Aging Parents and Planning for the Tough Decisions Ahead

Aging Parents and Planning for the Tough Decisions Ahead

Inevitably, the call comes when you least expect it. All of a sudden your mother is becoming a burden to the neighbors. They’ve endured a lot and they’re at their limit and they blame you for not being there. They can no longer deal with the constant calls, the running of errands to the pharmacy and the supermarket. At some point, they discover your mom sleeping in her bedroom in 100-degree temperatures without the air conditioning on. She hasn’t eaten for days, taken her medication or bathed. She said to the neighbor that she wanted to “disappear” and “had no reason to live.” The mental and physical deterioration of a parent is hard to deal with but imagine having to do it from thousands of miles away because taking off work and paying for an expensive airfare was not an option due to loss of work and tight budgets. So, the question is: how do you deal with placing your mom or dad in a facility appropriate to their needs and budget? We talked to A Place for Mom to get some professional answers.

Kelly from a Place For Mom
Kelly from a Place For Mom

What are the signs that your parent can no longer take care of themselves?

Primarily you want to look for signs that may indicate their overall health, wellbeing and safety are at risk. The holidays are a great time to take stock of how things are going for mom/dad.

Things to keep an eye on include:

  • Physical weight loss/gain
  • Changes in their daily routines and/or habits – are they no longer meeting friends, going to religious services, skipping the daily walk, sleeping more often, etc,
  • Check prescription bottles -- when was the last prescription filled and how much is left. Does it appear they are taking the medication as directed or skipping doses?
  • Look in the fridge – is there fresh food? Are there healthy options? Are you finding food untouched that you brought over last week?
  • Look around your parent’s home - is it being taken care of as usual? Is the mail piling up? Are several day of dirty dishes in the sink? Is the trash being taken out?  Is the yard maintained? Are the newspapers being picked up?
  • Is your loved one getting lost when driving or going for a walk?
  • Are they missing appointments and forgetting small things?
  • Are bills being paid or are they double paying

Bills gone unpaid and various other items may signal a problem with your parents.
Bills gone unpaid and various other items may signal a problem with your parents.

How do you decide on independent living, assisted living or a nursing home? Please explain the differences. What's the best option if there are medical issues? There are a variety of care options available today. The “right fit” will depend on the individual, the nature and degree of their medical issue(s), and their personal preferences. Decide what your partent(s) needs are within a care type – such as assisted living - each community varies in their setting and care services.  Some can handle more acute needs than others, while some will allow you to bring in outside services to supplement the care and services provided by the community.

When exploring your options, what are the things you should look for? Especially here in the Gulf Coast with hurricanes, etc. When visiting a community you should:

  • Talk with family members and friends who are there visiting a resident.
  • Speak to the caregivers and staff. How do they engage with you – are they friendly, sincere? Do they seem happy with their work? How do they describe their typical day?
  • Ask about daily activities and special events – look for options that match your loved one’s interests. Have your loved one participate in an activity while visiting.
  • Have lunch – how is the food, how is the atmosphere in the dining room? 
  • Observe the level of cleanliness
  • Follow your nose
  • Visit the outdoor areas
  • Ask security and safety Questions
  • Ask questions about personal care/observe current residents
  • Ask about move-out criteria
  • Above all, Trust Your Instincts

If you live on the Gulf Coast, consider what the facility's protocol is for a hurricane.
If you live on the Gulf Coast, consider what the facility's protocol is for a hurricane.

Specifically for hurricanes:

  • Ask about a hurricane deposit (typically about $5K) and its associated policies
  • Ask what processes are in place for each hurricane category;  when do residents stay-in-place and when are they evacuated
  • Ensure that you give clear instructions about how you want your family member treated in an emergency – will they evacuate with others or will you pick them up
  • Ask about a communities’ communication policy for emergencies
  • Check available resources like SeniorAdvisor to see what other consumers have to say about their experience with a community

What are the financial considerations to be taken into account? What options are there? Medicare? Other options? With today's economy, children may not have the funds to pay for care...what happens then? The average cost of staying in an independent living community can be about $2,400 a month, while assisted living averages $3,700 a month. Costs can vary greatly based on location, care needs, type of room, services, etc.

People often confuse Medicare and Medicaid.

  • Medicare is a federal insurance program for hospital and medical needs for individuals over 65 years of age. It does not cover Long Term Care.
  • Medicaid is a federally-funded, state-run health program that provides medical assistance for eligible individuals and families (including parents, children, seniors, and people with disabilities) with low incomes and resources. It pays for your health care costs, including doctor's visits and eye care, and in some cases dental care.

Educate yourself on what Medicare and Medicaid are before making a decision.
Educate yourself on what Medicare and Medicaid are before making a decision.

Medicaid will cover long term care, but it is only available if the senior has depleted all of their assets. Often we find people have not saved adequately for their aging needs.Other options to consider financially:

  • Veterans Benefits
  • Long-Term Care Insurance
  • Life Insurance
  • Investments (401k, real estate, stocks/bonds, pensions, etc.)
  • Reverse Mortgage
  • Low-income housing

Most likely your parent doesn't want to leave their home...how do you convince them that it's the best option for them? Start having the conversation early so you understand what your parent envisions when they can no longer live alone. This will help frame later talks and involve them in future decisions when the time has come to make a change. Waiting until a crisis makes it all that more difficult. Keep in mind that it may not be just one conversation and will likely be several discussions over a span of time. Focus the conversation on you. Let family members know you are worried and are concerned for their well-being.

Be sensitive to the fact that you’re talking about your parent losing their independence as they know it today. Find ways to highlight the ways they will gain independence back by moving to a community where their needs are met. If they have friends living in senior communities, take them there to visit for lunch, during an activity, etc., and enlist the help of people your mom/dad trusts or listens to, such as doctor, clergyman, friends, or your siblings.If a change needs to happen quickly, it may help make the decision easier and less overwhelming if you visit different communities on your own first, and then pick your top two for your parent to visit.

Communication is key when encouraging your parent to leave their home and live in a facility
Communication is key when encouraging your parent to leave their home and live in a facility

If you're the person slated to make this decision for your parent, how do you deal with it from miles away? Nationwide services like APFM can help you understand the wide variety of care and living options and discuss what might be a good match for your loved one based on your specific situation and budget.Be sure to everage online resources – many communities have virtual tours and floor plans. Sites like SeniorAdvisor.com provide ratings and insight on other people’s experience with a senior care provider. You can call a community directly to ask questions and request more information and don’t be afraid to ask for help, especially from friends, family or other members of the neighborhood community that can help with the process?

If they haven't specified you as having power of attorney (as it still may be their partner who has died), how do you go about it? What are the responsibilities? In most states you can get a POA form from a lawyer, a doctor and a financial advisor, among other resources. As long as a loved one knows they are signing, they can sign and you can get it notarized. If they have advanced Alzheimer’s, you’ll likely need to get a conservatorship, which can be pricey and lengthy. Keep in mind there are two types of power of attorney -- conventional power of attorney and durable power of attorney. A conventional power of attorney is set up for a specific period or until a task is completed. A durable power of attorney stays in effect until you cancel it, you are unable to make decisions or you die.

When Alzheimer's or dementia sets in, special facilities are needed.
When Alzheimer's or dementia sets in, special facilities are needed.

What does the son/daughter do if their parent doesn't like where they've been placed and get belligerent? This is not an easy situation. You should assess the situation and make sure your loved one is safe and secure and consult a social worker who may help get to the root of the problem. Often our loved ones will open up to someone else and share what’s really going on.If it’s dementia-related, the change in behavior may be caused by medication, or where they are in the process of memory loss.Often communities will engage a behavioral specialist to see what’s going on and how the behavior can be addressed.

Children sometimes move their parent into their home but can't handle it. How do we get over feeling inadequate and guilty for putting our parent in a facility? For instance, some parents do not even speak to their children after they're moved into a facility...are there any key phrases or words to share with your parent in order to overcome this rift? Bringing a parent into the home is a full-time job and can negatively change the dynamic of the parental/child relationship. A transition to an assisted living community can strengthen the relationship but it can take a while.When speaking with your parent, emphasize the improvements in their quality of life. Focus on the ways they now have more independence vs. before. For example, they are able to maintain their privacy with their children as the daughter/son is no longer bathing them, getting them dressed, helping them use the bathroom, etc.  Parents want to keep the parent role.  

Engage your parent(s) in the decision-making process and it might get a little easier.
Engage your parent(s) in the decision-making process and it might get a little easier.

If a parent has Alzheimer's or is depressed and/or anxiety-ridden, what facilities are the best to consider? It really depends on the ailment, the symptoms and the individual. In general, a community that offers memory care is an option for someone with Alzheimer’s. For someone suffering from anxiety, a small residential home may be a good fit due to the smaller setting and fewer caregivers rotating in.

Other important things to know:

  • People really need to think about this sooner than later. Start educating yourself on the options and costs. Start thinking about your budget and planning financially – for your parents and for yourself.
  • Have the conversation with your loved one –ask what they envision for the time when they can no longer live by themselves. 
  • Let your parent be a part of the decision making.
  • Resist denial. Don’t overlook the small things, don’t assume “it’s just old age” and don’t ignore the big things that could be a safety risk.
  • Start engaging other family members in the conversation and communicate what you’re seeing with mom and/ordad and your concerns.
  • Don’t be afraid to ask others for help.