Caregiver Tip of the Month

— Elderly Parents in Financial Denial —

Situation. My parents are in their 80s and my mother has quite a few health problems. They now live in a small house in a senior community. I've discovered that they are 'again' having financial problems. Unfortunately, they are not open to having me help them with their finances. I think it is in part because they don't want to lose their independence, but they've always been private about their financial affairs, and accuse me of being nosey.

Now they are to the point that they have fallen behind on their mortgage, and at this rate it's almost impossible for them to catch up. My daughter and I have helped them in the past with small money matters, either lending them money or helping them figure out a way to pay for things. But those instances are happening more often. I'm sure that if someone could review all their finances and help them with a budget, it would make a big difference.

My daughters and I are the only family they have in the area, so we are limited to having anyone else talk to them about these problems. Is there a third party I could have work with them/us to straighten things out?

Recommendation. Being able to manage one's money is a source of great private pride for most people. It is another element of their feeling of independence.

Running out of money, on the other hand, can be a huge embarrassment, particularly for the elderly. As a result, they tend to cannibalize whatever assets they can find to keep their heads above water. And when that doesn't work, they slide further into financial difficulties and become even more reluctant to discuss their problems. Without help, it can become a downward spiral into financial chaos. But to admit that they need help, and to accept that help, means to them that they are no longer capable of living independently.

You first need to get a handle on their true financial situation. While it may ultimately be best for them to give you their financial power of attorney, and/or to hire a reputable bill paying service, you first must overcome their state of denial. We suggest that you discuss your situation with a reputable geriatric care manager in your parent's area. They have a lot of experience in working with seniors in denial.

A geriatric care manager is a medical professional trained in geriatrics, social work, nursing or counseling. They can help older people in a wide variety of ways, often starting with a thorough patient assessment to identify needs and developing an appropriate plan of care for them. They can also screen and supervise professional caregivers; coordinate medical care; pay bills; and act as a liaison with the patient's family. Depending on your needs, they can also screen and supervise other qualified people to help with housekeeping, laundry, shopping, maintenance and repairs; review applicable financial and legal issues and offer referrals to geriatric specialists; and assist with a change of living arrangements, if that is most appropriate. Most important, they know how to talk to elderly clients, and to suggest appropriate changes for them, all while allowing them to retain their dignity and sense of worth.

To find a care manager near you, look at the website of the National Association of Geriatric Care Managers. This is the major national association of health care professionals who oversee long-term care arrangements needed by older people. Their website includes a locator to help you find a nearby care manager; click on "Find a Care Manager" in their left-hand menu.

For the financial power of attorney (and other advance directives your parents should have in place), talk to an elder law attorney. Check the yellow pages in your local telephone directory, or go to the National Academy of Elder Law Attorneys' website. On their home page for the public, you'll find a link in the upper left corner (just below their logo) that will help you locate an elder law attorney.

To find a competent bill paying service, first check the website of the American Association of Daily Money Managers. This is a growing association of professionals who assist people who have difficulty managing their personal monetary affairs. This often results from physical changes due to the aging process (limited vision, arthritis or other conditions which limit the ability to write), or because of Alzheimer's Disease or other cognitive impairments. With members now in most states, you can check to see if a member is near your parents by clicking on the "Find a DMM" link in their website.

Rather than your continuing to be the "financial bailout," there a variety of other resources that may be of help. We discuss these resources (and others) in some detail in our article 12 tips to help you find money (and free resources) for care at home.

Our visitors ask ...

Q. My Mother will be 79 this December. She is having a horrible time with her vision. Her eyelids have dropped and her doctor said it is not bad enough and will never be bad enough for Medicare to kick in. She cannot safely drive, even to church. Her quality of life has dramatically dropped. She is otherwise great, and very independent. She said that life is not even worth living; she is so depressed because she cannot afford the surgery. What can we do for her? It is about $4000.00 and we, her kids, do not have the means pay for this, regretfully. We are very upset. Is there anything we can do to help her?

A. While it is true that Medicare won't pay for cosmetic surgery, this condition should not be considered to be cosmetic. While we can't say that it is covered by Medicare, it could be true that it would require extra proof (paperwork) that her current doctor doesn't want to do. Call Medicare toll-free at 1-800-633-4227 and ask if blepharoplasty (surgery to repair droopy eyelids) would be covered in your mother's situation. (For more information from the Mayo Clinic, click on blepharoplasty.) If the procedure would be covered by Medicare in your mother's case, you may have to find another doctor to do it.

Daily Living Solutions

— products for seniors —

As we grow older, it often becomes difficult to use many everyday products because of arthritis and other conditions. If you or a loved one needs a little help – or a lot – we've selected a group of practical and affordable solutions from our affiliated merchants to help overcome those limitations.

Whether you are looking for yourself, or to help an elderly senior continue living in their own home, you'll find a wide variety of supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button telephones, canes, walkers, rollators, wheelchairs – and much more.

Everything is sorted into convenient categories in our Solutions for Seniors section.

Caregiving – Finding the money for care at home

A variety of resources can help pay for care at home. We discuss these resources in some detail in our article 12 tips to help you find money (and free resources) for care at home.

Caregiver Reminder

What you need to know when your loved one
is a Medicare hospital patient

If you are looking for assisted living, home health care, skilled nursing or a nursing home, it's usually because of a medical crisis involving a loved one. You're probably in a time crunch – decisions have to be made quickly. The hospital may have said that your loved one will be discharged tomorrow. They've given you a list of rehab facilities, and it's up to you to pick one. But, how do you know which one is best? Are some better than others?

If you're in this situation – take a deep breath – relax a little – and read the next paragraph. You might make a better decision as a result.

Medicare has special rules to keep patients from being discharged from the hospital too soon. In spite of what the hospital may have said, your loved one cannot be discharged until 3 days after the hospital gives you a form called a Notice of Noncoverage. If they have not given you the Notice, insist that they do. (You won't get into trouble by insisting, and neither will your loved one.) This will give you additional time to find the rehab facility that's best for your loved one.

Hospitals discharge their Medicare patients quicker and sicker that ever before. In 1968, patients age 65 and older stayed in the hospital an average of 14.2 days. By 1982, that was down to 10.1 days. Now it only 6.4 days.

Why? Medicare is under constant pressure from Congress to cut expenses. Now, Medicare benefits pay a hospital the same fixed fee for each patient with a particular medical condition – even if one patient's condition is more severe than another's. If a patient stays too long, the hospital has to pay the extra costs out of its own pocket. But, the shorter a patient stays, the more money the hospital gets to keep.

How bad has the situation become? According to The Wall Street Journal, "Nearly one in five people admitted to hospitals with broken hips are discharged before all of their vital signs are stable ... . Those patients are far more likely to die or be readmitted to the hospital within two months."

To protect you, Medicare guarantees you certain rights if you think you are being asked to leave the hospital too soon. Unfortunately, these rights are given to you along with all the other papers a hospital makes you sign when you are admitted. So, they are usually lost in the shuffle, with most people never realizing how important they are. Hospitals sometimes take advantage of that fact. ...

Our visitors ask ...

Q. My husband's grandfather has us very concerned with his driving. In the last 3 weeks, he's damaged each of his 2 vehicles backing into his garage and other things. Before that, he pulled out directly in front of another car on a freeway causing his car to get totaled. His kids live in other states and even though we've called them with our concerns, they have not done anything to make sure he should be driving. Of course, this grandfather doesn't think he has a problem and is very defensive when we bring up the subject. Is there anyway to set up the local police to check his driving ability?

A. First, I suggest that you look over our article, "When to Put the Brakes on Elderly Drivers."

Then, you may wish to discuss the situation anonymously with the department in your state that issues drivers licenses. Please remember that, even though you may be correct in your assessment, your husband's parents, aunts and uncles may strongly disagree with you (out of sight ... out of mind).

Recommended Reading and Videos

Many excellent books and videos can help guide you through the caregiving process. For our recommendations, including a brief description of each one, click here.

The material on this site is for informational purposes only, and is intended as a supplement, not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. More