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Crazy but true, your parents are more likely to become unable to do things and need help than they are to just die having never been a burden. I know, I could candy coat the whole thing but the usual life cycle for those raising a family is that eventually you’ll have to step in and manage mom and or dad. And from one caregiver to the world… it’s a heavy toll. Those that escape it are blessed. Doing anything “because you have no choice” is usually no fun. I hate using the word “fair” but it sure doesn’t feel “fair” that we go from childcare to senior care. AND I can tell you changing my daughters diaper is NOWHERE in the same ball park as having to pick poop up off the floor or diaper wipe mom or dad, grandma or grandpa – nowhere near in the same ballpark.

So friends and fellow readers, as unexciting as thinking about this might be, you’ll need to prepare to help them stay as safe as possible and be as comfortable as possible in their last stages of life. Or you could abandon them but then there is all that guilt and what goes around comes around crap… LOL… sorry you gotta make light of this or you’ll go nuts.

The things to consider.

You gotta have “the talk”. And do it now before you “can’t” because friends losing the ability to communicate effectively can happen in a singular moment. With the odds going up fast as one ages. Only 25% of adults have had an in-depth discussion with their parents about things like long-term care, inheritance, living arrangement and funeral preferences. No that it is not just younger adults in their 20′-30’s that have neglected to have such a talk. Of those surveyed aged 50 and up, 1/3 of them haven’t even had that discussion with their own spouse let alone their parents.

It happens in an instant. Mom and Dad, uncle or aunt, grandma or grandpa – whomever you may feel some responsibility over can go from being totally fine to NOT fine at all and in need of serious care… or even part time care. Either way, I can assure you it’ll change your life immensely. It will not only require your time but if you’re wired like most people we talk to it can throw a wrench in your emotional life. As the author of this article I can tell you it’s broke my wife and I down to tears many many times. It makes us angry, sad, uncertain, guilty and more each and every day. It’s a rollercoaster of an experience especially if you’ve still got a child or two of your own to care for that want your attention as well. My daughter is now 13 and she has at some level had to take a back seat to eldercare her entire life.

So this conversation is the elephant in the room. The more prepared you are in advance, the less stressful it will be for your whole family. NOT stress free, but less stressful – plans and process people !!!

Call for a Family Meeting

Bring the tissues and the boxing gloves if you’ve got family. Maybe consider starting it out with a prayer… Just know it could be an awkward experience. Especially because people will often say one thing but when it comes down to it and the rubber meets the road — they may not come through. If there is money to pay for some help maybe the family can appoint the sibling with the time and expressed interest to get paid for their help. This can go a long way in keeping people resentful of the sibling out of state or the sibling in state but too busy or lame or whatever… A fair wage can make people feel like they’ve done the right thing. MAKE sure to document and keep a paper trail though because medicaid will look back 5 years on money spent from your “senior’s account” to make sure the expenses are bonafide, legitimate senior care expenses.

When arranging the meeting, say something like: “The reason, or the purpose behind getting together is to discuss getting mom and/or dad the best care for their needs and wishes as they get older”. Some family might be reluctant to have this talk, but make it clear how important is is that everyone is involved.

Here are a few housekeeping tips for a good senior care family meeting:

  1. Converse in person if at all possible. Phone or email won’t provide you with honest emotions or feedback and a video chat while better than email or phone, still isn’t the same as in the flesh.
  2. Have issues and concerns prepared in advance so you won’t feel rushed or scrambled getting your thoughts together. (See below for some questions to ask.)
  3. Ask everyone to drop their phones and devices in another room so the the conversation can be the main focus. Let everyone know you’ll take a break or two but you just want people present.
  4. Make notes of various points and concerns so you can reference them in the future if necessary. If a particular issue is unanimously agreed to, be sure to highlight it as such. Those are big wins when everyone can agree.
  5. Recognize every family and every person is somewhat different. It could get heated or stay quiet. Most importantly though – LISTEN. Don’t wait to rattle off the next comment whilst you pretend you’re listening. Just listen, try to understand where someone is coming from and then if needed respond.

Okay, so what should you discuss?
The biggest item is; Where will your parent/s will live out their days and how it’ll be paid for. You’ll want to discuss your parents’ current well-being – physically, mentally and financially. You’ll want to know their plans or hopes currently and check in with what they’ve considered for when they can no longer live independently. Once all that’s been discussed, all siblings should weigh in on how, where or even if they can help. Some tips below can help make this uncomfortable discussion go a little easier.

Determine Your Parents’ Needs and Wishes

During the discussion, find out what if any your parent/s’ plans are.
1) Discover if they want to “age in-place” (by staying in their own home) or move closer to one of their kids?
2) Would it make sense to downsize their home? This can be a bad idea too if you would prefer to shelter some cash from medicaid. In many states medicaid can’t touch their personal residence, one car and roughly $2000 in savings. Beyond that it’s fair game and they’ll go after it. Sometimes upsizing, or upvalue-ing is smarter.
3) Would it make more sense to move to a senior living community where they’ll have structured activities to keep them more engaged? Or is “nursing” care more fitting?

AND something I have to point out from experience. So in Michigan assisted living in a well kept somewhat upscale facility with amazing food and regular activities is running us 6k a month. He is fairly self sufficient but does have dementia. They are NOT a memory care facility but they take him anyway because he’s pretty easy to deal with. With that said on a scale of 1 to 5 I’d give it a 3. AND it’s only getting a 3, because I have no choice but to compare it to multiple places we’ve experienced that were worse yet. The people are decent but lazy as hell which is all too common. We pay to have him looked in on EVERY hour and guess what – in their world that means open the door press the “I’ve been here button” and leave because my friend is texting me and it’s more important than you or your problems. They are for the most part completely untrained hourly workers. It’s Waltonwood by the way, across from Beaumont Royal Oak if you’re wondering. OK… back to the blog post.

While having the meeting I think it’s important that you get some time with mom and or dad NOT in the room, let alone the house. You should discuss your parents’ current health and whether they truly capable to live independently even now.

When visiting with your parents look for some of these signs. They can clue you into a few things around mom and dad.

How are their eating habits?
Are they able to cook for themselves or are they eating out or using prepackaged meals?
Are they eating healthy foods?
How do they look?
Examine their legs.
Often below the knees, elderly people will begin to retain water and discoloration, skin tags, sores and more begin to appear. It’s very common. It’s tied to a host of issues and if you see this be sure to get to your doctor. 
How do they hold conversation?
How is their hygiene? Look at their finger and toe nails, their facial (hair), their skin, their teeth, their clothing, their bed linens.
Odor – do they smell? Does their home smell?
Is their house as they’d typically kept it? Look for signs of them getting sloppy.
Memory – look in the microwave, on the stove top, on pan bottoms — are there scorch marks? How old is the food in the refrigerator? From personal experience I’ve had to toss more than half the contents in my mom’s refrigerator on multiple occasions and she isn’t even senile. Schedule – Are they missing appointments, paying bills on time, hiding money, losing money. Is the mail unopened?
Support System – if it’s not family, who can help? Are there any church groups, neighbors etc.. My experience is those are mostly pipe dreams. People are too busy or way to apathetic.
Getting Around — Do they still drive a car? Are they getting around the house, up the stairs and into the bathtub with relative ease? (Install handles please) Have you been in the car with them while they were driving to see for yourself how they’re doing?A great tactic to get a feel for their driving skills of late is to walk around the car. Look for dents and dings and scratches.

NOTE: Car key conversation… keep in mind that at some point that elderly senior shouldn’t be driving. At 50 I already know I’m not as keen on the road as I was 10 years ago. I hate admitting it but I’ve sensed it. I can only imagine what another 20 or 30 years could bring… My wife and I had to take that privilege from my father in law a couple years back. The crazy thing is he still looks for his car… Old “AL Zheimer” wants his car all day every day. It’s a really tough conversation yet at the same time it’s not. For me it’s not about what they’re losing. It’s about what I’m taking off the road. My father in law was a 2500 pound murder weapon. There was no way in hell I was letting him go kill someone just because I didn’t want the pressure of taking his car away. That, as I say “was easy math”.

I’ve also provided a senior well being safety checklist (PDF) here. Feel free to download it !

Comparing Senior Care and Housing Options

In all candor you’ll want to know my wife and I have pretty much determined unless you can pay double, say 12-15k a month (could be more depending on where you live), you’ll just have to choose the situation you dislike the least. Because friends… unskilled labor is the norm in the elder care business. No matter if it’s assisted care or a nursing home.They can’t keep board certified nurses on staff 24/7 and still make it affordable to you, the paying customer. It’s just pure math. With that said it could also be some greed in the hands of the home and facility owners but I truly don’t know what their profit margins are. Candidly we’ve been through hospice too and that’s not always much better. And hospice in the company of professional licensed health workers and hospice amidst a mix of licensed and not licensed caregivers and friends… they can both suck.

Your parents may be somewhat independent today, but the odds are one day they’ll need long-term care (by one estimate, at least 70% of seniors will). There are several types of long-term care solutions, ranging from assisted living communities to in-home aid. Making the best choice depends on your parents’ health requirement, your time, skill and financial resources and your collective wishes.

Assisted Living Communities (aka Personal Care Homes) are designed for seniors who can no longer live safely on their own but who don’t need around-the-clock medical care. Residents live in their own private apartments, and services provided include daily living assistance, medication help, meals in a shared dining room, some activities and housekeeping. Some take Medicaid, but most are privately paid. In Metro Detroit, MI – we’ve paid 6k a month and though the food and facility are great – the staff is mediocre, mostly untrained and pretty much clueless. AND… that’s a step up when compared to others we’ve experienced. Waltonwood is the name of that facility across from Beaumont in Royal Oak, MI. We’re actually paying extra for hoursly check ins which translate to someone stepping in, hitting the button and darting back to their cell phone. We’ve seen it happen firsthand every time we visit.

Below are some national average costs for long-term care in the United States (in 2016). Average costs for specific states are also available. (source https://longtermcare.acl.gov/costs-how-to-pay/costs-of-care.html )

  • $225 a day or $6,844 per month for a semi-private room in a nursing home
  • $253 a day or $7,698 per month for a private room in a nursing home
  • $119 a day or $3,628 per month for care in an assisted living facility (for a one-bedroom unit)
  • $20.50 an hour for a health aide
  • $20 an hour for homemaker services
  • $68 per day for services in an adult day health care center

The cost of long-term care depends on the type and duration of care you need, the provider you use, and where you live. Costs can be affected by certain factors, such as:

  • Time of day. Home health and home care services, provided in two-to-four-hour blocks of time referred to as “visits,” are generally more expensive in the eveningon weekends, and on holidays
  • Extra charges for services provided beyond the basic room, food and housekeeping charges at facilities, although some may have “all inclusive” fees.
  • Variable rates in some community programs, such as adult day service, are provided at a per-day ratebut can be more based on extra events and activities
Last modified: 10/10/2017

ALSO – this is an interesting site as well with a calculator loaded with your state’s averages etc.. – Good Find for those trying to get some clue as to cost for senior care. https://www.genworth.com/about-us/industry-expertise/cost-of-care.html

Nursing homes provide seniors with a high level of medical care and are a better choice for those with complex medical conditions, since licensed nurses are available 24 hours a day. Long-term residents typically share a room (but private rooms are available) and eat together in a central dining room. Most people also pay out of pocket for nursing homes, but you might be eligible to get help from Medicaid for these (very high) expenses if you run out of money.

Average cost: $205 per day or $6,235 per month. For a private room: $229 per day or $6,965 per month
Home care services allow seniors to stay in their homes while receiving assistance from home health aides for Activities of Daily Living (ADLs), such as bathing, dressing, getting to appointments, and preparing meals. You can hire in-home personal care on a once-a-week basis, daily, or for around-the-clock care.

Average cost: $21 per hour
Adult day health care locations are community-based centers where seniors can get healthcare services, social activities, and therapeutic services. They offer a reprieve for family caregivers (especially working ones) and a social environment for seniors who don’t need 24-hour care.

Average cost: $67 per day
There are other options as well, including independent living communities (retirement villages for seniors who are very independent and have few medical problems), which cost between $1,500 and $3,500 a month, and respite care, for short-term stays.

Here’s a breakdown of a few senior housing options:

These are just average costs, though, which will typically vary by area. To find specifics for your location, head to this interactive map at Genworth for the median cost per state and region.

Once you’ve decided on the type of living arrangement, compare senior living communities near you at these sites:

a) Medicare’s nursing home compare: nursing homes that are Medicare and Medicaid-certified, along with ratings, inspection reports, and other measures of quality
b) Eldercare.gov: The Department of Health and Human Service’s senior community services locator, where you can find adult day programs, housing options, in-home services, and other types of assistance
c) A Place for Mom: a free service that finds senior living communities based on your needs (FYI, they’re paid by their partner communities)
d) Yet another resource to learn about senior care in Michigan and beyond. https://longtermcare.acl.gov/

Decide on Whether or Not to Be Your Parents’ Caregiver

The numbers above likely shock those of us who haven’t given much thought to our parents’ need for care when they’re older. (In New York, the median cost for a semi-private room in a nursing home is over $10,000 a month.) With the costs of long-term care so high—often even more than we might make in a month altogether—the most affordable option might be to care for your parents in their own home or move them into yours. If you have a strong relationship with your parents, it’s also the option you might lean towards first, since sending your parents to a home can (unjustly) feel like you’ve abandoned them. But there are some very important considerations here.

The emotional toll: Being the primary caregiver and living again under the same roof with your parents is an enormous role reversal. Now you’re taking care of mom and dad, the people you’ve counted on for support and strength but whose health and quality of life might be deteriorating before your eyes. Not everyone will have the emotional—and physical—strength needed to provide the day-to-day care, like bathing, feeding, or dressing elderly parents, particularly if they’re frail, have a serious illness, or can’t remember who you are. It’s no fun just thinking about it.

Logistical problems: On top of that: you might not have much room in your home to begin with, you might currently be living and working thousands of miles away, and your workplace might not be very flexible with time to tend to your parents (who could be considered dependents just as much as your kids would). There are a number of sacrifices you might have to weigh, similar to ones parents have to make for their kids, but in some respects even harder.

Financial costs: If your parents stay in their home or in yours, you might still have to hire a home health aide (possibly for thousands of dollars a month) and do home improvement projects that make life easier for the elderly, such as modifying a kitchen with cabinets and appliances that reduce the need to bend or a bathroom remodel that swaps a bathtub or traditional shower with a walk-in shower.

Splitting “the burden”: If you have siblings, it gets even harder: Who will take the responsibility? The sibling doing most of the caregiving could easily get resentful of the others, and those who aren’t doing the caregiving could feel guilty. In this case, you might consider setting up a family care contract, in which the family member taking responsibility of the elderly parents gets paid from family funds as I mention above.

Having the Family Care Contract reduces resentment and can offer other benefits too;

Having a formalized care giver contract can allow the aging senior to utilize their assets to remain at home, receive quality care and financially reward the individual that is providing that care. This can provide the family caregiver with protection should the other family members pursue legal action after the aging senior is deceased. It is unfortunate, but it does happen more often than you think. Also having the contract and keeping good records of the pay by check will save you later if a home becomes the only solution and invoking medicaid is more likely

ON THAT NOTE: Medicaid… MANY homes from assisted living to nursing homes to group homes and more take medicaid because they get some tax breaks from uncle sam. BUT what they’ll to is try to keep filled with those able to pay out of pocket because they earn more money. SO they want to in essence have their cake (Uncle Sam Tax Breaks) and eat it too. They will lie or play stupid and tell you otherwise just to keep you from becoming a medicaid resident full time. And we’ve found even the sweetest smiling nurses, office workers and more will lie lie lie. Report those idiots to the the state.

I’ll share more in an article next time on the finance side but I’ve found only the attorney we paid gave it to me straight.