It's been more than four years since I started the thread, and three years since the last update.
Dad's doing fine. He healed from his perforated ulcer, and then about six months later he went through several months of chemotherapy for an obscure form of multiple myeloma:
http://www.early-retirement.org/forums/f38/multiple-myeloma-questions-58350.html
http://www.early-retirement.org/for...-of-waldenstr-ms-macroglobulinemia-58633.html
As near as we can tell, everything's in remission.
In 2012 Dad went through a phase of sundowning and once, in a rare flash of anger, he actually stomped out of the care facility. Per their procedure they called the local police and sent one of the staff to follow him. Dad calmed down a few blocks later, stopped when the police car rolled up, talked it over with the patrol officer, and went to the hospital with them. When my brother caught up with Dad a couple hours later, he'd had been given a physical exam and was being assessed for clinical (chemical) depression. The hospital put him on a low dose of Lexapro antidepressant, which continued for about a year. He's tapered off that and the sundowning does not seem to be a problem anymore. We were pretty concerned about the whole incident but Dad remembers none of it.
These days his only medications are Lisinopril (for blood pressure) and donepezil (Aricept) for cognition. The latter is a little controversial for use in mid-stage Alzheimer's but it appears to at least limit the rate of the decline.
Dad's still verbal and mobile and he keeps up with his physical, occupational, and speech therapy. His weight is stable, always a good sign for an Alzheimer's patient. He tires more easily and spends most of his days working on a jigsaw puzzle (which is actually a good activity for Alzheimer's patients). He still goes out for Sunday lunch with my brother but we're not sure how much longer he'll want to keep doing that. Over the years the decline has been slow and inevitable.
The care facility has been outstanding. I regularly hear from the accountant and the staff does quarterly teleconferences. (Dad even sits in on the conference calls. He's always amazed to learn that I'm calling from Hawaii.) My brother drops by randomly at least twice a week, so that helps a lot, but many of them are also professionals who really seem to take pride in their care.
We take it one day at a time, but we favor slow medicine over aggressive treatment. If Dad's myeloma came back or he had some other health crisis, it's quote possible that we'd favor palliative medication and hospice. Of course those decisions depend on the situation, how badly it affects him, and how much pain he's dealing with. Dad's symptoms started seven years ago and Alzheimer's progresses in completely unpredictable fits and starts. Dad could easily live with it for another decade.
John Hancock eventually moved to electronic deposit of Dad's long term care insurance payments, which made my financial chores a little easier. (They still mailed me a monthly letter to notify me of the electronic deposits. No wonder they have to keep raising premiums.) They continued to apply the policy's 5% inflation factor each year, which raised its payout cap to $318K. However they inexplicably stopped paying after the penultimate deposit, claiming that the policy was capped at $312K. The form letter was from Hancock's Time/Fortis subsidiary, and Hancock even sent a second notification on their stationery with the same text cut&pasted into their format. To add insult to injury, the text was formatted in a four-point font that required a magnifying glass.
I fired back a response with my payment records and copies of their previous correspondence about the $318K cap. After a tense two weeks they deposited the final $6K and followed up with a terse letter noting that my "request" had been "approved". Yeah, thanks for that. I still have no idea what provoked them to change the cap to $312K. I received the final 1099-LTC tax form in early 2015 and haven't heard from them since. Their customer service was horrible from the day I filed the claim until the day it reached its cap.
Needless to say, I'm not a fan of long-term care insurance. I certainly don't want my spouse to have to deal with the chore of filing the claim and tracking the payout. Here's some newer research on the subject:
Why I Won't Buy Long-Term Care Insurance - Military Guide
Dad still has his pension and Social Security, and I've conservatively projected that his assets will last another eight years. (The care facility predicts that they'll raise their rates by about 4%-6% annually.) A couple months ago, after Dad's second roommate passed away, the care facility inquired how we felt about moving Dad to a private room. It's quite a bit more expensive ($275/day vice $245) but 95% of Dad's moods and complaints have been related to roommates. Those issues generally got passed right on to my brother, who would have to drive into the care facility a few evenings a month to help Dad settle down. We decided to go with the private room at least as much for my brother's benefit as for Dad, and today everyone is much happier. As Dad's assets dwindle, we'll start the Medicaid application when he has about a year of payments left.
I get along well with the Denver probate court. (To be appointed as Dad's conservator while living in Hawaii, I actually had to sign a waiver of my extradition rights.) They thoroughly review each report and they're quick to tell me when the numbers look wrong or when my projected spending plan needs an update for the court's approval. We go through that drill every March but I spend a little time each week updating the expense register and the spreadsheets. When the annual report is due then I can usually cut&paste the numbers into the report and mail it off. (The probate court doesn't do e-mail either.) I've never been audited but they probably have plenty of other conservators to keep track of, and I think I'm pretty low on their list.
I've learned that financial institutions don't give a crap about probate court appointments. Even Dad's local bank in Grand Junction dragged me through a knothole to access his checking account (with its pension and Social Security deposits). I'm technically supposed to notify all of the companies he does business with, but I've stopped volunteering that info. Whenever possible, I do business online and avoid talking to humans. If I get a letter in the mail then I respond on their website or even via e-mail. I've kept his finances as simple as I can and I do all payments & transfers electronically. If a company thinks the finances are handled by my Dad, then I don't correct them. I haven't written a paper check as conservator yet, and I hope I never have to.
I don't plan to update this thread very often, but I'm subscribed to its notifications or you can send me a PM.
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