I need practical (not legal) advice on dealing with parents in assisted living.

Disclaimer. I have an attorney. I will go to him for legal advice.

My parents are 85 (dad) and 83 (mom). Today, I moved them into an assisted living facility. Since mom has Dementia and dad has diabetes, they are in a “focused care” unit. My dad’s mind is still pretty good. Mom has difficulty completing sentences. They have a long term care policy that will pay for about 5 1/2 months of care. Then, Medicare will take over once I have liquidated their assets and spent down their money (which isn’t a lot). I have power of attorney for my dad but will need to be made guardian of my mom since she isn’t legally able to sign because of the Dementia. I also have a mentally disabled brother whom I will also need to become guardian for. I have another brother but he lives 1500 miles away. I live approximately 250 miles from my parents. I would have tried to move them closer to me but uprooting my younger brother wasn’t really an option. He’s in a group home that he loves and there’s not one anywhere near where I live.

I’m looking for tips on ways to make the transition easier for me and for them. I’ve got a ton of their papers to go through and I’m really not sure what to look for or how to even organize them. Organization is not really one of my specialties.

Any advice would be greatly appreciated. I apologize if this reads like stream of consciousness. I’ve been under a lot of stress the past few days.

My dad spent last summer in a nursing home, then moved to assisted living while he dealt with what turned out to be a heart problem. It was temporary, as once he recovered from a valve replacement his strength returned and he’s back home.

Not sure how much help this will be, but here’s what I’ve found:

  • Are you sure on the “Medicare will take over once their assets are liquidated” bit? In general, Medicare does not pay for assisted living; it does pay for nursing home care. Those two things are very different in my area.

  • Does your Dad still drive? If so, that will help as he’ll be able to go out and get stuff he might need. If not, that might be difficult with you living so far away. Depending on the level of assisted living, your parents might need things like toiletries, new clothing, etc on a regular basis. Will you be able to visit often enough to take care of that?

  • Work with the staff to ensure your parents are really being cared for. At least in my area, the staff can get VERY overworked; they’re great people in general, but sometimes response times can get slow. Like all things, the squeaky wheel gets the grease, and if you call and (nicely) inquire about less-than-great care, your parents might get some extra attention.

  • LABEL EVERYTHING. In the ~2 months my dad was in assisted living, stuff went missing, including a walker. I don’t think it was malicious, it’s just the nature of the beast. At least if everything has a name on it, it’s likely to find its way back.

Good luck! I know how hard this is.

I can believe this.

Is there a social worker, or the equivalent, at your parents’ assisted living facility?

My parents are in assisted living. Actually, at the moment my mom is in the hospital, and we (my sisters and I) are trying to sort thru the accumulated paperwork. I am also hundreds of miles away, as you are. The social worker at their facility is very experienced in these kinds of issues, practical rather than legal.

Pardon me for asking, but are your parents OK with where they are living? My mom is mentally better than my dad, but now without her with him, he is very upset, and my mom is upset because he is upset and alone without her, and she is regretting the decision to move to assisted living. And I don’t know how to reassure them.

If you are a believer, I am praying for you. If not, I am sending good thoughts. Either way -

Regards,
Shodan

In Oklahoma, strictly speaking it’s not Medicare but “Advantage”. The rules are the same as Medicare’s nursing home rules.

Dad drives but he’s given me the keys. He’s a little upside down on one car and owns the other outright. He and I can leave money with the home and they will shop for him. I’ll also setup Amazon deliveries.

Good idea on the labeler. I’ll get one tomorrow.

Thanks!

I don’t know if there’s a social worker or not. I’ll find out.

This is only their second night in the home. Dad is ok but mom is struggling. It’s not the facility, it’s being away from home. I don’t know how to reassure her either. She was crying when I got there this evening but fine by the time I left.

I’m a believer. My dad is a liefelong Gideon. Pray away. It’s greatly appreciated.

Make your wishes known to the staff. Your parents probably won’t know to ask if there’s a minor blip. So go through the way to ask for help with your Dad. I feel bad for your Mom. Mr.Wrekker was able to keep his parents in their home. It took a bunch of help and gobs of cash. There is not a reputable care home in this area. They both died in hosipital ( at different times).
I hope it goes smoothly. Mom should start to settle down pretty quick. Label their clothing too.

Sorry if this sounds harsh, but I think it fits into your request for practical advice.

You need to make some hard choices WRT how much of your personal time/emotions/$ you are willing to commit to this situation over the long run. And realize that your sibling and other family members might well reach different decisions than you – and family and friends might be very happy to criticize/second guess any decision/action you take.

The situation you describe has no end date, and could turn into a sink, consuming limitless amounts of your resources. Beware of using up too many resources trying to ease every immediate concern that arises, only to find your tank is empty when some truly significant need arises months/years later.

I’ve known some people who have largely given up their personal lives to care for family members. That is fine, if that is the right choice for you. But if so, have that be the result of an intentional decision. Don’t just get slowly sucked into it, and then regret/resent it.

You might find it useful to speak with a social worker to develop some tools for handling this situation over the long run. As well as a financial advisor. And at least attempt open communication with other family members to try to ascertain whether you are all on the same page.

I also suggest getting all the necessary paperwork in order. Power of attorney, living will, etc. And at some point (while they retain as much of their faculties as they do) it doesn’t hurt to look into end-of-life options. Talk with your parents to ascertain their wishes re: hospice and the like. Better to have some idea of the possible choices that exist, then to wing it when you get a call in the middle of the night saying your parent has had a stroke and asking if doctors should implant a pacemaker.

Best of luck.

I’m sorry you’re having to deal with this. My wife and I just put her mother into assisted living about three months ago.

To expand on the advice above, see if you can find a social worker or LPC who specializes in eldercare. We paid a healthy chunk to consult with a licensed clinical social worker whose nickname is “The Old Lady Whisperer”. Worth the money; she gave us practical advice on legal and insurance stuff, but also good therapeutic counsel on how to make the transition easier on everyone, and - not least - taking care of ourselves during all this. It’s not an easy thing, and your sibs and you will have to make some hard choices; it’s important that you look to your own emotional health, as well.

Sending you good thoughts.

My mother-in-law is in assisted living now. Our lessons:

-Find out where all of the money is now, and act now to move it into a trust (or however you decide to handle this). (For example, do they need 2 cars now? Do they even need one?)
-Talk to a financial planner if you can, to organize the money piece.
-Do not co-sign anything for them without understanding the long term ramifications. Some debts will continue after their deaths if you set things up with the wrong way.
-Get everything lined up now, for both of them, for power of attorney, right to make medical decisions, and so on.

In my mother-in-laws case, she has lost track of her assets entirely. We are constantly finding out new information about accounts. Her lack of organization is making things much, much harder than I would have imagined. I would have the goal of getting it all as organized as you can now. It will help immensely later.

Boy. This one really hits home. I’m very quickly seeing how true this is. I appreciate the “harshness”. I showed my wife and she agreed because her parents are in failing health as well. I’m going to do my best not to let their situation consume my life or my resources.

Please look into this further to make sure your parents are enrolled in the necessary programs, because I think you may be mixing them up. Generally speaking, it is state Medicaid (Sooner Care, in your case) that pays for long-term care after one spends down one’s own assets. Medicare and some Medicare Advantage plans will pay for skilled nursing care for a limited period of time, but that is dependent on the patient’s condition (e.g., he or she has to be receiving physical therapy), not his or her assets. I may be wrong, of course, or at least overlooking something.

Disclaimer: I am not your lawyer, and you should not consider this to be legal advice. This is just an anonymous person suggesting that you take a second look.

I’ll second that. Maybe it’s different where the OP lives, but this is what I’ve found:

  • Medicare pays for skilled nursing for a limited time if there’s real need. In my Dad’s case, it took getting him admitted to the hospital for >3 days and a doc who agreed that he was in too bad of shape to bring him back to his house, where he lived alone. While in the nursing home, the docs figured out the root of his problem was that he needed a stent and a heart valve replaced. It was going to take ~6-8 weeks to make that happen. Medicare, for some unknown reason, decided he was well enough to go home a couple weeks BEFORE the procedures were done, and stopped paying for the nursing home care. (that was a fun week for me. “WTF are we gonna do with Dad?!?”, followed by much panic).

  • Nursing home care around here runs ~10K/month.

  • Assisted Living, depending on level of need, runs $4.5-$6.5K/month. Luckily, my Dad had enough assets that we were able to move him in assisted living for a couple months until he was well enough to go home. Medicare, Medicaid, and any other insurance pays nothing for Assisted Living. Nada. Zero.

  • Around here, it’s a very common practice for older middle-class folks to sell their homes & move into assisted living until the money runs out. Once the money is gone, they move into a nursing home on Medicaid’s dime. But you have to be dirt poor for that to happen, and the nursing home sucks big time. Understaffed, dreary, blech. I honestly hope my Dad dies before he has to go back to a nursing home.

Anyway, that’s my story, I sincerely hope the OPs situation is different and I’m wrong, but as far as I can tell, getting standard health insurance, Medicare, and Medicaid does not pay for assisted living at all.

Oklahoma’s Medicaid Advantage program has an option for assisted living service option. You can read about it here. http://www.okdhs.org/services/aging/pages/also.aspx

You do have it figured out! My apologies; the name of the program confused me.

Sorry for your situation, but glad to be of some help. Also, realize that whatever you and your wife decide is the best course of action given your specific situation, there will be no shortage of people happy to criticize your choices/actions. :rolleyes:

The media, medical and eldercare communities, and other aspects of society seem to suggest a specific course of action - which may not be exactly what you are most comfortable with. Sure, you want to be flexible enough to adapt to changing information, but steel yourselves to recurring reminders that other people/interests promote different approaches.

Try to ascertain what your parents - and you - feel about the “quality of life” and various end-of-life options. In some situations, declining care is a perfectly valid (IMO preferable) option. And look into hospice well before you get to a point where it is needed.

Also, look into what provisions you and your wife have in place re: your own late-in-life care.

Good luck.

Absolutely zero apologies are necessary. Having me double check that I wasn’t misunderstanding was well worth my time.

My aunt was in a care home and I was her guardian. It’s going to be incredibly stressful for you. So feel free to vent here. Something you need to understand is that you need time for yourself and your family. So you should only visit at most every other weekend, so you have a weekend for you. Your brother being 1500 miles away is no excuse for him not helping, assuming he can afford the travel. He can fly down every so often.

Make sure someone goes regularly. And check the visitor book just in case lawyers are trying to pull a fast one, like they tried with my aunt.

BTW I’ve no idea what the paperwork trail required is where you are, but when I was the guardian for my aunt, I got the impression that the OPG were just grateful that we were actually keeping records.

Made me think of another weird wrinkle - it is the norm for folk in assisted care to express how much they appreciate visitors. Even if unintentionally, they can put a guilt trip on friends/family. I’ve encountered more than one instance in which I suspected such expressions largely reflected peer pressure from other residents - a desire to SAY that they had visitors, rather than a sincere desire to HAVE visitors.

Don’t be too hurt if you visit someone, and they act as though your visit is an intrusion. They develop their own routines once they adapt to assisted living, and what you think is a significant effort to visit might be viewed as an interruption of their scheduled card game, or even a nap.

I found it best to figure out how to scheduled visits around other chores in the general area, and to make visits short. Not a bad idea to bring a card, or flowers, or something - as memory fades, they might not remember that you visited.

Bolding mine.

This is definitely the case with my mom. Just about the only joy in life that she has left is her weekly visits from my disabled brother. He saw her on Sunday and a couple of hours later when I went by, she had forgotten that he had been there. :frowning:

Unfortunately, he doesn’t have the means to fly more than about once a year. He could afford to drive occasionally but I don’t know if he has the PTO to make it happen. I don’t begrudge him yet.