Mustachian eldercare - What do I need to know?

[CU Tiger]

I have a life dilemma and maybe some of you have experience that can help. My folks are in their mid-70s, and I am starting to see the beginnings of  age-related trouble with their health, memory, ability to cope with change, etc.

Nothing critical yet, but considering family history, and the fact that I am the adult child who will most likely care for them, I feel like I need to start arming myself with knowledge. Does anyone recommend any books, websites, etc. on dealing with aging parents. I really need to learn about the practicalities.

I feel like I have to prepare myself alone, because my sister has her own family, and my parents, other than preparing a will, do not want to talk about any unpleasant topics like age, infirmity, or death.

[Ybserp]

I don't know what you need to know. I'm replying so I can follow any answers you get. ::fingers crossed that good answers exist::

[MayDay]

I do not work in or study the subject, I just can relate family experiences.  FWIW.

Number one awesome thing is hospice.  It is always 100% covered by Medicare.  It can include help with in home care (not round the clock care, but maybe an aide twice a week and a volunteer visit and nurse visit once a week each) as well as inpatient care.  Patients are eligible for hospice care for six months prior to expected death.  Most people don't call until their loved one is in a serious decline and is looking at weeks or days.  If there is any question in your mind, a all  and ask for an evaluation.  It is free, and will give you info.

I guess the biggest question is how much money do they have, and are they going to put their foot down about remaining in their home (whether or not that is safe for them!).  If they have enough money and insist on remaining at home, you can consider a lot of hours of home heal care, but that can be extremely expensive.  If they are willing to leave their home, money again is the determining factor in where they might go. 

My grandmother began to decline and was initially cared for (poorly)  in-home by her (unemployed deadbeat) son.  She had some savings and a pension but not nearly enough to cover round the clock home health aides.  Eventually things got bad enough that she was put in a nursing home against her will.  She didn't have a huge amount of money, but was able to pay cash for about a year before she ran out.  Then the nursing home worked with my uncle (financial and medical POA) to get the house sold but not in such a rush that money was sacrificed. 

 In the end she ran through about half the house $$ before passing, and was able to leave a small amount to each of her children.  Had she not passed, she would have been able to stay in the same facility as a Medicaid patient, was she was already in.  They did not, however, accept patients coming in on Medicaid.  Thus she was in a much nicer facility than she would have been had she spent all her money on home health care, trying to stay home as long as possible. 

Meanwhile, my other grandparents graciously moved into a one floor condo with no maintenance needing to be done, and have not fought tooth and nail about staying home.  Much more pleasant experience all in all. 

[LadyStache]

Have you looked into long term care insurance?

[bogart]

My dad refused to plan for his old age, developed dementia, and is now living in a nursing home on Medicaid.  On a positive note, he's strikingly cheery (and unaware of the reality of his situation). 

You need to know what resources your parents have -- funds, long term care insurance -- and how proactive they are willing to be.  Two things I've realized as I've helped my dad navigate his circumstances (and have made decisions on his behalf, as things got worse) are that

• change is really, really hard when you are confused and not very capable (and thus dependent on others).  To the extent possible, getting into a place that will adapt to all your (possible) needs over time, both in terms of its physical attributes (wheelchair friendly, etc.) and its staffing possibilities (e.g. a continuing care retirement community) seems to me very prudent. 
• even if you have someone who is willing to take care of you in your home, or theirs, it's entirely possible your situation will deteriorate to the point where they cannot.  I wouldn't have done this for my dad, but even if I would have, I couldn't anymore -- he needs someone available around the clock and is unable to e.g. move from his bed to his wheelchair, or his wheelchair to a toilet.

I'd recommend starting by having a conversation with your parents and assessing their resources, willingness to plan, and willingness to discuss these issues at all.  Good luck to you.

[CU Tiger]

Have you looked into long term care insurance?

I do know that my mother has what she calls a nursing home policy. Obviously, I need more details...I am going to have to ask to see the policy and read it so I understand what she means.

[HopetoFIRE]

What if your parents have no money to pay for long term care/nursing home?

[former player]

Honestly, at the moment there are limits to what you can do, because your parents are still (legally) competent adults able to make their own choices.  So the first thing I would say is: respect their choices and keep the lines of communication open, rather than forcing anything on them (that includes discussions they don't want to have).

If your parents live near to somewhere you are settled, you are starting with a big advantage, as in my experience trying to look after them long-distance won't work for any of you.

I'm in favour of supporting the elderly in their own homes for as long as possible: it is familiar, and they will have built up familiar support systems with friends, neighbours, local handymen, and so on.   If they are finding daily maintenance difficult, a gardener and/or a cleaner would go along way to helping them stay there in comfort while keeping the house in decent order.  Also, if you can, make sure they are keeping on top of small repairs: it will keep the house comfortable and maintain its value. 

Do you have the option of shopping over the internet and getting it delivered to them, perhaps offering to do it for heavy/bulky items to start with?

Keep an eye out for them continuing to be safe to drive.  It is hard for any elderly person to give up driving, and not infrequently they go on too long and are a danger to themselves and others.

One way to approach the issue of living wills/powers of attorney might be to look into getting these done on your own behalf.  You would then know the ins and outs, have a reason for talking about it to your parents and be able to refer them to a good adviser if they express an interest for themselves.

Good luck.

[CU Tiger]

What if your parents have no money to pay for long term care/nursing home?

In my case, they do. My concerns are more like this: When you are about pregnant with your first kid you go out and buy that book What to Expect When You're Expecting. It is full of advice and information and lets you know that most of what you are experiencing is normal. You can prepare for what is coming next.

If there was a book like that for anxious adult children of aging parents, I would have it cued up on my Nook right now. Something that explained how I can best take care of them, myself, their finances, my sanity. I am a planning-type person, and knowledge makes me less anxious. I am just hoping to find some resources to help me feel less adrift.

In the message above, just knowing that there is something I can DO - read the policy and find out what it covers or does not cover, that is helpful!

Someone should write a book called What to Expect When Your Parents Are Getting Frail, Forgetful, and Don't Want to Talk About The Fact That We All Die (Eventually). It would be a best seller.

[former player]

Someone should write a book called What to Expect When Your Parents Are Getting Frail, Forgetful, and Don't Want to Talk About The Fact That We All Die (Eventually). It would be a best seller.

Too many variables, I suspect, both for the health and wealth of the parents and the situation of the child.  Although you could start the research now and turn the resulting book/blog into a side-gig.

[MayDay]

Probably the best thing you can do is have me see a lawyer to get all the financial and medical POA's done, and give you copies of the POA's, their medical policies, any insurance policies they have, all account info for savings accounts and checking accounts, etc. 

That is our biggest concern with my FIL.  We know DH is the POA and executor, but FIL won't give us any if the info.  If something happens to him, we will have to literally drive to his out (out of town) and dig through his entire house looking for the papers.  I don't know how we will ever find it all.  And if it is a medical emergency situation where decisions need to be made quickly, or something financial needs to be taken care of quickly, we will be screwed. 

We have asked repeatedly for him to give us copies of this info and he refuses, so there isn't much else I can do.

[oldtoyota]

Elderly housing with frequent care can be $5,000+ per month. I notice we rarely talk about that reality/possibility for ourselves in this forum...

[Ybserp]

Elderly housing with frequent care can be $5,000+ per month. I notice we rarely talk about that reality/possibility for ourselves in this forum...

True. I wonder how my childless aunt is going to be cared for in her last few decades, and if she would want support from us in a decade or two. (If wanted at all, this would be visits and support during fading mental capacity rather than anything financial as she has planned excellently for her declining years.) But for myself, it is hard to imagine a good way to age.

I suppose in my dream world, I just don't age. I have prefect physical health, continually make a lasting impact on the world, and remain fully sharp and able in all things until a stroke or heart attack abruptly ends it at all... at age 115.

But back in reality, I suspect any big impact on the world really needs to be pushed for hardest between 30 and 55. Sure some people will be Churchill and do their most for humanity as senior citizens, but most of us need to try to do what we can while we have the most energy and most ability. (This generally means now.)

And as for the declining years, which will exist for most people, a good financial plan can help. A house or condo with a first floor master bedroom and bathroom with a walk-in shower is ideal if you want to stay in place for a while. Being willing to hire help (as non badass as that is) is important. If you can't see the dirt, you can't clean effectively. (But also if you can't see the dirt, you can't judge whether your Merry Maids are cleaning effectively either.) I don't see any substitute for regular interactions with younger family and friends who care about your wellbeing and are forthright enough to say "Mr/Ms. Ybserp, X is too dirty/broken/a health hazard; it needs to be fixed." Accepting that kind of feedback with grace is, hmm, a thing to work on.

[castoriehandley93]

I really suggest that you look for an insurance policy especially for long-term care. It is not an easy situation especially you're seeing early signs of dementia. I think that gives you a minimum of five years before dementia kicks in. It's like a timebomb, racing against time.

You did well in your first step. A will and a medical proxy to cover everything while they're still abled parents.

Second, have your parents see a doctor. It's won't be easy hearing your doctor confirm what you already suspected but it is still a thousand time better than being in a dark, assuming an illness your parents may/may not have.

Third, settle all the important papers you have.

Fourth, talk to an agent and discuss an insurance for them. If they decline because of their preexisting medical condition, talk to the nursing facility and negotiate payment terms.

Fifth, if all else fails, go reverse mortgage.

Sounds grim but that's just how things work. It's not gonna be easy and it never will be but just hold on and get a grip. Discuss all these things with  your family...including your parents

[Pigeon]

This is so difficult.  I'm dealing with it now with an elderly MIL and my father. 

I think you do need to have a conversation, if for no other reason than to understand their plans and their wishes.  My MIL wants to remain in her home forever.  She is very inflexible about everything, is 90 years old, and her mental state is deteriorating.  It's making me crazy.  She shouldn't be living alone at this point.  Maintenance of the house falls on my husband mostly, but she's not always upfront about what needs to be done.  She also refuses to let us make any changes that would actually  make it safer for her, like putting in handrails or a first floor laundry.  Her philosophy is that if you don't acknowledge aging, it doesn't happen.  She makes my head explode, but she's not my mother and I can't make her do anything.

Look into what services your town provides and start talking to your relative about them. Our town will provide transportation to doctor's appointments, for example.  The problem is that my MIL, who shouldn't be driving at this point, refuses to use them.  So, she gets lost and frustrated trying to drive to places outside her comfort zone and it's only a matter of time before something bad happens.  She already had an incident involving being stranded with two flat tires in a horrible neighborhood. 

Senior housing can be very expensive, as can be paying for home help, depending on how much you need.  Investigate your options now and discuss them with your relative and maybe you can come up with a realistic plan.  My dad is moving this week into senior housing and while he's not thrilled, he's willing to look at the benefits.

[Trede]

I recall my mom finding a particular paperback really helpful when dealing with her mother's decline.  I've emailed her asking for the title and will post it here if she remembers it.

I keep this topic on my radar ever since my MIL started declining.  She's also in the camp that refuses to talk about her finances or her plan for the future, but I've got a file going on care facilities in our area anyway.  Someday it will be a useful stash of information.  One thing I found out that gives me some comfort for my own future is the existence of "geriatric care managers."  There is a national association and everything: http://www.caremanager.org/ and the site has a library and resources section to start with.

 

[bogart]

What if your parents have no money to pay for long term care/nursing home?

Then, depending on their circumstances, they will eventually need to rely on Medicaid to get these services.  They will have to qualify, which means both being in bad enough health/condition and being poor enough.  Though the latter is pretty straightforward if they are single, it's more complicated if they are married, as one might need care and the other might want to live independently and need a budget to do so.  It can get complicated/unpleasant.

[bogart]

If something happens to him, we will have to literally drive to his out (out of town) and dig through his entire house looking for the papers.  I don't know how we will ever find it all.  And if it is a medical emergency situation where decisions need to be made quickly, or something financial needs to be taken care of quickly, we will be screwed. 

Based on my own experience with my dad, in the medical emergency situation this actually is NOT a concern (the exception would be if there are multiple potential decision makers, e.g., kids, and they disagree with each other.

My dad fell and broke his hip and was COMPLETELY incoherent (conscious, but hallucinating, basically) and had no medical POA (or any other kind) and the doctors were 100% (110%) happy to have me making decisions, signing papers, etc.  It was interesting, actually -- I mean, the only evidence they had that I was his daughter was my word (and my dad's, too, but -- again -- he was not a reliable source of info.).  A few years before that when my dad had a stroke but WAS coherent, I had to struggle to get to the doctors to talk to HIM not ME and let him make his own decisions.

There are some high-profile cases of problems, of course, but absent a conflict over decision making (family members battling it out in the hospital) I think the medical care providers are usually very happy to have anyone willing to make the decision, honestly.

Now, financial matters are another issue altogether ...

[begood]

We had a situation with my dad where he had put my brother on his HIPAA form but not me - not a deliberate decision, just an oversight.

So I was there with him in his hospital room. He was unconscious. The doctor who came in would not speak to me about his condition. Instead, he called my brother in California, and then after my brother had spoken with the doctor, my brother called me to give me the update. I was SITTING IN THE ROOM with my dad and could not get any information about his condition.

As soon as my dad woke up, I called his attorney and had her draft something for him to sign. They had a notary public in the hospital who made "room calls" and we got it signed, sealed, and delivered in about six hours. It's now part of his medical record, so I should not face that particular problem again.

So at a minimum, it would be good to make sure that you are included on a HIPAA form so if there's a medical problem and your parents can't verbally give consent, you can still get information.

[elaine amj]

For my MIL, we started hiring a housekeeper. We pay a local lady about minimum wage to come for 2 hours to clean house and cook lunch for my MIL. Technically she's really there because my MIL is afraid to be alone for too long but my MIL cannot stand paying someone (even though its next to nothing) to just "sit around". She's not an easy person, so we sneak the cleaning ladies generous bonuses fairly frequently (my MIL will NOT pay more). Because the pay is low, we don't typically hire the best cleaners around, but it's good enough.

Professional home help is very expensive, so this was a much lower cost way to manage, especially since she just really needs someone to be there and for now, we don't need the extra skills.

She does get a free Personal Support Worker 2x a week to help with baths. She will make the bed then and pop the laundry in the washer. Technically she also will do exercises with her and a few other things but for now, she just does baths and laundry.

When she needs more assistance, we will likely extend the hours of the cleaning lady. When she needs more skilled assistance, that's when we will likely move to hiring skilled help.

She deals with depression so we would sooner not do the nursing home scenario. She tried it once and hated it and was home again 2 days later. She does keep saying she will try a nursing home again whenever she gets frustrated with her current situation.

[Spartana]

What if your parents have no money to pay for long term care/nursing home?

Then, depending on their circumstances, they will eventually need to rely on Medicaid to get these services.  They will have to qualify, which means both being in bad enough health/condition and being poor enough.  Though the latter is pretty straightforward if they are single, it's more complicated if they are married, as one might need care and the other might want to live independently and need a budget to do so.  It can get complicated/unpleasant.

I the US they have something called a Spousal Impoverty Act http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Spousal-Impoverishment-Page.html http://www.nolo.com/legal-encyclopedia/medicaid-protections-spousal-income-during-long-term-care.html so that if one spouse is in need of Medicaid for care, the other spouse is allowed to keep the house, their own income/assets, and half of all shared assets as well as an income so that the non-ill spouse can continue to live in their home and not have to suffer becoming impoverished due to the other spouses for medical care.

[Spartana]

Number one awesome thing is hospice.  It is always 100% covered by Medicare.  It can include help with in home care (not round the clock care, but maybe an aide twice a week and a volunteer visit and nurse visit once a week each) as well as inpatient care.  Patients are eligible for hospice care for six months prior to expected death.  Most people don't call until their loved one is in a serious decline and is looking at weeks or days.  If there is any question in your mind, a all  and ask for an evaluation.  It is free, and will give you info.

 

Agree Hospice care is awesome but Medicare doesn't cover the room and board costs of a nursing home (which can be $5000/month or more)  - just the "hospice care" costs. I also believe the Medicare only covers a 90 day stay at a nursing home for other illness or injury while the person is actively rehabbing, and not just for basic caregiving and help with daily living tasks. Need to pay for that stuff yourself. Here's a link and an a bit about it:

http://longtermcare.gov/medicare-medicaid-more/medicare/

www.medicare.gov/publications/Pubs/pdf/02154.pdf

■ Room and board: Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. However, if the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay

Medicare pays for temporary skilled care in a nursing home after a hospital stay. Nursing home care must be medically necessary for rehabilitation purposes. Medicare does not pay for long-term nursing home or custodial care

 

[HattyT]

The New York Times' New Old Age Blog is a good resource.

http://newoldage.blogs.nytimes.com/

[HattyT]

When I was considering moving my Dad (80+) in with me, I consulted with an excellent, tho expensive, elder attorney in Northern Virginia.  She came highly recommended and saved me tons, (oh and monetarily too).  I am still 2 ½ years later reaping the benefits of that $400 consultation.  Having an expert steer me around typical pitfalls was priceless. 

[bogart]

I the US they have something called a Spousal Impoverty Act http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Spousal-Impoverishment-Page.html http://www.nolo.com/legal-encyclopedia/medicaid-protections-spousal-income-during-long-term-care.html so that if one spouse is in need of Medicaid for care, the other spouse is allowed to keep the house, their own income/assets, and half of all shared assets as well as an income so that the non-ill spouse can continue to live in their home and not have to suffer becoming impoverished due to the other spouses for medical care.

Well, sort of.  The "community" (living in a regular community, non-institutionalized) spouse can keep the house, if the couple owns one (equity $543K or less, so, plenty for most Americans), one vehicle, their own earned income, and half the (other) shared assets up to $117K.  If they don't have their own income, they're guaranteed access to somewhere between $1.9K but not more than $2.9K/month in income (depending on the state, the min/max are federally established) from their spouse's income.

If the community spouse has retirement accounts and is drawing from them for living expenses, they may be protected (sheltered on top of the $117K shared assets), depending on the state.  They also may not be.  If they're not in "draw down" (the beneficiary hasn't started taking payments from them) then they are considered "available" like other assets(!).  If they are in the name of the spouse who needs nursing home care, then regardless of their status (draw down or not)  they are considered available to pay for that care, even if both spouses were planning on using them (or are using them) as a source of income in retirement.

If the community spouse has other income-generating assets, e.g., rental properties -- tough luck, they count as available to cover costs that would otherwise be covered by Medicaid, except for the $117K protected amount.

So -- yes.  The "community" spouse is protected in that they can keep the house (if they own one), a car, $117K, whatever they earn, and an additional somewhere between ~$2-3K per month in income, provided that the income comes from somewhere sheltered, like their own 401K or a spouse's (traditional) pension, or Social Security.

If they don't have their own retirement account (or for that matter, own their own home), or there's no pension or not much in the way of social security, well, there's no protection to bump their income up to $1.9K.  So for some, the protections are -- adequate if not fabulous.  For others, not so much.

[Spartana]

I the US they have something called a Spousal Impoverty Act http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Spousal-Impoverishment-Page.html http://www.nolo.com/legal-encyclopedia/medicaid-protections-spousal-income-during-long-term-care.html so that if one spouse is in need of Medicaid for care, the other spouse is allowed to keep the house, their own income/assets, and half of all shared assets as well as an income so that the non-ill spouse can continue to live in their home and not have to suffer becoming impoverished due to the other spouses for medical care.

 

If the community spouse has other income-generating assets, e.g., rental properties -- tough luck, they count as available to cover costs that would otherwise be covered by Medicaid, except for the $117K protected amount.

So true! Why it's so important for spouses, especially older spouses, to look at how their assets are held and understand what may happen to those assets if one of them needs care. Also for single people who are dependent on certain assets (rental property for example) for their income to know that most of that stuff will be sold to pay for their care before Medicaid kicks in. Even if you or your spouse uses Medicaid, after you pass away they will claim much/all of your remaining assets to reimburse any care you received from Medicaid  if not set up right before hand.

As a single childless person who'll have a small pension and a paid off house, my plan is to just use up my assets then go on Medicaid. After I pass away they can take my house and any remaining assets for any repayment.

[bogart]

As a single childless person who'll have a small pension and a paid off house, my plan is to just use up my assets then go on Medicaid. After I pass away they can take my house and any remaining assets for any repayment.

Unless I'm misunderstanding something about your circumstances, as a single person they'll take your house and assets before you pass away, if you require Medicaid to cover LTC or other expenses. 

As a (divorced) Medicaid recipient, my dad's allowed $2K in assets, and all his income (a pension and social security) goes to cover his nursing home costs, except that he's allowed to keep $30 per month for "incidental expenses" (obviously this is not enough to cover even clothes/haircuts, never mind anything else) and to pay for his Medigap policy (his possession of which saves the state money).  He had about $30K to his name when he started living in the nursing home and had to spend all of that (except the $2K) down before Medicaid kicked in.

[Spartana]

As a single childless person who'll have a small pension and a paid off house, my plan is to just use up my assets then go on Medicaid. After I pass away they can take my house and any remaining assets for any repayment.

Unless I'm misunderstanding something about your circumstances, as a single person they'll take your house and assets before you pass away, if you require Medicaid to cover LTC or other expenses. 

As a (divorced) Medicaid recipient, my dad's allowed $2K in assets, and all his income (a pension and social security) goes to cover his nursing home costs, except that he's allowed to keep $30 per month for "incidental expenses" (obviously this is not enough to cover even clothes/haircuts, never mind anything else) and to pay for his Medigap policy (his possession of which saves the state money).  He had about $30K to his name when he started living in the nursing home and had to spend all of that (except the $2K) down before Medicaid kicked in.

You're right - in most cases they would allow me to keep what your Dad has and they would take my house and any assets and much of my income to cover my costs while I'm alive. But there are ways around that - at least the house part. Here in Calif you can state in writing that you believe that you will be able to return to your home after your stay in a Medicaid funded nursing home and that will allow you to keep the house (with a lien against it to repay your nursing home costs once you died). So unless they can medical determine that you will never be well enough to ever return to your home, then you are allowed to keep it (and some of your income to maintain it) "just in case". There are also ways to pass it on to your heirs  but I'm not sure how that's done. I just know that the Elder Care lawyers and estate planners are always touting it. I'll see if I can find some links but here's one for now - talks of different ways/people you can leave your house to in order to avoid it being sold to pay for your care.

 http://www.elderlawanswers.com/protecting-your-house-after-you-move-into-a-nursing-home-6897

I’m a widower/divorced person living alone. Is there a way of keeping my house while in a Medicaid nursing home?

This answer to this depends on length of time the patient intends to spend in the nursing home. If the patient plans on becoming a resident of the nursing home permanently the property must be sold. If the patient expects a full recovery or intends to return home, Medicaid will allow the patient to keep the house. This can be based on the patient’s intent to return home, rather than their expected ability to return home.

I live in my house with someone else. Is there a way of keeping my house while in a Medicaid nursing home?

Depending on who lives in the house with the Medicaid patient and how long they have lived there it may be possible to keep the home. Medicaid allows for a spouse, children under 21, an adult blind or disabled child, or a sibling who’s been living in the house for one year or more and owns part of the house along with the patient. Should a non qualifying person be living in the home with the patient, the house will be sold.

[bogart]

But there are ways around that - at least the house part.

Gotcha, makes sense!

[Dee18]

My mother is 91, living alone in her own home, in a city far from my sister and me.  Others have mentioned the all important documents for medical situations.  Try to find out what your parents would want and go ahead and make that known to any siblings.  When my father died, my mother made her wishes clear.
For now, check what services are available for seniors.  These may include low cost door to door transportation, a social worker consultation in the home about how to make it safe,etc.  Key things include: rails on both sides of stairs, grab bars for baths and showers, no loose rugs, and all necessary rooms (including laundry) on one floor.  Were either of your parents in the military? If so, additional services may be available. 
Also, foster great relationships with the neighbors.  My next door neighbor lived to be 96.  I kept an eye on things and stayed in touch with her son who lived across the country. 
There is a book called "Caring for Aging Parents" that might be good.

[Christiana]

There's a book called My Parent, My Turn about caring for aging parents.  I only flipped through it quickly, but I did see a section about how to keep older people healthy, so that they can go much longer without the more expensive and draining levels of care, which was something I hadn't thought about before.  I think there was also some practical information about dealing with their doctors and medical appointments.

[Spartana]

I was fortunate enough to be FIRE'd already when my parents (who were divorced from each other) began to need some help. I choose to live fairly close to them (within 100 miles) and had the free time to do what was needed - which fortunately didn't end up being much. They were also very forth coming with their financial issues and future desires so made that easy. But, things can get complicated when you have siblings, step-siblings or are caring for multiple sets of real parents, step parents and various relationships. Some serious weirdness can happen if everyone wants one thing and you, as possibly the primary caretaker or helper, wants it a different way. Or when you say, hate your wicked step-mother but she is unable to care for your father (or herself) and you have to deal with her and possibly her kids. Lots of inter-tanglements.  So having the parents (or multiple sets of parents) tell you what they want and what they have and what they expect from you and other family members before hand is crucial. They may have expectations that you won't or can't do, and it's best to clear that all up before they need care.

[mr threelittlebirds]

Sorry this is kind of long, first reply. 

A lot of things these other people have stated is accurate.  You will need to have these conversations with them while they still have decision making capability or it will get more complicated.  Probably easiest thing to do would be to talk to an Elder Law attorney, but it would cost money (obviously).  There should be social service agencies that can also provide information but I will try to sum it up for you. 

They need healthcare and financial power of attorney paperwork and these are two different things.  This designates a decision-maker if your father or mother lacks decision making capacity due to illness or injury including dementia.  If both of your parents are not able to make decisions it would fall to a consensus of living children, and then other family members which all can be avoided with Healthcare POA (I am not an expert on Financial POA).  So your father could designate your mother and also one to two back-up decision makers in case she is not able to make decisions.  Healthcare POA relates to medical decisions and financial POA relates to money, taxes, estate, stocks, banking, bills, etc. 

An elder law attorney can also help with assets allocation especially if one spouse gets ill or requires more assistance while the other remains independent. 

They should be evaluated by a Geriatrician for possible dementia and mental capacity. 

As far as services for your parents there are services provided by Medicare (home health care) that may come out to the house a couple times a week for a specific service, not just to do things for them (e.g. Physical therapy, wound care, medication management).  You can also pay privately for services that can include cooking and cleaning.  There are some memory related companies if the issue is dementia or memory.  There are lots of services for people to stay in their home and you could also look into a local Council on Aging or Senior Services agency. 

If they get to the point where it is not safe to live at home there are different options.  Some people live in Independent living which is basically like a Condo in a senior building with little extra perks.  Assisted living units offer additional assistance with meals, bathing, medications, and more.  They can cost betweent 3,000 to 5,000 a month! Even more if it is a "dementia unit."  Insurance does not cover Independent or Assisted living. 

Then next step would be long-term care in a nursing facility.  This is also not covered by Medicare, but is by Medicaid.  If they are over the income/resource guidelines they will have to pay privately unless they have long-term care insurance. 

Best bet is to find a local senior service agency or Alzheimers association (maybe alzheimers.org?) that can provide information to you and your family. 

Good Luck!

[NCGal]

I recall my mom finding a particular paperback really helpful when dealing with her mother's decline.  I've emailed her asking for the title and will post it here if she remembers it.

I keep this topic on my radar ever since my MIL started declining.  She's also in the camp that refuses to talk about her finances or her plan for the future, but I've got a file going on care facilities in our area anyway.  Someday it will be a useful stash of information.  One thing I found out that gives me some comfort for my own future is the existence of "geriatric care managers."  There is a national association and everything: http://www.caremanager.org/ and the site has a library and resources section to start with.

Geriatric Care Managers I spoke with in FL charged $150 to $200/hour. We (my brother and I) decided we could learn what we need to know on our own. My mother was in assisted living and had dementia. After she passed we faced a similar situation with her twin sister, for whom we are POA. We moved her from FL to assisted living in NC. She was on a Medicare Advantage plan which no longer applied out of state, and she needed alot of medical assistance. If anyone is facing the possibility of moving a relative on an Advantage plan out of state, you may want to help him or her get on original Medicare and/or start finding out about Medicare options.

[MsRichLife]

Elderly housing with frequent care can be $5,000+ per month. I notice we rarely talk about that reality/possibility for ourselves in this forum...

True. I wonder how my childless aunt is going to be cared for in her last few decades, and if she would want support from us in a decade or two.

We've talked about this with DH's family. His parents are pretty open about how they plan to get through the rest of their life (since we've all just been through the passing of DHs grandfather) and have talked about downsizing their current home and perhaps eventually moving into the aged hostel in town if they needed to. They are starting to de-clutter so we aren't left to do it and are talking about inheritances etc (But we've told them to spend it all, we don't need it).

My parents are not in a good position for their final years and I do worry a lot about what we are going to need to do for them.

DHs sister is single and childless and we often have discussions with her. Our son will be the only child on that side of the family and I don't want him burdened with eldercare of three of us. In my mind I imagine setting up a 'retirement like' retreat for us and our friends to see out our final years. We'd pool our money to pay for someone to care for us in our homes when we could no longer do it ourselves. Much to think about.

[begood]

Prior to discovering MMM, I had imagined going to a retirement community and choosing a place much like my dad had, which was 2000 s.f. (larger than the townhouse he and my mom moved out of!) and had two bedrooms, 2.5 baths, a sunroom, a living room, a dining area, and a kitchen, plus a one-car garage. It was a duplex on  a cul-de-sac. Lovely! And, frankly, great for the kids and grandkids, who could stay right there with the grandparents when we visited.

But post-MMM, I think I'd choose an interior apartment, one bedroom, or maybe one bedroom plus den in case we did have overnight guests. I'd choose whatever had the lowest monthly fee, downsize my crap to fit in it, and then feel free to travel more if I wanted to.

The downsizing comes eventually anyway - there's rarely any getting around that. Why not do it on my own terms, simplify my life, and save some money at the same time?

[okashira]

When I was considering moving my Dad (80+) in with me, I consulted with an excellent, tho expensive, elder attorney in Northern Virginia.  She came highly recommended and saved me tons, (oh and monetarily too).  I am still 2 ½ years later reaping the benefits of that $400 consultation.  Having an expert steer me around typical pitfalls was priceless.

It would be nice to share some of the good advice you got. It's good that you recommended a random elder care attorney, but as with anything, YMMV and someone could end up hiring a bad attorney and get bad information.
It's nice to hear from someone who knows they had a good experience.

[HattyT]

Everyone ages differently, with different health, financial, family, housing, legal concerns.  So the advice will be pretty specific.  You are right, not just any professional will do.  The way to find a good one is to ask for recommendations.
One place to start, on a general level, is with the New York Times' New Old Age Blog.  It has stories of challenges others are facing and can help a person identify the concerns which should make it to the table.  http://newoldage.blogs.nytimes.com/