What makes my Action and Implementation Program unique is that I look at elder care from the caregiver’s point of view. My experience and that of many other care givers is summarized below:

1. One person bears most, if not all, of the work.
2. Unless you’ve done this before you have no idea of the amount of work involved.
3. The annoying attitudes or habits of your Loved One (LO) do not go away merely because they get old.  Those habits only get worse.
4. Federal or state governments or your relatives will not voluntarily reimburse you for any money you spend on elder care.  Out of pocket expenses average $500.00 a month.
5. The intersection of inheritance and elder care will set powerful emotions into play.  You have to look out for your interests.  I’ll tell you how to prepare for visits with your lawyer.
6. The perception of what relatives think is due to them from an inheritance can over ride rational decisions or compromises.  I’ll show you how to negotiate with your relatives.
7. The efforts you make in elder care will be heavily discounted by your relatives.
8. Day to day life may go on uneventfully, and then a crisis (a fall, a stroke, or an accident) will occur that changes everything.
9. Elder care can go on for longer than you expected.
10. You have to take action to prevent becoming isolated and overly stressed.
11. Taking care of your needs is not a luxury, it is a necessity.
12. You love is not going to save them.

Go to HomeCareSurvival.com for a free DVD about elder care.

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.

In the previous post, I looked at two suggestions that Dan Taylor uses in his book, The Parent Care Conversation namely Challenges and Alternatives.  The next two steps are Resources and Experience.

The hardest part with Resources is trying to get your LO’s to think differently about their  situation.  To free up their minds to what they can use for their care.  They may not realize how much is available to them to help them solve their particular problem.  If home care is new to you also you may not be aware of the resources available.
One way to remedy that is to contact the Area Agency for Aging in your county.  This is a governmental agency that was set up to provide information about what programs and facilities are available for the elderly.  The agents can give you the direction you need.

I would also suggest that you consult an elder law attorney.  You can find one through the National Academy of Elder Law Attorneys on their web site naela.com.  If your parents don’t have he financial resources for their care the attorney can prepare the application for Medicaid.  If they have assets the attorney can advise you on inheritance issues or how to turn those assets into cash for your LO care.

Based on what challenges they are facing and after discussing the alternatives and resources the next step is to get your LO to describe what outcomes they would like to Experience.  The purpose o this is to get them to see that with planning and support they still can use their remaining years to achieve some of the goals they set for themselves.

This is my whole point.

Nothing is written in stone.  If relatives think they could manage elder care better, let them try.  The temptation is to let past family patterns of behavior dictate present or future patterns of behavior.  That was fine when you were twelve but it may not be fine when you are forty five and have a family to raise.

Don’t lead with your heart.  Elder care is immensely complicated especially if there is an inheritance involved.

Don’t do this alone.  Don’t depend on verbal agreements with your relatives.  Don’t depend on past patters of behavior.  You need to protect yourself.  You are not going to rescue your parents.  You do not want to fight this out in court.

If you are considering home care for your elderly parent(s), talk to an expert be it an elder law attorney, a geriatric case manager, or a financial planner.  Let them spell it out to your relatives about the work and the cost.  If your relatives think they can do it better, let them try.

I heard of a story about a woman who was taking care of her mother who had multiple conditions.  The caregiver’s brother had financial problems among other issues.  He wanted to care for the mother because he saw it as an opportunity to gain access to the mother’s financial resources.

He took his mother in.  Two weeks later, he called it quits.  It was way past his ability and skill level.

If you don’t think you have the financial skills to manage your parent(s) affairs, it is easy enough to hire someone with those abilities.

Plan ahead.  Get good advice.  Don’t be intimidated.

Some people I know solved the problem by selling their homes, before the meltdown, and relocated to a Continuing Care Community.  They have a suite of rooms and there is no maintenance for them to do.  Should they need it they can go to an assisted living wing or the nursing home wing.

This arrangement calls for a sizable down payment and monthly payments.  Not everybody can afford it.  It does allow the parents to keep their independence and does not place an undue burden on the children.

But what do the rest of us do?

Home Instead offers non-nursing care.  We happily used them when we provided home care for my father-in-law.  Home Instead has a 40/70 rule which says that if your parent is over 70 and you are over 40 you should be talking about their plans for the future.

And if not you, then who?

And if not now, when?

This blog and the Action Program we put together is an attempt to answer that question.

The longer you put this off the more complicated it becomes.  You need to talk with them while they still have their full faculties and can make the best decision for themselves.  This is the best time to talk with them regarding decisions about money, property, housing, and the legacy they want to leave behind.

This is the best time to enlist the help of siblings or other relatives so that a crisis doesn’t force you to deal with  all of their issues as well as your own.

If there are issues regarding their care this is also the best time to have them adjudicate those issues and not have to guess as to what they would have wanted.

If you think your life is complicated now, you have no idea how complicated it will be if you don’t plan for home care for your elderly parent.

A woman went to her attorney to have a durable power of attorney and a health proxy drawn up.  This was a step in the right direction and I applaud her efforts.  She showed the documents to her daughter who then became very upset.  Her mother named both her daughter and her son as co-agents.

That was bad enough considering the son lived on the west coast and the daughter on the east coast.  What made this arrangement especially bad was that the mother required that both would have to put their original signatures on any hospital consent form.  What if there was an emergency and a decision had to be made now?  How could they speak for their mother?

The daughter went to the attorney who drew up the documents and asked why he did so.  He said, “That’s what your mother wanted.”  The attorney the mother went to was her real estate lawyer.

If your parents tell you this you need to see all the documents for yourself.  You need to see if they are signed or notarized as required by law.  You need to see if you are mentioned and in what way.

In our case, my father-in-law’s second wife had him revoke his living trust he made up years before.  She had him draw up a new will which favored her children.  He never told us that he had done so.  We found out only after she suddenly died and there was a reading of the will in her attorney’s office.

As a result of that change, we are now engaged in a lawsuit that could cost us $216,000.All because we did not ask to see his documents.