This is a rewrite of an article that I wrote for a small trade journal in New Jersey in September 2002. The information is still relevant:
The nightmare began when your mother fell and broke her hip. She had a hip replacement, and later spent several weeks in a facility receiving intense physical therapy. Then, during your final discharge conference the social worker delivers the “final blow”. “Your mother can no longer live alone. She will need some kind of daily assistance.” The social worker continues. “If you return her to her home, you or someone will need to stay with her.” You remind her that you work full time, often till late at night. “There are professional services that can help, “she answers. “They range from companies who specialize in caring for seniors in their homes to the assisted living communities that are cropping up all over the country.”
Now you begin to panic. You promised you Mom you would NEVER put her in a nursing home. She receives only the minimum social security and there isn’t much in her savings. Medicare is paying for her therapy at the rehab center, but that will stop in only a few days. Once Medicaid stops paying, the social worker quoted you a private pay fee of $260 a day until you can make a decision. You struggle to hold back your tears as you are hit by the enormity of the situation. She is your mother, and suddenly she needs your help. You have no idea what are you going to do?
This is not an isolated incident. Day after day, as the director of an assisted living community in Florida, I hear similar stories from adult children and care takers. Almost daily, I meet families who do not prepare for the unpredictable effects of aging either to themselves, or as adult children, to their parents. In 2002, over 16 million adults in this country were over the age of 75. Statistics proved that 50 percent over the age of 75 had at least one disability, and almost 72 percent over the age of 80 had difficulty with daily living activities such as dressing, bathing, eating and walking. These numbers are increasing rapidly. People are living longer and as they get older, the probability increases that during their lifetime they may have to accept some sort of assistance to live.
It is impossible to discount the media coverage of nursing home neglect and the adverse care suffered by seniors. Understandably, there is a fear of living where one is concerned about abuse or abandonment. The best solution is for a senior or adult child to explore the options that exist while they are healthy and strong. It is prudent to create a plan that covers the contingencies if one is no longer able to live independently. What will happen if there is a loss of mobility or memory, deafness or even blindness? Leaving these questions unanswered leads to frantic choices, family feuds and decisions clouded with emotion.
Getting families to broach the subject is easier said than done. Dr. Michael McGee Ph.D. and Executive Director of the Center for Senior Stress in Tallahassee, Florida described the dilemma that exists between parent and child. “The parent, afraid of worrying or burdening their children, avoids the discussion. Aware that they are getting older, they have no information to assist them. As parents, they fret about the financial obligations for them and their children, the loss of familiarity, and the fear of having to rely upon their offspring. The adult child on the other hand, not wanting to infringe on their parent’s rights, also struggles with this emotional turmoil and lack of knowledge. Unfortunately, they often fail to recognize the frailties in the ones who have raised and nurtured them. Neither is prepared to face the ambiguity of the role exchange.”
Dr. McGee indentifies the signals to take actions, such as the onset of poor eyesight that prevents driving, loss of hearing or subtle confusion. Who goes first? Dr. McGee feels parent are waiting for their children. He advises adult children to approach the subject first.
“Open the lines of communication well before there is a crucial need with a big family meeting” urges Twyla Sketchley, an attorney who practices elder law in Florida. She advocates addressing the legal issues early. “Admission to the E.R. or the Intensive Care Unit is not the time to call for a durable power of attorney.” Once the discussions begin she advises “attach yourself to a least one professional. Whether it is a lawyer, a doctor or a psychologist, choose someone you trust to guide you when you need it.” She discourages relying on Internet sites, for those are often ineffective, especially if applying for some form of government aid.”
Ms. Toni Nelson, MSW, whose company Continuum Care counsels adult children and seniors emphasizes, “Let your family know that it is not bad or unusual to need assistance. We are all interdependent in one way or another.” Ms Nelson also recommends making a Plan A and a Plan B. “Plan A, of course, is living at home healthy and happy with no assistance.” Plan B is just in case that does not happen.
When making Plan B. Ms. Nelson cautions, children should allow their parent the same freedom to make decisions that their parent gave them. Therefore, the guts of the plan need to be acceptable to everyone. She explains that Plan B is for “ years down the road,” and helps not only to understand a parent’s wishes, but also to give them time to digest it, visualize it and accept it in their mind. “It will be a much easier step if you ever have to implement it.”
One of the biggest fears is not having enough money. Local senior centers, retirement communities and investment firms frequently hold seminars to outline some of the newer options. Long term insurance and annuities are fast becoming popular, and many are available to older seniors who thought they had missed the opportunity. Objectively, itemize the cost of living at home. Often food, taxes insurance, maintenance and utilities will add up to a large portion of the cost of renting in a community.
Become familiar with the resources in your neighborhood. Independent retirement communities and assisted living facilities are fast becoming popular. Smaller areas may have private homes for seniors needing assistance, and private help, although expensive, may be more appropriate in some settings. Don’t be afraid to visit, have lunch or attend a function at a community even if you never intend on using their services. If nothing else, you will enjoy the free food, and if by chance you are forced to follow Plan B, there will be less fear of the unknown.
Many seniors are living in homes not customized for poor eyesight, stiff bodies crawling into bathtubs or unrestricted pathways for wobbly legs and bodies. There are no pathways for assistance appliances such as walkers and wheelchairs. It takes courage to face these situations early on, and to prepare for the unpredictable. The families who plan ahead will lessen the likelihood of having to make rash decisions during an emotionally stressful time, and in turn assure their loved ones a better opportunity for a safer happier future.
Karen Pinney is the administrator of a large independent and assisted living community in Tallahassee, Florida. She has been assisting senior in the health care industry for over 15 years.