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