The eldercare thread

[ducknald_don]

J_ You will die despite doing all the right things.

[sodatrain]

I'm wondering whether we, the non-old, too often let the elderly get away with age-based excuses that really has more to do with their lack of effort or interest. For example, if I had a dollar for every time I've heard a given senior talk about "how that computer stuff just come naturally to young people", it could have paid for at least one IT-course at the senior center. Ditto "not being able to do this or that activity because they're old" and not because they haven't picked up a dumbbell for the past 30 years. Some old people learn just fine---but some simply don't care to learn and at some point they realize they can just ask others to pick up after them.
...

People have a right to self-determination, but insofar they self-determine to avoid taking responsibility for keeping up with the times, they don't have a right to have others to pick up the slack just because they're a certain age.

I absolutely see this in one of my late 70's parents. Ask about doing/trying something new and simple, and there is just no will to try. They ask for help immediate - and I'm inclined to push back a little bit - "at least try". Smart people. Just no interest/will from the one to try new things. They will gladly just skip it and not try and push it onto someone in most cases. Other parent is willing to engage/try/challenge. Sent the parent who has no will do try something new a very easy no kneed bread recipe to make. That was apparently familiar enough so they baked it. and enjoyed. it.

I'm starting to see the need to find the right balance between self-determination, encouragement/support of "use it or lose it" and autonomy (that apparently ends in support from me and sibling at some point some how)

[delay]

I absolutely see this in one of my late 70's parents. Ask about doing/trying something new and simple, and there is just no will to try.

When you grow old you have less energy every year. You can spend your energy on maintaining things in your life or on learning new things. It's easy to see how the payoff from maintenance is larger.

This can be frustrating from a younger person's point of view, as the older person cannot afford adjustments that seem like little effort to you.

[Laura Ingalls]

The situation with my mom is pretty dynamic. While we were away in June, July, and August she had near constant UTI. She sat around a bunch and here memory issues escalated. The UTIs abated but her memory issue escalated. She has stopped driving and is moving to assisted living soon. Her short term memory loop has gotten very short and keeping track of a calendar is basically too much.

Her concept of money is getting to be a bit more of a vague. While she isn’t usually mean or she combative she is way more of a PITA. Younger son or I cook and then we serve ourselves. She struggles with assembling a taco or putting the rice on the bottom of a stir fry or curry.

I have been basically caregiving constantly though I take all day Friday off.

[chenda]

If not done already I would suggest she gives you power or attorney for both health and finance asap. Getting POA after a person has loss capacity is difficult and time-consuming and without POA managing your mothers affairs becomes very difficult.

[Frita]

I have been basically caregiving constantly though I take all day Friday off.

This sounds like a challenging transition into assisted living for your mom. How are are you doing with that schedule?

[Sclass]

Just wanted to toss in all POAs are not created equal depending on where you are. In CA we have DPOA, the durable power of attorney which might as well be called Dementia Power of Attorney. I learned the hard way that a simple POA doesn’t hold when a person becomes incapacitated here. By the time questions started coming up about my mom’s state she was far beyond signing anything.

A number of times early in my mom’s diagnosis this was brought up to me. I had POA over my mom’s financial accounts but questions started coming up when she got really sick. Her brokers started asking if she was incapacitated. We got into a tight situation with rescheduling our withdrawals as her expenses ramped up.

When I needed to sign mom up for hospice it came up again. I technically couldn’t authorize hospice. There was a point the hospice care doctor and agency just threw up their hands and said don’t worry about it. They wanted the Medicaire payments that badly.

ETA- oh yeah you need to get the advanced medical directives in place too. Second form after the DPOA. I did not. My dad convinced my mom not to sign that for me. They were both scared of that one because it put lifesaving care decisions in my hands. You need to have the right to deny care at a certain point. As horrible as it sounds for me to say this, I wanted to pull the plug on my mom about a year before she passed during a hospitalization but I couldn’t. Things stretched on a year and as these things go longer they get exponentially more difficult.

[Laura Ingalls]

My brother has the power of attorney and has been using. He occasionally needs some more accountability than he has.

My mom is also listed as her sister’s POA and me as contingency. She is struggling more physically than congnitively. She lives alone with not any real family around. She is about 50 miles from my ILs and I am probably the closest person to her of a younger generation.

I don’t enjoy being at my mom’s much. I enjoy being separated from my spouse even less (he just finished a house sit solo).

Another situation that relates to this is that she has this radically under performing stock/bond portfolio.

11 years ago when my dad died and we transitioned to semi retirement our portfolios were almost the exact same size. She has had 80k of outflow as rmd’s and ~250k of inheritance in. We have spent 250k out of the brokerage on our life (shortfall from paltry earned income. Currently, our brokerage is seven figures higher. Her performance is like 2% a year for the last year 10 years. Makes me crazy. Mostly that the Edward Jones’s business model isn’t felonious.

[Sclass]

I don’t enjoy being at my mom’s much. I enjoy being separated from my spouse even less (he just finished a house sit solo).

Yes this is really tough. My parents almost shipwrecked my marriage. Know your limits. One day it’s going to be just you and your spouse. You’ll get there but it requires balance in the present.

[Frita]

Separation from your spouse, sorting through the finances, and coping with an unpleasant situation sound hard. A lot to process. I wish you strength.

Death and illness seem to prompt all sorts of control power and control behaviors. When my FIL died (after prolonged Hail Mary treatments that actually decreased his quality of life), his second wife had a stack of bills she hadn’t bothered to pay. Even after that was resolved, there have been more issues (refusal to care for property and self). Most recently she fell and took several days crawling to reach her cell and call for an ambulance. The mindset, hers and the extended family’s, is still active denial punctuated by episodic reactivity. I don’t recommend that.

[bridgebetween]

I have an elderly parent.... looking like she cant live alone.
My sister is refusing to help out.
I am a single guy, in a relationship. So far, ive been doing 90% of the effort.
Theres been huge arguments about this.
Sister's life is too busy with kids, activities, parenting... cant = wont.
I feel like I am being railroaded into something, and my relationship will not last because of it.
Any advice from people with similar situations?

[chenda]

Any advice from people with similar situations?

Put her in a care home, or hire a home carer.

[7Wannabe5]

Start researching senior support services in your area. Depending on your location, the best solution will be somewhat dependent on your mother's current housing situation and her financial situation both in terms of income and assets. Care homes and care workers are quite expensive, so anything you can do to reduce the amount of care needed first may prove helpful. For example, even moving from a house to an "active" senior facility will likely greatly reduce the number of tasks with which your mother might need assistance. Technology can also be quite helpful in terms of automating grocery and paper product deliveries or setting up virtual medical appointments so aided transportation is not needed, etc. etc. Everybody knows that we are moving towards an overwhelming burden of elder care, so I have found that being a bit assertive with forward looking solutions is increasingly acceptable. You might also want to think outside of the box and consider co-operating with others with similar problems to come up with affordable solutions. For example, if you want to keep your mother in her home, and there are extra bedrooms, advertise to find another senior who needs some assistance to move in, and split the costs on a care-giver who is also given a room of their own.

[chenda]

@bridgebetween - apologises if my last post came off as a bit blunt. However, I do think that moving to a care home, or any form of sheltered accommodation, can in some circumstances be a very positive step for an ageing relative, inasmuch quality of life can improve considerably for both the person and their relatives. Be aware that a lot of sheltered accommodation can have substantial exit costs i.e. if she later sells her property the company may be entitled to a share of the equity.. Also research what government benefits she might be entitled to.

I was reading this morning that the US as a huge informal care market, where families hire people to take care of aging relatives (who may not have all the correct paperwork but are nonetheless in much demand) Word of mouth referrals or social media might be the way to look for such care workers.

[7Wannabe5]

Yes, informal care can be less expensive, but you will be carrying the liability. It's really no different from hiring a babysitter vs. placing your child in a daycare center. Even seniors who need some ongoing medical care can often get by with visiting nurse if basic housekeeping and personal care tasks are addressed. It's also the case that there are many ways that seniors can be accommodated so that they can continue their own personal care tasks. For example, my mother is still able to dress herself, because she only wears loose dresses which are hung on hooks on the wall, and she has a device which allows her to pull on her socks from a distance. A traveling podiatrist checks in once a month to take care of her feet, and a visiting beautician comes by once a week to wash her hair, and when I'm not around, a housekeeper takes care of the laundry, garbage, and general heavier cleaning. It's actually less expensive overall to pay the elder-care specialists and housekeeping services more on an hourly basis and then hire a care-giver who is really just there for light housework and companionship-towards-safety for more hours at a lower rate.

In the U.S., the cross-over line for full-time nursing home care is likely to be full-on dementia, lack of mobility to the extent can't toilet self by any means, and/or a condition that truly requires 24/7 medical surveillance or intervention. If you are fairly cogent and can somehow hobble your way to the bathroom, and you don't need to be attached to 3 separate monitors, you will either be at home or paying for assisted living on your own dime.

[ertyu]

Would a person in an advanced state of dementia just stop eating and die if there are no available caretakers, or is there an amoeba part of you that will drive you to the nearest dumpster/neighbor door to beg even if you're not all there and fully cognizant of what you're doing

[7Wannabe5]

@ertyu:

I think it varies, but disordered eating does happen with dementia. For example, the grandmother of a friend of mine was discovered to be drinking frozen fruit juice concentrates undiluted. Also, you may have seen in the news lately that 95 year old Gene Hackman only survived for a week after his 65 year old wife/caretaker died suddenly from Hanta virus. In a senior community, even an independent "active' 55-and-up community, there are usually going to be enough busy-bodies around to notice if nobody has seen you in a couple days. One of the purposes of meals-on-wheels delivery is to perform a daily check-in on the senior, and then call their family contact if they do not come to the door to get their lunch. To the extent that affluence buys you the ability to be reclusive in old age, it may tend towards shortening your life. Semi-related somber note for the ladies would be that less than 3% of wives leave their husbands when they become terminally ill or incapacitated, but 22% of husbands leave their terminally ill or incapacitated wives, so it's even more critical for women to maintain and invest in a social circle beyond their spouse (who is also more likely to die first) into their advanced years; an older male partner barely constitutes one leg on your stool towards survival.

[chenda]

@7w5 - It struck me as odd that Gene Hackman, who could presumably afford the best care money could buy, didn't have carers visiting daily, or even live in care.

Milk bottles pilling up by the front door used to be an early warning sign but UHT ruined that.

[Henry]

I was reading this morning that the US as a huge informal care market, where families hire people to take care of aging relatives (who may not have all the correct paperwork but are nonetheless in much demand)

I have a TSLA fanboy buddy who believes the aggressive deportation process currently taking place in the US that significantly shrinks the workers in in pools such as domestic assistance is to create an employment vacuum that can/will be filled by bots.

Now back to our original programming.

[7Wannabe5]

@Henry:

I doubt that is the strategy, because even very expensive bots would already be much cheaper than human care workers. Also, I am on a bit of a mission to install technology wherever it would be helpful for my mother for this reason, and I have often found that the creative use of simple technology is more helpful than the advanced technologies. For example, if you can no longer button your coat, I suppose you could use a robot to do that for you, but you could also just switch over to wearing a poncho.