PV Mirror, Dec 4-10, 2010, issue # 112, pg 16

Last week’s article addressed a challenge that most of us will face eventually; that of caring of for our parents. I described many different situations and the effect on the “adult child” who must meet their parents’ needs while raising their own children, maintaining a demanding career, living out of town, etc.

Must do no matter what

Everyone must create certain legal documents, “advance directives”, before any problems occur. It is so much more difficult to make decisions in the midst of a crisis or stressful situation. It is essential to know who (one or more persons) is legally allowed and required to make both the medical and financial decisions if the person became incapacitated. Everyone seems to know this is necessary, but not everyone follows through and gets it done. Things quickly become very complicated if such documents are not in place. You must have a living will and power of attorney letters and a patient advocate form and/or health care proxy. These must be drawn up ahead of time while the person is still of “sound mind” or considered capable of making such decisions. They cannot be made afterwards!

Can you imagine what it’s like to try to check someone into the ER when they have had a seizure or a stroke or are hallucinating or don’t know who they are because of dementia? Try and get them to agree to some procedure or to sign a waiver, etc. In the beginning of dealing with my Dad’s Alzheimer’s, we had power of attorney letters but no patient advocate form registered with the hospital. After a great deal of arguing and insisting that my Dad couldn’t sign his name, we finally took his hand and wrote an “X” as his signature. It is very stressful and upsetting for the patient who is confused, for the staff, and for the family.

Financially, imagine if suddenly in an emergency, you (the adult child) couldn’t get access to your parents’ bank account or couldn’t sign on their credit cards? What if you never completed the power of attorney letter giving you the right to handle their banking; sign their checks and credit cards, sign their tax returns, handle property transactions, pay bills; mortgages, utilities, deal with their health insurance, social security, etc.????

I’ll tell you “what if”…you would have the nightmare of legally obtaining “conservatorship” or “guardianship”. And then you would have to keep impeccable expense records to show that you have not misappropriated the money or properties and would then present these records in court every year for approval. I’m sure no one thinks that sounds fun! When choosing between getting advance directives and power of attorney letters drawn up or waiting for the sudden incident or disease that requires that you go to court, no one would intentionally choose the latter. Act now!

Other conversations to have

Ask your parents (or those of you at this age, please consider), where they want to live if one of them is widowed or becomes ill, or unable to live alone or on their own anymore. Many adult children just assume that their parent will come live with them when the time comes and never even ask their parent what they want.

Most elderly who have moved away to warmer weather do not want to return to the northern cold winters, for example, or they do not want to live among the chaos of you raising your children, or they don’t want to give up their home, their friends, their lifestyle, nor their independence.

If they can no longer take care of themselves or it isn’t safe for them to live alone, what do they want to do? Do they want to hire in-home staff, move into a senior citizen living center, or go to an assisted living or nursing home? Most people do notprefer the whole nursing home idea. In fact, they would rather consider almost any other option. Once my father realized he had Alzheimer’s he specifically made us promise not to put him in a nursing home or assisted living facility. Besides the disease process itself, that was his greatest fear and concern. In fact, nobody wants to be left alone or forgotten or only visited sporadically around the holidays because “they don’t know any different anyway”.

Obstacles

You must also consider obstacles to such choices. Assisted living and nursing homes do not allow pets, for instance. One colleague told me about an elderly patient who has Alzheimer’s and refuses to leave her home because she refuses to give up her dog. This is a very real emotional attachment and should not be underestimated. Many facilities have long waiting lists that could take months or years to get in or they may not accept patients with certain diagnoses.

Then there is the emotional detachment of letting go of all of their belongings, selling their home, and leaving their memories behind. Everyone fights for their independence and resists anyone’s attempts to take that away, so imagine being told “you can no longer drive, give me the keys”, or “you might set the house on fire, you can no longer cook for yourself”. Imagine going from a home with several rooms to a one room space that you are supposed to adapt to and feel comfortable.

The financial drain of assisted living and nursing homes is tremendous. The average cost starts at $56,000/year and any long term stay is not covered on insurance or Medicare. In-home care could cost less or as much or more, depending on the number of hours/week you have staff. The financial burden must be considered and talked about beforehand. Believe it or not, it is sometimes worth considering qualifying them for Medicaid. No matter what you or your parents’ financial situation, there is a lot to consider, strategize, and plan.

Ask your parents where they want to die; in the hospital or at home. Ask them how they want to die; what life sustaining and/or saving measures, a “DNR” (do not resuscitate) order, hospice, etc. Ask if they want to be cremated or buried and where.

Although these subjects may make you or your parents uncomfortable, they should not be avoided.