@CT1417 did a great job explaining, I would just like to add, regarding the ADLs, it’s not always common sense, for example, eating as an ADL, well shopping goes first, and meal planning, but soon they cannot even cook. My mother is struggling to put toast in the toaster, adjust the time, “oh no, when it’s stuck please don’t stick a knife in the toaster!” etc., in no way is she capable of her own meals, but she can put the food into her mouth and so eating is not an ADL issue for her at this time, so even though you may be uber focused on the problem, it might not meet the standard.
DH and I have talked seriously about LTC coverage for ourselves and having watched it over the years, and even sold a bit, having watched our parents, we are thinking not to bother. One parent needed that level of care for 30+ years. One for less than six months, in their late 90s, one for a few days, and one is still not qualified for LTC, but is mid-90s and requiring a lot of my time and effort, so I am not sure it is the right investment for us. Oh, but if you do find it works for your situation, be sure to check out the policies which have a life insurance benefit if you don’t use the LTC benefit, at least you get your money back and a bit of interest.
Thanks @CT1417 and @somemom Yes, I am thinking of one of those plans which include life insurance. I do hear what you say @somemom about food prep not included. Of course, I’m mostly interested in the cognitive decline piece.
As another data point, try to figure out what you’re really thinking the elders may and may not need. The elders in my life would not qualify for LTC benefits as they can still perform activities if daily living, even my aunt who finally succumbed to lung cancer.
Aunt finally did qualify for benefits in the very last month of her life after decades of paying premiums. She needed help long before she qualified for benefits.
It doesn’t matter how slowly and painfully the tasks are accomplished, just that the Insured as ability to perform them: toileting, transferring from bed to chair, feeding self, bathing (in some policies), and a few other things.
It does NOT include regularly taking medications, shopping, preparing healthy meals, or any of these tasks. Folks may need help with shopping, preparing meals, regularly taking meds, and other things long before they qualify for LTC benefits.
Whatever you do, save assets so you can hire the help you need when you need and don’t rely on LTC providing assistance when you feel you need help.
My sister took my mom for her checkup today. The doctor ran a battery of tests and concluded that she has Mild Cognitive Impairment. Oh, boy. Here we go. However, it turns out that she quit taking her BP medicine two months ago without telling anyone, so maybe getting her BP back down will help.
Anyone used Lorazepam for anxiety in their senior? We are trying the smallest amount tablet and using half, earlier this week I gave it in the morning, she was too tired and wobbly all day, but felt it wear off in the evening. I switched to one half pill at bedtime, figuring at least she would sleep. We had a big weekend with outings and that should have tired her out, but now today she is complaining that she is too tired all week from the pill.
Could this be true? Could their be a long term effect or is it just an excuse for being tired? My mother is always looking for a reason she feels less than ideal.
@somemom – I agree with your first paragraph entirely. There can be many years of care needed before the insured has deteriorated enough to satisfy the definitions of the policy. My mother believes that her LTC policy should be paying for everything, the way her retiree surviving spouse medical & dental coverages pay for almost 100% of all her medical & dental costs. It took many months to convince her that she needed help and she needed to pay for that help OOP because she was not yet benefit-eligible.
The $40K she has paid in LTC premiums could have paid for a lot of not medically necessary in-home care w/o any of the hassle of documenting with the LTC carrier.
@HImom – I agree completely with your entire post. Your last line sums up my feelings about LTC.
“Whatever you do, save assets so you can hire the help you need when you need and don’t rely on LTC providing assistance when you feel you need help.”
I want to point out that even eny my D went on various meds. it took monitoring, shifts in dosage and sometimes swapping meds out, trying different. And she was able to verbalize the effects. With any change, her doc had her back in a few weeks later. to monitor helpful and side effects. . I wouldn’t think it’s simple with the elderly, especially if you aren’t just trying to tame extremes.
For my elders, being able to pay for someone to spend 30 minutes every morning, making sure the meds are taken, showering, changing clothes and eating breakfast is a HUGE deal! They still CAN perform all activities, just have NO memory, so the CNA being hired for every day provides continuity and structure plus helps them correctly start their day. The CNA is less than $150/week or less than $600/month and peace of mind is invaluable!
$600x12=$7200/year, which is allowing them much more independence than if they had to move to assisted living. They have no LTC insurance. I don’t think they’d adjust well to assisted living—they hate being in the hospital and having to deal with all the personnel there. They’d also have to be separated and move again if differing amounts of care are needed.
I do think seniors do better in their own homes unless they move to an IL/AL/CCRC etc soon enough, and by their choice so with full emotional buy in, to connect to the community and craft a new life for themselves. I saw with my DH’s parents that it was too late and the were both exhausted by just trying to figure out the ADLs of their new life. After nearly 50 years in a home everything from the toilet to the toothbrush to the TV was in a different place. Figuring all that out used up all their energy. It was sad. And one of them was quite angry, the entire time.
@somemom my neighbor’s parents (in another state) wouldn’t move from their home/downsize. They have help coming in but will run out of money for that in the next year - then they probably will be forced to go into nursing home/skilled care.
MIL/FIL are in their own home with care coming in now 6 days/week and Meals on Wheels 5 days/week. When one of them dies, the other cannot live alone - but probably have an option to live with another son or with us. FIL will probably outlast MIL based on family longevity and his current medical status. I can deal with FIL, but MIL had a mental status change Aug 2017, and she has been terrible to me ever since (before then all was great over 40 years). I can not deal with her in my home for living 24/7. At their home since her mental change she treats me like a slave/servant, in a bad/nasty way.
@somemom Lorazepam for my dad was a disaster. He was sedated but agitated. The staff likened it to a caged animal as he wouldn’t sleep, tried to pace, but was unsteady.
@HImom when I needed to get a CNA for the “reminders” you mentioned, it went very quickly to needing full-time care. Certainly much more than $150/week. The LTC policies I came across state they cover such dementia care. Though I do agree having the freedom to buy the care that you need, when you need it is a more ideal situation.
@somemom Lorazepam is a sedating drug. IMHO it should be used sparingly in certain situations. For general anxiety, have they tried an SSRI type drug that can help the root anxiety instead of just masking it?
Tried fluoxetine, tried Citalopram, now we were spending a week trying Lorazepam and then trying Mirtazapine
Luckily my mother is just tired and a bit wobbly not any of the weird effects that I have read about, on the Lorazepam, but maybe I take it down to a 1/4 pill, except they are so very tiny it’s rough to know how to even do that without reducing it to powder.
@somemom how long did you try the citalopram/fluoxetine? I think you need 4-6 weeks to see if they work. Now of course not every SSRI works for every patient.
The Ativan (lorazepam) is often given as one starts an SSRI to mask the symptoms until the SSRI does its job. Or people use Ativan for stressful situations or for occasional insomnia etc.
I also think these drugs act a lot different in elderly patients. Ideally I’d love a geriatric psychiatrist to Rx them. My folks former CCRC had one on staff and he was excellent. Are you doing any adjunct therapy? I never thought my mom could break some of her lifelong thinking patterns but the geriatric neuropsychologist has helped her with some coping tools.
My mom didn’t do well with Lorazepam either. We ended up giving her 1/4 of a pill of the lowest dose before bedtime and that helped a little bit but overall, not the best.
Citalopram stopped after a few days, very anxious and jittery, refused to take it; fluoxetine we went 2-3 months, she was worried and bothered in different ways than usual, but no better.
I changed the Lorazepam to 1/4 pill at night and will wait a bit longer before the mirtrazapine so we don’t confuse the side effects.
I wonder if there are any geriatric psychs here, I will check!
My mother took Lorazepam; as she aged, I would break a 1mg tablet in half and give it to her the three afternoon/evening pill times. There were some left after her death, and they have been a Godsend for me; when the grief was worst or I had to handle something without tears, it calmed me without sedating.
I have a question about having a caregiver come in to make meals.
My father could use some assistance and refuses to take meals on wheels. He delivered it in his younger days and does not want “cafeteria food.” We have just about decided to bring someone in 3 - 5 days/week for a few hours in the evening to make dinners, do laundry, and generally pick up around the house.
My question is, who does the menu planning and who does the shopping? My dad is currently able to order groceries to be delivered, though I don’t know how long he will have the mental capacity to do this. I’d rather not be the one planning his menus if possible. Does the caregiver sit down with the patient and plan the menus? Who then does the shopping? Do they plan it a week ahead and then I shop? I’m not sure how it works. Thanks for any advice.
For clarification, my dad lives alone, a few miles from my house. He’s beginning to slip mentally but still manages his own affairs and drives short distances. Physically, he’s weak.
You need to find some one who can cook food to your dad’s liking, which is not easy. I interviewed many many caregivers for my mom and make sure they know that the first week is a test period, I can let them go without any reason.