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    Dementia Dilemma

    For the past several months my 88 year old Mom has had difficult moments. On a few mornings she woke up and thought she was in her old home  and not at the independent Living Community she had moved into. Once in awhile she thought she was at the Senior Center waiting for a friend to pick her up, but every time I went to see her she recognized who I was and seemed relatively lucid.

    Then things changed. She caught a very uncomfortable stomach virus and had to go to the hospital to get treatment. While she was there her alertness diminshed dramatically but she still recognized who I was.  After four days in the hospital she was moved to a rehab. facility. I went to visit her there and she surprised me by calling me by my father’s name. I had become my father. After an hour visit I told her that I had to go home and would be back in two days. She was very angry with me expecting me to stay there with her. There was nothing I could do to diminish her anger. She expected her husband to stay with her or at least visit her every day. When my father was very sick with Parkinson’s she visited him every day in the nursing home and she expected him to do the same for her.

    How do I respond? Do I go along with her and become my father for her? Or do I continue to remind her that I am her son. She was very angry today when I called her, asking why I was not with her. Then she asked me how long we had been married. I was in a no win situation. I told her I would see her three days this week and she was very unhappy, expecting more.

    Dementia is a very elusive force, slipping into the background one moment and returning with power a few hours or days later. It seems to appear in stages, at first a moment or two here and there, then just in the mornings and now as a full time agressor. I felt very confused and depressed when I first noticed that my mother no longer recognized me as who I was. I had always feared that this would occur someday. But now it is here and I must come to grips with it. Should I embrace it as part of my Mom’s existence or fight it and her every chance that I can?

    Preparing Yourself For The Family Meeting

    Once you have created an agenda for the Family Meeting and discussed it with your parents and their trusted adviser, you are ready to have the meeting. Although it seems like a very difficult and perhaps impossible task, I assure you that once the Family Meeting occurs, everyone in the family will be thankful. For many families, issues like finances and death have carefully been avoided at family gatherings for years. But it is on everyone’s mind. It’s like the big white elephant that sits in the middle of the room that everyone tries to avoid but cannot overlook.

    Once communication has opened up, a burden has been lifted from the family. There is a lightness and freedom to discuss topics that were left unsaid for a long time. Future family gatherings will be less stressful because doubt has been removed and everyone knows where he or she stands. Your parents will experience much more comfort and less anxiety facing the problems of growing old knowing now that the family is working with them.

    You may find that one or two family members will try to undermine the meeting, using the excuse that it will upset your parents or will uncover old issues that shouldn’t be discussed. But don’t let them deter you. Consider the alternative. Do you want to keep everyone in the dark until after your parents have passed away and then deal with everything in a crisis mode? Or do you want to discuss things rationally and clearly with your parents and siblings so that everyone is included? The choice is yours.

    But if one of your siblings does not want to participate or warns you that an open conversation with your parents is dangerous, thank them for expressing their opinion, but do not be deterred from having the meeting. Encourage them to attend. Consider either audio or video recording the meeting and providing them with a copy. Get them involved in any way you can. You do not want them coming back to you five years after your parents have died and inferring that everything was done your way and they didn’t have any say. Don’t give them that weapon to use against you.

    Moving a Mom with Alzheimer’s

    When my mom was alive, she had a short stay in a local hospital. She returned from that hospital visit with a virus that caused her to begin to deteriorate. She had contracted a urinary tract infection while there and it dramatically affected her memory.

    We began ’round the clock aides and continued that for almost a month. The changing of aides every twelve hours confused her even more. She forgot when they were coming and what their names were. And it was costing us over $12,000 per month. So we made a critical decision. We decided to move her to an Assisted Living Facility close to our home on Cape Cod that specialized in working with memory-impaired residents. We were very concerned that she would resist the move.

    My wife picked her up and told her she would be staying at the facility until she got her strength back. A week before the move, we met with the Executive Director, discussed the transition and selected her room. The Director told us that she might have some difficulties in the first few weeks but that resistance would be shortlived.

    Sure enough, when she arrived she began telling the staff that she wanted to go home. The first week was very painful. We wondered if we had made a terrible mistake. But with the persistence of the staff and our reassurances, she adapted to the new setting after a few weeks. Now she is very happy with her new friends and is only twenty minutes from our home (instead of 3 hours).

    Making decisions for your parents can sometimes seem awkward and difficult, but many times it has to be done. It is very uncomfortable to experience a reversal of roles and become the parent of your parent. But in our case, my Mom would have continued to deteriorate in her previous setting. As my wife and I reflect back upon this decision, we are certain that it was the right one.  We know she is in good hands and is the right home for herself and her family.

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    Financial Advisors may reprint any articles from The Gift of Communication Blog in your own print or electronic newsletter. But please include the following paragraph:

    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.

    Solve Family Disputes with Elder Mediation

    Mediation is the process of bringing two or more parties together who are seeking to resolve a conflict. The mediator’s role is to facilitate communication between the parties and help them discover a solution. The mediator’s job is not to solve the problem or impose a solution.  The process is completely voluntary, and any of the parties can withdraw at any time.

    Mediation can be very helpful in dealing with issues that adult children and their elderly parents face every day. Is it time for the parents to sell their home and move into an assisted living facility? Which child should provide care if a parent wants to stay in their home? How much care does a parent need? Is there disagreement among siblings as to what to do?

    A good mediator will not place blame or responsibility on any one party in the mediation. Through a process of asking questions and soliciting discussion, the mediator will help the parties come up with a solution that works for them. The mediation will not work unless all parties agree that the solution is appropriate.

    In the past, most mediation was done only by attorneys. A new field is developing now which allows professionals from other fields such as Geriatric Care Managers, Financial Planners, and Clinical Social Workers to become mediators. Each state has specific requirements for individuals to be classified as mediators. Check with your local senior center, council on aging or the Internet to find mediators in your area.

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    PERMISSION TO REPRINT:
    =======================
    Financial Advisors may reprint any articles from The Gift of Communication Blog in your own print or electronic newsletter. But please include the following paragraph:

    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.

    VA Program pays for Mom and Dad’s Long Term Care

    Looking for a way to help Mom and Dad pay for home care or assisted living? Perhaps you are their caregiver. Wouldn’t it be nice to receive some extra income to help you provide their care? There is financial help available for senior veterans and their spouses.

    For veterans who served during a time of war or for their surviving spouses, the Veterans Aid & Attendance Pension will pay additional income to cover long-term care costs. The great news about this program is that the VA will allow veterans’ households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit.

    In 2017, Pension can provide an additional monthly income of up to $2,127 a month for a couple, $1,794 a month for a single veteran or $1,153 a month for a single surviving spouse of a veteran. This money can be used to help pay the cost of home care, adult day services, assisted living or nursing home services.

    In order to reduce income to meet the income test for pension, a rating for “aid and attendance” or “housebound” is crucial. Not only does the rating significantly increase the benefit amount but without a rating, room and board costs for assisted living are not deductible for purposes of reducing income. Only the much smaller assisted living medical costs are deductible.

    For home care, non-medical costs are only deductible if the in-home attendant is licensed for healthcare in that state or if there is a rating. Since the non-medical costs for home care represent the bulk of all costs for long-term care at home, without a rating, those households with a non-licensed attendant would not qualify for the benefit. Examples of medical or nursing services at home would be things such as help with activities of daily living such as dressing, bathing, toileting, ambulating, feeding, diapering and so on. Other services might include medication reminders or supervision necessary to provide a protective environment for the care recipient, as in the case of dementia or Alzheimer’s.

    A rating for aid and attendance is automatic if someone is a patient in a nursing home or that person is blind or so nearly blind as to need assistance.

    It is our understanding that a non-licensed in-home attendant could be just about anyone receiving pay for providing services. This might be members of the family, friends, or someone hired to live in the home. Unfortunately, a spouse cannot be included in this list for reimbursable caregivers.

    For a disabled person who has been rated, a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented.

    Refer to the Veterans’ Administration Geriatrics and Extended Care program for additional information.

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    PERMISSION TO REPRINT:
    =======================
    Financial Advisors may reprint any articles from The Gift of Communication Blog in your own print or electronic newsletter. But please include the following paragraph:

    Reprinted from Bob Mauterstock’s The Gift of Communication Blog. Subscribe at http://www.GiftofCommunication.com  and receive Bob’s Family Meeting Checklist Guide.