Caregiver Tip of the Month
— Make a List —
Some parents who are elderly and/or suffering from dementia habitually demand that other people (their caregivers) do things they are capable of doing themselves. Here are some suggestions for coping with this behavior.
First, decide whether their demand or request is genuinely urgent. If it is, act promptly. But, don't let them lead you into the trap where everything becomes urgent. Don't fall into the trap of saying "How High?" every time they yell "Jump."
If your parent makes a non-urgent demand of you, whether it's a "to do" or an "I want," regardless of whether it's reasonable or unreasonable, don't automatically say "NO" or become confrontational. That most often results in anger or resentment. Instead, say something like, "That sounds like a good idea." This gives them positive feedback from you ... feedback that subconsciously confirms that they are still capable of making the right decisions for themselves.
If you can't respond to their request or demand right now, or if it is unreasonable, don't feel bad about putting it off. Simply tell them, "I can't get to it right now, but I will put it on my long list of things to get done. I will get to it as soon as I can." In other words, you agree that what your parent wants is important and perhaps a good thing, but that you can't do it "right now." By telling your parent that you will be happy to do it when you can get to it, there is no promise of when that will be.
This approach lets them know that you have a long list of things to do, that you have other important things to do in addition to what you parent wants, and that he or she will have to wait until it works with YOUR schedule. (Many parents will actually end up doing some things for themselves if they want them badly enough.)
Of course, use good judgement when using this approach. You don't want to encourage climbing a ladder to change a light bulb, or doing something that could end in disaster. But, for those things they are capable of doing on their own, put them off as long as you can. If something is not within their ability, put it on your list, and get to it the next day if at all possible.
Our visitors ask ...
Q. Where I can find information (support) on how to deal with an elderly alcoholic parent? I have been surfing the net for awhile and can't find anything on the topic of DEALING with a parent's alcoholism on top of everything else we have to do to take care of them.
A. Perhaps the best way to start is to have a frank discussion with your parent's doctor, or even your own. There are new medications that can help people overcome their addiction. However, because most addicts are in self-denial, you (and the doctor) may have to tell your parent that the prescription is for some other condition. While it's a "little white lie," that is sometimes necessary when dealing with the elderly, particularly those who are suffering from dementia.
Daily Living Solutions
— products for seniors —
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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 Tip #2
— Can my father be evicted from his nursing home? —
Situation. "My father is living in a non-profit care facility (nursing home). It will keep him when he runs out of money. It is a wonderful place and they treat him very well. He has no assets and is hiding none. He has dementia and is very confused. He is angry and upset a lot. Could they tell me he can't be there anymore? If so, do they have to help me find a place for him or would they be required to find a place? He will run out of money in about 6 months."
Response. Most (if not all) nursing homes have the legal right to discharge a patient for a variety of non-financial reasons, including being a threat to the safety of other patients and/or the nursing home's staff. But, that usually doesn't happen. Instead, depending on the laws of the state where your father lives, the nursing home may restrain him chemically (with sedative drugs) or with physical restraints. To learn if and under what conditions your father can be discharged or restrained, read the contract you (or he) signed when he was admitted into the nursing home, together with any amendments that you (or he) may have signed later.
The contract will also spell out what assistance, if any, his current nursing home will provide in finding another nursing home if they (his current nursing home) discharge him. In most cases, you will receive no help; you'll have to find a new nursing home on your own. However, most nursing home contracts state that they must give your father (or you) at least 30 days notice in writing in advance of the date when they want to discharge him.
Regarding the financial aspects of your father's situation: If someone already lives in a nursing home when they run out of money, the nursing home cannot throw them out – in most cases. However, when he does run out of money, his nursing home may require him (or you on his behalf) to apply for Medicaid to avoid being discharged. (Medicaid is the federal/state program that pays about half of all nursing home expenses.) Once again, this will be spelled out of the contract signed with the nursing home when your father was admitted.
(Another reason for applying for Medicaid when his money runs out: It will pay for the medical care he receives outside the nursing home, including office visits with medical specialists, lab tests and exams, hospital stays, etc. If that type of care is now being paid for by Medicare, his Medicare coverage will stop when he runs out of money if he has not applied for and been accepted by Medicaid.)
In 1999, Congress passed Public Law 106-4, "Nursing Home Resident Protection Amendments of 1999." In summary, the federal law says:
1. If a private-pay or Medicare patient lives in a nursing home while the nursing home is a Medicaid provider (most are), he or she cannot be discharged for financial reasons, even if the nursing home later withdraws from the Medicaid program, but continues to provide nursing home care to other types of patients. HOWEVER, nothing prevents the nursing home from moving the patient, without his or her permission, into a lower-cost room, including a ward-type room for several patients, or a special Medicaid section of the facility. But, the nursing home cannot transfer the patient to another nursing home without his or her specific permission.
2. A Medicare or private-pay patient who enters a nursing home when the nursing home is not in the Medicaid program can be discharged [evicted] when he or she is no longer able to pay the charges of the facility, even if the patient then qualifies for Medicaid. But for this type of discharge to be allowed, the nursing home must have informed the patient of this discharge [eviction] policy in writing, and received the patient's written acknowledgment, when the patient began residence in the facility.
As you can see, there are several "ifs" involved, including whether or how soon your father (or you on his behalf) should apply for Medicaid. We recommend that you discuss it at your earliest opportunity with an attorney who specializes in elder law. 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.
A final word of advice: While you and other members of your family may be able to help your father financially, be very careful about accidentally becoming a co-signer for any of his debts, or signing any other type of document where you agree to become financially responsible for him. If you were to become a co-signer or become financially responsible, you would be legally obligated to use your own money to pay his bills.
If you do have to sign something for your father as his Power of Attorney, make sure that you include POA after your name AND that you also sign his name after yours. That isn't forgery as long as you do have a valid Power of Attorney. And, acting as his Power of Attorney does not obligate you to use your personal funds to pay his expenses.
Our visitors ask ...
Q. My grandmother is going to start hospice and will need a caregiver with her at almost all times. She wants her family to do it and not hire someone. We feel that hiring a caregiver for a few days a week would be best for all involved. She has the money and that way no one else will get burned out and have to sacrifice their own jobs. Do you know where I can find a checklist for hiring a caregiver, and a guide on how to bring up hiring a caregiver with my grandmother?
A. CareGuide@Home has an excellent article/checklist called Hiring a Home Care Worker. Regarding how to talk about the subject with your grandmother, I recommend that you ask the hospice service for guidance. They have a lot of experience in this and similar matters.
Our visitors ask ...
Q. My very active mother has had a couple of strokes which left her without her peripheral vision on the right side. She also can't retain anything even when she tries to read. She also has CHF (Congestive Heart Failure). She needs someone to be home with her: 1) to take her to the many doctor appointments, 2) take her shopping, her favorite sport. And, that someone I would like to be, is me.
She is comfortable with me but I need to work. Is there and organization that can provide for me the resources to stay at home with her, and I hate to say it since she is my mother, to get paid for doing so?
A. Several states now offer Medicaid programs that pay for in-home care if your mother is eligible. The eligibility requirement is usually less intense than for nursing home care. Some of these states will pay the caregiver even if the caregiver is a relative. Check with your state's Medicaid office to see if that's a possibility.
Something else to consider: Can your mother get a reverse mortgage on her house? This could be an answer for you, although it can get complicated. Generally, the bank giving her the mortgage will give your mother so much money per month based on the equity in her house and her life expectancy. When your mother passes, the bank gets the house. It does mean that there will no house for heirs to fight over, but you and she will get the financial help you need now.
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.
For more helpful information from our website, click here. To see previous issues of this newsletter, click on Archives.
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