Our care giving started out slowly and the irritations in melding his care into our life were minor at first.

It began when he/she read his New York Times. My father-in-law had the habit of watching TV until 11:30 and then reading the paper until 1:00am. He would sit in the living room recliner while watching and reading. Unfortunately for us our bedroom is across the hall from the living room and the light would shine directly into our bedroom. As we never slept with the door closed this became a problem. We ultimately resolved the reading problem by getting my father-in-law a TV and recliner for his room.

There will always be issues in any relationship, of course and eldercare is no exception. What began to be bother me was that all our efforts were taken for granted by my father-in-law and by other relatives. It was assumed that we would just do everything. I expected that we could integrate eldercare into our lives without effort, and more tellingly,  without clearly establishing what I needed from other relatives. I felt they should have known what to do and take a greater part in the care giving

I did not  realize the cost of elder care in terms of time, effort, money, and frustration because those costs came upon us slowly. I didn’t negotiate with others for their support. That was my fault and the beginning of years of building anger.

For a free DVD on elder care go to HomeCareSurvival.com .

The negative emotional aspects of anger, frustration, isolation, and guilt are more difficult to deal with. These emotions creep up on you, complicate your life and your care giving efforts, last long after the care giving is over, add to your physical stress, and can shatter families and lead to law suits.

This series of blog posts will try to address these negative emotions and how to deal with them.

Of course, there are positive emotions in elder care. Compassion, responsibility, gratitude, and competence are part of caring for an elderly parent. Some seniors have planned for their care so as not to be a burden on their children. Some families come together to support the primary care giver. Some cultures value older people and family members vie for the honor to care for their seniors. Elder care in these circumstances is a different, rewarding experience.

The positive emotions make care giving a wonderful family building experience. That was the expectations Jill and I had when we started caring for her father.

I loved my father-in-law. I met him the same day I met Jill. In the 35 years up to that day in 2001 when we began caring for him I never had a harsh word with him. He gave us the down payment for our home, the home we were now welcoming him into.

Our home has four bedrooms and our four children were living at home with us. My father-in-law spent the winter of 2001-2002 in California with his son and moved in with us in March 2002. Our son, Eric, gave up his room so my father-in-law had easy access to both the kitchen and the bathroom. In the beginning, he was able to bathe himself, dress himself, make his own meals, and could safely go for walks.

What could cause anger and frustration?

I’ll cover that in the next post.

For a free DVD on elder care go to HomeCareSurvival.com.

The guidelines for what is covered vary from state to state and the amount of money available to pay for Medicaid covered services are subject to political forces.  To find out what those guidelines are in your state and which program is the best for your elderly parent, contact your local Area Agency on Aging.

The Qualified Medical Beneficiary Program is for those people who are at or below the poverty level which is defined as $4,000 in financial assets for an individual or $6,000 for a couple.  The state will cover the premiums and deductibles.

Specified Low Income Medicare Beneficiary Program is for those people who are 10% above the poverty level.

If you plan on using Medicaid for your elderly LO you should contact an elder law attorney who specializes in filing Medicaid applications.  The attorney will also advise you on how to manage your LO’s financial assets.

You need advice of what expenses are eligible and which are not.  You do not want the state to come after you to reclaim money to reimburse it for the expenses they covered.  Go to naela.com for a listing of elder law attorneys.

Hospitalization, doctors’ visits, and medications are covered.  Not all doctors take Medicaid so you have to find one that does and be prepared to wait for an appointment.  If you can’t wait for an appointment then you will have to go to the emergency room for treatment.

Most states have a waiver program that pays for services at home instead of placing your LO in a nursing home.  If your LO qualifies for admission to a nursing home but would prefer to live at home you might be eligible for PACE (Programs of All-Inclusive Care for the Elderly).  Your LO will be provided with all that he/she needs to live safely in their home.

Visit Medicare.gov/Nursing/alternatives/PACE.asp for more details.

Call your Area Agency on Aging or the State Health Insurance Assistance Program (SHIP) for information on the PACE program or any other issues regarding Medicare or Medicaid.

Medicare has different parts.  Part A covers the hospital costs of people over 65.  It also covers people under 65 who have kidney failure.  It is paid for by contributions from employers, employees, and the self-employed and from premiums deducted from the social security payments of the person receiving the coverage.  The premiums are deducted automatically from their Social Security payment.  If your LO is not receiving Social Security there is a seven month enrollment period, three months before their 65^th birthday and four months after.  Be sure they don’t miss this enrollment period.

Medicare does not cover long term or custodial care, which is what elder care usually involves.  The services that are covered have to be prescribed by a doctor and provided by a Medicare approved facility.

Medicare Part B is paid for by the premiums of people who voluntarily enroll.  The federal government pays the rest.  Medicare Part B covers physicians’ costs, lab costs, outpatient care and certain home care services.

If your parent is covered by another form of insurance, such as a retirement program, he/she may not want to enroll in Part B.  If that is the case he/she must let Social Security know about their decision.

Medicare Part B covers 80% of the bill. The remaining 20% has to be covered with a separate insurance policy.  We used the AARP program and were very satisfied with it.  We had the premiums automatically deducted so there would be no gap in the coverage.

When buying the Medi-Gap insurance make sure that it does not exclude pre-existing conditions.  Be sure also that they buy the policy within six months of turning 65.  If you enroll during that period, the insurance company can not charge more because of any pre-existing condition.  As always, fill out the insurance application completely.  Don’t give the insurance company a reason to refuse claim.

To get more information on Medi-Gap insurance go to Medicare.gov or call your local area agency for aging.

In the next post, I’ll describe Medicare HMO’s and Medicaid.

The specifics in the case are as follows.  Sir Edward Downes, 85, was in failing health.  His wife, Joan, 74, has terminal liver and pancreatic cancer.  They traveled to a clinic in Switzerland where for $7,000 per patient they were given poison and died a peaceful death within a few minutes.

To quote Nancy, “The problem is that Sir Edward, while in failing health at age 85, was not dying.  His eyesight was nearly gone, his hearing was weak, and he faced the prospect of life without his soul mate.  But sorrow is not grounds for a doctor to assist in a suicide in most places that allow it.  Nor is despair.  The Netherlands permits euthanasia for those suffering intolerable pain; Oregon requires two doctors to confirm that the patient has less than six months to live.”

Nancy later concludes, “Advances in palliative care mean that those last years of life do not have to be a moral, medical and financial nightmare.  I respect Sir Edward’s right to make what his manager called a “typically brave and courageous” choice.  I just wish he’d had better choices.”

I have two comments.

First.  When my father-in-law was living with us, we tried to give him what he needed to make him content.  Although he was ten years older than Sir Edward and had multiple health conditions he never complained.  At most, he would say that he was getting old and that “something is bound to go wrong.”  He was content just to be with his family and that is one of the great advantages to home care.  They are in a place they know and cared for by people who love them.

Second.  As a volunteer at the local Veterans Hospital and Nursing Home I meet a lot of service men.  One former Marine commandeered me to help him with a life long project of his.  He wanted the Navy to upgrade his brother’s Bronze Star to the Congressional Medal of Honor.  His brother had died in combat in the Pacific theater under heroic circumstances.  The Marine asked me to type letters for him because his hands were crippled and to send them to numerous officials in Washington, D.C.

He had a mission to complete and up until the day he died he kept working on it.

Hopefully we can encourage those people we are providing elder care for to make better choices.

If you are just getting started to figure out your parent’s current financial condition there is an easy way to find out if there are funds available to help you.  Go to benefitscheckup.com and answer the survey.

There are questions about your parent’s financial condition, the housing arrangements, and what medications they are taking.  The survey takes about thirty minutes to complete.  When done the web site will produce a list of all the federal, state, and local programs that your parent(s) qualify for.

Why not take advantage of the programs that already exist to help you help you take care of your elderly parents?

A recent article in a local newspaper describes a service has taken both ideas to a new level.  The author, Ronald Roel, answered a question about elder care planning for the reader’s 83 year old mother.

Roel acknowledged that some elder law attorneys specialize in certain aspects of elder care such as Medicaid application, or estate planning.  He pointed out that some elder care attorneys are now offering Life-Care Plans.  According to Roel, Life-Care Plans “bundle services such as asset protection and Medicaid qualification with care coordination, nursing home advocacy and crisis intervention.’

“The principal goals are to help people obtain appropriate care at home, in an assisted living facility or, if necessary, a nursing home, help make decisions relating to health care, long term care and special needs through later stages in life; and help find the best resources to pay for such care.”

The services that Life-Care Plans provide are paid for on a retainer basis for a specified period of time.

I like this idea.  It is a holistic approach and because relatives have to be involved it puts them on notice.  They cannot escape their responsibilities.

The book reads like an exciting crime novel.  A novel that puts you at the scene of a crime, you watch what is happening and when you want to scream STOP you find that you have no voice and that you are powerless.

In many ways Irene found herself having to fight the very people who should have been helping her.  In addition to the normal stress of elder care, the legal issues she had to deal with made everything so much more difficult.

Irene’s book points out a larger concern that is common place in elder care and that is who can determine if an elderly person is competent to execute the proper legal documents.  It is an issue that has not been adequately addressed.  Protecting your loved one from exploitation can have huge repercussions both financially, legally, and relationship wise.

Irene’s book is more than a great story.  She has added resources, petitions, and an afterword by Dr. Bennett Blum.  Dr. Blum is an internationally acclaimed expert in geriatric and forensic psychiatry.

In the afterword, he includes a list of behaviors to analyze whether an elderly person is or has been a victim of undue influence.  He also gives a list of behaviors that will help you to recognize changes in your loved one’s mental abilities.

Irene’s website is ParadiseCosts.com.

Remember the idea is to use their assets to provide for their care.  Their assets may not be enough however to cover the expense of home care.

The first way to understand what programs are available to help you and how you can access those programs is to go to benefitscheckup.org.

Benefitscheckup.org is a service of the National Council On Aging.  You will be asked to supply information about your parent’s current financial condition, their housing situation, and their medical needs.  Based on their responses you will be given a list of the programs that are available to you in your area.  The survey takes about thirty minutes to complete but it is worth the time.

The second thing to do is to review their social security statement for accuracy to be sure that they get all the money due to them.

The third thing to do is to sign up for a supplemental medical insurance policy.  This will cover the 20% that Medicare does not cover.  Without this coverage they or you  could be stuck with huge bills.  For example, Medicare covers twenty days of rehab and a supplemental insurance policy covers an additional eighty days of rehab.  If you didn’t have that coverage you would have to pay for the rehab.

We used the AARP program and had it deducted automatically from his account.  This way there was no way the bill could be overlooked and his insurance canceled and we stuck with the bills.

If you are really unsure of what is involved in home care for the elderly, it might be useful to contact a geriatric care manager.  A care manager is a highly trained nurse or social worker who can coordinate the care your LO may need.  This service is especially valuable if your LO does not live near you.

Care managers charge for their services.  To find a care manager ask for a recommendation from your local hospital or go to caremanager.org for a referral.
To find out how to interview a care manager to see he/she is the right one for you go to  my Action Program.

If you just want to get an idea as to what is involved in elder care and what services are available for you contact the Area Agency for Aging in your county.  This is a government supported agency, their services are free and they can give you an overview of elder care.