Helping Aging parents

[JBTX]

I am sure this has been discussed before and I don’t know if this is the right forum.

My brother and I have two aging parents - one 92 the other 88. They are both showing what is probably a form of early dementia. My dad got lost running errands and drove hundreds of miles before the police found him. He is also becoming frail and less mobile. Mom is fully functional, but has really bad short term memory issues. She literally won’t remember what you talked about a day before, or sometimes even an hour ago. She will text me daily on issues we discussed the day before.

Brother and I are out of state. It has become obvious that they need more help, but neither of then admits they have an issue (they both recognize the other has an issue) and they are fiercely independent, and want to stay in their home. I’m pretty sure they would reject out of hand anybody coming on a daily basis to check on them. They miss medical appointments and don’t remember what the doctors tell them.

We are going to start making more frequent trips there. I am trying to help with some finances and other stuff from afar (without their full knowledge, they are also very private).

It seems like the only choices are to move there near full time or wait for something catastrophic to happen. Any discussion of assisted living or in home help are swatted down quickly. This is only going to get worse.

Curious to know how others handled such situations.

 

[RetiredHappy]

If they resist any help or listen to you and your brother, the last resort will be to contact Adult Protective Services. Your identity will be kept private from your parents. A social worker will be assigned to them and do an evaluation. Since the police was involved in locating your father, I am surprised that a social worker has not already been assigned to him. Anyway, the social worker will come to the conclusion that they should not be left home alone and come up with proposals, which may include moving them to a facility. They will "manage" your parents' case.

 

[Jerry1]

This is only going to get worse.

Curious to know how others handled such situations.

Correct. It will only get worse. You don’t have to wait until something drastic happens. You have to go and insert yourself and common sense into the situation. They won’t like it and from their point of view, it will be catastrophic. Unfortunately, that’s the way it goes. DW’s mom stayed in her house as long as possible. When she came to live with us, she kept walking away. We had to put her in a memory care unit. That was very hard on everyone, but not as hard as the thought of mom hurting someone driving or walking off and getting hurt or worse.

Hang on, this is the toughest thing me and DW have ever been through. Get good counsel and do what you have to do. Praying for you.

 

[JBTX]

If they resist any help or listen to you and your brother, the last resort will be to contact Adult Protective Services. Your identity will be kept private from your parents. A social worker will be assigned to them and do an evaluation. Since the police was involved in locating your father, I am surprised that a social worker has not already been assigned to him. Anyway, the social worker will come to the conclusion that they should not be left home alone and come up with proposals, which may include moving them to a facility. They will "manage" your parents' case.

I think there is a procedure with such driving incidents that a letter will be send requesting a doctor visit and a visit to DL office, and that letter has been received. Don’t recall anything about social workers but good to know that is a possibility.

 

[Sunset]

Get yourself as power of attorney immediately.
Someone will come along and steal all their money or house.
If they forget to pay property tax, the house will be sold out from under them.

As intrusive as it is, they need OP & sibling to get involved and take control.

We have an old relative, over 90. We put an apple air tag on his house key ring and one in his car. So if he gets lost walking or driving we know where he is located. Also added joint to his account,

He gave away his house. Adult protective services didn't do squat other than see he was not dying.

 

[NeilDH]

My family on my mom’s side dealt with a similar situation with my great-uncle (95) and -aunt (92). He fell a year ago and we all basically didn’t let them move back into their condo and got them into assisted living. He kinda had wanted to (and dislikes it now) and she really didn’t (and largely likes it now). It just had to be done. You all either gotta choose to be their FT caregivers or get them into assisted living, or get them home help. And it’s fully OK if you -don’t- want to be FT caregivers. In any case, there could be some agony involved for all parties, but a workable solution can be found.

I agree a POA needs to be established if not getting on their accounts, or at least some kind of added-user access to them so they can be tracked by you in addition to, in place of or in spite of them. And of course wills and an executor(s) established (or a trust). I’m becoming the lead on their finances. My uncle is not letting go of control, for better or worse, but I’m at least tracking the money as best I can and sometimes helping him keep it straight — he had been meticulous with it all his life, but now he’s slipping and even he realizes it at least somewhat.

 

[Ronstar]

We have been going through this with DW's 95 yo mom for 5 years. I agree with above POA advice. And take away the car keys and sell their car before something catastrophic happens. Then you either need to move nearby (for daily visits), get them home health care, or get them into assisted living.

You have to put their wishes and feelings aside when they no longer think rationally, and do what you think is best for them. That's the tough part.

A consultation with an elder care attorney is a good place to start.

 

[The Cosmic Avenger]

I would recommend approaching it a bit like a parent who doesn't want to have a will -- remind them that if they don't decide, someone else will decide for them when they can't, and it may not even be a family member, it may be a stranger. And if they start accepting help now, it may avert that completely and help them stay in their home for the rest of their lives instead of having the choice taken away from them. You can cite the police involvement with his driving issue and say they may already be on a list for such treatment. (Not all adult public guardianship is problematic or detrimental, but it's certainly not uncommon, and it is legitimately an option they should avoid if they have other choices.)

 

[Jeffman52]

DW and I moved from Georgia to Ohio about 6 years ago to be closer to her dad who was 88 at the time and having some of these issues. We specifically chose a house that was "door to door" less than 10 mins. We installed cameras at the entry/exits with motion detectors so we knew when he went out and when he came back in. He had a scooter so we installed GPS on it because he had decided to go 5 miles to Kroger on it once and we were not aware he was going on a road trip. We visited VERY often and my SIL and BIL also visited more often so that he was not alone much. We learned as we went on how we could mitigate the danger represented by his condition.

But even with all of that, there did come the time when we had to move him to assisted living. He did not want to go, and he looked right at DW and said, I never thought you would do this to me. But it was way past time and it was a tragedy waiting to happen if we didn't. He did pass away last year at 93 after a fall, and pneumonia. We never regretted moving here to be with him in his last years, regardless of how it ended.

 

[Aerides]

Get yourself as power of attorney immediately.

This is the only way to have power vs. watching from the sidelines. But it might be too late if they won't say yes to that.

 

[ivinsfan]

This is the only way to have power vs. watching from the sidelines. But it might be too late if they won't say yes to that.

With what OP writes it's too late...and getting a POA for a person that isn't competent is a real problem. Nords had a very difficult experience getting one for his father. Any of you who have an elderly parent ie 92 and 88 should consider having a serious discussion with your parents to put a POA in effect before it's too late. OP I wish you and your parents the best.

 

[Gallaher]

Wow! We all get our turn. My in-laws 91 (good health), 85 (terrible health) are posing great challenges. Both refused to sign wills until recently ( why? ). They have almost nothing, have lived successfully on just SS. They both should be in assisted living but have no way to pay for it. FIL has always planned for his five kids to take care of them. Unfortunately, three of the five have their own financial challenges.
Meals on Wheels has been a huge blessing. Not for the food but because they check in daily.
I’d start with Meals on Wheels
Are they Church members?
Neighbors?
Can you find a local Senior Center?
Sounds like you are ready to do the work if you know what needs to be done. Now you need a regular/daily check in.

 

[skipro33]

Try to get them to sign powers of attorney for financial and medical. The two are separate. File the DPA for medical with their medical records. Then try to get them in to see a neurologist for a diagnosis of dementia. Once that happens, the DPA kicks in and you have full control of both medical and financial decisions.
This is what I was able to do with my father. To get them to agree, I pretended that I wanted them to be MY DPA and since they were mine, how about I be theirs? I explained that they taught me everything I know about finances and wanted them to be covered by someone with that ethic if something ever happened to them such as an accident, never mentioning their current medical deterioration.
Instead of moving to them, I offered to have them move in with me. Once I had them in, we sold their house to fund a more permanent solution. My mom passed away within the year and shortly after, we took Dad touring retirement communities. We convinced him by telling him he needed to be out on his own, not living under my roof with my rules, just like when I was a kid. The lure of his 'independence' did the trick. We found one that took those with a diagnosis of Alzheimer's but still fully functional with a sliding scale for monthly charges based on his needs as he progressively got worse. We also got an attorney who helps vets get VA benefits and in my dad's case, got him an $1800 a month pension for serving in the Navy during Korean conflict. He was nowhere near Korea and only spent 2 years in the Navy, but that's what he got. This was based on his diagnosis and living in the care facility. The VA said all his income went to medical needs now and that he qualified for the pension. I never would have imagined that and the lawyer worked pro bono. I did gift him a case of his favorite wine though.

 

[ivinsfan]

OP one thing to mention is when the financial and PA talks start either you or your DB take the lead and keep the lead. Nothing good comes from both of you trying to accomplish the same thing, any kind of distrust or confusion will be worse if your do this. Keep it simple, mention the sibling ie brother Joe thinks we should do this, or brother Joe wants the best for you but only one brother should be the point man. One child should present a calm consistent attitude, this isn't easy when they get angry or push back but it's important.

On your point about an eldercare attorney...do any of you know any attorney you have worked with in the past? Go there first...and don't delay.

 

[pacergal]

OP--How frightening for you and your brother to experience your father lost/driving and having police help to locate him.

Perhaps a place to start, which has been mentioned, is a consult with an elder law attorney.
Would your folks sign an ROI with their Dr to at least let him/her talk with you about their care and concerns? That would allow you to discuss dementia testing/removing drivers license, etc with the medical professional, along with plans for ongoing care and what you and your brother are noticing vs what presents in the office.
That may also be the start of DPOA talks, not to "take over" but to assist (in their minds), which would allow you to make decision as things get worse. Which they will, sooner than you think.

At some point, both you and your brother may need to visit with them together to talk about wills, power of attorney, etc. If put to them as giving more power to family to make decisions, rather than a dr or judge, it may be more acceptable.

One way I always approached my father was, "you don't need this now, Dad, but let's think about the future". That helped his willingness to discuss, process, make decisions. (even though some things he did need now, at the time!)

Best wishes as you navigate this. It is now easy dealing with the issues of aging parents.

 

[nwsteve]

I would recommend approaching it a bit like a parent who doesn't want to have a will -- remind them that if they don't decide, someone else will decide for them when they can't, and it may not even be a family member, it may be a stranger. And if they start accepting help now, it may avert that completely and help them stay in their home for the rest of their lives instead of having the choice taken away from them. You can cite the police involvement with his driving issue and say they may already be on a list for such treatment. (Not all adult public guardianship is problematic or detrimental, but it's certainly not uncommon, and it is legitimately an option they should avoid if they have other choices.)

We found this logic effective with my 90 yr old FIL. to nudge him into a living trust (DS/DBIL Trustees) with all his real estate. A move that proved VERY beneficial when it came to his last years and a repositioning of investment of a ground lease which was abandoned by a franchiser at the end of a 40 yr lease. More than doubled lease revenue albeit with a lower credit leasee and ultimate sale at his death.

 

[atmsmshr]

This is a sad part of life that DW and I promised to not put our children through. We signed up on a CCRC wait list at 62 and said call us in 10-13 years.

• Been thru this with in-laws and on the journey with my parents who are currently living independently. Both were out of state. In a crisis you can jam a lot thru someone who is in a shocked condition. If they are stubbornly independent – chip away over time before the inevitable crisis.
• Basic necessary steps:
• Durable POA, Health Care POA and Living Wills. None of these matter in the moment if they are not preregistered with Primary Care Doctor, and POA is not preregistered with the bank. Keep a Health Care POA on your phone for emergencies. It takes awhile to set this up but it is most important.
• Set up a simple will in accordance with state laws and try to obtain prior concurrence of siblings.
• Avoid probate and set up primary and secondary beneficiaries: bank accounts, stocks, CDs, auto.
• Sign on to any Safe Deposit Boxes and know the inventory.
• Verify identification is not expired and renew if necessary. (Real ID for plane flights)
• Know the Medicare poverty rules for your state. Not all are the same.
• Know if a parent is eligible for VA benefits such as Aid and Attendance. (e.g. wartime vet who may not have even been in a combat zone) Get a copy of any DD214s.
• Write down dates of birth, social security numbers.
• Get a copy of last year’s Social Security Statement.
• Get a copy of ALL identify documents including marriage certificate, government IDs.
• Get a copy of Medicare, supplemental insurance, prescription insurance cards.
• Make a copy of all current medications and medical aliments.
• Know how to pay the bills down to the account number.
• Put all of the above into a folder for you to keep at the ready!
• Perform annual Check with providers to ensure Insurance continuity.
• Get to know the neighbors, their friends and give them your telephone contact.
• Place a list of important telephone numbers on their refrigerator.
• If they have cell phones, ensure you are listed as ICE.
• In case of dementia – get a specialist diagnosis before whatever event happens. You just can’t stick Mom in Memory Care after Dad dies without a diagnosis.
• Go with them on their annual checkup with their Primary Care doc at a minimum.
• Know the local community resources – in detail, before they are needed.
• Have an open dialogue about ‘Honoring their wishes in the autumn of their lives.’ Write it down. Have them sign it. Can help if you need to get guardianship.
• Have frequent but noncontroversial discussions on driving ability.
• Share with them alternatives such as Uber/Lyft (which you can order from your phone no matter your distance to parents), senior transports, UberEATS, grocery delivery etc. It helps with giving up the keys for them to know they are not trapped.
• Go out and look at some local senior living options. Talk to the staff and residents during tour. Understand their payment structure and levels of care. Identify which ones accept Medicare.
• Set aside about $10k to help them transition if they are in spend down to Medicare. You will not get them into senior living without personally signing as guarantor. Medicare approval is not automatic nor is it fast.
• Set up an insurance policy for burial/cremation before spend down is complete.
• Ensure you have spouse or sibling support. The time and emotional toll is heavy.

 

[jimmy38]

First of all, I'm sorry that you're going through this

I've been in a similar situation (but am an only child) - I found it helpful to think through discussions before having them, such as framing them in a way that made my parents still feel in control and independent (even if they weren't...). The old me would speak before thinking and that created a lot of issues!

Remember to take time and care of yourself - It's easy to get overwhelmed, especially when managing things from afar. You got this!!

 

[Jerry1]

• Know the Medicare poverty rules for your state. Not all are the same.

Very comprehensive list. I think on this bullet point you mean the Medicaid poverty rules.

 

[SecretlyFI]

• Go out and look at some local senior living options. Talk to the staff and residents during tour. Understand their payment structure and levels of care. Identify which ones accept Medicare.
• Set aside about $10k to help them transition if they are in spend down to Medicare. You will not get them into senior living without personally signing as guarantor. Medicare approval is not automatic nor is it fast.

Same on these bullets - did you mean Medicaid? I think nursing home and similar places sometimes take Medicaid, but not Medicare.

 

[marko]

How about some at home help as a starting point?

Someone who might come in to help with meals, bathing, and/or driving. At the same time a bit of supervision built in. Ease them into the idea of some help rather than a radical shift to a nursing home.

In addition to myself, my brother has two daily helpers and a weekly cleaner. They've become sort of his buddies that break up much of the boredom and he looks forward to seeing them.

Costs are tons less than a nursing home and depending upon income can have subsidies through your local elder services.

[Edit] Sorry, I missed your comment about swatting away home services.

 

[JBTX]

I would recommend approaching it a bit like a parent who doesn't want to have a will -- remind them that if they don't decide, someone else will decide for them when they can't, and it may not even be a family member, it may be a stranger. And if they start accepting help now, it may avert that completely and help them stay in their home for the rest of their lives instead of having the choice taken away from them. You can cite the police involvement with his driving issue and say they may already be on a list for such treatment. (Not all adult public guardianship is problematic or detrimental, but it's certainly not uncommon, and it is legitimately an option they should avoid if they have other choices.)

Thanks for this. This is something I hadn’t thought of and may be a useful way framing the issue.

 

[JBTX]

Thanks for all of the helpful comments. I’ll take a run at POAs next time. I suspect my mom would agree, my guess is my dad won’t. If I could at least get my mom’s that is a start.

It is hard to know where to draw the line - in terms of letting them live the way they choose, and when to assertively intervene.

As to the finances I now have at least some visibility and some online access but it would be better if it was all above board

As to the driving, luckily my dad hasn’t driven since the incident. Nobody has specifically told him not to, I guess maybe he just got spooked by the whole affair. But now is is agitated that the DL office has gotten involved and views the whole thing in a semi conspiratorial way.

Mom is fully functional, other than she forgets most of what you tell her after an hour, and keeps bringing the same things up over and over again Groundhog Day style and sometimes ends up wasting time fruitlessly on the same things. Sooner or later that will get bad enough to where it causes serious issues.

 

[Koolau]

I went through much of this with my parents and I lived only 6 blocks away. For a long time, I simply stopped in every day and made sure everything was okay (enough food, pills taken, no falls, no serious illness.) The really good thing was that mom always knew to call me (and how to call me) if she needed anything.

Eventually dad went into a memory care unit and passed quickly. Mom stayed in her home (with my help) for several more years. Eventually, she got a UTI and had to be hospitalized. She never got to go back home as her dementia got worse due to her illness. She went to a memory unit from the hospital.

So, you may find that the situation will get worse before it gets better. It got to the point that I was willing for mom to stay in her home - even if it meant that she wouldn't get as good of care as she would have in a nursing facility. She wanted to stay in her home. As long as she and I could manage, that was okay. But when we could not manage, the decision was made for us by her illness.

She did give me POA - vital step if you can get it.

My heart breaks for you. I have at least some idea of what you are going through. It was a blessing to be close to mom and dad. I don't know what to suggest since you are far away. Blessings and prayers.

 

[Nords]

Thanks for all of the helpful comments. I’ll take a run at POAs next time. I suspect my mom would agree, my guess is my dad won’t. If I could at least get my mom’s that is a start.

It is hard to know where to draw the line - in terms of letting them live the way they choose, and when to assertively intervene.

As to the finances I now have at least some visibility and some online access but it would be better if it was all above board

@JBTX, just to make sure the vocabulary is correct, you want to get a durable power of attorney.

A regular power of attorney becomes invalid when the grantor is no longer mentally competent. You might be able to get things done with a POA, but as soon as the financial corporation knows that the person is mentally incompetent then they’ll stop working with you. And frankly, financial corporations have seen these issues a lot more than any of us.

If you’re unable to obtain a DPOA and the financial corporation won’t work with your POA, then the next step is typically filing a petition with your local probate court to appoint a guardian and a conservator.

Even when you have a conservator’s letter of appointment, many financial companies still won’t work with you (especially the national ones, and possibly even your local banks). In this situation you’d only get the justice you can buy (with a lawyer and another court order) and it’d still take weeks.

If you have online access to your parents’ accounts without a DPOA or a conservator appointment, then you’re technically violating the law. However if you’re acting in a fiduciary manner for your parents, and if the financial corporation can officially ignore what you’re doing, then you’ll probably get away with it.

If you haven’t done so already, it’s time to contact an eldercare business or a geriatric care manager near your parents. Do the interviews now (while you have more time than you’ll have during a crisis) and hire someone to open a file on your parents (their ages, addresses, health histories & issues, medication requirements). Then when you get the 2:30 AM phone call from a first responder, you can redirect them to the GCM (and contact the GCM yourself) to help with the crisis while you’re heading to your parents’ location.

Feel free to post more questions here or send me a message. I was my father’s conservator for over six years (Alzheimer’s) and I learned a lot— the hard way.