Care options for parent (mental health, death of spouse)

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
Post Reply
User avatar
Topic Author
XtremeSki2001
Posts: 1645
Joined: Fri Mar 09, 2007 2:28 pm
Location: Philadelphia, PA

Care options for parent (mental health, death of spouse)

Post by XtremeSki2001 » Wed Jun 17, 2020 2:26 pm

Hi All - Have always received great advice from the members of this forum. Asking again for some input and guidance.

My father (70) passed last week and my mother (67) relied on him heavily. She has mental health issues, primarily anxiety and depression, and spent the better part of 2019 going in and out of an inpatient facility (w/ electroconvulsive therapy (ECT) and the whole 9 yards) after her mother passed away. My father controlled her medications. She has otherwise been mentally stable for 2020 though she doesn't really go anywhere / do anything. She meets with a therapist once a week and talks to someone from her outpatient program weekly (more like telehealth/wellness check). I'm still in the process of getting waivers signed so I can speak to all her doctors.

She's living with me and my sister for the time being, but we're seeking longer term care options for her. For many reasons, it's not realistic for her to live with me or my sister long term. I see this as a two-step process:

1 - Near term care options while she lives in her current home.
2 - Long term care options after she sells her current home.

Seeking input for #1 right now. My mom can basically take care of herself/drive a car/etc., but when depression hits it's usually sudden, she won't answer calls, won't get out of bed, etc. So really we need more like a daily wellness check and medication control. Not sure if anything like this exists, but provided financials below since obviously costs are a big factor here. Thank you so much in advance for any help!

Income/Retirement
- Retirement Accounts - $500k
- Pension (includes all medical) - $40/yr
- SS - ~$30k/yr
- Other - ~13k/yr (for the next 3 years, then ends)
- Dad's Truck - probably get ~$10k for it

Debt
- Mortgage - $160k (house worth ~$340k)
A box of rain will ease the pain and love will see you through

ThankYouJack
Posts: 3373
Joined: Wed Oct 08, 2014 7:27 pm

Re: Care options for parent (mental health, death of spouse)

Post by ThankYouJack » Wed Jun 17, 2020 2:44 pm

I'm sorry about your loss, mother's health struggles and difficult situation.

I would check with your county's Division of Aging (or Housing) department. They may have or know of some resources and have social workers who could be helpful.

Also, I don't know a lot about this company, but this may be an option - https://www.homeinstead.com/

User avatar
LilyFleur
Posts: 1259
Joined: Fri Mar 02, 2018 10:36 pm

Re: Care options for parent (mental health, death of spouse)

Post by LilyFleur » Wed Jun 17, 2020 4:30 pm

It seems like after losing your father, it is a loving decision for you and your sister to have your mom living with you. Does your mom have friends? Isolation, as I am sure you already know, is risky.

When my grandmother went into a nursing home, my mom organized her three siblings to each call grandma on a particular day of the week. Minimally, once your mom moves elsewhere, you and your sister could come up with a schedule for phone calls.

I think as you are able to talk to her doctors you will understand more of what will be best. My mother had dementia-related mental health challenges (paranoia), and because my sister and I were far away, we hired a private-pay geriatric-care social worker who was absolutely wonderful at helping us understand our mother and make decisions for her care. My mother refused her meds about half of the time and her behavior would be much worse after that. Unfortunately, it is illegal to make someone take their meds. If your mother is cooperative with taking her medicines, that is a positive.

stan1
Posts: 8504
Joined: Mon Oct 08, 2007 4:35 pm

Re: Care options for parent (mental health, death of spouse)

Post by stan1 » Wed Jun 17, 2020 5:25 pm

Sorry to hear the news.

Her inpatient treatment facility should have social workers or patient advocates (terms vary) to help find the services she now needs that she didn't when discharged. They will know the local options and will at least have additional points of contact. Can also facilitate coordination with medical teams. We've found these staff to be very helpful and compassionate transitioning family members into home-based services and long term facilities.

User avatar
Topic Author
XtremeSki2001
Posts: 1645
Joined: Fri Mar 09, 2007 2:28 pm
Location: Philadelphia, PA

Re: Care options for parent (mental health, death of spouse)

Post by XtremeSki2001 » Wed Jun 17, 2020 5:39 pm

LilyFleur wrote:
Wed Jun 17, 2020 4:30 pm
It seems like after losing your father, it is a loving decision for you and your sister to have your mom living with you. Does your mom have friends? Isolation, as I am sure you already know, is risky.
Some mutual friends of my fathers, but no friends of her own ... unlikely she would go out with these mutual friends without my father.
LilyFleur wrote:
Wed Jun 17, 2020 4:30 pm
When my grandmother went into a nursing home, my mom organized her three siblings to each call grandma on a particular day of the week. Minimally, once your mom moves elsewhere, you and your sister could come up with a schedule for phone calls.
Absolutely.
LilyFleur wrote:
Wed Jun 17, 2020 4:30 pm
I think as you are able to talk to her doctors you will understand more of what will be best. My mother had dementia-related mental health challenges (paranoia), and because my sister and I were far away, we hired a private-pay geriatric-care social worker who was absolutely wonderful at helping us understand our mother and make decisions for her care. My mother refused her meds about half of the time and her behavior would be much worse after that. Unfortunately, it is illegal to make someone take their meds. If your mother is cooperative with taking her medicines, that is a positive.
Thank you for your input. My mom has never really resisted her medicines, but she has abused them on a few occassions.
stan1 wrote:Sorry to hear the news.

Her inpatient treatment facility should have social workers or patient advocates (terms vary) to help find the services she now needs that she didn't when discharged. They will know the local options and will at least have additional points of contact. Can also facilitate coordination with medical teams. We've found these staff to be very helpful and compassionate transitioning family members into home-based services and long term facilities.
That's a good idea ... thank you!
A box of rain will ease the pain and love will see you through

Mudpuppy
Posts: 6126
Joined: Sat Aug 27, 2011 2:26 am
Location: Sunny California

Re: Care options for parent (mental health, death of spouse)

Post by Mudpuppy » Wed Jun 17, 2020 7:14 pm

There are options for in-home health aides, but since your mother does not sound like she needs assistance with most activities of daily living (ADLs) and instead needs medication management, you would likely have to pay out of pocket. Most companies require a contract with a minimum number of hours per day, and often with a non-compete clause that you won't hire any of their employees "on the side". Some companies do have a one-hour shift option for clients who need only a minimal level of assistance, but that's very rare. Most require at least a 4-hour shift (or longer). So it's an option, but it would likely be expensive, particularly if all of the local providers required a 4-hour shift.

Edit: Also, the in-home health aides I've worked with were not certified to dispense medication. They could prompt my relative with "It's time to take your pills" but they would not fill the pill minders or actually hand over the pills. There was an in-home nursing option from the same company that could provide a higher level of service, but with a higher price tag of course.

Katietsu
Posts: 3460
Joined: Sun Sep 22, 2013 1:48 am

Re: Care options for parent (mental health, death of spouse)

Post by Katietsu » Wed Jun 17, 2020 7:35 pm

What about a home health aide to come in for a couple of hours a day/5 days a week to help with cleaning, laundry, maybe make lunch, be there during shower time if falls are a concern, etc. Then, besides the practical help, you would have someone to warn you if mental health problems worsened. The contact with another human being on a daily basis might even help to avoid a return of the mental health issues.

You could hire someone directly in my area for $15-$20/hr or through an agency at $25-$30/hr. The other 2 days a week, you or your sister could stop in with lunch for a visit.

If you have a serious concern about medications, there are high tech options for medication. We looked at a device that you (or an RN) would fill once a week. It would be programmed to dispense the right medication at the right time, sort of like a gum ball machine.

123
Posts: 5955
Joined: Fri Oct 12, 2012 3:55 pm

Re: Care options for parent (mental health, death of spouse)

Post by 123 » Wed Jun 17, 2020 8:46 pm

How far is her home from yours? Distance can make things difficult for routine drive-bys/visits.

Would she be open to video conferencing with your or your sister a couple of times a day or maybe a couple of security cameras that you could monitor her over the web (kind of a granny cam)?

We have an elderly neighbor who lost her spouse over a year ago. While she is still able to take care of herself she didn't like living alone and wasn't interested in moving to assisted living. The family resolved the situation by having various family members do a sleep-over at her house at night (family members involved live within a few miles). I think the widow prepares dinner and breakfast for the visitor so it keeps the widow occupied as well. I've noticed that one family member tends to do worknights and another weekends. Of course this arrangement works best if there are a lot of family members (which including children/grandchild) willing and able to participate.
The closest helping hand is at the end of your own arm.

User avatar
Topic Author
XtremeSki2001
Posts: 1645
Joined: Fri Mar 09, 2007 2:28 pm
Location: Philadelphia, PA

Re: Care options for parent (mental health, death of spouse)

Post by XtremeSki2001 » Thu Jun 25, 2020 11:49 am

Thank you for your thoughtful responses. My mom has been with us now for about a week and seemingly takes care of herself so long as there's no major tasks. For example, she can shower, make lunch, carry conversation fine but if asked to do something independent like call and update Social Security she is overwhelmed.

I spoke with her outpatient care provider and they stress not disrupting her from anything she's been doing (e.g., on her laptop for 6+ hours a day) and wait 3-6 months before making any major life decisions. As you can imagine, we're taken back by this advice.

We have found some great technological devices to control medication, complete with notifications to my phone if it's being tampered with. However, my mom has stressed repeatedly she does not want to be alone.

I think the best course of action is to have her live in an independent housing place that also has games, outing, and assisted care (if ever needed). That way she's not alone, we're close by (within 20-50 mins), and she has social options. The real challenge is waiting 3-6 months to have these conversations. Not sure we can wait.

Mental illness is hard for me to grasp. My in laws are much older than my mom and very high functioning. My mom is also high functioning but unwilling to do things that require effort and wants others to do things for her.

Sorry, kind of a rant!
A box of rain will ease the pain and love will see you through

Mudpuppy
Posts: 6126
Joined: Sat Aug 27, 2011 2:26 am
Location: Sunny California

Re: Care options for parent (mental health, death of spouse)

Post by Mudpuppy » Thu Jun 25, 2020 12:56 pm

It's okay to rant from time to time. Caregiving is a very stressful thing, and it's good to have health ways to vent.

I have to wonder if the pandemic is playing in to the 3-6 month timeline more so than concerns about disrupting schedules. But you can use this time frame to really evaluate the housing options. Look into what sort of levels of care they provide, such as how they handle transitions to higher levels of assistance.

Also look into various facets such as staffing levels, how secure the facility is when someone needs that level of care (i.e. protecting against them wandering off once cognitive decline becomes severe), how they've rated during evaluations, and so on. Their response to the pandemic will also be telling of how they operate day-to-day outside of crisis.

clip651
Posts: 650
Joined: Thu Oct 02, 2014 11:02 am

Re: Care options for parent (mental health, death of spouse)

Post by clip651 » Thu Jun 25, 2020 10:42 pm

Realistically, she's a new widow that was relying heavily on her husband for support. She's going to need a lot of support going forward. Short term, family is probably best to provide this for her to the extent that that's possible. I don't think a 3-6 month adjustment period is out of line at all. She wasn't in great shape to begin with, and this is a big life change for her. It sounds like you or your sister will need to personally support her with tasks that need taking care of (paperwork, appointments, etc).

I realize this is a lot coming at you all at once if you weren't previously involved much in her care due to your father/her husband's support of her. And you are undoubtedly grieving your father as well. As a caregiver for a family member myself, I sympathize that this can be overwhelming.

If this were my own family member, given the current pandemic, I would be very reluctant to consider new group housing options (assisted living or nursing facility) for someone in her age group, unless there were really no alternatives. You are unlikely to be able to visit much due to visitor restrictions due to infection concerns. And her risk of becoming infected may be very high in such a situation. And I doubt you'd even be able to visit to really see how the place is run at the moment. [Edited to add - social options (games, outings, even going to the next room to have a chat with another resident) may also be extremely limited at this time due to efforts to prevent coronavirus infections. So she might mostly be alone in her room all day at a facility.] YMMV of course, just my 2 cents.

Since she doesn't want to be alone - do you or your sister work from home? Can either of you be in the same house with her most of the time (perhaps taking turns) as she grieves and starts to adjust to her new reality?

Otherwise, home health services may need to be hired. If she mostly just needs a companion to keep her company and keep an eye on her, rates for that are generally lower than for nursing care. But it depends on how much help she needs with medications and what tier of care that puts her in with an agency. And if she wants someone there all the time (or perhaps all waking hours) this will get pricey.

Another option, if she wants to stay in her current home (or even with you and/or your sister), is to get her a live in caregiver. This would be one person, full time (with some breaks for vacation, etc, that you and your sister might need to cover yourselves or hire someone to do so). Arrangements vary, but typically your mom would provide room and board for this person, plus a salary. While this sounds like a lot - it can be cheaper than paying for help by the hour or paying for full time residence in a facility that can provide the care she needs. Talk to local home health agencies and/or a social worker at the facility where she was previously treated for details on what might be available in your area, and whether a full time live in caregiver might be a good solution for her.

best wishes,
cj
Last edited by clip651 on Thu Jun 25, 2020 11:17 pm, edited 3 times in total.

clip651
Posts: 650
Joined: Thu Oct 02, 2014 11:02 am

Re: Care options for parent (mental health, death of spouse)

Post by clip651 » Thu Jun 25, 2020 10:44 pm

duplicate post - deleted

clip651
Posts: 650
Joined: Thu Oct 02, 2014 11:02 am

Re: Care options for parent (mental health, death of spouse)

Post by clip651 » Thu Jun 25, 2020 10:47 pm

Another thought is that you may want to consider counseling for yourself and your sister. This may help you to better understand your mother's condition, and to deal with the stresses of caregiving and working towards future decisions for her.

User avatar
Topic Author
XtremeSki2001
Posts: 1645
Joined: Fri Mar 09, 2007 2:28 pm
Location: Philadelphia, PA

Re: Care options for parent (mental health, death of spouse)

Post by XtremeSki2001 » Mon Jun 29, 2020 8:53 am

Thanks again for the thoughtful posts. It's becoming clearer each day the road will be long. Although my mother is young (68) and functioning, her attitude is defeatist. Everything from preparing a meal or asking her to call Social Security is 'too much'. However, she has a hair appointment in another state and suddenly can live alone, make her meals, do her laundry, and drive back to my house (1+ hour). I don't get it.

CJ I think you're right. My mother relied heavily on my Father more than I appreciated until now. She essentially will only do things if 'forced' and otherwise is basically another child I must care for (I have 4 children under 7). My sister will have twins tomorrow so just me for now I guess.

Tried to start probate today. Gave my mother the phone number and she said she didn't know what to do and left it at that. This is the kind of stuff I'm facing. Ultimately, I'll probably just go it alone because we need to start moving forward. No idea what to do with a 2,500 sqft house in another state that's sitting vacant. Mother wants to 'wait until the fall' before making any decisions about anything. :shock:

Prior to this we saw my mother 10 or less times a year. She never called us unless she needed something (fix her laptop, etc). No relationship with our kids before or now. It's overwhelming and I just feel like I'm trapped with no way out.

Fortunately I work from home so I'm here with my mom. She's on her laptop all day except for meals. She's not active or eating healthy. I don't know where to draw the line with some of this stuff.

We did talk about a caregiver or living an a independent care housing place yesterday. Neither was well received. We only brought them up to plant the seed. Our fear is waiting too long and allowing her to become too comfortable with everything being done for her while living her.

I'm definitely whining :) and I accept that.
A box of rain will ease the pain and love will see you through

Carefreeap
Posts: 2751
Joined: Tue Jan 13, 2015 7:36 pm
Location: SF Bay Area

Re: Care options for parent (mental health, death of spouse)

Post by Carefreeap » Mon Jun 29, 2020 9:19 am

XtremeSki2001 wrote:
Mon Jun 29, 2020 8:53 am
Thanks again for the thoughtful posts. It's becoming clearer each day the road will be long. Although my mother is young (68) and functioning, her attitude is defeatist. Everything from preparing a meal or asking her to call Social Security is 'too much'. However, she has a hair appointment in another state and suddenly can live alone, make her meals, do her laundry, and drive back to my house (1+ hour). I don't get it.

CJ I think you're right. My mother relied heavily on my Father more than I appreciated until now. She essentially will only do things if 'forced' and otherwise is basically another child I must care for (I have 4 children under 7). My sister will have twins tomorrow so just me for now I guess.

Tried to start probate today. Gave my mother the phone number and she said she didn't know what to do and left it at that. This is the kind of stuff I'm facing. Ultimately, I'll probably just go it alone because we need to start moving forward. No idea what to do with a 2,500 sqft house in another state that's sitting vacant. Mother wants to 'wait until the fall' before making any decisions about anything. :shock:

Prior to this we saw my mother 10 or less times a year. She never called us unless she needed something (fix her laptop, etc). No relationship with our kids before or now. It's overwhelming and I just feel like I'm trapped with no way out.

Fortunately I work from home so I'm here with my mom. She's on her laptop all day except for meals. She's not active or eating healthy. I don't know where to draw the line with some of this stuff.

We did talk about a caregiver or living an a independent care housing place yesterday. Neither was well received. We only brought them up to plant the seed. Our fear is waiting too long and allowing her to become too comfortable with everything being done for her while living her.

I'm definitely whining :) and I accept that.
You're not whining but I do think you will find a support group helpful. This is a tough journey. I will PM you with a link to another financial group chat which has a Elderly Parent Support thread. Lots of support and resources.
Every day I can hike is a good day.

dbr
Posts: 32810
Joined: Sun Mar 04, 2007 9:50 am

Re: Care options for parent (mental health, death of spouse)

Post by dbr » Mon Jun 29, 2020 9:51 am

Been here and done this twice, actually three times. Issues have been Alzheimer's, senile dementia, substance abuse, and mental illness (multiple combinations).

It can be a very long story and I am not writing novels today so I will make a couple of points:

1. Your county social services organization and your mother's physician(s) can be very helpful at locating resources. This requires physicians of more than one specialty. There are also community services and help organizations that do a lot, for her and for you. Explore all of them. Especially explore how these things can be paid for. If you think the IRS is a byzantine empire, welcome to the world of social services.

2. In two cases the ultimate solution that worked was to get the person under care in a facility, whether assisted living, mental assisted care, or a nursing home. At-home care can be more time and stress* for the family or can work very well. My third case was that a full-time live-in care giver worked, but that was because the person hired was unique.

*So, one of those weekly pill minders managed by a visiting county nurse stops working when the patient identifies it as a cake, frosts it, and puts it in the oven starting a fire.

A second anecdote, not going into detail, is that this kind of caregiving requires massive dedication and expertise on the part of the caregiver. Did you know that many medications can cause rather than help dementia, and you may be the only one to figure out which one is which? I won't recite the long and painful story about this. But it has a happy ending, relatively speaking.

DebiT
Posts: 258
Joined: Sat Dec 28, 2013 1:45 pm

Re: Care options for parent (mental health, death of spouse)

Post by DebiT » Mon Jun 29, 2020 10:39 am

My condolences to you on the loss of your dad, and the tough situation you find yourself in,

Is it possible to sell her house and use that money to try an apartment in your town? It sounds like you are overwhelmed with 4 kids under 7 and now your mom. Maybe an apartment would be a trial compromise between returning to her home (where she has no friends, but does have mental health workers) and assisted living (which would cost a great deal more).

You have my sympathies, as does she. I was widowed last year, thankfully without the problems your mother has in terms of functioning. It is a giant adjustment under the best of circumstances, let alone COVID. Think baby steps

If she can’t or won’t do the legal things that need doing, it may be easiest to get a POA and just start doing them yourself, one at a time. Possibly your sister can help with research, some phone calls, etc, although with new twins time and and energy may not be present.

Deep breaths. At least she sounds like she occupies herself in your home. My sympathies, and also condolences on the loss of your dad,
Age 62, life turned upside down 3/2/19, thanking God for what I've learned from this group

dbr
Posts: 32810
Joined: Sun Mar 04, 2007 9:50 am

Re: Care options for parent (mental health, death of spouse)

Post by dbr » Mon Jun 29, 2020 10:54 am

DebiT wrote:
Mon Jun 29, 2020 10:39 am


If she can’t or won’t do the legal things that need doing, it may be easiest to get a POA and just start doing them yourself, one at a time. Possibly your sister can help with research, some phone calls, etc, although with new twins time and and energy may not be present.

On that note, it is absolutely essential you have a durable POA and a health care POA. Also it essential that you actually get those on file and exercise them at financial institutions and health care offices while she can still say yes, as often these POAs are not recognized.

In one of our cases refusal to grant a POA caused a family member to have to go to court to get custody or, in effect, leave a person to die in their own dementia. Having to do custody under court order is the last and least desired way to manage this. In another case we had POA but the county was able to take the legal steps that saved that person's life. Remember a POA does not allow someone to force another person to do something even if not forcing them means death.

Mudpuppy
Posts: 6126
Joined: Sat Aug 27, 2011 2:26 am
Location: Sunny California

Re: Care options for parent (mental health, death of spouse)

Post by Mudpuppy » Mon Jun 29, 2020 1:17 pm

clip651 wrote:
Thu Jun 25, 2020 10:47 pm
Another thought is that you may want to consider counseling for yourself and your sister. This may help you to better understand your mother's condition, and to deal with the stresses of caregiving and working towards future decisions for her.
I would second this recommendation for counseling for everyone, including the OP's mother. The intersection of grief and mental illness is complex for all involved. Individual and group counseling can help them navigate these difficult times.

The OP might also want to see if there is a NAMI family support group in the area.

fleetwdl
Posts: 25
Joined: Fri Jan 06, 2017 2:59 pm

Re: Care options for parent (mental health, death of spouse)

Post by fleetwdl » Mon Jun 29, 2020 2:08 pm

"on her computer 6 hr's/day" raised a red flag for me. Even as you work through these near term and long term decisions, you should also attempt to protect her financial resources, as many elderly are taken advantage of, and many of those instances begin through the computer.

Nutmeg
Posts: 198
Joined: Wed Jul 26, 2017 12:52 pm

Re: Care options for parent (mental health, death of spouse)

Post by Nutmeg » Mon Jun 29, 2020 10:09 pm

dbr wrote:
Mon Jun 29, 2020 10:54 am
DebiT wrote:
Mon Jun 29, 2020 10:39 am


If she can’t or won’t do the legal things that need doing, it may be easiest to get a POA and just start doing them yourself, one at a time. Possibly your sister can help with research, some phone calls, etc, although with new twins time and and energy may not be present.

On that note, it is absolutely essential you have a durable POA and a health care POA. Also it essential that you actually get those on file and exercise them at financial institutions and health care offices while she can still say yes, as often these POAs are not recognized.

In one of our cases refusal to grant a POA caused a family member to have to go to court to get custody or, in effect, leave a person to die in their own dementia. Having to do custody under court order is the last and least desired way to manage this. In another case we had POA but the county was able to take the legal steps that saved that person's life. Remember a POA does not allow someone to force another person to do something even if not forcing them means death.
I agree that a durable POA and a health care POA are essential. In my case, I also arranged by telephone for my relative to authorize the medical insurance company to talk to me. For another relative, if an issue arose with a company, I would add the relative to the phone call with a company to obtain authorization for the company to talk to me about that particular issue, which just entailed having my relative answer security questions.

When you obtain a durable POA, be sure that the POA authorizes you as agent to do everything the principal could do, not just in general language, but specifically. Some states require the principal to specifically state that the agent has the power to make gifts, even to himself, or name a beneficiary, even if that is himself. This could be important powers to have in order to carry out the principal’s wishes, which presumably would be to name both you and your sister as beneficiaries. If the original POA is recorded, you can obtain certified copies of it, which can help when you are attempting to convince an entity to accept it.

dbr
Posts: 32810
Joined: Sun Mar 04, 2007 9:50 am

Re: Care options for parent (mental health, death of spouse)

Post by dbr » Mon Jun 29, 2020 10:17 pm

Nutmeg wrote:
Mon Jun 29, 2020 10:09 pm


When you obtain a durable POA, be sure that the POA authorizes you as agent to do everything the principal could do, not just in general language, but specifically. Some states require the principal to specifically state that the agent has the power to make gifts, even to himself, or name a beneficiary, even if that is himself. This could be important powers to have in order to carry out the principal’s wishes, which presumably would be to name both you and your sister as beneficiaries. If the original POA is recorded, you can obtain certified copies of it, which can help when you are attempting to convince an entity to accept it.
Yes, in our state they have a list like that with checkboxes or an election that all boxes are checked.

Post Reply