Anyone dealing with an aging parent?

shoboemom · July 22, 2012, 10:11am

I have been spending the last few days looking at assisted living and nursing home options for my mother. She lives at home now, with my aunt, but it isn’t the best situation for either of them…so we’re trying to decide what IS the best situation.

She has physical and vision limitations that make simple things a challenge, so she isn’t really able to get out and do things, even with assistance it can be difficult.

So we are thinking and rethinking about what to do…Grappling with decision making…Do we move her in to Assisted living…which will give her some social interaction, help with daily needs and assure her of a spot in a nursing home should she need it-but worry that she might run out of funds for it? Do we try to modify our home to bring her here, with perhaps some in home nursing care, which would be less expensive, but require big changes, and still wouldn’t give her the social interaction she needs? Do we buy a different house that might be better set up for all of us?

I don’t expect anyone here to know what we should do in our situation, but I would like to hear how you have dealt with similar situations, perhaps what your experience with the assisted living/nursing home system has been, especially as it pertains to finances.

thumper1 · July 22, 2012, 10:30am

Check the Parents Cafe…I think there are a couple of threads there that address this.

Lergnom · July 22, 2012, 10:51am

My mother lives at home with full time care. Both physical disability and increasing dementia. It’s expensive but she’s happy, considering her main interest is watching Nickelodeon.

My advice is that if your mother is or was social, then assisted living is better. My mother was a loner so interaction with care givers suits her. We wanted her to go into assisted living when she was capable of that but she fought.

There are elder care social workers. There are a number of private companies that consult as well as care workers associated with hospitals. Look into those. You’ll get a better handle on what can be done. I consulted with a private one and it helped - though my mother hated her. It wasn’t expensive. My sister-in-law works in this field so I’ve heard about the challenges many families face.

BTW, this is not an “anyone dealing with” but “everyone is dealing with” issue. Ask around. You’ll find nearly everyone has this going on. As my sister-in-law says, people should understand this is extremely common and that resources are available. She sees way, way too many families struggling through this without advice.

DrGoogle · July 22, 2012, 11:54am

I think it depends on the parents, I wouldn’t assume all aging parents should be in nursing home. Some people are ok with nursing and some are deadset against it.

GladGradDad · July 22, 2012, 12:08pm

^^ ‘Assisted living’ is not a ‘nursing home’ - aka ‘Skilled Nursing’. They’re quite different.

The assisted living facilities I’ve seen are pretty much apartments for seniors that also offer some assistance such as having an on-site dining room so the resident doesn’t need to make meals although a number of them have kitchens in the apartments as well. They usually have call buttons in the event of an issue and they do have assistance services if needed to transport the person in a wheelchair if they can’t do so on their own and can help with medication dispensing, dressing, showering, eating if needed. The facility is staffed with caregivers with perhaps an RN on staff. There are generally activities for the residents including working out, playing cards, doing excursions, and other interactions with the various residents. People are in an ALF because they need assistance and usually don’t have a medical issue that needs attention.

A skilled nursing facility has more of the feel of a hospital with patients in hospital type rooms and the patients need a much higher level of care. The skilled nursing is staffed with caregivers but also a fair number of nurses and has a doctor overseeing each patient. People are in a SNF because they have a medical issue that needs attention - i.e. healing.

An assisted living facility is usually much less expensive than a skilled nursing facility.

I’ve been pretty impressed with some of the assisted living facilities I’ve seen. It can be the right decision for the resident because they can interact socially with more people, don’t need to be dependent on the family, and don’t need to impose on the family. It’s the more independent option for a person to take since they’re basically in charge.

emeraldkity4 · July 22, 2012, 12:16pm

My mother sold her large house in the suburbs, well before she needed assisted care because she grew tired of hiring people to work in the yard twice a month. (my father had died decades before)

Ironically, when she bought her much smaller condo which was centrally located in a larger suburb, , she found herself paying landscapers fees anyway as well as constant upkeep fees, like changing the carpet in the communal area every few years and absorbing construction defects that weren’t found when the builder was still liable. ( she took my BILs advice to move in to a brand new building rather than my suggestion to use an established builder)

She had a housekeeper and was able to have groceries delivered, but she was on several medications that affected her memory and balance and she had several falls during the night. She also had difficulty keeping track of her medications. I wanted to convert our detached garage into a mil apt, ( which I still want to do), but I couldn’t convince H - he wouldn’t give up his man cave even though he has half the basement as a workshop.

She moved to an assisted living complex which was very nice, with gorgeous grounds and it was fairly close to my sister( as was her condo). It was a large studio room and I think she could have lived there happily for years, unfortunately my brother and his wife separated after he was laid off and he moved in with her,( despite loud and frequent protests from my sister and I) she died six months later after a series of incidents.

My mobility has been severely impacted by osteoarthritis already in my early 50’s, but as H & I live in a very walkable neighborhood with good access to whatever we need, we are looking at what we can do to improve our ability to stay in our “starter” house. ( joke- because of investing in private schools, tutors & other expenses, we never did “move up”)

Recent research has found that the varied diet we can get in our homes contributes greatly to better health over the institutional diet in * institutions*.
[Thriving</a> Gut Bacteria Linked To Good Health - NCPR News from NPR](<a href=“Thriving Gut Bacteria Linked To Good Health | NCPR News”>Thriving Gut Bacteria Linked To Good Health | NCPR News)

But if mom living with her sister isn’t working, assisted living where she could get prepared meals along with keeping a small kitchen,sounds like a good compromise towards staying at home. The one my mom was living in, had a nice feel to it, with planned activities and events that didn’t feel perfunctory, and a van to take people shopping, to the Dr. Etc.

In relation to finances, my mom funded herself from the sale of her house, investments etc. Our investments haven’t done nearly so well & long term care is expensive which is why we are looking at redoing our current home.

I also found this to be very interesting, mainly because of pain, I am a very bad sleeper.
[Study:</a> Interrupted Sleep Predicts Nursing Home Placement - Lindsay Abrams - The Atlantic](<a href=“Study: Interrupted Sleep Predicts Nursing Home Placement - The Atlantic”>Study: Interrupted Sleep Predicts Nursing Home Placement - The Atlantic)

My husbands parents still are living in their home, and unfortunately although his parents have always treated me badly, we are the closest geographically to them. But I seriously hope that if they need more care, they move closer to one of their daughters, because I think being dependent on me, would make my MIL even witchier than usual.

MomofWildChild · July 22, 2012, 12:16pm

I am dealing with 3 aging parents (mother, father and stepmother). Father/stepmother are currently in an independent living branch of a pretty high-end seniors community in Charlottesville. They are about at the end of the line for independent living and do have some help a few days a week. We are investigating assisted living options, but many of the assisted living places are only single rooms. We found a few in northern VA that we are considering. They both have mobility issues but are still pretty good mentally.

Mother has some dementia and is wheelchair bound and can’t transfer without help and usually we use a lift to transfer her. She lives in an addition we built (with Mom’s money) after my stepfather passed away (it was actually supposed to be for both of them) onto my sister’s family house. It is a great layout and connects through a sunroom. We have caregivers come every day but not overnight unless my sister is gone for a vacation. We pay the caregivers very well and, as a result, have been lucky to find interesting women (retired nurse, other 2nd career people) who talk to mom, take her outside, take her to the hairdressers etc. 6 months ago my sister/brother in law moved my sister’s mother in law into the downstairs part of my mother’s section and the two ladies enjoy each other. The MIL is 94 and my mother is 86, and it is all quite a handful for my sister, but it is our best option. We rotate about 5 or 6 different caregivers through the week and weekend.

Consolation · July 22, 2012, 12:57pm

My late FIL finally agreed to sell his house and move to a very nice assisted living situation (Henry Ford Village, near Detroit), but unfortunately not until his health had deteriorated to the point where he had to go into the nursing area almost immediately. (He was a victim of elder abuse by a grasping and mentally ill girlfriend who was intent upon getting him to marry her and/or leave her $$, but that’s another story.) It was unfortunate, because he would have loved the social life there had he moved in earlier and not allowed himself to be isolated from family and friends by the abuser. Other elders I have known have lived in similar assisted living situations, whether in a real apartment or a room/studio, and loved it.

My mother, on the other hand, is 89 and has continued to live alone in her house since my father’s death. H and I help her handle her affairs, and I have nieces in the vicinity who visit her once a week or more. We talk on the phone every day. She is extremely fit and active for her age, though, and very independent. She prefers to be at home, and has no need of physical assistance and no significant health issues. At least for now. (BTW, emeraldkty, she has been an insomniac for many decades. )

worknprogress2 · July 22, 2012, 1:10pm

I have had a lot of experience in this area recently.

If your mom is open to the idea of assisted living, it sounds like it would be a good idea. GladGradDad gave a great description - I would just mention that the term personal care is sometimes used, and means essentially the same as assisted living.

I think your point about priority for a skilled nursing bed if she were in assisted living is an excellent. I live in an area where there are a lot of retirement communities. What has happened, is that the ratio of independent living units to skilled beds is such that it is becoming more difficult for people who are being discharged from hospitals or who otherwise need skilled nursing to get a bed if they are NOT attached to a retirement community.

As for running out of funds, most reputable facilities will guarantee that they will keep an individual even if they deplete their assets. The facility will, however, ask for financial (&medical) disclosure prior to acceptance so if your mom is admitted, I wouldn’t worry about whether she will run out of money. I wouldn’t assume they would keep her, I would ask that question.

Here are some questions I would want to know:

If there is a skilled nursing facility on site, how often and what happens when a resident NEEDS skilled nursing and there are no beds available?
Tell me specifically how much assistance is given towards the activities of daily living. If my mom needs more assistance, but still is not appropriate for skilled nursing, is there on-site help available.

What happens when someone needs to go to an appointment - does someone accompany them? Is there an additional fee?

Does the facility have the right to determine that a resident needs a higher level of care?

May you visit the skilled nursing facility?

Just some thoughts - good luck to you!

Seahorsesrock · July 22, 2012, 1:13pm

Be prepared for a sudden change. One day they seems fine, next day they are riding the bus all over town with 8000dollars in their purse

Have all your ducks in a row and I mean all.

I am an only child and my mom lives in a studio apartment in our home. Major medical issue this week with back. She was doing rumba six months ago twice a week and walking miles a day, to see her age so much so quickly has been sad.

She still drives, but with her injury I have been driving her around.

As for care, it’s all about the money and what you can afford. And do not feel guilty for anything. Just do your best.

GladGradDad · July 22, 2012, 1:34pm

Another suggestion - choose a facility that’s very convenient to family members - you, your sibling, etc. It’s very beneficial to have family checking on them and visiting them regularly. It’s good for the resident and it’s good for the workers to know someone is checking on things all the time. A key to being able to do this practically is to choose a facility that’s near where you (or sibling) are - preferably within a few miles. This could be near your home or near your work but home would be better.

Another question to ask is whether you’re permitted to visit anytime you wish 24/7. You should be able to. You can also usually dine with them at the dining room if you want for a nominal per meal charge so you can easily have lunch there with them every now and then.

Check into the practical aspects of the on-site hairdressing facilities (something often very important for elderly ladies), transportation to doctor appointments, activities, fun excursions, sitting areas, the activity/involvement level and whether it’s a match for her (ex: daily bridge games, etc.), housekeeping, special meals, special assistance and how it’s charged (either a la carte or by bumping to a higher monthly cost level), friendliness and professionalism of the staff, etc. See if there’s any large ‘buy-in’ commitment or if it’s a month to month deal and pick whichever you think is the right fit for you.

You might want to make a list of 3-5 candidate facilities, visit them yourself first, narrow it down to 2-3, and then visit them with your mom. Visit multiple times first if desired. Try to visit around a meal time so you can see the residents in action. Try to eat a meal there. Make a careful decision.

musicamusica · July 22, 2012, 1:38pm

I was fortunate that my parents did the research years ago and decided on a CCRC:
[Caregiving</a> Resource Center: Continuing Care Retirement Communities: Wh… - AARP](<a href=“http://www.aarp.org/relationships/caregiving-resource-center/info-09-2010/ho_continuing_care_retirement_communities.html]Caregiving”>Learn About Continuing Care Retirement Communities)
Since they wanted to move closer to where my sister and my I lived, we did the facility shopping for them, narrowed the choice down to a few and then took them on a visit. Even when an individual or a couple decide on this independently it still is a rough decision. Nobody wants to be old and dependent. Luckily they had saved just for this new phase in life and they also were able to sell their house for a good price. So they are now in an independent living condo, there is also an assisted living facility on “campus” (yes they do call it that), and some wonderful features like a ladies choir, weekly classical concerts, on campus physical therapy,free limo rides to the grocery store and fantastic food.
I would recommend that you visit as many facilities as possible before taking your mom for a visit to any of them.

bamagirls · July 22, 2012, 1:45pm

We’re beginning our second, third, and fourth situation and each is different. Generally, patients must be able to “transfer” on their own at a minimum in order to qualify for assisted living. This means going from bed to chair or chair to wheelchair (if needed) without assistance. There are different levels of care up offered at different rates of pay up to that point. Assisted living costs vary, but in general are half the price of nursing home care and are self-pay. Once a person’s ability to pay is exhausted and they qualify for Medicaid, other options would need to be considered such as a nursing home. Medicaid doesn’t cover assisted living, but it does cover nursing home care. Two years ago we were paying $5,000.00 per month for a relative (using her funds) as a self pay in a nursing home in a semi-private room. This cost reflects only the cost of a semi-private room and 3 meals per day. Medication, physician’s visits, rehab, and other services are all extra. Self pay costs more per day than Medicaid pays. Regulations may vary slightly from state to state, so I’d highly recommend looking into the required documentation for qualifying for Medicaid if there is any possibility you will be responsible for caring for an aging parent or family member. It can be a very cumbersome process and it helps to have these documents where you can find them. Once a person has dementia or if they are opposed to entering an assisted living or nursing home you may find they are of little help in locating some of the required documentation. We found it helpful to locate the documents and place them into a binder all in one place. As difficult as the conversation can be, it’s a good idea to talk to aging parents about medical and financial power of attorney and to make arrangements in advance of the onset of dementia in case they are needed later…this requires trust on each side.

Family dynamics should be considered when making a decision about whether a relative may be cared for in a home setting in addition to the needs of the individual for whom care is required. Caring for an aging family member can affect the entire family…and it most likely will. It’s a huge commitment and shouldn’t be made lightly. We’ve done both, and I can tell you that it takes a commitment both ways for it to be successful. Similarly, one should perform due diligence in researching assisted living, nursing home, and hospice care for anyone for whom they are charged with making decisions.

One other piece of advise I’d like to share is to consult with a skilled lawyer with knowledge of estate law in advance of making life changing decisions or financial commitments. It can save you a tremendous amount of time and trouble later.

worknprogress2 · July 22, 2012, 2:04pm

Musica -

It doesn’t sound as though the OP is looking at this type of contract - but to anyone else whose parents are considering this - read YOUR contract carefully. What your salesperson says, or what even a disclosure statement says, may differ from the contact you sign.

My folks are at a CCRR with a “Type A” contact that they understood to mean “unlimited” care and that their fee would remain the same as they needed more care. NOT SO!

My parents were living in two bedroom/two bath independent apartment and as we pursued the possibility of a two-bedroom/one bath apartment in Terrace Crossings (an assisted living facility), we were blindsided by additional fees. The first fee was an additional monthly charge calculated by an equalized rate, a term not used in our contract and one that would not be easily recognized by a layman. The second fee was a charge imposed because my parents would require two bedrooms. These additional fees totaled more than $1500/month.

Just ask a lot of questions! :)

ellebud · July 22, 2012, 2:09pm

We are dealing with a declining mil. The night my fil died the woman from hospice gave my husband and his brother the following advice: (she is a social worker specializing in gerontology) The best solution is to remain in the home with full time care as long as possible. Assisted living, while an option after the family home, is very much a mixed bag. In Los Angeles we have small home situations with 4 or 5 guests. The other option is to have mom or pop live in a child’s home with or without help. Depending on the parent this can work out.

Mil lives with my husband’s brother and his wife. She pays them…a fair amount. In this case it seems to be working. I don’t like the situation (she stays in her room and listens to books on tape with no other stimulation) but she’s not my mother. (And since she called me a conniving k word, not for the first time I really don’t get involved.)

Bottom line: If the parent can stay in the family home, has assistance and mobility and social connections…keep them there. The cost of a gardener is nothing compared to a good assisted living community and the turmoil and upheaval of change.

worknprogress2 · July 22, 2012, 3:55pm

ellebud - that has been my approach with a couple for whom I am their “daughter” - although not by birth.

They live in a neighborhood close to their church and they have many friends nearby. With a combination of an outside handyman/gardener plus a couple of hours of in-home care per day they have managed very well. When someone asks me, “How can I help?” I reply with a simple job - take them to hairdresser or pick up their favorite chocolate milk only available at a different grocery store, or run to the liquor store once a month for their case of wine. Something simple, specific and routine. I have my DH in charge of filling pill tenders - he does two weeks worth at a time - and I handle all bills and trips to doctors. It seems to be working okay. Having help in the home is great, because it can be expanded if one of them is in the hospital and the other needs more care.

The only downside - is that I am hoping if either one needs skilled nursing we will be able to snag a bed in a great community. As I have said, many of the retirement communities that HAVE skilled nursing are closed to those not in their system or in another system where there is some reciprocity.

And to echo a point made by someone - if your mom does go to assisted living, the closer to you the better.

Planestate · July 22, 2012, 4:26pm

We recently hired a senior care manager to help with my mom. My mom lives 2-3 hours away from her 3 kids, and we can’t easily get to her to help with everything. The care manager will call her every month to evaluate how she is doing, and visit every 3 months for a more detailed interview. The biggest advantage is that the care manager has access to screened/licensed home health workers with various skill levels (from cooking to skilled nursing) so that we can gradually increase the care as needed. The initial cost is $500, plus an annual fee of $500 from which hourly expenses are subtracted if care is needed. My mom stated unequivocally that she wants to stay in her own home, so this seemed like the best option. If you google “senior care management” and the name of your mom’s city I suspect you will find some listings, it seems to be a growing field.

ellebud · July 22, 2012, 4:49pm

work: You are a good person.

worknprogress2 · July 22, 2012, 5:46pm

ellebud - not always ;)

ChuckleDoodle · July 22, 2012, 6:37pm

We finished our basement for my mom, it’s a complete mil suite made for her to include full kitchen and laundry. We have a chairlift to get her downstairs and all doorways are wheelchair accessible. Mom loves it. She recently fractured her back so we purchased a bed that can raise at the head and feet similar to a hospital bed but more comfortable for her.

It’s a sad thing to say, but I see mom getting more frail every year and she’s only 79 years old. Hubby and I have worked it out where we ‘trade’ off on taking her to appts. So far it seems to be working but we have discussed the next step getting a care giver.

Our biggest obstacle is getting mom to eat. She takes medicine that makes her think she’s not hungry and then when she goes to take her medicine, she gets nauseous due to the lack of food in her stomach. I have tried everything from ensure to making her food but to no avail. So if anyone has any ideas, please let me know.

Anyone dealing with an aging parent?

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