<p>somemom, on Move-in day at our daughter’s college, I had a discussion with another parent who is a financial planner, and he said the same thing about pacemakers. He deals with families who are in financial stress because a family member who had a pacemaker installed subsequently developed dementia. The pacemaker just keeps them going and going when they might have died of natural causes otherwise. </p>
<p>Is the pacemaker doctor a cardiologist? If so, he may only be seeing a heart that he can fix. Sometimes specialists miss the big picture. Fix the part, but break the person. We ran into the same thing with my dad’s urologist. </p>
<p>Las Ma, I remember you telling us about your dad’s urologist proposing some invasive procedure that, even here from my kitchen, sounded like an inappropriate use of medicine for a very sick man. I was glad that his regular doctor nixed the procedure when you brought up your issues with him.</p>
<p>At some point, these invasive procedures are doing no favors for the patient or their family.</p>
<p>yesterday, Dharma said the pacemaker was set for today. </p>
<p>I emailed the realtor the caregiver monthly cost (salary plus taxes and other things) and said, yes, I am sure you are shocked by this, but to be legal, this is what it cost, and initially this is what my mother insisted on. She will understand that saving on caregiver costs will affect a price agreement, (quicken things up) should be get to price negotiations. </p>
<p>You know so much about the details surrounding things like pacemakers. I know nothing. The MD called my cell phone and said, your mother’s heart rate is so erratic, we feel it is best to give her a pacemaker. She agrees; they asked for mine too and I said yes. Yes, the surgeon is a cardiologist - I asked. </p>
<p>Dharma, no need to be that specific with the realtor – cost breakdowns, etc. All she needs to know is that you need to sell as quickly as possible, and you’re flexible (within reason) on price. </p>
<p>Dharma, in your dealings with realtors and doctors, I have a feeling you are giving so much information that it’s hard for them to see the forest for the trees. If I were the realtor and got some long message about monthly costs for your mother’s caregiver, I would stop reading. Realtors don’t need to know the details of your mother’s finances.</p>
<p>What is the message you want to give to your realtor? It is not “The caregiver’s FICA costs $X and blah blah blah…” It is rather, “My mother has a big burn rate in her house right now and we are strongly in favor of having a signed contract with no contingencies in the next two weeks, even if we have to lower our price to get there.” Don’t bury your lede here.</p>
<p>The RE agent isn’t a financial counselor or from a placement agency. She is trained in home sales and purchases. She doesn’t have to read, translate or advise on your financial matters. You hired her to sell fast, not to go into your spreadsheets, nor to bond in any way.</p>
<p>Why bring her into an area that is not her bailiwick? And then why provide even more, deeper detail? All these details can reduce people’s desire to interact. Or the level at which they do. You are adding to her workload, taking her away from her primary duties, distracting her.</p>
<p>“We need to close asap. What will that take?” Now, that’s her expertise. Don’t laden her down with extras.</p>
<p>Yes, try to edit. The realtor doesn’t need to know everything YOU know. Tell her only what SHE needs to know.</p>
<p>And try to edit in your own head. You have done the calculations and the breakdowns, over and over. Now it’s time to set aside the spreadsheets, and bottom-line it for yourself. Next time you’re tempted to think about or talk about details, say this to youself:</p>
<p>“Staying in the house costs more than AL costs.”</p>
<p>That’s it. Period. Finis. That’s all you need to know at this point. That’s all anyone else needs to know at this point. There is no further need to rehash details, either in your own head, or in conversation with anyone else. </p>
<p>Keep it simple.</p>
<p>“Staying in the house costs more than AL costs.”</p>
<p>Dharma- is the cost of the caregiver more or less than the fee for the ALF. My interpretation of what you have said is that it costs you more per month for in home care than for ALF. Am I understanding that correctly? If so, screw the 10 days magic thing, you will run out of money sooner rather than later with the in home care, right?
Yes, you would still pay some utilities and taxes & insurance with Mom in ALF, but the amounts would be lower with the home empty. Heck you could potentially have better showings with Mom out.</p>
<p>Yes or no, is the cost per month for the Polish woman, including taxes etc., more or less than ALF?</p>
<p>Yes NYS has stringent rules about smoke/CO detectors. Thats an easy fix. An older home will have many issues not up to code. </p>
<p>Everyone has voiced what I was thinking. Real estate agents should discuss only real estate issues. Not personal financial or medical issues. Their job is to close the deal.</p>
<p>DW- You are navigating a lot here. Keep your eye on the prize. Much of what I have to say echoes others wisdom. </p>
<p>Consider that post-hospitalization, your mother is likely to be weaker and more frail. Perhaps see if she can go straight to rehab if it is a qualifying a 3 night stay. Express concern for her safety, assess her walking and strength informally before her discharge. Talk with the discharge planner. How sweet it would be to get her right into assisted living directly from rehab. Bliss compared to working around her daily at her house to get her out the door, while she changes her mind, criticizes your packing and asks for the perfect lunch. She is going to be distressed and likely contrary with the move. Anticipate it. Steel yourself. Transitions are tough on people as a rule, and with her profile, it will be a time of escalation. Also, if any of the assisted living places have a skilled nursing rehab facility attached or affiliated, and she is moving within a facility, that could ease the logistics and maybe even help with securing both beds. Such a planned transition might also allow you to dismiss the caretaker knowing for sure that she is not going home again. </p>
<p>I agree with others to focus on getting her situated in the appropriate level of care ASAP. If there is money to cover a gap in January, use it NOW if need be. January is a “lifetime” for someone in this state of health and fiscal circumstances. </p>
<p>Also agree to talk only fast sale with realtor. Keep your mother’s finances out of it. One can drown in spreadsheets and ironically, this focus can obscure your mission. Too much anticipation is too much stress all around. Be NIKE and just do it. I know it is hard and complex. But yet, there is a simplicity here that is stunning. Your mother’s health and finances make getting her out of her house to assisted living as soon as possible both in her best interest and imperative. Before you do anything, ask how it advances that one goal. You need to spare yourself excess work with no pay-off. </p>
<p>Realtors don’t need spreadsheets. You need to move ahead with getting your mother out of the house. Period. She will have you spinning in circles if she sniffs any lack of focus or momentum on your part. She may do that anyways, but try to put all the noise and extraneous analysis aside and just get her out of the house to an available bed, hopefully after rehab. Much easier to minimize her back and forth and have her go while she is basking in the attention of the rehab staff as she did last time. </p>
<p>Hang in there. Nothing about this is easy. Except putting it behind you once she is settled. </p>
<p>I am so confused. At the end of August you vowed to have her in AL by early to mid September, made visits, lined up assessment, chose favorite places, had a place to agree to have medical paper work and deposits ready for you in a week. You had already done the math showing the higher cost of the caregiver and your mother had agreed. It’s as if none of that has already happened now! If you have to pay for AL for a month or two and pay yourself back from the proceeds of the house as a worse case scenario, can you do it? When it comes time for your mother to come out of hospital this time, tell the case worker that she lives alone, that you cannot care for her in your home (no reason necessary) so she will need rehab that will get her ready for assisted living. Then you immediately reserve the AL slot. She goes from rehab to there - period. Your mother will finally know for sure what is going to happen and that is the kindest thing after all these changes and visits and spreadsheets. That same Band-Aid is still coming off slowly, slowly. </p>
<p>Agree with preironic, except for this: talk to the case manager * today *. And every day as long as she’s there.</p>
<p>Very important what preironic said: Tell them she lives alone. Tell them you cannot care for her. Do not explain, just say those words and then STOP. They are not going to cross examine you. I believe they are not allowed to send someone home if they’ve been informed that adequate care is not available. </p>
<p>She’s in the hospital 3 nights, right? I think that alone qualifies her for skilled nursing.</p>
<p>Somemom, yes, the caregiver is costing more than an AL. The caregiver costs $6,200 in salary a month; added costs bring the expenses associated with her employment to somewhere under or near $6,500. The AL my mother likes is $5,450 (something like that) a month. Remember, my mother insisted on a caregiver (and a reverse mortgage) and I was cowed into submission. Without CC guidance, I would never have gained ground on my own with my own limitations. </p>
<p>Preironic, I can well understand the confusion - pardon me for causing frustration. What happened was that, as I’ve written before, after I posted what you refer to right above, the realtor told me not to make the AL commitment until 10 days before the closing. I got really scared that we would put my mother in AL, fire the caregiver, the house didn’t sell, and we ran out of money and had no where to put my mother. So we took out the home equity loan to give her extra months with the caregiver if it took time to sell the house. Not a brilliant plan, I know. I admit humbly, from this forum I am constantly discovering and groaning over my own ineptness and limitations.</p>
<p>Certainly it is right to keep the focus with the realtor ONLY on real estate. But just let me say, the realtor opened her email to me this morning asking about my mother, wanting to know how she is and what her plans were.The realtor herself opened the discussion. She brought a birthday card to her house last Tues. What I wrote about my mother’s expenses was extraneous; I see it was needless and pointless and leading away from the pressing matter at hand but it was only three words! </p>
<p>Now its time for the good news. The realtor called to say, out of the blue, the bidder raised his bid $10,000. He doesn’t know it, but he raised it to the price my mother will accept. So it appears we have a deal. Frustratingly we are waiting for him to say YES that we will have our oil company do the test and we will pay for it and we are asking them to pay to inspect the septic. </p>
<p>Things have changed on the medical front. This am I got a call from the cardiologist saying they are worried that two medications my mother takes will interfere with the effective installment or workings of the pacemaker, and they want her to go home for a week, go off these two meds, and come back and have the pacemaker installed in an “outpatient clinic.” I had a guest in the house and after I put down the phone I started to worry that my mother would become unwell at home alone with Barbara, imagined the ambulance again, and wishes I had asked or could call back to ask if she would be safer , as I believed in rehab. But I got caught up with my friend and did not handle this well.</p>
<p>At 4:55 my husband showed me that a woman from the discharge office called. This may be about just what I was thinking - that they want to send her to a NS for safe observation. </p>
<p>So if my mother is not coming home to Barbara tomorrow and going to a NH, I am faced with the second-most difficult situation of this stretch of events. (The first was my speech to my mother that I would put her under the Protective Care of the Office of the Elderly of NYState and abandon her if she did not agree to go to AL). </p>
<p>Difficult but necessary to face: If they want to send my mother to rehab, or indeed keep her in the hospital, I think the best all around choices would be (1) send the caregiver home for good with a bonus and close out the zillion files I had to open to be an Employer (2)keep her in NH as long as possible until I found an AL (3) move her directly to an AL. </p>
<p>I went online this morning and learned that in my county there are 10 Assisted Living facilities (none at the five star level, but there are TEN.) I asked at two of the five stars today what it took to get on the waiting list (a check they do not cash.) The third good place I will call tomorrow am; they had open rooms last time I checked.</p>
<p>CF: “” If I were the realtor and got some long message about monthly costs for your mother’s caregiver, I would stop reading." CF, I love you and love getting your posts but you greatly exaggerated here. It was Far from being “some long message” (although I understand how/why you might get that idea.) Truly, I think it was three words. </p>
<p>And after we talk business, the realtor doesn’t briskly hang up; she asks about my mother. I keep details to the BARE MINIMUM. I have learned.</p>
<p>LasMa: "Agree with preironic, except for this: talk to the case manager today . And every day as long as she’s there.</p>
<p>Very important what preironic said: Tell them she lives alone. Tell them you cannot care for her. Do not explain, just say those words and then STOP. They are not going to cross examine you. I believe they are not allowed to send someone home if they’ve been informed that adequate care is not available.</p>
<p>She’s in the hospital 3 nights, right? I think that alone qualifies her for skilled nursing.</p>
<p>I can’t talk to the case manager today because the office closed at 5 pm EST and I called at 4:55. I think she’s been there Four nights. I think poor Barbara who worked so hard to please my mother might be going home tomorrow afternoon. For me, this is a frightening future to unfold. As a teacher and fundraiser, I have been somewhat shielded from life’s tough scenarios. </p>
<p>How much of a bonus do you think I should give Barbara? I was thinking $100?</p>
<p>Having a pacemaker installed in a person of your mother’s age and frail health in an outpatient facility is insanity. These surgeons may be glad to send a very sick patient home so that you can take care of them, but it’s ridiculous. Do not agree to this stupidity. </p>
<p>I speak, in this case, from sad experience. My dad was sent home from a surgery, still very ill, and my mom and I were at home taking care of him. He was very sick, and didn’t seem to be getting better. Although we did everything we knew to do, and followed all the instructions, we didn’t realize until too late that he had had a heart attack while recovering. I still can’t forget this-- I know that if he had had better care from me, his remaining years would have been better. Hospitals and doctors are putting too much responsibility on people who are not qualified to bear it.</p>
<p>Dharma, I’m so glad that you have decided the caregiver experiment is over. You can give the caregiver a nice bonus tomorrow, and send her on her way. That way you won’t have any temptation to let your mother return to her house. And of course, it is simply impossible that she go to your house, that is out of the question, so she will have to remain in the skilled nursing until she moves to AL. </p>
<p>Uh, before the cardiologist takes your mom off two meds – are they meds she needs to be taking? Is the primary doctor OK with that?</p>
<p>Agree with Fang about the nuttiness of outpatient surgery for your mom. My dad was re-admitted to the hospital – THREE separate times – because doctors wanted to hustle him out and didn’t take into account his age and poor health. They’re under pressure to reduce hospital bed-days and too often err on the side of booting the patient out before they’re ready. As Fang says, that puts the burden for medical care on non-medical people. This may be minor surgery for a 60-year-old. But NO surgery is minor for someone like your mom.</p>
<p>Was your mom having symptoms related to her heart? Or was it just something that the cardiologist picked up on during an exam? </p>
<p>Fang. It was not your responsibility to provide better – i.e., medical – care for your dad, which was what he needed… You’re not an MD, and you had to rely on MDs who told you it was OK for him to be home. Your dad was served poorly by his doctors, and that is a tragedy. But he was not served poorly by his daughter. </p>
<p>Ok, so, It costs more in home than ALF
You did a HELOC (on HER home I hope) and have not accessed it
I have no comprehension of paying more for home care than ALF and waiting for some magical 10 day perfect time to move
I say move her to ALF this week or next, you have the medical review so pick one and do it.</p>
<p>I know how easy & simple it is for me to say this, not having to face your mother & her attitude as well as her hostility. My in laws are horrible to deal with on all this, older than your Mom, they are still in their home and things are okay, but not super. We have no power whatsoever to influence what happens, though in fairness, they are making all their own arrangements and are not asking our help.</p>