Advice for childless couple?

[growing_older]

I had to spend some time in a nursing home myself when I had a medical condition that needed care. Ultimately I got better and was able to return home. But I left more determined than ever to make sure I had enough money to afford the best such facility in the area. There can be a big difference in the standards of care, and this is one purchase that I really really want the best available.

 

[razztazz]

You don't have to be old and fading and in a care facility. This is exactly how I lost most of my 40's. Drugs I didn't need for diseases I didn't have that the doctors were certain of and adverse reaction/side effects blithely dismissed as not happening or "It's not the drugs you just have some new diseases."

This is why this whole "old age" scenario gets scary. When you are old and have already "jumped the shark" it's real easy for anyone to assume yes, you probably DO have something and yes, you probably DO need the drugs. And unless you have very involved family, preferably sons and daughters who are doctors and lawyers themselves, the system (And that means the people IN the system) really don't care if they kill you. There's always more where YOU came from

While I love the idea of CCRC and have some family experience with them, they are not the answer to everything. My grandmother was a long time CCRC resident and finally moved to the daily nursing support section when she was in her mid 80s. The doctors told family that she had multiple organs failing, cancer and other problems and they had her under a heavy regimen of drugs to keep her comfortable and expect she had 6 months to a year left to live. Luckily her nephew (a doctor) came to visit and blew a gasket. She was being over-medicated and over-sedated. Once he got her off most of the meds she felt a lot better, returned to her lower level assisted care section and lived into her late 90s (more than 10 more years). CCRC was dutifully caring for her, but no one cares as much about a specific patient as family (or the patient themselves, if coherent). A real potential tragedy was averted.

 

[athena53]

You don't have to be old and fading and in a care facility. This is exactly how I lost most of my 40's. Drugs I didn't need for diseases I didn't have that the doctors were certain of and adverse reaction/side effects blithely dismissed as not happening or "It's not the drugs you just have some new diseases."

Or- "here's a new prescription for the side effect". DH got a prescription for an anti-nausea med after he noted that occasionally he had nausea. A week later he felt sick and I was afraid he wouldn't keep down the important meds he'd just taken, so I handed him one. Well, it worked, but that night at dinner he wasn't talking sense. It was scary as heck. I asked him to draw a picture of a clock face with numbers (a family member who's a psychiatrist told me that's one simple test for cognitive skill). After being asked 3 times, he drew a circle, drew lines dividing it into wedges like a pizza, and crammed a few numbers out of order onto the left side. Thank God it was only temporary, but I could see someone with a profit motive concluding he had developed dementia.

He's not taking that pill again.

 

[Brat]

Often this is the result of a variety of physicians prescribing medications. Yes they ask what meds you are taking but few (IMHO) know how they are metabolized by the elderly. Find a physician who has geriatrics as a specialty.

 

[Sunset]

Often this is the result of a variety of physicians prescribing medications. Yes they ask what meds you are taking but few (IMHO) know how they are metabolized by the elderly. Find a physician who has geriatrics as a specialty.

I fail to see, how any doctor could know the interactions of the 1,000's of available drugs in various combinations on just an average human body, let alone a young vs old person.
It's just too much to ask them to know.

If the doctor uses a computer program to calculate possible interactions that would work, otherwise it seems impossible to me.

 

[Teacher Terry]

It seems like many are assuming they will need care and not able to live independently. I have mostly seen the opposite where people age in place in an apartment or small home. Most did this until death or close to it. Only 25% of people ever end up in nursing homes.

 

[athena53]

If the doctor uses a computer program to calculate possible interactions that would work, otherwise it seems impossible to me.

I found a good web site that allowed you to look up interactions but it seemed to be generic; the answer was the same for any antibiotic vs. any antihistamine, for example. I didn't find any red flags for the anti-nausea med and anything else DH was taking. But, as Sunset noted, we're all different. If DH were prone to frequent bouts of nausea, or it were a mission-critical drug like an antibiotic, I'd be on the phone to the doc's office. In this case, it's safe to say I'd be reluctant to have him take that one again.

DH actually tried to get referrals to a geriatrician; the one he could find wasn't taking new patients. Although it's a much-needed specialty, it's not popular because you're pretty much stuck with whatever Medicare pays.

 

[razztazz]

It seems like many are assuming they will need care and not able to live independently. I have mostly seen the opposite where people age in place in an apartment or small home. Most did this until death or close to it. Only 25% of people ever end up in nursing homes.

Absolutely true. In fact having run all these numbers and scenarios ad nauseam the upshot is the terrible ending/long ride into the final sunset is not likely to happen. We will perhaps need some help for a spell. Then perhaps The Big House (Hospital/Nursing Home) for a spell right at the end. But mostly we will just die fairly quickly and not after running on fumes for several years.

If you are really into playing the percentages, and we all are here, and that's more or less what investing/AA/ and ER are based on. You wouldn't spend much time on worrying about CCRC, Nursing homes, impoverished surviving spouses, which relative you can trust to stand up to the medical and/or insurance industries. Just keep an "In Case of Emergency Break This" plan around. And speaking of probabilities, you probably won't even need that. If you are on your way out ya'll won't be giving a carp about the details anyway.

On the other hand, what the hell is all this money for if not to handle the Black Swans? Or in this case, what I'll call Gray Swans. The Known Unknowns.

Of course we are all Planners so what else would we expect to do? And perhaps our workload (worry) is increasing to fill the available filing cabinet space? (Money)

 

[Teacher Terry]

I am usually a big planner but not in this case. WE downsized to a small home with astro-turf so not much to maintain. If I get really old I may want to go into a condo.

 

[razztazz]

I am usually a big planner but not in this case. WE downsized to a small home with astro-turf so not much to maintain. If I get really old I may want to go into a condo.

That's pretty much the way I'm playing it. In fact I could stay here, hire someone to check on me 3 times a week, pay for cabs to take me shopping, get one of those I Fell Down and I can't Get up, alarms, pay someone to mow the grass and shovel the walkway and it would cost the same or less than moving into an apartment.

If I get really bad off I can fund a few yrs in The Big House at retail rates. If I last longer than that..... well, it won't be too much longer.

All the big money is in Transfer on death status. Any meager items like dispatching a house or apartment, or car, and disposing of the "burden of civilization" can be done fairly easily.

If I get some lead time call a lawyer, pay him to get rid of it. If I go suddenly without any lead time there is an office at the State or County level that does that in most places. The NYC one was the subject of a thread here about 2 yrs ago.

 

[JoeWras]

DW and I are in this situation too. We've agreed to consider the idea of a CCRC, probably sometime after we hit 60, we'll start thinking about it.

I will say that having to guide Dad through both independent living and then assisted living was a real eye opener. In the end, these are businesses and someone in the corporation will have a cold heart. Even in the best run place.

As for CCRCs, some may have fine print about removal if you are violent. I think they avoid that in most cases by drugging those prone to it into a haze. And if I do lose my mind and become violent, maybe a drug haze isn't a bad thing. I don't know. It is tricky, KIDs or NOT.

Finally, to the OP, don't forget NOW. Make sure all your documents are up to date! Should you and spouse go out together in a fiery crash, you may not want your assets going places at the State's choosing.

 

[W2R]

That's pretty much the way I'm playing it. In fact I could stay here, hire someone to check on me 3 times a week, pay for cabs to take me shopping, get one of those I Fell Down and I can't Get up, alarms, pay someone to mow the grass and shovel the walkway and it would cost the same or less than moving into an apartment.

One nice thing about CCRC's is that you can get somebody to make sure you are taking your medication as dictated by your doctor, even if you are becoming a bit "drifty". Also, if you can't reach your alarm (or are unconscious or for some other reason can't operate it), they will check on you when you don't show up at meal time.

But with F right next door, we are thinking of trying to muddle along together as long as we can, checking on one another each day. Being introverts, we'd rather live in our own homes as long as possible.

If I was ultimately left completely alone, I'd promptly get on the waiting list for a CCRC.

 

[razztazz]

One nice thing about CCRC's is that you can get somebody to make sure you are taking your medication as dictated by your doctor, even if you are becoming a bit "drifty". Also, if you can't reach your alarm (or are unconscious or for some other reason can't operate it), they will check on you when you don't show up at meal time.

But with F right next door, we are thinking of trying to muddle along together as long as we can, checking on one another each day. Being introverts, we'd rather live in our own homes as long as possible.

If I was ultimately left completely alone, I'd promptly get on the waiting list for a CCRC.

Maybe I'm misreading just what CCRC is. If I am decreasingly functional beyond the At-Home living assistance I can pay for (Cheap stuff/non-institutionalization) I have the bread to throw at a REAL assisted living operation. I have no problem with that. But that little "What-if" scenario you painted is too small a number for me to wring my hands over. I cannot move into place maybe 10 or 20 years BEFORE I get "drifty" just in case I get drifty

If any of that other stuff happens ie I did everything possible with the alarms and visitations etc etc and I still fall and have to eat it... well then, to paraphrase Edward G Robinson "That's the end of Ricco."

If What I read as CCRC is really an Assisted Living Community, to quote Gilda Radner: "Never mind."

 

[JoeWras]

razztazz: I guess the ideas is you just move among the levels of care seamlessly, versus having to do the hard work of finding a REAL assisted living operation.

You choose your CCRC while you have a brain, before you lose it and can't make that choice.

But there are other issues. Will the CCRC be there in 30 years? What will it be like? Will it have been sold to new ownership? Etc., etc. Those are the issues that give me pause. You ostensibly are making a real decision today, while you can, that really might only come into play 20 years or so hence.

As for medication reminders or health checks: independent living places will do that too, although you may pay a few bucks per day extra (they are all different). Most assisted living places do it as part of the normal pay. I'm guessing W2R might have just been talking about the later parts of CCRC living.

 

[Walt34]

If I was ultimately left completely alone, I'd promptly get on the waiting list for a CCRC.

It might be too late by then, some have waiting lists of ten years or more. We're already on one, having applied several years ago and I'm 66. They really don't want you there until you're at least 70 but I wanted to be at or near the top of the list when the time comes. The guy at the one we applied to said they've had one 90-some year old guy on the list more than a decade. Every time they call he says "Nope. Not ready yet." so he goes back on the list. So you do have that option if it's offered where you are.

 

[W2R]

It might be too late by then, some have waiting lists of ten years or more. We're already on one, having applied several years ago and I'm 66. They really don't want you there until you're at least 70 but I wanted to be at or near the top of the list when the time comes. The guy at the one we applied to said they've had one 90-some year old guy on the list more than a decade. Every time they call he says "Nope. Not ready yet." so he goes back on the list. So you do have that option if it's offered where you are.

Yeah, that worries me, I admit it.

 

[Scuba]

Most people who move into CCRC's are in their early to mid 80's. Usually the move happens because of some "event" such as a fall. I definitely see the benefits of a CCRC but they won't manage your money or make healthcare decisions. That is left to the resident and his or her family members. Clearly we need some younger friends!


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[becca]

I agreed to be alternate POA and Executor for my childless biological aunt and her husband many years ago. Another uncle was the primary POA and Executor. Well this uncle developed a brain tumor and died quickly, then my aunt developed lung cancer and died, leaving me as primary POA/Executor for her husband who is not my biological relative. My mistake, I should've resigned before it got to this, but now he is incapacitated, can't walk or talk, 91 years old. He was living in a CCRC and has been moved to the LTC section. I live 5 hours away, and it has been a lot of work taking care of his health and financial needs. I know this sounds heartless, but I just went through this with my own dad and I am really resenting having to do this with an uncle I was never even close to. This uncle didn't make it easy for me either....I have had to search for everything I need to conduct his business, ie, title to his automobile, safety deposit box key, tax returns, etc. I would never agree to do this again. Now I have to get rid of all the contents of his 2 bedroom apartment. The nursing home calls me daily asking me to make health care decisions. He does have biological nieces/nephews and I am seriously considering revoking my POA and having one of them appointed. Think hard about who you want to be your POA and it works best if you live close by.

 

[JoeWras]

becca, bless you for carrying through this far. If it really is a burden, you probably should get the transfer to another POA taken care of soon, before he passes. Again, not to be heartless, but it gets really complicated then.

I have a friend in your same situation. In this case, an aunt of a spouse. He is an incredible man to do what he has done for her estate. Because of the local laws, and the fact most of her stuff went to probate, he's had to send out something like 18 letters to all kinds of per stirpes relatives AND get responses from each one. It has been a huge burden. Sure, he has taken a reasonable "expense" for this, but it is a pittance.

This kind of thing isn't easy for anybody.

 

[Walt34]

Now I have to get rid of all the contents of his 2 bedroom apartment. The nursing home calls me daily asking me to make health care decisions. He does have biological nieces/nephews and I am seriously considering revoking my POA and having one of them appointed. Think hard about who you want to be your POA and it works best if you live close by.

I had to do this with my mother's estate and helped DW deal with her father's and for her, near the end of his life it was close to a full-time job. And we were local. I can't imagine having to do it from 5 hours away.

I'd be the last one to call you heartless if you handed the task off to another relative.

 

[Bestwifeever]

I agreed to be alternate POA and Executor for my childless biological aunt and her husband many years ago. Another uncle was the primary POA and Executor. Well this uncle developed a brain tumor and died quickly, then my aunt developed lung cancer and died, leaving me as primary POA/Executor for her husband who is not my biological relative. My mistake, I should've resigned before it got to this, but now he is incapacitated, can't walk or talk, 91 years old. He was living in a CCRC and has been moved to the LTC section. I live 5 hours away, and it has been a lot of work taking care of his health and financial needs. I know this sounds heartless, but I just went through this with my own dad and I am really resenting having to do this with an uncle I was never even close to. This uncle didn't make it easy for me either....I have had to search for everything I need to conduct his business, ie, title to his automobile, safety deposit box key, tax returns, etc. I would never agree to do this again. Now I have to get rid of all the contents of his 2 bedroom apartment. The nursing home calls me daily asking me to make health care decisions. He does have biological nieces/nephews and I am seriously considering revoking my POA and having one of them appointed. Think hard about who you want to be your POA and it works best if you live close by.

Thank you for this thoughtful and honest post. I hope one of his biological nieces or nephews will take it over for you.

 

[Silver]

I agreed to be alternate POA and Executor for my childless biological aunt and her husband many years ago. Another uncle was the primary POA and Executor. Well this uncle developed a brain tumor and died quickly, then my aunt developed lung cancer and died, leaving me as primary POA/Executor for her husband who is not my biological relative. My mistake, I should've resigned before it got to this, but now he is incapacitated, can't walk or talk, 91 years old. He was living in a CCRC and has been moved to the LTC section. I live 5 hours away, and it has been a lot of work taking care of his health and financial needs. I know this sounds heartless, but I just went through this with my own dad and I am really resenting having to do this with an uncle I was never even close to. This uncle didn't make it easy for me either....I have had to search for everything I need to conduct his business, ie, title to his automobile, safety deposit box key, tax returns, etc. I would never agree to do this again. Now I have to get rid of all the contents of his 2 bedroom apartment. The nursing home calls me daily asking me to make health care decisions. He does have biological nieces/nephews and I am seriously considering revoking my POA and having one of them appointed. Think hard about who you want to be your POA and it works best if you live close by.

I can understand many of your issues. I cared for my father in my home for several years before he died, and then was the executor after his death. It was a challenging several years.

My husband and I have no children and no family at all. We know we are on our own, and are planning the best we can for our future care. My question to you is....would it have made a difference to you if there had been an agreement of payment for your oversight right in the beginning? A legal process that paid you a specific amount, let's say somewhere between $5,000.00 - $10,000.00 a year, every year until the death of both your aunt and uncle, to be the fiduciary and POA? Would that make it a little easier to bear?

I have no idea the legalities involved but I am sure there are many. I guess I'm just asking if knowing your time and effort was being acknowledged through an agreed upon amount of payment, would you want to continue?

I would expect that needing to trust the person appointed is most essential, but asking someone to do this without an understood "fee" is asking to much, I think.

 

[Teacher Terry]

I volunteered to do this for a friend of mine who has Alzheimer's and her DH was dying of cancer. I did not want her to be a ward of the state. She has no kids but does have 2 adult step children. I was doing everything but thankfully the stepson took over the financials for me although I have access to review. It is a lot of work and she is an hour away in a facility. We go to visit every few weeks to keep track of how is doing on meds, etc. The home calls us for stupid things but when her neck was stuck down and she couldn't raise it and it was hurting they never called. A call to her doc got her meds changed and it went away. However, if it had stayed that way too long it would have been permanent. We never expected to be paid because they could not afford it. I think if one of the other kids is willing to take it over that would be great providing they really do look after him in the home. YOu should just make sure they will look out for his best interests. This is a lot of work and not fun.

 

[Scuba]

I agree, it is a lot of work looking after someone in a CCRC or home, and if you don't do it, the person doesn't get as much attention as someone with strong advocates who visit frequently will get. Just human nature.


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[JoeWras]

I agree, it is a lot of work looking after someone in a CCRC or home, and if you don't do it, the person doesn't get as much attention as someone with strong advocates who visit frequently will get. Just human nature.

Very true, even in the very best facilities.