Coping with aging parents

[NW-Bound]

Both my wife and I have been living close by our parents, and hence are able to help. Having the most free time, I was the one to spend more time to comfort and to provide company to my father in the hospitals and convalescence homes during his last days. My brothers and I have done house maintenance for my mom, who now lives alone.

My wife has been alternating with her siblings to spend time with her father in a nursing home to feed and to comfort him. We saw that his nursing home roommate did not have many visitors, and he looked sad.

It is really depressing to spend time in hospitals and nursing homes, seeing elderly people near the end of their lives, but it is our duty. It is likely our kids will not bother to take care of us like we do our parents. Even then, I do not want help from my kids either. I will just buy a one-way ticket to Holland where they will let me go gracefully, from what I have read.

 

[rocketdog]

Nords, it sounds like a very tough situation you are facing with your father. I couldn't help but notice in your original post, that your father started on hydrochlorothiazide about 18 months before the mental confusion and forgetfulness started. One of the side effects of hydrochlorothiazide is "confusion", and the incidence of side effects may be increased by alcohol.
Your father has more problems than "confusion", but the hydrochlorothiazide might be contributing to his mental difficulties.
I'm not a doctor, and I only just googled "hydrochlorothiazide side effects"...but it might be worth asking a real doctor about drug interactions.

 

[Free To Canoe]

Tomorrow morning I make the 2 hour drive down to talk to my mother about POA, living will, joint checking and considering an assisted living place. This thread is very timely and helpful. I want to get her thoughts on these subjects while I can. She is not very far behind Nord's dad in that regard. The repeating over and over and over. The lack of eating and weight loss. In addition, she is having trouble remembering to take her thyroid and BP medicines regularly (this part greatly concerns me since she has no thyroid).

In October she got sick with blood in her stool that turned out to be C-dif. It made her dementia condition much worse. This period was my wake up call that she will need help and I am the one to provide it. She is "better" now and back to living independently but I think just barely.

I am still uncertain on how it will play out but thanks Nords and others for taking the time to share your experiences.

Free to canoe

 

[Brat]

One of the challenges of reaching an advanced age is that your friends are failing too. Does he have any friends who you trust to visit him or take him out from time to time, even if you pay them 'under the table'.

His LTC insurance may have an in-home care option that could be used if you could document his need for assistance. It will require a MD's certification so if he hasn't seen a MD in a while you will end up waiting until he is hospitalized.. the LTC waiting period would start then. Also, the visitor can document your father's needs which can help physicians assess his situation. If your Dad is a contrary cuss you can tell him that just because he sees a MD doesn't mean that he has to take his advice. The choice is his. You would just like him to visit the doctor so that if something serious happens there is a physician who can check up on the hospital.

IMHO the one aspect of aging that men have difficulty coping with is dependency. I have a former widower-colleague who used a Smith & Wesson when he realized that he was failing. Most LTC facilities prohibit residents from having a gun for just that reason.

 

[Nords]

Dreamer, you're absolutely right about the alcohol, and it all comes under the general heading of "independence". Even when his brain has the blood flow to be capable of being logical, it's not logical on this issue.

... that your father started on hydrochlorothiazide about 18 months before the mental confusion and forgetfulness started. One of the side effects of hydrochlorothiazide is "confusion", and the incidence of side effects may be increased by alcohol.
Your father has more problems than "confusion", but the hydrochlorothiazide might be contributing to his mental difficulties.
I'm not a doctor, and I only just googled "hydrochlorothiazide side effects"...but it might be worth asking a real doctor about drug interactions.

I am still uncertain on how it will play out but thanks Nords and others for taking the time to share your experiences.

One of the reasons I lay this personal stuff out on websites to (mostly) total strangers is because you keep coming up with good suggestions. I read the prescription "side effects" labels and printouts but none of them mentioned this!

When he went on BP meds they tried several before settling on these two. He was hammered pretty hard with all of the side effects and almost didn't complete the process. His description of the weeks of testing was pretty brutal, and I can see why he's burned out on doctors.

Thanks, everyone. I'm adding it all to the list of things to keep mentioning to him as well as to my brother, and perhaps someday having a conversation with Dad's doctor.

I should point out that when this guy was in his 30s he had all of his wisdom teeth removed on the same day because it was more efficient. On a Friday because he could leave work early. He didn't realize that when the painkillers wore off he wouldn't be able to get a prescription until Monday. Later he joked that he couldn't even grit his teeth (engineer humor).

This is also the guy who, as a widower in his 60s, waved off all filial offers of companionship & help for his prostatectomy. He even took taxicabs to & from the hospital.

When spouse and I have these conversations she rolls her eyes and says "Gee, honey, good thing you're not like that."

One of the challenges of reaching an advanced age is that your friends are failing too. Does he have any friends who you trust to visit him or take him out from time to time, even if you pay them 'under the table'.
His LTC insurance may have an in-home care option that could be used if you could document his need for assistance. It will require a MD's certification so if he hasn't seen a MD in a while you will end up waiting until he is hospitalized.. the LTC waiting period would start then. Also, the visitor can document your father's needs which can help physicians assess his situation. If your Dad is a contrary cuss you can tell him that just because he sees a MD doesn't mean that he has to take his advice. The choice is his. You would just like him to visit the doctor so that if something serious happens there is a physician who can check up on the hospital.
IMHO the one aspect of aging that men have difficulty coping with is dependency. I have a former widower-colleague who used a Smith & Wesson when he realized that he was failing. Most LTC facilities prohibit residents from having a gun for just that reason.

My Dad sees "friends" as an intrusion and a burden. He may be a hermit but he's content in that lifestyle. And yes, that makes him very hard to keep tabs on if someday he doesn't answer his phone.

His LTC policy kicks in wherever he is, after some sort of waiting period, when a doctor certifies that he's unable to accomplish at least two of the activities of daily living. I understand that's pretty typical. Finances appear to be the least of our worries here.

Spouse jokes about her 9mm healthcare plan, but a sad fact is that a lot of old folks are lousy shots. And among my Dad's alcohol, the winter's icy sidewalks, the brutal cold, his driving, and his hiking the Rockies by himself... it's pretty easy to worry.

 

[DangerMouse]

We were going thru the same thing with my inlaws last year. Refused all help, insisted they were coping fine. I went to visit for the first time in 3 years and was horrified at the state of their house. It made me sad to see a couple who were so house proud living in what I would classify as unhygienic conditions. However, they refused all help, because in their eyes there was not any issue. FIL obviously had the onset of dementia and was becoming more argumentative and not a pleasant person to be around.

FIL died last July now MIL is home on her own and has refused to move to a facility. She can not dress or bathe herself and it is a sad situation. She doesn't want outside help, she wants her children to sacrifice their lives to wait on her. Who knows how the story will end.

However, you need to find some way to have someone check on him regularly. Reason I say that is an Aunt of mine died recently, a most miserable character who had alienated everyone. She lived on her own, had a fall and was not found for days, by which time she had died.

 

[LARS]

I have not read the entire thread so excuse if this advice has already been given.

I am currently dealing with mother and father (in mid eighties) and both are suffering from dementia. Father's appears to have been stroke related and mother's is from deteriorating blood flow to brain. She has been on Aricept (check spelling) and it has STOPPED further lose of facilities and she seems to have reached a plateau.

Not sure if it will work for your Dad, but worth talking with his doctors about.

Good luck, it is a terrible disease for all to deal with, both the afflicted and the care giver.

 

[Nords]

However, you need to find some way to have someone check on him regularly. Reason I say that is an Aunt of mine died recently, a most miserable character who had alienated everyone. She lived on her own, had a fall and was not found for days, by which time she had died.

There's a constant tension between trying to treat our parents as adults while attempting to figure out if they're still capable of reasoning as adults.

I don't know where that line is drawn, and it sure doesn't stay put.

One point is that my father could've died anytime during the last 20 years as a result of not having anyone to check on him after an otherwise innocuous domestic accident. From now on his dementia may make that probability higher than it used to be, but there's no easy way to decide where he crosses the line from "careless" to "dangerous". He feels the probability is still so low as to make the discussion a threat to his independence and even insulting. Is that a rational attitude? Maybe I'll understand better in about 25 years.

I think the decision point is where he endangers others (and the landlord threatens eviction or not renewing his lease) or where he scares himself into getting help. Of course there's also the "no decision" point where he dies of an accident because he wanted to preserve his independence.

But before that point (or without it), I and my conscience are on our own.

You Navy veterans may recognize the concept of "intrusive leadership" and its many abuses being invoked here...

 

[kyounge1956]

(snip)
My Dad sees "friends" as an intrusion and a burden. He may be a hermit but he's content in that lifestyle. And yes, that makes him very hard to keep tabs on if someday he doesn't answer his phone.(snip)

(snip)
However, you need to find some way to have someone check on him regularly. Reason I say that is an Aunt of mine died recently, a most miserable character who had alienated everyone. She lived on her own, had a fall and was not found for days, by which time she had died. (snip)

An old college friend (bachelor, >80 years of age) of my dad's stopped answering letters and phone calls, and my parents were worried about him, thinking possibly dementia or other age-related problems. I was able to find name/address info of some of the other people who live on his block. My parents called a few of his neighbors, who verified that they had seen him, he looked OK etc. I am wondering about this myself, as in a few decades I will most likely be 80+ and living alone.

 

[Cattusbabe]

Oh boy Nords, You have a tough one on your hands. I feel you and all I can say is Dh and I have been there and done that with MIL and are on the way to there with my parents. You have as good a handle on this situation as I have seen. (Used to be a LTC nurse, DH was a therapist in LTC. This is never easy and each situation is unique.)

What we did was what you are now doing and that was arm ourselves with information and line up resources so that when we needed to make a move we could do so quickly with out having to dick around doing research.

Keep family members in the loop and have a plan.
As you are discovering parents wait until zero hour to agree to interventions and then want them done instantly. That is the nature of the beast. Know your option before you need them.

AARP has a lot of great information re: the care giving role and the internet is full of information about adaptive equipment and the like.

Having some sort of contact person i.e. a Case Manager in your Dad's town would help but it seems that he is limiting contact with Medical Personnel.
Should there be a hospitalization you can set up a lot of that stuff then.

Oh, You probably already know this since you posted your story here but I am going to post this anyway. Spread the wealth, don't go it alone. Many hands make light work. Good luck.

 

[calmloki]

Everybody dies. The tough thing is striking that perfect balance between facilitating independence and providing care. Interesting to see the difference between the way my gal and her sister care for their almost 95 YO Mom. My gal is easy going and patient with her Mom, tries to help her make her own decisions and feel that she is as independent as possible. She calls that care-giving; working for her Mom to assist her in doing what she's always done. I call it golden ticket - the Mom has pretty broad latitude in her desires. My thinking is that at 95 if she wants a coke or a drink or a smoke or pretty much anything she should have it. (in fact, a small diet coke per day is about the limit of her vices) Of course there are two ways to look at that - it might shorten her life by 6 months or it might cut her remaining life in half. The sister does care-taking - there care is focused on diet and exercise, the house is redone to facilitate easy care by the care-taker. The Mom is trained in new habits and diets. The Mom's health is perhaps better under the care-taker but her desire to live and joy in life is greatly diminished. Bet her life will feel like it drags on forever if care-taking continues....

Is life to keep a body going or a mind? Does one honor the habits and practices of a lifetime or decide one has a better idea and force that idea upon the old dog? Think my view is clear enough - absent compelling reason I'm against training old dogs. Clean the occasional mess up and get favorite food to them, leave what is familiar in place, and God willing, they die in bed or get hit by a bus.

Lots of permutations in relationships and abilities and care needed or possible - we all do the best we can with the situations we have - and feel the shadow of the reaper upon us as we see him closing on our parents. Close or not the parent's genes are ours and there are ways we act because of them. And when they leave we move to the head of the line to consider our own final act...

 

[Nords]

And when they leave we move to the head of the line to consider our own final act...

Been a few of those conversations around Hale Nords too...

 

[Brat]

A lot of us have been in variations of the situation you are in now. Keeping your brother in the loop (I assume you have no other sibblings) is critiical. All you can do is line up resources for the inevidable day of crisis and let your Dad know that you are willing to give him a hand when he asks.

After what my DH and I experianced we resolved to NEVER put our kids through that! Consider the posibility in 20-30 years there but for the grace of God goes your daughter. Do what you can to spare her that grief.

 

[DangerMouse]

There's a constant tension between trying to treat our parents as adults while attempting to figure out if they're still capable of reasoning as adults.

I don't know where that line is drawn, and it sure doesn't stay put.

...

This is so true. I don't feel anyone should feel guilty or be made by others to feel guilty because their parents have lived the consequences of their own choices. Please don't think I was implying you are responsible to ensure your fathers actions are monitored. In most cases it would be irrelevant if you were in the next room, when somone's number is up they will be gone regardless of the amount of effort anyone makes.

Brat, you make an interesting observation about ensuring you never put the next generation thru what you went thru. It seems like a large number of our friends are going through the same experience with their parents refusing to take any outside help offered. We have all vowed that we will learn from what we are all experiencing with our parents and when it is our time will ensure we act in a different manner.

 

[Nords]

After what my DH and I experianced we resolved to NEVER put our kids through that! Consider the posibility in 20-30 years there but for the grace of God goes your daughter. Do what you can to spare her that grief.

Well, I'm seein' the other side of that now.

Our last Nords reunion was when Grandpa died in 2002 after nearly 14 years in dementia care. We had a lot of time to talk during the viewing and the service and the burial (in Milford, OH near Cincinnati) and Dad said "Guys, I've made plans to make sure this doesn't happen to you like it happened to me." My brother and I both heaved huge sighs of relief and took no further action.

Seven years later, my Dad's idea of "plans" is a lot different than what we would have done. I don't think Dad deliberately stopped short of identifying housecleaners and caregivers and visiting nurses and full-care facilities, or maybe he couldn't bring himself to look at that situation. Or maybe he just doesn't remember what he did and we won't learn about it until we get a look inside his file cabinet. I think he feels that he's taken care of his will, his medical directive, and his LTC insurance-- and that's all he thought he needed.

I think the problem is that we adult kids don't know (or don't learn) what's really needed until it's too late to make sure it's being taken care of.

My spouse has condensed this whole discussion into three words from a sitcom: "Just shoot me." I don't think I share that sentiment (for either of us) and I'm glad I don't have to delve into the mechanics of that "plan" for a few more decades. And from our genetic/lifestyle indicators, maybe I won't be the first one to have to make that decision.

For our daughter's sake, there's a very very nice brand-new full-care facility with a memory care ward opening next month just three miles from our house. How convenient!

 

[REWahoo]

My spouse has condensed this whole discussion into three words from a sitcom: "Just shoot me." I don't think I share that sentiment (for either of us) and I'm glad I don't have to delve into the mechanics of that "plan" for a few more decades.

I'm of the opinion many (most) who plan on using the Hemingway Solution fail due to the situation you describe with your dad. How can you implement the plan when you can't even recall what it was? Keep a note on the refrigerator door saying "shoot yourself"?

 

[Walt34]

We have all vowed that we will learn from what we are all experiencing with our parents and when it is our time will ensure we act in a different manner.

Which is why I can see DW and I moving to a continuous care facility in ten years or so. We don't have kids and wouldn't put that burden on them if we did.

One BIL calls that (continuous care facility) "waiting to die". I call it facing the reality that in 20 years I'm going to be almost 80. Hopefully I'll still have all my marbles but if not I don't want DW to have to deal with some cantankerous irascible unreasonable senile old coot.

 

[REWahoo]

... I don't want DW to have to deal with some cantankerous irascible unreasonable senile old coot.

I'm not positive but it does appear you may be too late...

 

[brewer12345]

Tough deal, Nords. My sympathies.

This is a wake-up call/reminder for me. I have nudged my parebts to get their affairs in order, but they have been lax about it. Time to start pushing them again. Dad just turned 70 and is a heart patient (having issues with arythmia now). He recently had a minor accident after a dizzy spell. Mom is in OK shape, but heavy. They live in a small town 45 min south of us and the house is not set up for degrading physical conditions. Time to push them on the will, healthcare directive, POA, etc.

 

[Orchidflower]

REWahoo is cracking me up....

If you are only 70 years old and going into continuous care, isn't that a little early to be throwing in the towel UNLESS you have a family history of early dementia? Just my opinion.

 

[Nords]

I'm of the opinion many (most) who plan on using the Hemingway Solution fail due to the situation you describe with your dad. How can you implement the plan when you can't even recall what it was? Keep a note on the refrigerator door saying "shoot yourself"?

Yeah, Galt pretty much ruined the credibility of that method, along with his own credibility.

I used to think that my Dad was just going to "take a hike", literally. Now I think that he's enjoying life too much to even consider the issue. If he ever revisits it then he may be too incapacitated to do anything about it. Even worse, he might not be able to finish the job.

Personally I think I'll always be curious about the next sunrise, even if I spend my entire day playing Windows Solitaire...

Tough deal, Nords. My sympathies.

This is a wake-up call/reminder for me. I have nudged my parebts to get their affairs in order, but they have been lax about it. Time to start pushing them again. Dad just turned 70 and is a heart patient (having issues with arythmia now). He recently had a minor accident after a dizzy spell. Mom is in OK shape, but heavy. They live in a small town 45 min south of us and the house is not set up for degrading physical conditions. Time to push them on the will, healthcare directive, POA, etc.

I'm just getting started in the new vocabulary of a new to-do list:
Will.
Healthcare directive, medical directive, living will, whatever the current term is.
Some sort of HIPAA permission for you to be told by their doctor/hospital what's going on. This may be different from the previous sentence.
Release from your parents on a doctor's form allowing you to speak to the doctor (with or without your parents present).
Durable financial POA: as you know, this can be a hassle. Many financial institutions have their own forms and nobody else's will do. It's far easier to be added as a joint owner of a checking account, which of course has its own estate-planning issues. My Dad says that when he needed POAs for his father (in 1988), the banks would give him a blank form and not ask where/how it was signed. But this was in a small town and they knew him.

It's also very helpful for the parents to write letters telling the kids what type of funeral/service they want, how they want to handle the transfer of possessions, and in general what they wish to happen when their estate is settled.

My Dad has taken care of #1 and #2, but will go no further than that. I'm starting with that assumption, anyway, and hoping to make progress later. The rest probably gets handled after "the call" in the ER or the doctor's office

 

[brewer12345]

I sent Mom an email this morning pushing her to get the estate planing done, which she has been procrastinating on for a good 5 years now. I am trying to get them going with my estate lawyer, which should smooth things when the inevitable happens.

 

[Brat]

Consider giving your parents a gift certificate for the estate planning project.

Even when your affairs are in order, legally, it is a challenge to help our parents face their own frailty and accept assistance. It may be only my experience, but men particularly won't accept help from anyone but their wife. I think this is the reason why elderly widowers often marry again (remarriage should be anticipated in estate planning).

From time to time in the Pacific NW searches are conducted for elderly men who have gone walking/hiking alone. The need to walk is often associated with Alzheimer's but I suspect this is more associated with the resolve of some to to demonstrate the to family that they are still capable of taking care of themselves.

 

[bright eyed]

Hey Nords, just wanted to share my empathy for your situation. My FIL had a slew of medical probs (i think i shared some here) and it is a lot extra to do and extra emotional drain as well.

If anything you are well equipped to handle it and he is lucky to have you as a son!

Best wishes to you and your family thru this...

 

[DangerMouse]

Which is why I can see DW and I moving to a continuous care facility in ten years or so. We don't have kids and wouldn't put that burden on them if we did.

One BIL calls that (continuous care facility) "waiting to die". I call it facing the reality that in 20 years I'm going to be almost 80. Hopefully I'll still have all my marbles but if not I don't want DW to have to deal with some cantankerous irascible unreasonable senile old coot.

We are thinking of moving to a facility when we qualify at 60. In Australia our facilities have 3 levels of care. First is independent living which would allow us to have an apartment or villa. When things start to go downhill we would get assisted living - stay in the same residence and they would come and provide required assistance. Last stage is nursing home where you are lying on a bed in a private room in the nursing home waiting for the end to come.

We also don't have children and figure we should make the decision whilst we are at the top of our game. 60 may seem young, but personally I think there are a lot of advantages. First, when you buy in there is no stamp duty which is about 5% on any property you purchase in Australia. Secondly, you have a built in neighbourhood watch so when you are away you don't have to worry about what is going on at your property. We intend to travel a lot so whilst we are away the facility will rent our place out for respite care so that will give us additional income. These places have so much in situ, ie. gyms, classes of all kinds, we will decide what we participate in and what we don't. Also while we are younger it's not like we are confined to premises. Just think at 60 we would be the youngest people there and that will give us a chance to age in place and get to know a wide range of people. I think it will be easier to make the move at 60 than being 80 and having to shake up your life.