Elder Care, You & Your Family

In the way of free advice that pops up now and then, I thought I'd share the story of a friend who has gone through a horrible experience regarding care of an elderly parent. And I think I've got a few tips even if you're young and its your parents' parents that might be an issue, since it may affect you as well (below the fold)

Now of course things could improve with a Democratic Administration and stronger majorities in Congress, but I'll just remain skeptical for now. So preparation now will save you so much headache later. My state for example used to exempt one's home for back payments of aid for nursing homes. Now no longer...they reserve the right to go back after that asset.

And it's not just prescriptions and insurance. Though plenty of seniors have been hammered by the donut in Medicare D. If you're at all using non-generics, you need to be worried about out of pocket in this gap between regular Medicare Part D and "catastrophic" coverage.

My friend's parent was healthy and independent. A medical situation that was unforeseen, of course, occurred and there was no longer any chance of living independently. Though immediate hospital care got the parent up and around, the question came up about what happened after discharge.

I won't bore you with the exact details of finding the right assisted living center based on cost, services, etc., and the issue of finding a nice one.

For-profit assisted living centers are exactly that. They're nice enough, but they can go from $1500 to $3000 for room and board and very basic services such as laundry, etc.

Anything else, such as prompting for meds, could see a rate hike. And of course once a parent is there and gets comfortable, how likely are you to want to move them?

Now if you have the bucks, I'm not necessarily bashing theseP folks. Lotsa hard working people in there. But if you come from modest means, that may not be a long term solution.

It takes a LOT of leg work. My friend found the perfect place after two years of paying a higher priced place...and that is after selling the family home and trying to save the parent's nest egg.

One can't calculate the stress suffered by my friend. I saw it, wondered myself what would happen if the nest egg ran out.

The one good thing is my friend pressured and pressured as nicely as possible the parent to make a will, Patient's Advocate, and Power of Attorney. That allowed a lot of the business to go forward. Even with this, hospitals, social workers, the legal system are going to treat you like a number. Which you are. You're either a prepared number or you are screwed.

So check with a GOOD lawyer. If you're young or your folks want to put it off, YOU go get a will for a simple couple of hundred bucks. Leave your parent something in the will, like 5% of your assets or a favorite teddy bear. At least something to get them thinking about it. They may think it's as ridiculous as them making a will, but it might get them thinking.

I don't want to scare anyone, but it needs to be talked about.

Probate Court will screw you, too, if only in the amount of delay that you have never experienced, if you have never gone through the legal system.

And a lawyer will charge you mileage and pass on the filing fees, etc.

Nursing home care space is at a premium, and I believe they have extended the period of time that Medicare will go back and look at all family assets and bank statements. Of course they do this to probably make sure no one is defrauding the government but it is another thing to be hip to.

Wills, trusts, powers of attorney....it all kinda sucks.

But ask yourself "what if?"  I hope it never happens to you, but my friend pretty much two years of life sucked out. There are complications that are unique, but there are even worse nightmare scenarios out there.

•  tips/recs/remember when a candy bar was a quarter

  by Belvedere Come Here Boy on Sat Mar 29, 2008 at 05:32:07 AM PDT

  •  Recced for ElderCare Lawyers

    Usually, you think of lawyers (rightly or wrongly) in bad terms.

    I know a few Elder Care Lawyers and they are amazing and dedicated people.

    by resa on Sat Mar 29, 2008 at 07:13:27 AM PDT

  •  Oh, and I remember

    when candy bars were 5 cents.

    Did you know that the AARP is now inviting people to join early BEFORE they turn 50? You can't imagine how shocked I was to get a letter from them. I just wasn't ready.

    by resa on Sat Mar 29, 2008 at 07:17:47 AM PDT

•  Lawyer

  I wholeheartedly agree - people over the age of 50 should go see a lawyer RIGHT NOW to preserve their rights & resources going forward.

  It is going to get worse before it gets better.

  by aimeeinkc on Sat Mar 29, 2008 at 05:43:18 AM PDT

  •  Amen, and get a GOOD one too

    My friend's first lawyer was, ahem, not as good as the 2nd one.

    Actually delayed some things going forward because the office was sloppy.

    I remember my friend's describing the look that came over the 2nd lawyer's face upon hearing about the first guy.

    Peace out.

    by Belvedere Come Here Boy on Sat Mar 29, 2008 at 05:47:12 AM PDT

  •  I recommend everyone over the

    age of 18 to prepare a living will and power of attorney.  You can generally pull a template for your state from the intertoobz.  Anyone who is married and has any property or children -- execute a will, living will and power of attorney.  Get it over with -- death, accidents and catastrophic illness is not just the purview of the elderly.

    by gchaucer2 on Sat Mar 29, 2008 at 05:55:45 AM PDT

    •  Living Wills/Advance Directive

      living will and documents for power of attorney if needed.  Plus regular wills.  Have had them since we were in our fifty's.  

      As one of five children and the only girl, I have been dealing with an elderly mother in poor health for several years.  She was in an senior citizen apartment for several years and I did the leg work and paperwork to get her some in home assistance.  That meant a Medicaid "spenddown" - and had to be figured out and filed every quarter to keep her help.

      Then a new Govenor (Blunt of MO) tried to tighten (screw) the system to get people off that had a SS check that was "too" high... and as luck would have when checking with the Division of Aging to see what would happen to mother's aide visit (3X a week) and nurse (1X a week) they suggested I apply for the blind program for her.  I did and she met the qualifications due to her bilateral macular.. and we actually ended up financiallyl ahead, as we had been paying ourselves an amount each month to make her "spenddown".  

      Last year after an admission to the hospital health deteriorated more and she went to assisted living.  She insisted on a private room and we kids paid the difference for that private room. This month she had to go to a nursing home.

      We have had a horrible time the last year with trying to keep things going.  Even though I paid the bills no one would "talk" to me because of privacy issues.  We fought with the credit card company over her bill.  She didn't want to give anyone power of attorney because she was afraid we would "put her in a nursing home".  Thank heaven she did have a living will/advance directive with a designated medical power of attorney.  

      After the uproar with the credit card, I finally convinced her to sign out a "limited" power of attorney for "financial" issues with the youngest son's name on it - since she thought she could control him better.  Thank heaven we got that, as people only ask if you have one but don't seem to really read it.  My brother has signed tons of papers in the last two months for her.  

      In our extended family in the last ten years we have had two people that were less than fourty years old who became mentally incapicitated and died.  Neither one of them had a living will regarding their wishes.  One of them was in the proces of a divorce and the "wife" was the one in charge of what to do - the parents had no say so.  In both cases the decision was made to "pull the plug" - but it was not easy.  And if they had been in a Catholic hospital it could have been much more difficult than it was.  

      Everyone should have a living will, no matter what their age.  My son is NOT listed on ours since he is a staunch right to lifer.  When my daughter converted to Catholicism, I asked her if she would have any problem with the pull the plug issue (she didn't) and I trust her to follow my wishes.  

      Living wills do not cost anything to do.  They very by state, some require notary and others only two witnesses.  You can get a copy of the one for your state from your local hospital.  You need to pass around copies to everyone, including your current doctors.

      If you have an older parent, you also need something on power of attorney - even if it is limited to once they are incapcitated.  

      by JWC on Sat Mar 29, 2008 at 07:22:10 AM PDT

•  Plan ahead or the s#!t will hit the fan

  I know. I left Hawaii for a reason.

  by FishOutofWater on Sat Mar 29, 2008 at 05:55:38 AM PDT

•  Irrevocable living trust

  After my mom died, I took my dad to a lawyer so he could get a will, and a living trust set up.

  Part of the purpose of the trust was to protect his assets; he was slipping mentally, and had always been an extremely generous man.  We feared that he would get swindled by someone if he had full access to his funds.  With the trust, we kept a few thousand dollars in his checking account, and he had access to a credit card with a $5,000 limit -- but the rest of the funds were off-limits, unless my sister and I authorized the release of the funds (we were joint trustees).

  The other advantage of a living trust is that the trust document can specify that the corpus of the trust will be distributed in accordance with the terms of the will -- and then that is done outside probate.

  Because yeah -- probate is a pain in the ass.

  Now other difficulties having to do with the day in the probate of my mother's estate made it so that we have to have a portion of my Dad's estate go through probate.  But the portion that was in the trust does not.

  by Frankenoid on Sat Mar 29, 2008 at 06:01:55 AM PDT

•  A few of things I learned

  while having power of attorney for an elderly client:

  1.  There's an online government website that rates assisted living, extended care and nursing homes.  I won't link to it because I found it inaccurate;

  2.  Personally investigate any facility -- they vary dramatically in care -- do not be duped by decor.

  3.  I believe that unless a trust was set up years ago, assets have to be bled down to pay to pay for a facility.  At around $1600 for a single person the person is entitled to Title 19.

  4.  The woman I loved and tended to, paid down all of her savings then switched to Title 19 (I never told her because she would have been devastated).  She was in a terrific Catholic facility and never had a change of room or care after the switch.

  5.  Talk to a knowledgeable Elder Care attorney re: the Title 19 and Trust issues -- the trust issues have changed for the worse in the last several years, I believe.

  6.  Finally, even if you or the elderly family member is not religious, look into facilities run by religious groups -- Catholic, Christian, Jewish -- my experience is that they do not discriminate against those of different or no faith.  Each one I looked at was beautifully run.

  by gchaucer2 on Sat Mar 29, 2008 at 06:05:15 AM PDT

  •  terrific post, only thing I would add

    is from my friend's experience...feel free to pull a surprise visit. You should understand if they don't have someone to guide you around immediately, but if they seemed a bit freaked out or say you must have an appt., then I would be wary.

    by Belvedere Come Here Boy on Sat Mar 29, 2008 at 06:11:28 AM PDT

    •  Excellent advice

      Actually, that's what I did with one of the mega chains -- place was gorgeous but the staff sucked and were rude.  I did have an appt. for the place we picked but I was there unannounced once or more a week for the 3 years she was a resident there.  Nothing changed.

      by gchaucer2 on Sat Mar 29, 2008 at 06:24:53 AM PDT

•  Things are getting worse

  I read that Bush wants to decrease regulation of nursing homes (pardon me while I tear some hair out). The treatment my father received in several nursing homes was troubling.  Reportedly, also, funding for Alzheimers is very much less than it should be.

  Given that a large percentage of Americans working today will end up needing Alzheimers care in a nursing home, this is an alarming situation that promises a tragic end to many lives.

  by Deep Harm on Sat Mar 29, 2008 at 06:11:26 AM PDT

•  Folks should check on

  Medicaid waiver programs as an alternative to institutions. I work in that program as a "personal care assistant". It can be a headache for family, finding and hiring competent people, as there is no registry of workers, no benefits for workers, etc. But it can keep your loved one at home. Some workers are organizing under SEIU.

  by emmasnacker on Sat Mar 29, 2008 at 06:34:58 AM PDT

•  If any New Yorkers have questions

  on these type issues, I may be able to provide answers or some guidance.

  by Cuseology on Sat Mar 29, 2008 at 07:13:33 AM PDT

•  An even more troubling trend.

  Older people now have assets.

  Will we have those assets when we become older?

  I've noticed the crises in this country will have a long end game.

  People in their golden years at this point in time have:

  pensions
  savings
  paid for homes
  maybe a union or other fund to turn to

  I look around at myself and my friends taking care of parents in this position. We don't have many of those things. Pensions are becoming a thing of the past. Rising costs eat up savings. The real estate market is rotten, and unions are becoming scarcer.

  I'm sorry to say I don't have anything to offer the younger generation. I'm scrambling to stay afloat, without a house, no savings because of medical costs, and the only thing set aside for my old age is an IRA that will only let me move my money around in various aspects of the stock market. Good luck with that.

  It was always a truism that one could turn to parents for help when times got tough. They had a cushion built from long work lives, investments, and a stable real estate market.

  I don't see too many people who will be able to turn around and do that for their children.

  by WereBear on Sat Mar 29, 2008 at 08:22:51 AM PDT

•  Medicade rules will vary from state to state, so

  check carefully.

  IIRC, in Iowa, if there is any asset in the patients name within the last 3 years at the time of death, the State will go after it for reimbursement.  It doesn't matter if it's the family home and the surviving spouse still resides there.  They want their money back.

  Some families have 'sold' the family farm to a child/ren relatively early to by-pass this.  But, even if the title changed hands within that time frame, they'll try to take the money.  So, be very careful of when you transfer titles to anything.

  Living wills and powers of attorney are very important as well.  Dad held medical power of attorney for mom and held a copy of a living will for her.  Most of their assets were in both names and dad had no problems with most moving to his name only as a right of survivorship.  There were a couple of sets of stock or 401k's that Dad had to get a lawyer for transfer.  The one stock that he had trouble with, he fixed so that my sister and I wouldn't have the same issue when it's his time.  Dad has also set up a 'special' checking account for final expenses.  The acct has dad's, my sisters and my name on it.  So, there will be no issue of money not being accessible then.

  by nchristine on Sat Mar 29, 2008 at 08:40:43 AM PDT

•  Power of Attorney

  This is a complicated area and will be very hard to deal with for your parents because they will not like the idea of giving you power over their money and if there are siblings, thats another likely problem.  

  When my mother first came down with dementia, I took her for an evaluation with a doctor and social worker and the social worker told us to get a power of attorney but she said it should be a "springing" power of attorney.  Fortunately, the lawyer I went to just wrote up a regular power of attorney.  A springing POA puts you in almost as bad a spot as having no POA and having to get a guardianship because you have to get doctors to certify that she is not competent.  Why would a doctor stick his/her neck out like that?  

  When I told my brothers about her giving me the POA, one was fine with it and we had no problems talking about her care, finances, etc. The other was OUTRAGED that I went and got a POA.  We will probably never speak again.  He hadn't seen our mother for 5 years and would not talk to her or visit her or even agree to meet for lunch.  He could have confronted her about her choices for himself but he preferred to be angry with me.  Thats another problem you can have without a POA and having to get a guardianship to have control over an elderly parents money just to pay their expenses:  You have to go to court and estranged siblings can cause problems by contesting the guardianship, just to be spiteful.

  If you do get a POA, it might end up being of questionable value anyway because your parents' financial institutions may want their own POA signed.  That was true in the case of every account my mother had though having the POA probably would have helped me if I had been unable to get her signature on the form the banks sent me.  Would I have had to go to court or go through some other legal steps that might cost thousands of dollars?  

  When I was successful getting it in order to have access to her money, I spent $500/year of her money to buy a $150,000 term life insurance on myself so that I would have peace of mind that if I died suddenly, my younger brother would have the money available to get our mother into a good facility and pay for it for 2 years, while he pursued a guardianship.  You cannot have two active POAs in effect at a financial institution (which makes sense).  So he would have been starting from Square One with our mother at a decreased capacity.  Also, he could not have taken her into his home to live.  

  by Lois on Sat Mar 29, 2008 at 08:54:10 AM PDT

  •  good post, though state laws may supersede

    what the banks want. Worth checking into. Banks either have to have a national or state charter, and I'm sure at least would have to agree to do business under the state's laws.

    My friend didn't have any family problems, but his 2nd lawyer suggested to be wary anyway. These things tend to creep up and bite you.

    In any event, I believe a conservatorship was granted when the other siblings didn't object.

    But your story is to be well noted.

    by Belvedere Come Here Boy on Sat Mar 29, 2008 at 09:30:28 AM PDT