Parents caring for the parent support thread (Part 2)

She’s concerned that she will have “another stroke.” She never had a stroke.

But thinking about this entire affair got me and my dh thinking. At the time of her fall and subsequent surgery/rehab, nobody – not her doctor, not her children – sat down with her to explain exactly what happened. Nobody said, “You have severe osteoporosis, which means your bones are very fragile. Weak bones can fracture spontaneously, and that’s what happened to you. You didn’t break your hip as a result of falling. You turned your body, which caused your hip to fracture spontaneously, and the spontaneous fracture caused you to fall. This is not uncommon in people with osteoporosis.”

All her children know this because we witnessed it and have a mental model that accommodates this knowledge and her doc confirmed that this was the likely scenario. We assumed that she also understood. In hindsight, we realize that she never had the knowledge that this was a possibility, that osteoporosis leads to fractures. She needed a thorough explanation from an authority figure. Because she did not have an explanation, she has filled that void with her own made-up story that makes sense to her. A stroke is something she has heard about.

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While medical precision is lacking in what mil is saying, the nature of osteoporosis is somehow well captured in her fears. How vulnerable she feels has a powerful accuracy to it. Even without an “incident” her world has, and can again, change in an instant. Agree that acknowledging the concern is a good starting point for forging an alliance as you go forward together towards whatever plan makes the most sense. Even when cognition was compromised, listening carefully to my parent’s concerns helped by setting a tone of collaboration, even if others were simultaneously orchestrating the direction.

All the best to your family. Though my last parent died 5 years ago, I remember the amount of empathizing and finessing going on like it was yesterday.

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Many facilities that will take Medicaid patients want the elder there for a certain amount of time at full pay before Medicaid takes over.

My FIL was in this situation – the facility wanted two years of full-pay before going on Medicaid. That was about how much $ he had, but he was almost 87 and still living independently, with an aide who came 2x/day, twice a day. That setup was going to drain his cash in about the same amount of time.

tl;dr – Moving her now may be the only way to get into that facility and have it covered by Medicaid when the $$ runs out.

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Assisted Living facility may not have any Medicaid patients. I am familiar with skilled care/nursing home, and Medicaid there after funds run out.

Maybe the ‘new’ facility has a range of care, with assisted living and higher forms of care as well.

Figuring lifespan is as tricky as timing the stock market. It’s a concern with my uncle who I am PR for. He is now in skilled nursing with dementia but is only 77. At the rate he has gone down hill I think his money will be fine. His mom lived to 95 but my dad and other uncle were 85 and 78. He claims he will make it to 80

My H stepmom was in her mid 70s when his dad died and she had life tenancy in house that belonged to kids. They joked we wouldn’t have to deal with house for a long time since both her parents were still living in their 90s. She died a year later.

So I feel for those trying to make responsible decisions with regard to quality of life and managing assets. The ‘what ifs’ can be paralyzing.

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Yes, we thought my mom would make it to 95 and she died at 82. And of course we can’t believe that Dad is 85 and thriving. At least he is fine for money.

I always say life would be much easier if we had a crystal ball! Lifespan in my family is all over the place. Grandparents on one side lived into their early to mid 90s. My mom was 78 when she died after a decade plus of dealing with Alz. My dad was 82 and lived 20+ years post heart transplant and a first heart attack before age 50. My H’s side is also all over the place. 1/2 died early from cancer in their very early 60s and the other 1/2 in their 90s.

I just saw where 1/2 of the population will have cancer some time in their lifetime. Of course some of the treatable skin cancer counts in that too. Women get old enough have a 1 in 2 chances of breast cancer.

What state was this in? I never heard of this before.

I think the most prudent course of action, at least for my MIL, is to plan for life until about 105. No downside to planning for it.

@Brantly, my FIL was in NJ. BIL (H’s brother) handled all of his dad’s care and looked at a few places for him, including a skilled nursing facility he stayed at several years ago and liked. Not that FIL needed it yet, but the two-year full pay window was closing as FIL’s resources were getting low.

For better or worse, we never had to confront that issue. FIL went from living at home with minimal aid to passed away from Covid in two weeks.

@CountingDown I’m so sorry to hear about your FIL’s death from covid.

Thank you for your reply. I’d never heard of this two-year-at-full-pay-before-Medicaid situation. My MIL is in New York. We’ll have to look into that.

I wonder if two years at full pay at an assisted living would meet the two-year-full-pay-pre-Medicaid requirement for a skilled nursing facility next door to and under the same organizational umbrella as the AL facility. If so, that’s the linchpin of this entire enterprise, and it will be 100% clear that she has to move. Her current AL does not have continuing care under the same umbrella. The one we want her to move to does.

@brantly, I hope this is helpful:

Thank you! I’ve read a lot of stuff, but this seems to be the seminal source.

My grandmother also had the need to have two years full pay in her nursing home but could stay on Medicaid if she lived beyond the two years. I thought it was just that nursing home but sounds like not. It was very nice as far as nursing homes go and I’m sure my grandmother seemed like a pretty safe bet given she was around 90 and had had a major stroke a few years earlier. Bring stubborn and determined to get a bargain, however, she lived a good five years or more in the nursing home (I jest, she had severe dementia at the end, but she was a stubborn old lady and I could totally see her deciding she was going to outlive her money just to show them).

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Here’s a Q&A from NYS:

Sometimes (actually OFTEN) I think as a “well resourced and developed nation” we do a horrible job of taking care of our children and our elderly - often the people who cannot do for themselves. Shameful.

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We also needed to show 2 years of full pay resources for FIL’s facility before admittance. He passed away after 6 months there. This was in NH.

How many of you have / had financial power of attorney, and how does that come about?

Found out today that my father has sold – well, Mom was not sure herself, but it was probably stock or he cashed a CD— some 5-figure amount to donate to his non profit. Which is not in and of itself terrible, but brought up the issue of when/how do we step in? He is working on their taxes and when Local Sibling pointed out the refund calculated was 1.2 million, Dad just replied “I can check, but it might be right” My parents are wealthy, genuinely so, and have always been big donators but we don’t want him to start emptying their bank accounts bc they may need that money for care or moving. (To be clear, we are not interested in inheriting anything at all)

My dad made me POA when my mom got sick. The attorney did it for us when he updated his will.

Note that POA only goes into effect if the person is incapacitated or loses their ability to manage their own finances so it’s a document that can, and IMO should, be done proactively (like a health care POA).

Also be aware that it’s too late to do the form if a person already has lost mental capacity. Then it becomes much more difficult as the person would need to be legally declared incompetent.

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