financial means to cover their needs. If not, consider getting a reverse mortgage on their home. A reverse mortagage is a loan based on the value of the home. The loan does not have to be repaid until they either sell the house or pass away. I highly recommend getting a reverse mortgage through FHA as it's a governmental agency and less likely to screw the homeowner. I got one for my mom and it was a godsend.