Thinking Ahead

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Hello, Dearie,

I am seeking someone who can help my family plan for my elderly father’s care.  He is currently in assisted living in Vermont but will run out of money in the next couple of years ….

       — Far Away

I am seeking someone who can help my family plan for my elderly father’s care.  He is currently in assisted living in Vermont but will run out of money in the next couple of years and will have to leave his assisted living facility.  We would like someone with expertise about the different options open to him for when his money runs out to start planning for this possibility.  He is physically quite well for an 88 year old, but he has significant cognitive issues and normal pressure hydrocephalus.  I live in Seattle, but my siblings live in New England. We would love to hear from you.

Barbara:  All those years when you were caregiving for Daddy, I always wanted to jump on the plane and come and be with you.  It was so hard being far away.

Dearie:  I know that’s what you wanted, but it wasn’t necessary.  

Barbara:  You always said that, but it still didn’t feel right.  For me, I just wanted to be there.   I wanted to know and see what was happening.  

Dearie:   I know.  But you came when you could and you and I had many phone visits that were really helpful to me. 

Barbara:  Was I really that helpful?  I just remember feeling that I wanted to make everything better. 

Dearie:   You were a good listener and you were there with me at the end when Daddy was in the hospital. Things changed quickly, decisions needed to be made, we weren’t sure what would happen next.   

Barbara:  We tried to plan, but I guess you can’t plan for everything. 

Dearie:  You only can do the best you can at the time.  And I think we did.  I know you miss Daddy. 

Barbara:  Yes I do.  Should I tell this daughter not to worry.  Not to hop on the plane. 

Dearie:  Yes, I think that’s exactly what you should tell her.  And let her know that if her father, or her brothers and sisters want her there, if her father is in a crisis, then that would be the time to come.  But for now, when they are planning ahead for his changes and needs, it’s ok for her to be where she is and work with her family on the things she can do from the distance.  She has a life to live with her own friends and family.  And that is as important for her to keep that going.  I know that’s hard to hear. 

Barbara:  Oh, Mama, it’s such a tug on the heart.  Looking back, I guess – I hope – we did the best we could at the time.  Seems to me this family is trying to think ahead, but about different kinds of decisions.  There are finances involved, choices about where he can live and his memory problems.    

Dearie:   We’ve been lucky, haven’t we, so far, money hasn’t been a problem for me but it’s always a worry. 

Barbara:  Mama, I’ve told you over and over, you don’t need to worry.  You have enough if you ever need it for getting help at home or needing to move.   

Dearie:  I know you say that, but it’s still a worry and I try to be careful. 

Barbara:  I know you do Mama.  I don’t mean to be stern, I just want you to relax a little. 

Dearie:   I know, sweetie, I’ll try.  Just like you, all the children in this family are working together.  I’m glad for the father.  His kids care.

Barbara:  Yes, that helps a lot and they know they need to do some planning instead of being surprised by a big change. It might not prevent all crises, but it is an important step.   I wonder if they have been to a lawyer and completed their father’s advance directives with him. 

Dearie:  I remember doing that with you, it wasn’t fun.   It seemed like an unnecessary amount of paper work, but you kept telling me how important it was.

Barbara:  That’s right, because having signed those papers gives you guidance when decisions need to be made. 

Dearie:   I just want to let this family know they are doing a good job of taking care of their father.  Says a lot about love.

Barbara:  Yes it does, Mama.

Takeaways

Dearie:   I like that this family is working together and communicating with each other.  I wish for them to be able to share the work that it will take as their father changes and needs more care.  Some of the children may live closer to him and able to do one kind of care, the daughter who wrote the letter can do other things from a distance.  And then the brothers and sisters, will need to take care of each other.

 

Barbara:  First and foremost, find out from the assisted living what their limits and abilities are for taking care of your father. At what point will they say he cannot stay and what is their process for informing the family.  The worst thing would be for the assisted living to give you too short notice.  It also might be worth asking the facility now, if they ever do make financial accommodations for residents who have been in their community for many years. Other financial planning should be done with a knowledgeable elder care attorney, as well as completing your father’s advance directives, including a will, a living will and powers of attorney.  The other professional expertise that you will need is a geriatric care manager – they come in all flavors and sizes.  Typically, a care manager has a degree in either social work or nursing and may have other credentials in the field of aging.  Care managers can do as much or as little as you ask — from short consultations on options for care to daily managing home care aides and doing regular visits and assessments. Lastly, your father’s primary care physician will be monitoring his normal pressure hydrocephalus and his cognitive decline.  Some treatment options may be available.  Here is information from the Alzheimer’s Association on Normal Pressure Hydrocephalus https://alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/normal-pressure-hydrocephalus And here is a good article about the importance of advance care planning https://www.nia.nih.gov/health/advance-care-planning-healthcare-directives To find a geriatric care manager go to the Aging Life Care Association at www.aginglifecare.org/ For an elder care attorney go to the National Academy of Elder Law Attorneys at www.naela.org/

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Ask Dearie is a service of Barbara Green, LICSW and Sound Aging. Barbara’s mother is now 95 years old, and wishes for privacy. Though “Dearie” is fictive, she speaks much as Barbara’s own mother has over the years. Their conversations reflect an intimate mother-daughter shared history as well as the many conversations Barbara has had with other older women. Some of your questions may require more attention than Barbara can provide in this advice column. For a more in-depth response, Barbara may contact you about referral for a consultation.
 

©2019 Barbara Green, LICSW and Sound Aging | 206.799.7108 | barbara@soundaging.org Providing Advice to Seniors and Their Loved Ones in Seattle, Washington and Beyond