Elderly parents filter: One healthy, one not so much
September 11, 2013 10:26 AM Subscribe
My in-laws cannot live 120 miles from us on their own any longer. This is true.
My mother-in-law is relatively healthy and 73 with all her mental faculties.
My father in law is physically very healthy and 83 with dementia.
Where do they live together? Snow flurry inside.
Dad works out 3 times a week but has dementia and WILL NOT go to the doctor. We have tried EVERYTHING and I mean everything. He went once to the doctor, started neurological testing, walked out on the doctor who then sent word to the DMV. Now he has no driver's license, which is great, but also no diagnosis. His dementia is not awful, he recognizes everyone but he has paranoid delusions (DMV had audio-animatronic cars on the street out to entrap him), repeats himself constantly and has no long term memory at all. He can't remember his wife being hospitalized last year at all.
They need to move near to us (San Fernando Valley). Mom needs a community, so we're absolutely looking into senior retirement communities BUT the one we're most interested in said they won't take dad because he's got dementia. On the other hand, we don't want to send mom to an Alzheimer's/memory facility, as she is completely with us.
All of the wills, PoAs, etc are taken care of. We don't need any advice with regard to that but as far as living arrangements go, what do we do? Where do they live? How does this work for couples, one of whom is mentally healthy and the other is not?
Dad works out 3 times a week but has dementia and WILL NOT go to the doctor. We have tried EVERYTHING and I mean everything. He went once to the doctor, started neurological testing, walked out on the doctor who then sent word to the DMV. Now he has no driver's license, which is great, but also no diagnosis. His dementia is not awful, he recognizes everyone but he has paranoid delusions (DMV had audio-animatronic cars on the street out to entrap him), repeats himself constantly and has no long term memory at all. He can't remember his wife being hospitalized last year at all.
They need to move near to us (San Fernando Valley). Mom needs a community, so we're absolutely looking into senior retirement communities BUT the one we're most interested in said they won't take dad because he's got dementia. On the other hand, we don't want to send mom to an Alzheimer's/memory facility, as she is completely with us.
All of the wills, PoAs, etc are taken care of. We don't need any advice with regard to that but as far as living arrangements go, what do we do? Where do they live? How does this work for couples, one of whom is mentally healthy and the other is not?
Can't help specifically for California, but there are retirement communities out there that could take them both. You need to look for total care places. Ruthless Bunny is right and has a good suggestion.
My mother had Parkinson's with dementia. My parents moved to a place in New Jersey that has a range of living and care, including independent apartments, assisted living, and nursing home section. They moved to an apartment where they were pretty independent but the community managed their health care, and then when Mom needed it, Dad stayed in the apartment but Mom went in to the nursing home section. Ultimately, they could not actually live together, but her place was nearby, and he would visit her multiple times a day with the blessing of the facility, including even making sure she was in bed and settled for the night.
posted by gudrun at 10:39 AM on September 11, 2013 [1 favorite]
My mother had Parkinson's with dementia. My parents moved to a place in New Jersey that has a range of living and care, including independent apartments, assisted living, and nursing home section. They moved to an apartment where they were pretty independent but the community managed their health care, and then when Mom needed it, Dad stayed in the apartment but Mom went in to the nursing home section. Ultimately, they could not actually live together, but her place was nearby, and he would visit her multiple times a day with the blessing of the facility, including even making sure she was in bed and settled for the night.
posted by gudrun at 10:39 AM on September 11, 2013 [1 favorite]
Best answer: It sounds like you need a Continuing Care Retirement Community, they offer the spectrum from independent living to assisted living to skilled nursing and will accommodate a couple with different care needs. Specialized adult daycare plus security measures to prevent wandering off may be an alternative for the time being (for FIL, although it is not clear that he will agree to this). It's hard to tell without knowing how advanced he is, how involved your MIL is, and their budget.
A few additional thoughts.
(1) It sounds like you FIL has behavioral issues that will only get worse as time goes on. It's very important that you pick the right community and by this I don't mean pretty gardens, a nice lobby and a friendly marketing director (person giving you the tour). Some places keep people as long as they are relatively docile, others keep people even when they become difficult to handle or disruptive to other residents. Quality of care varies a lot too - some places put a lock on the door to prevent wandering off and call it a day, others provide a lot of activities and mental stimulation. Staff-to-patient ratios also vary and have a strong correlation with quality of care.
(2) Always remember that eldercare is Big Business. For example, large national chains have all the advertising dollars making them easy to find while often superior privately-owned residential care homes are all but invisible. Also keep in mind that some social workers are pressured to refer only to facilities in their hospital network (a huge ethical violation IMO!).
(3) Meet with a financial adviser specializing in this sort of thing asap. There are all kinds of things at play - planning such that one spouse doesn't spend all of the couple's assets leaving the other destitute; spend-down and claw-back rules (how many years' worth of financial assets the state will look at before they chip in for care), and many more. Memory care is hugely expensive (we are talking $5k-$7k a month and up) so it can take no time to power through whatever assets they have. Some places will keep patients who started out on private pay, others will kick them out so they have to go to a nursing home (last resort, IMO).
(4) You MIL's health is as critical as your FIL's right now. Caregivers for people with dementia live less (5-10 years less), get sick a lot more, experience much more stress, and so on. Do not forget your MIL just because your FIL's problems are more visible.
Best of luck, this sort of thing is incredibly stressful.
posted by rada at 12:09 PM on September 11, 2013 [4 favorites]
A few additional thoughts.
(1) It sounds like you FIL has behavioral issues that will only get worse as time goes on. It's very important that you pick the right community and by this I don't mean pretty gardens, a nice lobby and a friendly marketing director (person giving you the tour). Some places keep people as long as they are relatively docile, others keep people even when they become difficult to handle or disruptive to other residents. Quality of care varies a lot too - some places put a lock on the door to prevent wandering off and call it a day, others provide a lot of activities and mental stimulation. Staff-to-patient ratios also vary and have a strong correlation with quality of care.
(2) Always remember that eldercare is Big Business. For example, large national chains have all the advertising dollars making them easy to find while often superior privately-owned residential care homes are all but invisible. Also keep in mind that some social workers are pressured to refer only to facilities in their hospital network (a huge ethical violation IMO!).
(3) Meet with a financial adviser specializing in this sort of thing asap. There are all kinds of things at play - planning such that one spouse doesn't spend all of the couple's assets leaving the other destitute; spend-down and claw-back rules (how many years' worth of financial assets the state will look at before they chip in for care), and many more. Memory care is hugely expensive (we are talking $5k-$7k a month and up) so it can take no time to power through whatever assets they have. Some places will keep patients who started out on private pay, others will kick them out so they have to go to a nursing home (last resort, IMO).
(4) You MIL's health is as critical as your FIL's right now. Caregivers for people with dementia live less (5-10 years less), get sick a lot more, experience much more stress, and so on. Do not forget your MIL just because your FIL's problems are more visible.
Best of luck, this sort of thing is incredibly stressful.
posted by rada at 12:09 PM on September 11, 2013 [4 favorites]
Los Angeles County Area Agency on Aging. See if you can get in contact with a geriatric care manager or geriatric social worker. (There is probably a hospital social worker at your in-laws' doctor's office.) A geriatric care manager/social worker could help point you to suitable housing for your in-laws and would also be able to draw up a plan for your MIL to care for her husband.
posted by Rosie M. Banks at 1:46 PM on September 11, 2013 [1 favorite]
posted by Rosie M. Banks at 1:46 PM on September 11, 2013 [1 favorite]
You want an assisted living community that offers memory care or "memory support." The right one will have programs for each of your parents, and also allow them time together (maybe in the same apartment, maybe not--IANYgeriatric care manager, but you may want to look into hiring one to help with placement.
If your dad doesn't have a dementia diagnosis, but is showing these symptoms, for his safety and for ease of placement, you should have him seen by a neurologist or other geriatric specialist who is knowledgeable about dementia.
posted by assenav at 8:17 PM on September 11, 2013
If your dad doesn't have a dementia diagnosis, but is showing these symptoms, for his safety and for ease of placement, you should have him seen by a neurologist or other geriatric specialist who is knowledgeable about dementia.
posted by assenav at 8:17 PM on September 11, 2013
Response by poster: So - follow up. We finally got an Alzheimer's diagnosis. They are moving on April 1 to an assisted living in our neighborhood, something transitional until he is eligible for the memory support units. It's a weird place being too cognitively impaired for regular assisted living but not impaired enough for "memory care".
posted by Sophie1 at 1:02 PM on February 18, 2014 [1 favorite]
posted by Sophie1 at 1:02 PM on February 18, 2014 [1 favorite]
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It really depends on budget what your options are.
RetireNet.com has lists of places. Find a few that seem to answer your needs and call them. They'll turn you on to what they can offer or what's out there generally.
posted by Ruthless Bunny at 10:35 AM on September 11, 2013