Tips for providing short-term help with my grandfather's imminent death?
February 5, 2020 2:18 PM Subscribe
My last remaining grandparent (93) is on his way out. My mom and her sister (both late 60s) need my help dealing with legal/logistic/emotional/medical/everything. I'm going down there (Texas) tomorrow afternoon. What do I need to know?
I'll try and just keep it to the bullet points for background:
* My maternal grandfather is 93 and is likely to die within the next month or so. He is lucid and cogent, with limited mobility though not bedridden, from what I've heard. He does not have any sort of dementia.
* He lives in a large all-stages retirement home with on-site care including hospice care, but right now he's still in his same independent-living apartment that he's been in for a decade. My understanding is that the hospice nurses are checking in frequently.
* Our family is small, and I am the best-positioned of us all to go in person and assist with anything that might need to be done. I am flying down to Texas tomorrow afternoon to help with anything I can. I am currently scheduled to return home the following Tuesday, but I can change that if necessary.
* None of us is a medical professional, but I am comfortable and confident talking to all sorts of clinicians, due to my job in a related industry.
My questions for the community:
* Is there anything specific I should bring from my home? The only things I have on my list currently that are different from any normal trip are "old photos" and "soft blanket".
* Do you have any familiarity with this situation (especially specialized knowledge of estate law in Texas) that might be helpful? AFAIK all of my grandfather's assets have already been marked payable on death to my mom and her sister, so my slim understanding is that his will is almost moot in that case? His wife died more than 10 years ago and he did not remarry.
I am efficient and patient with getting bureaucratic/logistic things accomplished, and would be especially happy to take some of that burden off my mom and my aunt, if that is something I can do.
I know this all sounds very business-like and perhaps cold, but I think our family needs a little of that right now. We (including my grandfather) are a gallows-humor, results-oriented bunch. I think someone showing up with sensible pumps and two phones, ready to Get Things Done, will be welcomed. If there is anything that you wish you had done, or wish had been done by someone else, in a similar situation, i would be glad to hear it.
I'll try and just keep it to the bullet points for background:
* My maternal grandfather is 93 and is likely to die within the next month or so. He is lucid and cogent, with limited mobility though not bedridden, from what I've heard. He does not have any sort of dementia.
* He lives in a large all-stages retirement home with on-site care including hospice care, but right now he's still in his same independent-living apartment that he's been in for a decade. My understanding is that the hospice nurses are checking in frequently.
* Our family is small, and I am the best-positioned of us all to go in person and assist with anything that might need to be done. I am flying down to Texas tomorrow afternoon to help with anything I can. I am currently scheduled to return home the following Tuesday, but I can change that if necessary.
* None of us is a medical professional, but I am comfortable and confident talking to all sorts of clinicians, due to my job in a related industry.
My questions for the community:
* Is there anything specific I should bring from my home? The only things I have on my list currently that are different from any normal trip are "old photos" and "soft blanket".
* Do you have any familiarity with this situation (especially specialized knowledge of estate law in Texas) that might be helpful? AFAIK all of my grandfather's assets have already been marked payable on death to my mom and her sister, so my slim understanding is that his will is almost moot in that case? His wife died more than 10 years ago and he did not remarry.
I am efficient and patient with getting bureaucratic/logistic things accomplished, and would be especially happy to take some of that burden off my mom and my aunt, if that is something I can do.
I know this all sounds very business-like and perhaps cold, but I think our family needs a little of that right now. We (including my grandfather) are a gallows-humor, results-oriented bunch. I think someone showing up with sensible pumps and two phones, ready to Get Things Done, will be welcomed. If there is anything that you wish you had done, or wish had been done by someone else, in a similar situation, i would be glad to hear it.
Best answer: I'm sorry for you and your family's grief.
When my father was dying, one of the biggest distinctions my mother drew was between the people who asked what she wanted them to do and the people who just started washing dishes/getting supplies from town/etc. Executive function is typically a very scarce resource in these situations, so it's really helpful to add to the reserves rather than subtract.
Bring something easy but absorbing to do together with your mother and aunt and whoever else is spending a lot of time with him. Bananagrams got played a lot that month.
One thing I did a terrible job at when I went down there was coming up for air, to the point my mother started making up errands to get me out of the house for an hour. Don't be like me, practice self care consistently.
It turned out to ironically be my superpower that I had been estranged from him: I was much less overwhelmed with emotion by seeing him in distress than my mother and brother were, so I was able to sit at the bedside for longer, and I was the one who dealt with the funeral home at the end. I agree with you that business-like and cold can be an asset.
The very end will be exhausting.
You're doing a good thing. In my opinion, sitting with the dying is an extremely important act that is frequently neglected.
posted by PMdixon at 2:58 PM on February 5, 2020 [1 favorite]
When my father was dying, one of the biggest distinctions my mother drew was between the people who asked what she wanted them to do and the people who just started washing dishes/getting supplies from town/etc. Executive function is typically a very scarce resource in these situations, so it's really helpful to add to the reserves rather than subtract.
Bring something easy but absorbing to do together with your mother and aunt and whoever else is spending a lot of time with him. Bananagrams got played a lot that month.
One thing I did a terrible job at when I went down there was coming up for air, to the point my mother started making up errands to get me out of the house for an hour. Don't be like me, practice self care consistently.
It turned out to ironically be my superpower that I had been estranged from him: I was much less overwhelmed with emotion by seeing him in distress than my mother and brother were, so I was able to sit at the bedside for longer, and I was the one who dealt with the funeral home at the end. I agree with you that business-like and cold can be an asset.
The very end will be exhausting.
You're doing a good thing. In my opinion, sitting with the dying is an extremely important act that is frequently neglected.
posted by PMdixon at 2:58 PM on February 5, 2020 [1 favorite]
Best answer: Has your grandfather designated you as a Health Care Agent? Or anyone? It seems he will need to in order for you to make any medical decisions on the spot (Texas laws on Health Care Directives). It's unclear from your question how close your mom and aunt are geographically, but if you're going to be the point person you might want to make sure you're all on the same page about his wishes about extraordinary lifesaving measures. Do you know his wishes for what happens with his body? A funeral home, crematory, where a service might be held, etc.? If so, doing some of the outreach now may let you grieve a little more purely when he does die, instead of getting caught up in discussing what he might have wanted, finding a funeral home, wondering if he wanted to be cremated.
posted by cocoagirl at 5:07 PM on February 5, 2020 [1 favorite]
posted by cocoagirl at 5:07 PM on February 5, 2020 [1 favorite]
Best answer: Once the day comes, get a whole lot of death certificates- like at least two dozen, possibly more if his financial life is at all complicated. My mom dealt with all the legal stuff for my grandparents, and it took several years before all the places could be convinced that they were really dead- and the only way, often, was to send a physical copy of a death certificate. You could think that you could say to the cable company "he passed away yesterday, please cancel the cable service," but it often ends up being easier to just send a copy of a death certificate.
posted by rockindata at 6:47 PM on February 5, 2020 [3 favorites]
posted by rockindata at 6:47 PM on February 5, 2020 [3 favorites]
Best answer: My dad died in Texas under hospice care this week. The hospice social worker will probably have figured out any pressing legal/logistical issues (for example, they suggested my mom get dad to sign over the deeds to the cars while he still could) that should be handled beforehand, and there will be little left to do. Definitely if he has any subscriptions, credit cards, cell phone, memberships, utility autopays etc etc, work with him to get that cancelled or transferred while he's alive, as you will have to wait on death certificates otherwise and it is fucking grim having that conversation repeatedly so anything you can do now will be less you have to do in a few weeks.
It's an absolute blessing that he is in a facility that will not evict him for dying, or for not dying fast enough. This takes massive amounts of work and logistics off y'all's plates. Really mostly all you can do is just be with them. It is likely your mom and aunt could use some plain old logistical support for their own lives - errands you can run, cook and freeze some meals, get their cars serviced if they're due or nearly due, fix their computers and phones, move some furniture, get some stuff down from closets for them.
It's good to get to see him while he's alert and hopefully fairly comfortable. Take some pictures, get your mom and aunt in the pictures. Get some audio and video, collect some stories. Unless there is a very abrupt ending, there is likely a decline coming and your mom and aunt are going to have distressing memories of the final days. It may sooner or later be comforting to them to have something concrete to look at/listen to from before that point.
I'm sorry, this sucks. Enjoy your time with him.
posted by Lyn Never at 7:14 PM on February 5, 2020 [2 favorites]
It's an absolute blessing that he is in a facility that will not evict him for dying, or for not dying fast enough. This takes massive amounts of work and logistics off y'all's plates. Really mostly all you can do is just be with them. It is likely your mom and aunt could use some plain old logistical support for their own lives - errands you can run, cook and freeze some meals, get their cars serviced if they're due or nearly due, fix their computers and phones, move some furniture, get some stuff down from closets for them.
It's good to get to see him while he's alert and hopefully fairly comfortable. Take some pictures, get your mom and aunt in the pictures. Get some audio and video, collect some stories. Unless there is a very abrupt ending, there is likely a decline coming and your mom and aunt are going to have distressing memories of the final days. It may sooner or later be comforting to them to have something concrete to look at/listen to from before that point.
I'm sorry, this sucks. Enjoy your time with him.
posted by Lyn Never at 7:14 PM on February 5, 2020 [2 favorites]
Oh, and a note on the death certificates: from our experience so far, and mom's best friend lost her husband about a year ago, they faxed ("faxed" - put TinyFax or similar on your mom's phone if she has a smartphone, and show her how to use it) or scanned and emailed a lot more certificates than they had to provide anyone on paper. All the financial and government institutions wanted a real copy, but I think all the utilities and similar accepted fax/scan. Still, get a bunch because it's a pain to get more later.
And ask the social worker if they provide any assistance with that stuff. They might. Ours didn't, but it wasn't a facility like you're dealing with.
posted by Lyn Never at 7:19 PM on February 5, 2020 [2 favorites]
And ask the social worker if they provide any assistance with that stuff. They might. Ours didn't, but it wasn't a facility like you're dealing with.
posted by Lyn Never at 7:19 PM on February 5, 2020 [2 favorites]
Best answer: Please make sure he has a will! Everything after death is much more complicated and delayed, and there is more tax exposure if there is no will.
Medical power of attorney is another thing that will make his medical progress much, much easier. If there is a trusted family member, preferably local, who is savvy regarding medical issues and your relative's wishes, that person would be a good choice. You sound ideal if you are willing to take it on.
My aunt is currently in a nursing home with a terminal cancer diagnosis, but is not currently enrolled in hospice. She is declining, and it will be my decision when to pull the trigger on hospice because I have the medical POA. I'm not sure what you mean about hospice nurses checking in frequently. A patient is either in hospice or not, so perhaps they feel he would be a good hospice candidate and want to introduce the idea to him or his family members, but they will have no say now in his care. Keep in mind that hospice has to be formally ordered by a physician, but it is the patient's choice which hospice agency they prefer. Perhaps if you are more medically savvy than others in the family that is an assignment you can take on, to research hospice agencies. There are material differences among them, and I strongly recommend looking first at non-profit agencies. They have a much better reputation on the whole. You might also ask the nurses you see who have the best rapport with your grandfather which agencies they see as being the most skilled and attentive.
Lastly, I discovered that the financial responsibility for paying for my aunt's nursing home changes when she enters hospice. Hospice on-site medical care is completely paid for by Medicare, but when her official designation changes to hospice, her room charges will be split between her long-term-care insurer (which now, because she was incredibly financially savvy, are paid 100% by her long-term-care insurer) and self-pay. (No, this kind of coverage is no longer available!) So be sure to talk to the social worker, who will know the financial situation, and your grandfather's long-term-care insurer, if he has such a policy.
Good luck. You will look back on your time with your grandfather as some of the most important time you have ever spent. As sad as it is to see my 89 year old aunt in severe decline, I am loving spending time with her, and knowing that I am making a difference in her final days is very comforting.
posted by citygirl at 8:25 PM on February 5, 2020
Medical power of attorney is another thing that will make his medical progress much, much easier. If there is a trusted family member, preferably local, who is savvy regarding medical issues and your relative's wishes, that person would be a good choice. You sound ideal if you are willing to take it on.
My aunt is currently in a nursing home with a terminal cancer diagnosis, but is not currently enrolled in hospice. She is declining, and it will be my decision when to pull the trigger on hospice because I have the medical POA. I'm not sure what you mean about hospice nurses checking in frequently. A patient is either in hospice or not, so perhaps they feel he would be a good hospice candidate and want to introduce the idea to him or his family members, but they will have no say now in his care. Keep in mind that hospice has to be formally ordered by a physician, but it is the patient's choice which hospice agency they prefer. Perhaps if you are more medically savvy than others in the family that is an assignment you can take on, to research hospice agencies. There are material differences among them, and I strongly recommend looking first at non-profit agencies. They have a much better reputation on the whole. You might also ask the nurses you see who have the best rapport with your grandfather which agencies they see as being the most skilled and attentive.
Lastly, I discovered that the financial responsibility for paying for my aunt's nursing home changes when she enters hospice. Hospice on-site medical care is completely paid for by Medicare, but when her official designation changes to hospice, her room charges will be split between her long-term-care insurer (which now, because she was incredibly financially savvy, are paid 100% by her long-term-care insurer) and self-pay. (No, this kind of coverage is no longer available!) So be sure to talk to the social worker, who will know the financial situation, and your grandfather's long-term-care insurer, if he has such a policy.
Good luck. You will look back on your time with your grandfather as some of the most important time you have ever spent. As sad as it is to see my 89 year old aunt in severe decline, I am loving spending time with her, and knowing that I am making a difference in her final days is very comforting.
posted by citygirl at 8:25 PM on February 5, 2020
Best answer: When I found myself in this position, I put myself to work going through the records. Like many folks, my grandparents' file cabinet wasn't the most neatly organized, and you might find the same situation. Where does your grandfather keep his money, what are his account numbers, does he have a safety deposit box? Where is the deed to his house, his car title, what bills does he receive and how are they paid? Where are his vital records - social security card, birth certificate, any records from pension, military service, life insurance payments or death benefits that your family might be due, etc. These questions will come up, and if you can help with untangling these records that would be a huge help.
posted by backwards compatible at 4:59 AM on February 6, 2020
posted by backwards compatible at 4:59 AM on February 6, 2020
Best answer: If he is comfortable with it, put you or another relative on his bank account as a joint account holder. My mom did that before she got dementia and it was incredibly helpful for paying bills, funeral expenses, etc. She had no real assets tho. Probably wouldn't work in a higher asset situation.
posted by Cocodrillo at 5:17 AM on February 6, 2020
posted by Cocodrillo at 5:17 AM on February 6, 2020
Best answer: From the not-unexpected deaths in my family: nthing getting the funeral home set up. I've seen that done with a full-service funeral home (where the deceased had a file with info for an obituary, service preferences, etc), and one went with a crematorium I suspect they found online. It was helpful to have a place to call and not many decisions to make.
Collecting biographical info for an obituary may be useful - things like place of birth, parents' names, siblings' names, when he and your grandmother married, where he lived and worked and went to church, names of survivors. (Obituaries seem to be one of those things that everyone wants to happen, but no-one really wants to do it - and at least in my family no-one has wanted to write their own.)
If you're in a city big enough to have food delivery, maybe find a few restaurants that can get meals delivered, to your grandfather's facility and/or relatives' homes, so you'll have that for later?
Much sympathy.
posted by mersen at 5:17 AM on February 6, 2020
Collecting biographical info for an obituary may be useful - things like place of birth, parents' names, siblings' names, when he and your grandmother married, where he lived and worked and went to church, names of survivors. (Obituaries seem to be one of those things that everyone wants to happen, but no-one really wants to do it - and at least in my family no-one has wanted to write their own.)
If you're in a city big enough to have food delivery, maybe find a few restaurants that can get meals delivered, to your grandfather's facility and/or relatives' homes, so you'll have that for later?
Much sympathy.
posted by mersen at 5:17 AM on February 6, 2020
When I was flying out to see my dying dad, I read a book someone recommended called Being Mortal, by Atul Gawande. The first half didn't seem too relevant to my situation but I read it all on the plane because it's an easy read, and wow did it end up useful in ways I didn't foresee, especially when dealing with my dad's doctors, and emotional reactions of other people, including doctors, oddly enough.
So, I recommend reading Being Mortal while you're flying out.
posted by small_ruminant at 12:43 PM on February 8, 2020 [1 favorite]
So, I recommend reading Being Mortal while you're flying out.
posted by small_ruminant at 12:43 PM on February 8, 2020 [1 favorite]
Response by poster: It turned out that my mom and aunt had really done quite a good job on many of the things you all mentioned. They had a big binder full of account numbers, had sold his car, made the crematory arrangements, medical POA, etc. However, they were having a hard time dealing with some of the tasks that combined tediousness and emotion, like culling big boxes of photos and documents, and deciding which of his possessions were worth keeping or selling vs. just packing up for Goodwill. I was a big help keeping them focused with that kind of thing. And of course it was great to see him once more and watch a little more golf with him (Pebble Beach!) before he died --- I'm so glad that I was able to go down there for even just a few days.
I best answered the responses that mentioned something I did or that my mom/aunt had already done.
He did not die while I was there, but he did pass last Friday morning. Thank you all so much for your advice and well-wishes.
posted by slenderloris at 6:36 PM on February 26, 2020 [1 favorite]
I best answered the responses that mentioned something I did or that my mom/aunt had already done.
He did not die while I was there, but he did pass last Friday morning. Thank you all so much for your advice and well-wishes.
posted by slenderloris at 6:36 PM on February 26, 2020 [1 favorite]
Thank you for the update. I'm sorry for your loss. I'm sure you were an enormous help- it's amazing how paralyzing things like that can been when you're in the middle of a crisis, however slow moving the crisis is.
posted by small_ruminant at 12:27 PM on February 27, 2020 [1 favorite]
posted by small_ruminant at 12:27 PM on February 27, 2020 [1 favorite]
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I very much hope that your grandfather has signed a durable power of attorney naming the appropriate relatives or whomever to act on his behalf if he stops being lucid. If it includes your name, that might very well be helpful. I have been able to pay bills and do several things involving my dad‘s finances because I have a copy of the power of attorney form with my name on it along with a letter from his physician attesting to the fact that my dad is no longer capable of making decisions for himself.
Because the state laws are so complicated, if you have any questions whatsoever about the legal situation I encourage you to contact an actual professional specialist in Texas estate law.
One of the things that I am doing to help the rest of the family is arranging for my dad‘s cremation and paying for it now so that no one else has to worry about it when the time times. The biggest challenge I am facing is getting my dad the anti-anxiety medication he needs. In this state, people who enter a nursing facility are taken off all psychotropic drugs for 30 days and evaluated to see if they need them. The law is meant to be a protection against facilities drugging their residents into some kind of zombie state. One thing you might want to consider or find out is if your grandfathers access to medicine is in any way dependent on if he stays in his apartment or moves to a different part of the facility. I know that sounds like a crazy thing but it never occurred to me that my dad would not have immediate access to his medication once he left his home and went into this facility.
Also, it’s really exhausting just sitting with someone you love who is dying. Check in with your mom and/or sister to see what they think would be most helpful for you to do. They may want you to just sit with your granddad for a while and maybe give them a break. My niece came to visit my dad last weekend and it made him super happy.
posted by Bella Donna at 2:47 PM on February 5, 2020 [1 favorite]