Who should pay for one family member to act as caregiver to parents?

[Midpack]

Quote:

Originally Posted by ivinsfan Why is your sister now expressing disappointment that you do not want to pay her to care for your parents? Is she telling you one thing and your parents another? That is going to make the situation more difficult for everyone.

I probably misrepresented that by condensing too much. Dad thinks I am a bum for not paying sisters expenses (presumably half, he never said) and not being attentive enough, and sister thinks I am a bum for questioning her abilities as a caregiver and the wisdom of her quitting her job 4 years before minimal FI and moving near them to help provide care.

She did tell me she's sure she would not provide bathing or related help, not sure what else she would/not do for them - from her apartment nearby. And she let me know examples from others actual experiences don't mean anything, others don't know her, Dad or Mom - they can't be compared to others/strangers.

At least I now know I'm a clueless cheapskate, so the pressure is off (until next time?)...

[ivinsfan]

Next time is probably closer then you think.

You know we had a slight issue like this in our family business. It's a 50/50 split with close family. The family had teenage boys who would have been paid to do some of the heavy work that was starting to take a toll on us fiftysomethings. But, in the parents minds the kids would be working for half-pay because the money came from the family owned business. They went into the nearest town for summer work where they could earn "real" money. I guess the inheritance is the "family" pot and not real money. Good Luck, things will probably just keep getting stickier from here on out.

[jerome len]

Midpack you're a Saint for going through all your challenges with your parents and DS. The real challenge is aging parents trying to control everything in spite of their age. Truthfully, verry little of this makes good sense. They have money, home and loving kids. But......different viewpoints on who should do what when regarding financials and living space for DD.

What you really need is to define an outside elder care lawyer or care givier who's opinion and advice is accepted by your parents. Then let this "3rd person" individual give advice to your parents and DS.

Your parents will appears to be set. DS gets house, assets are split 50/50. They have a substantial estate, over 1m and growing so a 50% split would give DS a house and a 1/2 million bucks......that should take care of her needs. Now as your parents continue to age, lifestyle changes probably will occur........for their sake, passing on while asleep would be a kind way to end life......but that may not happen. So, advice from an elder care person trusted by your parents and accepted by your DS would be my goal. It really appears that you, DS and parents have had a good family lifetime relationship and it would be a shame if old age stuborness or demetiia caused agnst now......You have been and are a good son........you can and should be proud of yourself, knowing how hard your have worked for your parents and family unity. I dont know howanyone could have done better

[Midpack]

Quote:

Originally Posted by jerome len Midpack you're a Saint for going through all your challenges with your parents and DS. The real challenge is aging parents trying to control everything in spite of their age. Truthfully, verry little of this makes good sense. They have money, home and loving kids. But......different viewpoints on who should do what when regarding financials and living space for DD. What you really need is to define an outside elder care lawyer or care givier who's opinion and advice is accepted by your parents. Then let this "3rd person" individual give advice to your parents and DS. Your parents will appears to be set. DS gets house, assets are split 50/50. They have a substantial estate, over 1m and growing so a 50% split would give DS a house and a 1/2 million bucks......that should take care of her needs. Now as your parents continue to age, lifestyle changes probably will occur........for their sake, passing on while asleep would be a kind way to end life......but that may not happen. So, advice from an elder care person trusted by your parents and accepted by your DS would be my goal. It really appears that you, DS and parents have had a good family lifetime relationship and it would be a shame if old age stuborness or demetiia caused agnst now......You have been and are a good son........you can and should be proud of yourself, knowing how hard your have worked for your parents and family unity. I dont know howanyone could have done better

I'm no saint by any stretch, but thanks for the kind words nonetheless. And Mom is way more level headed thank goodness.

But I know of no way to bring an elder care person into the mix, especially since sister has already volunteered to quit & move close to them. Problem solved, no need for any outsider to intervene in their view. So I wait for the next episode, and hope they get their wishes to pass peacefully in their sleep before they lose their independence. I am sure we'd all like life to end that way...

[Sarah in SC]

Oh Mid, don't let them get you down. You know you are a good son and brother, but just not one that will bend to their whims. It's ok to be the bad guy in their eyes, because you know it isn't really the truth.


Sent from my iPhone using Early Retirement Forum

[MichaelB]

When taking the lead to provide care for a parent (especially when family dynamics are ever present) you need to have thick skin, a deep commitment, self-confidence and a strong sense of self-motivation. You won't get much thanks, but you can get some positive feedback - from forum members.

[Moemg]

Quote:

Originally Posted by Sarah in SC Oh Mid, don't let them get you down. You know you are a good son and brother, but just not one that will bend to their whims. It's ok to be the bad guy in their eyes, because you know it isn't really the truth. Sent from my iPhone using Early Retirement Forum

+1

[Nords]

Midpack, I'm sorry to welcome you to this world. There are a few steps that you can take now.

Quote:

Originally Posted by 2B Even after we had a neurologist diagnose Alzheimers', we had trouble with other people because FIL was so good at hiding it. We had some of his old friends get angry at DW for moving him out of his home. For ~5 minutes he could schmooze anyone. However, after the first 5 minutes he'd reintroduce himself like the person had just showed up and restart the schmooze tape.

Married couples are very very good at covering for this. People with dementia know subjectively that their cognition is declining for months, perhaps years, before they start struggling with the neuropsych tests. When it's someone you've lived with for a few decades, you may notice the decline as soon as they start to feel it. And if they're both declining then it's the "us against the world" mentality.

Here's the advice I got from a geriatric care manager: "Wait 'em out."

One day your parents will have to admit that they need help, and unfortunately it will probably be a crisis. Until that day you can take a few steps:

1. Start interviewing geriatric care managers in their neighborhood. You want someone who will go to their house or the hospital at 2:30 AM until your sister can get there. You want them to know a half-dozen skilled nursing facilities that could help your parents if there's a medical crisis. (A half-dozen because you don't know which one will have an opening when the inevitable crisis hits.) They'll also know a network of care providers for cleaning, yardwork, maintenance, and other tasks. If you're really lucky your parents will agree to talk to a GCM and then interview some of the people who could help around the house (for a fee).

GCMs would much rather get to know you now, and open a file on your parents now, than to have to start this relationship at 2:45 AM at the local emergency room. If your parents are hospitalized then the GCM can work with the hospital's discharge office to help you find a skilled nursing facility for your parent's rehab when they've recovered at the hospital. The hospital doctor can "order" your parents to spend the time at the SNF for the rehab, and you can reassure your parents that they'll only be there for a week or two "until they get healthy and they're ready to return home". (Medicare will pay for up to 100 days, and six weeks is common.) Once your affected parent is at the SNF then you can start the discussion about whether they want to return home.

A GCM is also very handy if your folks get pulled over by the police or picked up during a wandering crisis. GCMs know the police and fire departments and can work with them until your sister arrives.

Quote:

Originally Posted by Midpack My Dad told us when they fall, they can't get up on their own. Obviously sister across town in her apartment doesn't help there.

This is not good. The GCM will want to know about it. Your parents may also want to wear alert bracelets/necklaces to notify either your sister or the paramedics. A cell phone will only work if they'll wear it on their bodies instead of leaving it on the kitchen counter.

2. Ask your Dad (who may be the alpha male in this situation) to set up a joint checking account with your sister. They can put some money in it for her to pay the bills "if you guys want the help". If that proposal is acceptable then ask him to fill out a durable POA for your sister. It's really not worth much with other financial institutions, but your Dad will feel comfortable knowing that he can revoke it at any time. If you and your parents really get along then you could try to set up a revocable living trust with your sister as the successor trustee to your parents, but I'd be surprised if they'll agree to this step.

3. Maybe you could use "gifting" as the financial solution. For example, both of your parents could gift your sister $14K/year. Your parents could also each gift $14K/year to you, which you could immediately re-gift to your sister to give her a total of $56K annual compensation. They could also flat-out just pay her for her time spent at the house.

4. If your parents both end up in a care facility and are not competent to manage their affairs, state law may require separate people to be the guardian and the conservator. (Colorado does this.) You can either hire a professional or petition the probate court to appoint you-- perhaps your sister as guardian and you as conservator. My brother and I have been doing this for three years with our Dad, and his finances are easily managed (via the Internet) from over 4000 miles away.

5. Consider asking your parents (separately) if the other parent might be suffering from B-12 deficiencies, hypothyroid, or just plain ol' depression. All of those are relatively common and can cause a lot of problems, yet the first two are easily remedied.

Disorientation and delusional behavior can also be caused by a urinary tract infection (perhaps aggravated by incontinence), yet that's easily handled by antibiotics. UTIs can be diagnosed if there's a fever, but many elders have lower body temperatures and the fever may only be a degree or too. If an elder's normal body temp is 97.5 and they have a UTI with a fever, they may be running at 98.6 and the doctor will think everything's fine.

It's important to ask these question if for no other reason than to plant the seeds and let your parents think about them for a while.

6. Your sister might be able to offer your mother help with "spring cleaning" as a project. The two of them could work one room each week (or month) and a similar approach might help with yardwork. Eventually the discussion can be steered to diminishing abilities, and your sister can offer to interview housecleaners and landscapers... maybe even pre-screened by the GCM.

7. You need to educate yourself now (if you haven't already) and your sister needs to understand caregiver stress. Here's a few resources that have helped me tremendously over the years:
"When The Time Comes" by Paula Span.
"The New Old Age" blog, also by Paula Span, in the NYT. (http://newoldage.blogs.nytimes.com/) I think Paula is in her late 60s, so she's starting to explore this personally as well as parentally.
"Your Mother, My Mother" book about slow medicine.
"The Alzheimer's Reading Room" by Bob DeMarco. I realize that Alzheimer's may not be an issue here, but Bob is an expert on caregiver stress and dealing with difficult elders. It's the most popular Alzheimer's blog on the Internet: Alzheimer's Reading Room
If you're an analytical type then my may be put off by Bob's approach. Speaking as a nuclear engineer, don't give in to temptation to shoot the messenger-- we all need to pay attention to what Bob says about caregiver stress and caring for elderly parents.

Quote:

Originally Posted by Midpack Sister just shared some $ amounts that will add some perspective to the financial situation (and will undoubtedly surprise some). Parents have Medicare, TriCare and VA healthcare coverage. Combined pensions/SS total $130K/yr. No debts and their annual expenses are $24K/yr, they have been saving the rest. [I thought I was LBYM!!!] [update] In 2011 they had $960K in CD's, $300K house and $120K collectibles, jewelry, other property, no telling what the accumulated total is today. They haven't had any investments more risky than CD's for about 10 years, so no losses possible.

Quote:

Originally Posted by Midpack Maybe. But if you were 92, very conservative by nature, witnessed the 2008 GFC/ meltdown (from the sidelines), and you wanted to leave your daughter a substantial $ inheritance - no equity holdings might be a permissible choice. "Once you've won the game, why keep playing?"

If I understand this correctly, there's a military pension and perhaps even survivor benefits. Both of those have a COLA (the same COLA as SS), so inflation protection is largely built in. If they're happy with CDs then their finances look fine.

Tricare For Life will be secondary to Medicare, so those two will pay all the medical bills. There may be a small prescription co-pay.

If they're amenable to gifting/re-gifting your sister up to $56K then there's plenty left over for care facilities (and for paying her to help with home care). You could check the prices on care facilities ($200-$250/day is not uncommon) but if they have military pension income then they probably have enough income and assets for at least a decade of full care... even with annual sister gifting.

Quote:

Originally Posted by Midpack I need to follow up on this. They've told us "all their friends died long ago" and we accepted that, but it may not be entirely true. But when I get the chance I am going to try to work in a discussion, tours, with 'just in case you ever need it' as the premise.

I was never able to persuade my father to do this. But if your parents end up in a SNF "for a few weeks" after a hospitalization then that's the time to point out the service, the socialization, the free meals & laundry service, and the other hotel/resort amenities. If they don't like the one they're at, then you can all tour other facilities.

Speaking of military veterans, your parents may be eligible for a number of other Tricare and VA medical benefits like in-home medical monitoring. (They might also have too many assets to get this for free, but it could still be available in their area.) They may also be willing to have a discussion about funeral honors, burial/inurnment locations, or even burial at sea. The VA has plenty of information on tap to help with this.

If you want to discuss this more privately or in real time then send me a PM or we can set up a call.

[kimcdougc]

Midpack, I feel your pain. I am currently in the same situation. I live in the Pacific Northwest. My parents live in Texas. My mom has dementia. She has kicked my dad out of the house and he is in a travel trailer. She imagines other people being in her house plus various other imagined things happening which we will save for another time.


We tried to put her in assistant living. She refused. In the state of Texas you have no legal rights over senior citizens no matter what state they are in. In other wards, she needs help now, but we can't force her to move into an assistant living place.


We are waiting for her to get lost and the cops pick her up, then we will have some legal rights.


Hard situation. I have one sister who lives nearby who does all the physical things that need to be done for her. I feel bad for her because she has to do all that. I pay the bills etc and do what I can from Seattle. I do send money to my sister (from their accounts) to help with her gas etc.


It is not fair that your parents expect you or your sister to come and take care of them even if your sister is willing to do that. They should be willing to move close by to where either you or your sister is located. That is what we told our children we plan to do when the time comes.


There is no right answer for your situation and you will be in my thoughts and prayers to find the right path that works for all of you.

[Midpack]

So much helpful info here, I have cut-n-paste summarized it all (updated just now) in Word, up to 7 pages now, I can't thank you all enough.

It may be time for this thread to end (I feel I've asked/gotten more than I deserve already). Where it stands now (some of this I've already stated earlier), but in summary:

• I agree it’s a mistake for sister to quit her job (not FI) and move to an apartment near parents. But since she’s volunteered, I think Dad has latched on to this as the best solution, one he can enact at almost any time – so he has no reason to entertain or consider any other options. As a result, getting them to hire more in home help, tour assisted living, getting an elder care attorney/specialist involved, still seems out of the question. And of course sister doesn't think it's necessary either, so it would be 3 against 1 (me).
• And me talking sister out of moving if they when Dad asks is out of the question. She was very angry when I asked questions about what she might be getting herself into both financially and as a caregiver – ‘based on all your questions, you must think I’m stupid!’
• If parents elect to “hire” sister to care for them, I don’t see anything wrong with them paying all her expenses, including lost income for 4 years (until she is 70, eligible for SS, and planned to retire). I am not planning to help pay sisters expenses, and Dad knows that now (too his great disappointment), but I won’t rule it out.
• They already have pool & yard care, a handyman on call and a weekly maid. They realize they could hire others, but so far they don’t see a need. Mom may be the greater obstacle to hiring anyone else that would come in "her house." Mom doesn't even want sister living in their house.
• Dad tells us Mom is having some minor memory issues. But sister and I both think she’s fine (for a 92 yo) based on our weekly email/phone conversations with her. Mom’s “memory issues” may be partly Dad’s memory/recall issues – very hard to know for sure. Probably some truth in both.
• They are retired military living (far below their means) in TX. The chances they will run out of money even if they had to hire full time in home care for their remaining years are almost nil.
• They have all the documents (will, trust, MPOA, POA, advanced directives) done, we already have copies, and contact info for the attorney. And they are very well organized, we have copies of their entire home inventory with their estimated values for example. They’ve really covered their bases preparing financially, and sister and I are most grateful.
• While I feel bad we’re all going through this, I am comfortable with my position (just don't want anyone to think I am looking for sympathy, though some have kindly offered).
• I am afraid it’s going to take a “train wreck,” a serious fall, an auto accident, or some medical emergency to change the “plan.” While I am concerned this may play out badly, parents are competent adults, and they seem perfectly willing to live with the consequences of their choices - no matter what. They don't want to die, but they've told us repeatedly they're ready to die peacefully in their sleep, at home.

[Sue J]

Midpack,

Just sending you a {{hug}}

My Dad is 88 and has been in assisted living for a little over 2 years. It was an excellent move for him after Mom died suddenly at home and he broke a hip 2 weeks later. So yeah, he had to have a crisis to realize he needed help.

We took a tour of the facility, asked questions, met some people and then he said he'd consider it "down the road". Then my sister took him back for lunch and one of their social activities and before they left he asked if there was a unit on the first floor that was available. He saw it and it's close proximity to the dining room and asked if he could leave a deposit! He was ready and realized how many problems a move there would solve.

He very much wanted to be independent from my sister and I. Staying in his own home would have meant my sister (3 miles from him) making frequent trips for groceries and errands. He tried a home health aide and didn't like having someone in his home. He very much didn't want to be dependent on my sister. We are very glad that he had this attitude!

He has deteriorated a lot in the last 2 years and would like to die already. But in the meantime his assisted living facility has been wonderful. They accommodate a wide spectrum of assistance and he has progressed to where a nursing home may be needed in the future, but for now he can stay there.

He has far less money than your parents and this place is expensive, but he is still supporting himself and maintaining independence from my sister and I.

Good luck to you in getting through this.

[pb4uski]

Quote:

Originally Posted by Midpack Well the hoopla is over (for now?) and Dad and sister "accept" that we're not planning to subsidize sister, and they've clearly shared their disappointment in me. Glad to learn that I am a bad son and brother, makes the holidays special. It ended, as I expected, when Mom learned what was going on and put the kibosh on the whole deal as she did in March. Dad still insists that sister will have to move near them, just not now...and sister is certain she can help them come what may. Thanks again for the perspective you all offered, it was very helpful, even if it doesn't seem so just yet.

Sort of like Congress, kicking the can down the road but with more (or less?) drama.

I hope that you are not feeling like the bad guy even though they seem to be painting it that way. Your mom deserves a big hug next time you see her.

[pb4uski]

Quote:

Originally Posted by kimcdougc Midpack, I feel your pain. I am currently in the same situation. I live in the Pacific Northwest. My parents live in Texas. My mom has dementia. She has kicked my dad out of the house and he is in a travel trailer. She imagines other people being in her house plus various other imagined things happening which we will save for another time. We tried to put her in assistant living. She refused. In the state of Texas you have no legal rights over senior citizens no matter what state they are in. In other wards, she needs help now, but we can't force her to move into an assistant living place. We are waiting for her to get lost and the cops pick her up, then we will have some legal rights. .....

kim, my experience is very different. Around here, if an adult has dementia or other illness that they are unable to safely live alone and refuse help, you can petition the court for involuntary custodianship. I have served in that capacity twice in the last 3 years, for my grandmother and my great-aunt.

In both cases I was granted temporary guardianship based on a recommendation from medical professionals and a brief meeting of the judge with me and the ward. Then a mental health evaluation of the ward is done, interviews with relevant relatives, health care providers, etc. The ward is assigned legal counsel who represent their interests through the process. Then a short court appearance and custodianship is awarded.

With Gram, we just told her that the court decided that it was not safe for her to live alone anymore and that we agreed and that was why she couldn't return home. Nonetheless, she was always getting better and would be going home in a couple weeks (for many months, but that was fine as she was perpetually two weeks away from going home).

The reasons for the process is to avoid the situation you describe where someone wanders off and gets lost (or worse).

I realize that it may differ elsewhere but that is the process here (Vermont).

[Speculator]

I'm sorry for your situation and it appears you've received some good advice.

To help you in ferreting out resources for your folks (and for your peace of mind), I would suggest contacting a local Council on Aging, a nearby college or university with a school of social work or department of gerontology, and also call the local community resource hotline for additional resources in your parent's area. By speaking with objective elder care professionals, you would be better able to make an informed decision when your folks decide a higher level of support is needed. Ask for licenses when you interview potential caregivers and check these credentials with the state department of professional licensing. Unfortunately, there are a lot of sharks out there preying on folks who are in your and your sister's position.

Good luck!

[clifp]

Lots of good advice here. It does seem to me that from a financial fairness aspect, your sister should get paid for providing care for your parents. If she wasn't around and/or able you would have to pay somebody to provide it which would reduce the value of your inheritance.

Generally speaking I think it is preferable to have care from a family member,and as long as sister is willing to do it.

One think to keep in mind there is probably/hopefully going to 20+ year period after your parents pass that your sister will be in your life. I think it is important that you both feel treated fairly. Not all of the financial stuff has to resolved right now, and makes sense for you and your sister to have a on going discussion. If you need to compensate her after you parents pass you can certainly reach an agreement, and divide up the money fairly regardless of what your Dad thinks is right.