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My mother is 84 and has Alzheimers. We are spending her assets to provide care for her and we would like for her to be able to live in her home as long as possible. It will soon come the time that all of her assets will be her house and I would like to find the best way to tap that money. Her house is held inside her living trust and I am the successor trustee. I was wondering which would be the better option for my mother:
1. Getting a reverse mortgage; or
2. Buying the house from her and having her pay rent. I would need the rent to help cover the cost of the mortgage; or
3. something else that is smarter than either of the above options.
If we bought the house from my mother, where would you invest the money for her? (assuming there would be a total of about a 7 year time line before we would completely spend down the money gained from the house sale).
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My mother developed Alzheimer's about 7 years after my father died. When she reached the point of not being able to live alone, we found a retirement home for her to live in for as long as she was able to live with that level of structure. This was not an assited care place, just a regular retirement home that served meals and such. She was able to live there for 5 more years, and she had a reasonably decent quality of life during those years. It then became necessary to put her in an Alzheimer's facility, but by that point she didn't know where she was or what was going on, so she didn't seem to mind all the craziness going on around her. Fortunately for her, she soon thereafter developed cancer. She died within the year. From a financial point of view, we sold her house and invested the money, and then used those funds and her other savings to finance her care for the rest of her life. There was money left over in the end. The cost of providing in-home care is prohibitive, and will cut through a ton of money very quickly. In the first few stages of Alzheimer's, many folks (like my mom) can get by so long as they have a lot of structure, like in most normal retirement homes. She made friends, and together they had enough combined sense to take care of themselves and enjoy a few more years of life. Of course, I had to go over there many, many times per week to make this work, but I got to the place where I could keep things running with short trips to straighten out things. There's no good way to handle the issue of Alzheimer's, so good luck.
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My mother is 84 and has Alzheimers. We are spending her assets to provide care for her and we would like for her to be able to live in her home as long as possible.

First make sure you're dealing with as realistic assumptions as possible. She needs a thorough going-over by her primary care doctor and a reasonable life expectancy assessment. The other thing is to make sure you're using good cost assumptions. We paid $11.00/hr for in-home care for my mother. Medicare and health insurance pay nothing.

The much harder thing is to look at it in terms of what's best for your mother, not what you'd like to be best. There was a time after the onset of her illness that my mother could have adjusted to life in a retirement home, but my father wouldn't even allow discussion of it. By the time she was so bad that 24 hour care was required, it was too late for her to try to adjust to new surroundings. Luckily hearth failure caught up with her before her mind was totally gone.

IOW, if it looks like your mother is eventually going to have to leave her home, IMO sooner is better than later.

Phil
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As to how best to use your mother's remaining asset, her house, to maintain her, I suggest you cross-post your message at the Inheritance Strategies Board or the Estate Planning and the Fool Board.

Quite a few people knowlegeable about these matters frequent those two boards.

Trini
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ResNullis: My mother developed Alzheimer's about 7 years after my father died. When she reached the point of not being able to live alone, we found a retirement home for her to live in for as long as she was able to live with that level of structure. This was not an assited care place, just a regular retirement home that served meals and such. She was able to live there for 5 more years, and she had a reasonably decent quality of life during those years.

What would a "retirement home" be called if I look in the yellow pages? How are they different from assisted living? In the L.A. area, the retirement homes seem to mostly be assisted living, with the degree of assistance scaled to the needs of the resident. My mother is 88, and spring loaded against any mention of assisted living. There is a nice assisted living place only 1/2 mile from her home (in north Texas), but she won't consider it, even gets upset if anyone suggests it. She is afraid of being rejected socially, if I understand her. Not that that is what she says, but I think that is at the root of it. Worse, she can make that sort of thing (rejection) happen, I'm afraid. She can be even more obnoxious and unsociable than I am. lol (I hope!) She refuses to pronounce it "assisted" living, and says "assistant" living. Her other nightmare is that it will be like a nursing home. Nothing will dent her fixation on this. When she doesn't say "assistant living", she says "nursing home".

Her house is a mess. She eats mainly leftovers from when someone takes her out to dinner*, and she shouldn't be driving. She depends on my sister (who lives nearby) for a lot of things, and is basically driving sis nuts.

This is starting to look like a plea for help, so I'll just say it: How can we (sis, bro, and I) break down her phobia against assisted living? I agree with the posts here that say to get her into a retirement (assisted living) home while she can still assimilate. We desperately want her to stop driving, to eat properly, and to have a cleaner, better maintained environment. Money is not an issue. At her age, her funds will last longer than she will, and my sister and I can care for her financially if need be, but neither of us could have her in the house, if you understand this.

Any suggestions?

cliff
*Joke time: I claim that mom fed the family for 30 years on left overs. The original meal has never been found. I forget the source of the quip.
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"What would a "retirement home" be called if I look in the yellow pages?"

Try nursing home.

There are several levels of care and strict rules. Generally in the lowest level, the patient must be able to help herself to an exit in case of a fire alarm. If she can't do that, then she gets a higher level of care with more staffing (at higher cost) to provide that assistance.

These are very much like hospitals usually with group meals served in a common area for those who are able. They also usually have activities and sometimes sightseeing trips for their residents.
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"Medicare and health insurance pay nothing."

For those without assets, medicaid will pay nursing home costs. Most with decent assets do not qualify. Some attempt to qualify by giving away their assets. That is one of those subjects you need to discuss with an Elder Care Attorney in your state as the rules administered by the state and vary (though the money comes from the Feds). In most cases there is a three year look back period.

So one approach is set aside funds to cover 3 years of nursing home care. Give away the remaining assets. If she is in the nursing home longer than 3 years, let medicaid pick it up.
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How can we (sis, bro, and I) break down her phobia against assisted living?

I'll be frank; it may not be possible. Some possibilities:

If she has a trusted physician, clergyperson, etc. enlist that person's help.

Drive her around to look at facilities, especially if there are ones that house people she knows. (When I did this with my father I openend the trunk of the car to reassure him that this wasn't a trip to the dump.)

A personal note to you. I make no charges, I just offer experience. I was in Sis's position for 3 years. I returned early from a vacation in Europe because Sainted Brother couldn't make it from Denver amidst an emergency. When SB did manage to breeze in for a quick visit it was to issue (promptly ignored) edicts. Meanwhile I had to listen to, "I'd so like to see poor SB. He's so busy." When it would finally get to "get your butt on an airplane", SB's response was an innocent, "Well, you didn't say anything."

Your sister is under unbelieveable stress. Make sure you visit regularly to give her a little relief from the load.

Phil
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My mother went to a place that had four floors, a hundred or so individual (small) apartments, with tiny kitchenettes. There were many common areas throughout the place, plus a central dinning area that served three meals a day. The place provided maid service twice a week, plus had a nurse on duty at all times, plus security etc. It essentially was an apartment complex for seniors. The place had a bus that took residents to shopping areas, plus looked out for them. There were activities and such scheduled throughout the week, some of which were off premises. Some of the residents had their own transportation, but most didn't drive anymore. One fee covered everything--room, utilities, three meals, entertainment, and everything else. It was a self-contained world for seniors. It is listed in our Yellow Pages under "Retirement & Life Care Communities & Homes." There are a number of them in my town. Some have an assited living section, but the one my mother was in didn't. I checked out three or four. By the way, if you make a big deal out of your mom having Alzheimer's, many of these places might reject her out of hand. We had to obtain a medical certification that she could live safely in those surroundings, which wasn't hard to get, since the physicians in my town seemed anxious to help get her in. My mom didn't want to go, but I didn't give her a choice in the matter. After about a week, she loved it. Over the years that she was there, I noticed that almost every new resident reacted the same way. They hated it for the first several days, but then they loved it as soon as they met some friends. Folks living in these places tend to group together to take care of each other, since they all are in the same boat. Anyway, good luck. You'll need it, because Alzheimer's is the worst thing imaginable.
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Why don't you call your local Alzheimer's Association. They have so many answers for the problems we encounter each day. And they are aware of the resources available in the community including care facilities, doctors that treat the disease, things to do to make it easier to keep the patient in the home. All sorts of information.

When I took my patient to a neurologist recommended by them He told me "We have all sorts of tricks in this office". And he was right.

At least this was my experience with the Alzheimer's Association in western Texas.

Ivy

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The retirement communities for relatively able seniors are a good deal in part because they don't have to worry about being alone, or preparing meals. But the activities and friends make it a good deal.

Having a home of your own gets to be a burden. And when driving becomes difficult in many cases the results is a high degree of forced isolation. At least the communities give people close contact with others to keep active and busy when they are in the mood.
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Where do I collect my cyber antlers? Retired Fools have especially fancy ones?

-9000-
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Phil: A personal note to you. I make no charges, I just offer experience. I was in Sis's position for 3 years. I returned early from a vacation in Europe because Sainted Brother couldn't make it from Denver amidst an emergency. When SB did manage to breeze in for a quick visit it was to issue (promptly ignored) edicts. Meanwhile I had to listen to, "I'd so like to see poor SB. He's so busy." When it would finally get to "get your butt on an airplane", SB's response was an innocent, "Well, you didn't say anything."

Ouch! Right between the eyes, except I try not to issue edicts, even though I am older, smarter, and ever so much better informed. :o) (And better looking!) I visit once a year, but only for a few days. (Hey, it's north Texas!)

ResNulis: Anyway, good luck. You'll need it, because Alzheimer's is the worst thing imaginable.

Sorry if I implied my mom has Alzheimer's. She doesn't. She is just stubborn and frightened.

cliff
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Hey, it's north Texas!

Believe me, I understand. This is Kansas, and if I'd wanted to stay here I wouldn't have left in 1966 to have a life. I moved back in 1999 because I could and because I could no longer talk myself out of it. (I really tried.) It cost me a lot, but I wouldn't trade the experience for anything. Having been here has been incredibly helpful in dealing with the loss of my parents.

My best to you and your family.

Phil
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You are into an area that involves both Federal and State law. Additionally, since Medicade is a state program, there will be case law. In the financial area there are "look back" provisions -- which mean simply put a past financial decision (selling property, giving property away, etc.) can preclude benifits. Before you do something like buying your mother's house or a reverse mortgage, contact an attorney in your state who specializes in Elder Care. In Tennessee we were told the look back period was 3 years.

The last thing you need to decide 2 years from now your mother has to go into a home, she has no assests and the government says until you come up with the value of her previously disposed of asset(s), no medicade money is avaiable.

Gordon
Atlanta
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I don't believe we need to worry about look back periods. she is not giving her assets away. if we sold the house, she would be getting fair market value for the house and then using the assets to fund care.
Re: suggestions about assisted living/retirement living. Assisted living is clearly the best option for my mother, but one that she soundly rejects and I can't "force" her. Homes will only accept her if she goes on her own volition. other complication is that she is in California and everyone else is far away.
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"This is starting to look like a plea for help, so I'll just say it: How can we (sis, bro, and I) break down her phobia against assisted living? I agree with the posts here that say to get her into a retirement (assisted living) home while she can still assimilate. We desperately want her to stop driving, to eat properly, and to have a cleaner, better maintained environment. Money is not an issue. At her age, her funds will last longer than she will, and my sister and I can care for her financially if need be, but neither of us could have her in the house, if you understand this."

If money isn't an object, hire someone to be with her. You may not need 24 hours a day to begin with. Finding the right person can be tricky because many who would accept this job will steal her blind. Her pastor may make a recommendation; a visiting nurse agency in the area is a good resource.
When the person does have a degree of senile dementia, and Alzheimer's is only one type, then to keep the person as happy and functional as possible for as long as possible, to maintain that person in their own home as long as it makes any sense at all is a good thing. When you move the person, a number of little things we take for granted go awry. The person wakes up at night, needs to go to the bathroom, and can't find the light switch. Things aren't where they expect them to be. Then the person starts wandering around at night, and one thing leads to another. They look around themselves, realize this isn't the house to which they were accustomed for the last 40 years, and go out the door and down the street trying to go "home".
My sister spends time (paid, but not tremendously so) with a lady in her 90's who is NOT demented, but crippled with arthritis and needs help to get out of bed, into wheelchair, can't see. It makes her happy to be read to, be fed her meals, and generally to stay in her own home. The trick is to find the right person. Generally maintaining a person in their own home works until the person becomes incontinent, and if you have full-time hired help that will and knows how to change a diaper, they may be able to stay home until the end.
The resistance many people feel toward nursing homes is tremendous, and many of them are NOT good. There ARE good ones. Problem is that the staff are poorly paid and turnover is great.
I'd support maintaining your mother where she wants to be, which is her own home. Get somebody to cook and clean, and yes, take away her car keys. The hired companion can do the grocery shopping. Figure $25000 a year minimum, plus room and board. Maybe a lot more, depending on the local conditions. Get references--don't just put an ad in the paper.
Best wishes, Chris
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I'd support maintaining your mother where she wants to be, which is her own home. Get somebody to cook and clean, and yes, take away her car keys. The hired companion can do the grocery shopping. Figure $25000 a year minimum, plus room and board. Maybe a lot more, depending on the local conditions. Get references--don't just put an ad in the paper.
Best wishes, Chris

Thanks, Chris. This would be a good idea, and it is do-able except that mom won't tolerate another person in the house. We had a lady come five days a week when Dad was home, as he needed more care than mom could provide, Mom hated it. She wouldn't let the lady do anything, then complained that she didn't do anything. The lady was a saint to put up with mom.

I recall the famous bumper sticker: "Avenge yourself! Live long enough to be a problem to your children!"

cliff
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Cliff, you certainly do present a problem. That said, you have come here asking for suggestions, have received many good ones, and have shot down every idea presented. I see a problem with that even if you don't.

Now, before you say "you just don't understand"....I certainly DO understand. My Mother kept my Father at home long beyond the time she should have. She continued to rely on me and my husband to rescue her from her trials and tribulations. Including phone calls saying "he's fallen in the bathroom and I can't get him back up." The rescue squad was called on numerous occasions because she got him into situations she couldn't handle. I spent my 30th wedding anniversary at the emergency room after he fell and injured his spine. 12 hours there? not a problem, right?

As I had his medical power of attorney, I finally had to put a stop to it, and I did. Over her objections, her screaming that she was going to kill herself, after her not speaking to me for weeks because he was put in a nursing home, he FINALLY received the care he needed and deserved. He continued to live ther for 5 more years before his death.

You can't continue to allow your Mom to dictate to you and your sister, especially when her well-being and safety are concerned. Stand up, be a man, consult with your sister and DO SOMETHING. The alternative to not doing something could haunt you the rest of your life.

Kitty
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(Did you notice from her profile that Crosenfeld is an MD? I'd give her advice in this a few extra stars.)
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Cliff, you certainly do present a problem. That said, you have come here asking for suggestions, have received many good ones, and have shot down every idea presented. I see a problem with that even if you don't.

Kitty, that's a bit harsh, even untrue. I am indebted to Chris and to Phil for their suggestions. As to shooting them down, I have been experiencing this drama unfolding for ten years, and I have tried everything I can think of to get mom into an assisted living set-up. My sister and I got some day care help for mom when dad needed extra care. I have been the "Sainted Brother" who flies in once a year and "issues edicts" (I would if I thought it would help), and then leaves. The brunt of the care falls on my sister. She has power of attorney for both mom and dad. I do not.

Dad has been senile for several years, and it had advanced to the point that he wouldn't be able to function in an assisted living facility. He is incontinent, and sometimes couldn't find his bedroom. He would ask plaintively "Where am I?" He fell and broke his hip last year, and is now in a nursing home, where he will likely remain as long as he lives, and he hopes that won't be long. So his situation is resolved.

Mom has been the spanner in the works. I believe I will try to contact her pastor and hope he has some influence on her. I will be visiting the end of March for my yearly duty trip. It doesn't really matter what I think or say, as mom is "competent" and won't consider leaving her home or having anyone come in to help. My sister has a power of attorney, but she won't force mom to do anything.

So, I wish I could get her to accept assisted living. My original post was to ask if there is some other kind of retirement home not called "assisted living" as mom is dead set against assisted living. Until she agrees, or my sister will over-rule her, she will stay in her house. The other possibility that could sway her is her car. If I can get her drivers license revoked, she might have to move. Nasty trick, but I am not above doing a nasty trick. The more so as she is a danger to herself and to others when she drives.

Thanks to you all, including kitty, for the suggestions and advice. If nothing else, I see that others have had to deal with similar situations.

cliff
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" This would be a good idea, and it is do-able except that mom won't tolerate another person in the house."

You need a talk with your mother. On your annual trip this is a priority. With your mother, figure what needs to be done. Is there food in the house? Does she do her own shopping or have things delivered? Can she cook a meal without making you think she will burn the house down? Is the house clean? If cluttered but not dirty, is this the way it always was?
You now feel she is not safe to drive because why? She can't see, her reflexes are too slow, what? You have said she isn't demented. She remembers how to get from her house to the grocery store, her church, other places where she wants to go? Go on a short drive with her driving. Why is she unsafe to drive? Or is she?
I've had patients where the story goes that sister comes to visit, there is no food in the house, just empty beer bottles, and the sister now unfit to live alone has lost 20 lb in the past 3 months. Clearly this will not do and visiting sister tried to take sis home. First night, demented sister walks out the door, down the street, is picked up by police on the highway trying to walk home (to the next state, and without any money).
There have also been patients who complain that they are perfectly capable of living alone, and their daughter is trying to get her hands on their checkbook. Further, where daughter succeeded in getting her hands on mama's checkbook and effectively stole mama's assets, leaving her without money for support. Then comes the court fight where mama says she's competent and daughter says she isn't, daughter wants Power of Attorney. Only ones that do well in that situation are the attorneys.
Anyway, you need to see, face to face, just what the situation is. Presumably you will be staying with your mother. Being 90 is not in itself a reason she can't live alone. The older people get, the more different they are. Some at 65 have advanced Alzheimers', others in their 90s are sharp as a tack. Eventually of course we will all have physical problems.
If mother can't go upstairs because she can't climb the stairs, are there modifications that can be made to the house?
If mother can't drive because she can't see, can cataracts be removed?
If mother shouldn't drive because she gets lost in her own neighborhood, that is an early indication of Alzheimer's.
Note the difference between acute confusion and dementia. All of us have had the experience of parking in a shopping mall, making purchases, exiting a store with an armful of packages and had the momentary confusion. WHERE DID I PARK MY CAR???
Normal!!!
To spend the next two hours going up and down the rows of cars looking for it is NOT normal.
Most of us have passed our exit on the expressway because we were distracted, listening to the radio, deep in thought about something else, a variety of reasons. If that happens once in awhile, not a problem. If it happens constantly, that's a problem.
Further analysis is required. What does mother need help doing? Personal care? Shopping? Define what is to be done and then, with her, agree how it can get done. Bring in someone else, live somewhere else?
"Retirement community" may have a nicer sound than "assisted living" or "nursing home". Some of those places are really quite nice, and offer open houses from time to time so prospective residents can come visit and see the nice facilities. If making three meals a day has become too onerous, it should be possible to convince your mother that it would be nice to live somewhere where all she has to do is go to the dining room and have a hot meal all ready, which she could enjoy with friends while living in her own apartment, with maid service a couple times a week.
"She's not fit to live alone." That's pretty judgemental. It should always be followed by "because....."
When the problems are mental, in checking around you might find the phone shut off because the person forgot to pay the bill although there was plenty of money in the checking account.
All of us resist like crazy being told that we are no longer competent to manage our own affairs, to get in our car and go where we want to go...try to see this from your mother's point of view. And keep your sister in the loop, too.
Best wishes, Chris
Who works only with patients over 65...
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Chris: You need a talk with your mother. On your annual trip this is a priority. With your mother, figure what needs to be done. Is there food in the house? Does she do her own shopping or have things delivered? Can she cook a meal without making you think she will burn the house down? Is the house clean? If cluttered but not dirty, is this the way it always was?

Thanks again for your advice, Chris. It is very helpful, at a minimum in focusing my thoughts. I do talk with mom every week for a half hour to an hour by telephone. (That's why she likes me the best.) Her refrigerator seems to be filled with leftovers when I have been there. There is occasionally something “fresh” there. She has a freezer. I will be checking it this trip. She does her own shopping, wouldn't let anyone else do it, I am sure. She has a serious money hang-up. She is a child of the Depression, and it warped her permanently. (There were times they went to bed hungry, and didn't know if they would eat the next day, so she has reason to fear not having money.) I think she isn't likely to burn the house down. Electric stove is a positive, even if she gets worse. Housekeeping was never her strong point. She just doesn't seem to see the dirt.


You now feel she is not safe to drive because why? She can't see, her reflexes are too slow, what? You have said she isn't demented. She remembers how to get from her house to the grocery store, her church, other places where she wants to go? Go on a short drive with her driving. Why is she unsafe to drive? Or is she?

Mom was never a very good driver. Vision seems fine, she knows her part of the world well enough to navigate. My concern about the driving is more due to reports from my brother and sister. She seems not quite aware of the other traffic, she drives very slowly, and her reactions aren't very good. She sometimes withdraws into her own thoughts (This, btw, is nothing new, but is seems more noticeable to me now.)


I've had patients where the story goes that sister comes to visit, there is no food in the house, just empty beer bottles, and the sister now unfit to live alone has lost 20 lb in the past 3 months. Clearly this will not do and visiting sister tried to take sis home. First night, demented sister walks out the door, down the street, is picked up by police on the highway trying to walk home (to the next state, and without any money).

There have also been patients who complain that they are perfectly capable of living alone, and their daughter is trying to get her hands on their checkbook. Further, where daughter succeeded in getting her hands on mama's checkbook and effectively stole mama's assets, leaving her without money for support. Then comes the court fight where mama says she's competent and daughter says she isn't, daughter wants Power of Attorney. Only ones that do well in that situation are the attorneys.


So true. My sis has power of attorney, but as long as mom is more or less competent, she is loathe to force an issue like this.


Anyway, you need to see, face to face, just what the situation is. Presumably you will be staying with your mother. Being 90 is not in itself a reason she can't live alone. The older people get, the more different they are. Some at 65 have advanced Alzheimers', others in their 90s are sharp as a tack. Eventually of course we will all have physical problems.
If mother can't go upstairs because she can't climb the stairs, are there modifications that can be made to the house?


No stairs, no Alzheimer's, in good shape for her age. She has a few friends she enjoys. Her dementia is not seriously advanced. I think my main concern is that she isn't eating properly, and she has very little “life” other than sitting at home by herself. I could mention that the nursing home (where dad stays) asked her to stay away during lunch, as she was upsetting dad and the other pts. Apparently she scolded dad all the time. She resents him for being senile and deaf, and now crippled. He used to take care of everything and now he can't.

If mother can't drive because she can't see, can cataracts be removed? If mother shouldn't drive because she gets lost in her own neighborhood, that is an early indication of Alzheimer's.

Note the difference between acute confusion and dementia. All of us have had the experience of parking in a shopping mall, making purchases, exiting a store with an armful of packages and had the momentary confusion. WHERE DID I PARK MY CAR???
Normal!!!
To spend the next two hours going up and down the rows of cars looking for it is NOT normal.

I don't think her wits are very far gone. She is fixated on a few subjects. For instance, I am convinced she worried about going to Hell, even though she has been a devout Baptist as long as I have known her. This is an unbroachable subject.

Most of us have passed our exit on the expressway because we were distracted, listening to the radio, deep in thought about something else, a variety of reasons. If that happens once in awhile, not a problem. If it happens constantly, that's a problem. Further analysis is required.

Heh. My wife says if I become senile, no one will know. I do all those things now!

What does mother need help doing? Personal care? Shopping? Define what is to be done and then, with her, agree how it can get done. Bring in someone else, live somewhere else?

Her answer to these questions is that she doesn't need any help. She can take care of herself. She can do her own housekeeping, cooking, etc.

"Retirement community" may have a nicer sound than "assisted living" or "nursing home". Some of those places are really quite nice, and offer open houses from time to time so prospective residents can come visit and see the nice facilities. If making three meals a day has become too onerous, it should be possible to convince your mother that it would be nice to live somewhere where all she has to do is go to the dining room and have a hot meal all ready, which she could enjoy with friends while living in her own apartment, with maid service a couple times a week.

She has friends in a local assisted living home, and I have gone with her to visit them. I rave about how nice they are, and all the activities they schedule, how they have the bus to take them places. But she has a horror of the place. I believe she fears that she won't be accepted by the others. She may also not accept them. She has a well-developed persecution complex for many years. She can also provoke people, and she interprets their response as persecution. Shoot, I provoke people myself, such as kitty's reaction. The other unspoken objection she has (to assisted living) is that it costs money. I mentioned how fixated she is on money. Offering to pay for her doesn't really help.

"She's not fit to live alone." That's pretty judgemental. It should always be followed by "because....."
Did I say that? Oops!
When the problems are mental, in checking around you might find the phone shut off because the person forgot to pay the bill although there was plenty of money in the checking account.
All of us resist like crazy being told that we are no longer competent to manage our own affairs, to get in our car and go where we want to go...try to see this from your mother's point of view. And keep your sister in the loop, too.

I mentioned that dad always handled everything for them. When he became too senile to do it, mom rose to the occasion. I was proud of her. She pays the bills the day they come in the mail. (She had to, because if dad found them, they might be lost.)

My main concerns are that she isn't eating well, the house is dirty, and the driving. This is different only in degree from twenty years ago. My BIL won't go in her house because it isn't clean, and he says it has a bad smell. He is also slightly asthmatic.

I tried to contact her physician, and he wouldn't talk to me, as I am not her spouse, and I don't have power of attorney. Pity a son can't talk with his mother's physician.

I will try to talk with her Pastor while I am there.

Best wishes, Chris
Who works only with patients over 65...


Thanks so much for your posts, and for the time you have invested in her. It is much appreciated. Just composing the answers to your prompts has helped me focus.

Cliff
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To talk to your mother's pastor is an excellent idea.
A son CAN talk to his mother's doctor. The doctor should listen to your concerns. Because of confidentiality matters, the doctor will not tell you what he knows, but should listen to what you say. If you tell him that when you turned the kitchen light on in the middle of the night, cockroaches ran in every direction, he should listen; (and you should set out roach bait!);if you say she's not eating right, he should weigh her. If she's not eating right, she will be losing weight, or a blood test will show low albumen compared to what it was five years ago or 20 years ago. Alert the doctor, but don't expect him to tattle on your mother. If you express concerns, he should address them at her next visit.
If she's been reluctant to throw out food all her life--"waste not, want not" she won't change and shouldn't be expected to do that.
Clearly she wants to maintain control of her life, and that's reasonable. So do we all.
If she drives slowly she should stay off busy streets, but she may be fine in residential neighborhoods.
Many states require that drivers over a certain age, or elderly drivers who have had accidents, should come in and pass a test to renew their license. That system is fairly efficient at getting people who can no longer drive from behind the wheel.
She may need nothing more than a cleaning lady, but it is difficult for a cleaning service to do anything if there is a lot of clutter that the homeowner doesn't have a place for.
Incontinence tends to be a problem with elderly ladies. Ask. Is the smell in the house primarily in the bathroom?
Best wishes, Chris
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I do not intend to make myself look like an "expert" in this area... (In my mind, there is no such thing as an expert.) However, my wife, my sister-in-law and other siblings had similar experiences with my mother-in-law, whom we all held in great love and esteem.

She was brilliant, a college graduate at a time when many women simply did not go to college and worked hard all of her life. When my father-in-law passed away (long before her), he left her very little with the exception of their house. To her great credit, the house was sold, she bought a condominium and continued to do a "little investing" when something struck her as worthwhile. To make a long story very short, we missed some of the early signals of Alzheimer's and watched her deteriorate very slowly over a few years.

Finally, we suddenly realized that the time had come for assisted living. She wanted to "die at home" and we did try having 24-hour care for her there. It was terribly expensive and the care often inconsistent. She became ill, went to a hospital and from there to an assisted living place that she and her daughters had visited, several years earlier.

This made the move slightly easier, and we were able to bring some of her "special things" to keep in her room with her. She deteriorated rapidly, and finally passed away after about a little over two years. She had amassed quite a large portfolio so we all decided that money was not an object prior to going into any facility, and she had the foresight to get some excellent Long Term Care Insurance, which really helped.

I guess what I am trying to say is that this disease is the worst possible imaginable for everyone. In the end, she did not know who anyone was, where she was etc. Compassion is the only way for everyone to get through this. Agree with everything she says once she is safely in a facility. Ensure that there are "lock-down" capabilities and establish a genuine rapport with the caretakers and managers at all levels. Bring them gifts occasionally on holidays etc. Is this a bribe? You bet! Does it work? Emphatically Yes!

We visited her two or three times a week and one of us was always there on the weekend just to checkup on her caregivers and to see if she was getting everything that we had signed her up for...socialization outings, etc.. None of this is cheap. This facility was a little over 7K a month! We also provided additional expenses out of pocket. None of us wanted her money, but as it turned out, she had taken the steps and made the essential agreements early on in her retirement to ensure that everyone got something...

She was incredible and in my mind, still is one of the strongest influences in my life and of her children and grandchildren as well.

As I mentioned earlier none of this is cheap. Living at home is the best if you can afford 24 hour nursing etc. Nevertheless, there are limitations to everything. Contact your local Alzheimer's group through hospitals, social services, have a good lawyer and if money is or was involved, make sure you have a reliable financial advisor or broker. Make sure there is a living will and that someone you trust has full power of attorney! These two documents are probably the most important next to their will.

Most of all, love them, treat them with dignity, respect (even if they do not appear to know you are there or not), and love. Give generously of your time. (Some of the other patients came to know my wife and me and often waved or spoke with us from time to time.) They do know somehow who is who, and will enjoy even an occasional book reading or movie on TV with a relative or friend. I wish you well and pray for you and your family.
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You need to talk to the attorney that drafted the trust. You should not make any decisions until you find out about your state laws and the federal laws too. The look back period for nursing homes and giving away money,liquididating investments, selling houses, etc is 3 years. This is a federal law Clinton passed. Tusts figure into this too.

There are agencies that provide homemakers or certified nursing assistants. Homemakers cook, clean, and can do errands. Hire a place that is licensed and bonded. You can get 24 hour a day care, just someone to be there if you can pay for it.

You can look under Home Health Care or Nursing in the phone book. Most of these agencies have homemakers, certified nursing assistants, LPN, RN and various therapists such as physical, respiratory working for them.

You need to find your local agency on aging. This will be a county or city listing. They have senior citizen centers for the general public.
If you can find a senior center ask for the phone # for senior affairs or the agency on aging.

Also the senior agency will have info on adult day care. These programs are so people don't get lonely, and to offer care givers a break. The senior agency gets monsy from the federal gov't for these programs.
Many offer transportation to and from the day care place. Where I am seperate buildings were build on senior citizen centers.

They may need to know the income and assets of the senior person. Some are costly and others are based on a sliding scale for your income. Some depend on contributions which are voluntary. Even the costly ones are usually cheaper than having a homemaker in for 6 or 8 hours during the day. They usually offer meals and snacks too. Special diets are included within reason also.

Some HMO's that have medicare supplements have freestanding adult day care places too. Another resource is to call your Mom's primary care doctor. Often times they will have social workers and case managers that will address problems such as yours and help you to discover your local resources. Explain some of your concerns and ask for the name of the social worker.

Some people at adult day care have a lot of problems such as feeding themselves. They offer field trips, light exercise and lots of stimulation for the attendees. Then these people are not at home alone in front of the tv eating god know what.

Good luck,

Mctripat@comcast.net You can e mail me if you want and I'll try to help you more or give you more specific links for your area.
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So, I wish I could get her to accept assisted living. My original post was to ask if there is some other kind of retirement home not called "assisted living" as mom is dead set against assisted living.

I don't know what kind of resources are available in her area (and I don't believe in picking them up and moving them), but there are retirement centers that offer a full range of facilities, from independent living to full nursing care. We ran across one here that had the added feature that once you moved in, you didn't move again until you were off for your dirt nap. Most places relocate you to the specific type of facility providing your care level, but this place brings the care to you.

Have you checked with the local council on aging, or whatever they might call it there? They can sometimes offer referrals, suggestions, and even social worker interventions.

Phil
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I am convinced she worried about going to Hell, even though she has been a devout Baptist as long as I have known her. This is an unbroachable subject.

Oy! Get thee to her pastor this trip and have him address this with her.

I didn't mention earlier that SB is a devout fundamentalist, and if one doesn't in every conversation refer to "Jesus, my Lord and Savior" he is advised that he is on his way to Hell. I had such trouble calming Mom down after each of SB's visits that I finally asked her pastor to intervene.

As far as the doctor is concerned, have Sis get in touch with him and find out what kind of paperwork would be required for him to talk to you. I never ran into this problem, but my parents were dead before the new medical privacy laws went into effect.

Phil
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To Cliff666 -

There are lots of alternatives to nursing homes for people like your mother. To get you started, do a search on Continuing Care Retirement Communities (CCRCs) in Texas. Also check the state Department of Health, or whichever department licenses retirement and nursing homes. Some states publish lists of the faciltities they license on their web sites. She will still take persuading, but moving to a place where somebody else does the cooking and makes sure you show up for a meal once a day is not the same as a nursing home.

Good luck
Kathleen
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There are lots of alternatives to nursing homes for people like your mother. To get you started, do a search on Continuing Care Retirement Communities (CCRCs) in Texas.

Thanks. Will do.

cliff
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Cliff,
You may want to grab the Feb '04 Kiplingers mag. It has an article with some resources for providing parental care from long distance.

Thanks to you and all the follow-up posters for sharing. In the face of frustrations, there's comfort in commiseration.

Chris hit some good points on being wary of what we think should be done and what really needs to be tended towards.
When I tapped a friend that is a Social Worker specializing in Gerontology, her closing advice was, "if he's safe and content the way things are, there isn't much more for you to do. If that still bugs you, then maybe you should consider finding a support group for yourself to help you accept your limits."
After I rebounded from my initial defense (perhaps offense) at her comment, I realized that she was reminding me to be aware of crossing the line from trying to help improve things to trying to control things.


Also, someone fired up a board, which sits quiet, that looks like it could be a more active forum based on the contributors here.
http://boards.fool.com/Messages.asp?mid=20058154&bid=116503
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Taking away car keys is essential, I agree. Contact the DMV with your concerns if your mother will not voluntarily give up driving. That was actually a relatively easy battle with my mother. She was explosively angry about this, but then let go of her anger in about a month (which is quick for my mother). We then bought the car from my mother and gave it to my husband's mother. In any case, I think driving for my mother had become incredibly stressful for her and she was in reality relieved to have that stress out of her life. The DMV assisted because it required my mother to come in for a driving test and that was just too much for my mother to cope with. The safety issues are just too important to ignore. In our case, the front tire blew as my husband was driving the car on the freeway to his mother's. Fortunately, he was able to cope, but i bet my mother could not have.
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Thanks to you and all the follow-up posters for sharing. In the face of frustrations, there's comfort in commiseration.

Chris hit some good points on being wary of what we think should be done and what really needs to be tended towards.


After going through these experiences, or ordeals depending on your particular situation, with my and my wife's parents (my 93 year old father being the last one living) Kshimizu comments pretty well cover what I would reply:

It is good to see that others are facing very nearly the same situations as you have and that there just are not any pat answers. Realizing that you do have limits in controlling other peoples lives is something very important to remember in these situations.

That you continue to do what you think best for your parent(s) is important and responsible. There are too many adult children out there who really do not want to be involved.

Regards,
fingfool

Regards,
fingfool
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"Taking away car keys is essential, I agree. Contact the DMV with your concerns if your mother will not voluntarily give up driving."

Losing ones independence is the main reason the elderly insist on continueing to drive. As an AARP Safe Driving instructor allow me to give another consideration to assist in getting your elderly relative to give up the car keys.

Go to www.aarp.org and find out when the next Safe Driving class will be offered in the drivers area. Offer to pay the $10.00 for the elder driver to take the two day 8 hr class. 4 hrs each day.

I begin by telling the students that when they complete the class they will do one of two things:

1) Be more aware of their shortcomings as they age and make compensations so that they are a safer driver, or,

2) They will realize that they should give up driving a give up the keys and sell the car.

I and other instructors have actually had students at the conclusion of the class select option #2.

Just a thought to maybe provide a less stressful alternative to getting the DMV involved.

SGTPP214
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The suggestion of a safe driving course for seniors is a good one. In Illinois anyone 55 or over can take such a course and get a discount on car insurance. I took it this year and even though I consider myself a good driver, I learned a couple things. Or maybe I was just reminded of things I knew but had forgotten to do.

The issue of older seniors driving is a touchy one. Driving ranks up there with living in one's own home as a sign of independence. Certainly many very senior people continue to be good drivers. Others have recognized their limitations and restrict themselves to driving in town but would not go near an expressway. And then there are those who just don't realize they are a hazard on the road. Taking the driving course might help your parents decide where they fall.

BTW, I consider myself fortunate that my own mother stopped driving when her health became poor without being told. But she kept her car and I didn't argue. Just knowing it was there if her health improved gave her a feeling of independence that I didn't want to take away.
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hey Cliff, I know exactly how you feel about Mom, its not a fun job but someone has to do it..
Re: find a Retirement Home. Type those words with the state in the search engine and so many will come up you wont know where to begin!

Better yet, go/call local hospital and ask a social worker who works with the elderly, if she has any recommendations. Also, call Hospice and if you are real nice, explaining your plight to them, they might suggest where to look. They are not supposed to suggest places, but sometimes they will point you in the right direction!
I found a place for my mom that was suggested by a Visiting Nurse. She sees all the Retirement Homes, Nursing Homes etc etc.
Also, plan on spending a day at each place. Eating the food, seeing how the staff treats everyone, how clean the residents are etc etc
Take a look at their activity calendar, then go to the room where this activity is being held. Is it really being held, or is that just so the facility looks good?
Yes, some places have FAKE activity calendars!
One place I looked into had FAKE Food Calendar!
Each day, of the month looked like Gourmet Magazine! I personally spoke to the chef! Everything seemed Marvelous!
Until...the three dinners in a row, that were french fries and grilled cheese! My mom was on a "special low fat diet" that the chef was going to even make "Low Salt" just for her and one other woman. He lied.

Be Bold, Assertive and let them know you expect the Best for your mom, Then to test it out, stay a full day. If the place is decent, they wont mind or act like you are in the way.
Yes, its tiring and boring, but remember your intention is NOT to dump Mom, but to make sure she is Safe, and eventually content in her new living quarters. ( my specialists tell me that takes Six Months. )

One lucky thing would be if your Mom actually had a hospitilization. My mom had eight in one year, so one day instead of taking her "home", I had an ambulance take her to her "new home, prescribed by her physician".
Let her doctor be "the bad guy" if he/she is willing to do that.

Also, Write this on your heart, "It is for her best".
She might never realize that, but that is WHY you have to do it for her, make the BEST decisions, because someone has to do it for her.
good luck and before you do all this, Have her tested, by an elder care pychologist to see if she has dementia and to what degree. You will get a much better idea of her health, and how able she really is to take care of herself, drive etc etc.

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karrylin: One lucky thing would be if your Mom actually had a hospitilization. My mom had eight in one year, so one day instead of taking her "home", I had an ambulance take her to her "new home, prescribed by her physician".
Let her doctor be "the bad guy" if he/she is willing to do that.

Thanks for taking the time to give me your ideas. I like letting the physician be the bad guy. I will try to talk to him when I am there.

cliff
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First remember that your mother is frightened of loosing control and her independence. How many of us will willingly and freely turn in our car keys and leave our homes?

Have a family meeting and calmly listen to everyone's concerns and suggestions. Then ask for a family meeting with your mother's doctor and discuss your concerns. Having the recommendation for alternate living arrangements come from the doctor takes the blame off family members. After a hospital stay, our doctor recommended a "center" for physical therapy which was more readily accepted by our mother than if we had suggested an assisted living home.

Maybe you could take your mother to a gerontologist who is more accustomed to patiently handling, treating, and guiding an elderly patient than a general practioner. Call your local hospital's Physician's Referral Service for a list of gerontologists in your area.

The doctor could also tell your mom to stop driving. If necessary, you can loosen a wire, remove a fuse, or disconnect the battery so the car does not stop. It would be bad enough if your mother injures herself while driving but there is a very real possibility that she will injure or kill others.

Look for a support group for you as well as your mother. Being able to relate to others your concerns and frustations is a great stress reliever. A wealth of information can be gained from others dealing with similar situations. Call the Office for the Aging, Senior Citizens Centers, local hospitals, AARP. If they can't provide help, they may be able to give you a lead to another organization that can.
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Check out the following:
www.eldercare.gov 800-677-1116
www.Caregiver.com
www.alz.org
www.familycaregivers.org

Also write a letter to your mother's doctor clearly explaining your observations and concerns. Your mother may not be sharing 'all" with her doctor. His recommendations and instructions may be accepted easier than if the same information came from you.
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