My BIL and sister made family members promise to never put them into a care facility. Money is very limited so hiring help is not an option. Their income is such that they don't qualify for aid, but don't make enough to hire outside help. Any suggestions as to how to proceed?
Now on to assessing the situation. What it is, what is needed, what the assets are, and best how to proceed step by step. What to try and what to try first. Set aside the whole silly "promise angst" and get on with it would be my advice.
That is just pure selfishness.
No one wants to go into a nursing facility, but often there comes a time when there is no choice but that, promise or no promise. And why families are foolish to make such promises I'll never understand.
So the choices are either to struggle on their own, because as long as family continues to step up and enable their false illusion of independence, they will never see the situation as it truly is, and for the family to call APS to report vulnerable adults that shouldn't be living by themselves, or your sister and BIL agree to move into the appropriate facility using what money they have to pay for it and when that runs out apply for Medicaid.
Time for a come to Jesus meeting with the family, sister and BIL and lay these choices out.
With no money, you don't have too many choices. Daughter continues to do the caring.
Family pools their money together to get an aide in.
See if she qualifies for in home Medicaid who will supply an aide.
Or place her in a facility with Medicaid footing the bill. Which is the last thing you seem to want to do. A married couples assets can be split to make this possible. There are also Miller trust/QIT that help with the money over the cap allowed.
You probably need to see an elder lawyer to see what can be done.
This whole "promise not to put me in a home" business needs to be a two-way street.
Sure, I'll promise not to put you in a home, but ONLY if YOU can promise me not to ever get so sick that you need to be in a home.
All you can do is go back to them and said ooops. I should have never promised that because of X, Y Z. No senior is going to be thrilled with going to a home. Oh well. Such is life
I assume that you are talking about the care your retired doctor BIL needs and can't afford. Personally, I would encourage his POA to see a certified elder law attorney and find out what is available in his state to help get him qualified for care. Maybe the house needs to be sold and he gets put in a facility using the proceeds or goes into a small apartment with paid caregivers.
Tell the family that the one requiring the help doesn't get to drive the bus and impose upon them so he doesn't have to make changes. That is as selfish as can be for him and it is totally unfair to place the burden of propping him up on anyone. He should have planned better for old age and illness.
Very well said. Amen.
Gena / Touch Matters
Sorry if I sound bitter and harsh .BTDT with parents and in laws.
When the time comes call APS , or the relatives local area Agency of Aging . Let them deal with these people.
Do not move them into your home . That makes your home their residence . My nephew made that mistake . He’s in a very bad spot right now.
"Safe" can mean anything.
As a person declines their care can become more than 1 person can manage.
At this point in order to get the help that is needed you have to consider placing someone in a facility that can meet their care needs.
Have all "stones" been turned over to find other resources?
Has family contacted Senior Service or Area Agency on Aging in your area to determine if there are any programs that they would qualify for?
Is either a Veteran? The VA has programs that may help. And if a Veteran depending on where and when they served the help may be a little or a LOT.
Has there been an application for Medicaid made? Many/most facilities have long waiting lists for Medicaid beds and most want a person to "private pay" for a year or two before Medicaid.
I’ve learned that there’s a better way than jumping in and promising to do it all. Lay it on the line for them and tell them you’re unable to rearrange your life. Then offer to help them find another way to provide care for themselves.
Wow! Care for themselves! It’s in their corner now! What a wonderful idea!
Another aide said she noticed bruises on the mother. Long story short, the mom passed. There's speculation is the aide that left was responsible for the injuries to the mom and left before she would be investigated. There was a police investigation charges against the aide filed, but the prosecutor did not pursue because of "insufficient evidence" so the case was closed.
Both companies hired an attorney, who filed an answer to the complaint of abuse, if the mom suffered the injuries they weren't caused by the facility.
Good luck to the daughters in this case.
Your BIL and sister do qualify for assistance. If they were put into a LTC facility, their monthly income would be taken by the facility then Medicaid would pay the rest. No one has enough monthly income to pay for long term care. Whatever assets they have that haven't been out of their names or put into Trust (for at least 5 years 2+1/2 in the state of CA) have to be liquidated and spent-down on paying for their care. When they are all gone, Medicaid will pick up the tab.
They may not qualify for homecare service to be paid for by Medicaid, but they will qualify for Medicaid to pay for them in LTC.
The family will have to put them in LTC if their care needs are too much. No one should be giving up their jobs, homes, lives, and putting their own families second because two selfish, elderly narcissists only want family meeting their care needs.
Don't do it. Put them into Long Term Care. Or take a reverse mortgage on their home and bring in live-in caregivers.
I would not be so quick to blame the people who wish to stay in their own home I have a feeling they know what waits for them. It is a giant problem in this country that there are no adequate and affordable and compassionate provisions for elder care. Sure facilities will take their income and Medicaid may or may not pick up the tab. We’ll see after this bill that just went through begins having effects. . Perhaps there is another creative solution as you suggest like getting a reverse mortgage. But don’t blame people just because they got old and want to stay in their home. To me, it’s totally understandable.
On the positive side, my sisters and I formed a much stronger friendship than we had had before we had this common commitment and I did forge a new relationship with my mother.
On the other hand, we would have spent just as much time with her if she had been willing to leave her crumbling home. The difference would have been that instead of doing her housework we would have been keeping her company and taking her on rides and to lunch, etc. We all would have enjoyed those last years so much more.
Children who are of retirement age should not take on the work of caring for those who need significant help. Those who work in care facilities have training that enables them to do the necessary work more easily and safely. It is both unrealistic and unkind of an older person to expect relatives to take on work that is beyond their skill level or their fitness level, It is unrealistic and unwise of us who are, ourselves, elderly to attempt to do so. A gentle reality session should be instigated to explore better alternatives.
The bottom line to me:
You do what is necessary for the best quality care and welfare of the person needing the care. Situations and circumstances change and it is responsible to adapt as best one can to provide the best care possible.
The first (or second) question / comment is:
Who has the legal authorityto make these decisions?
That person must do whatever is in the best interest of the person, including the financial considerations / care available. I certainly didn't want to put my companion/friend of 18 years in a nursing home; that was all he was able to get (all free due to being on Medicaid). While hardly the best care, it was 24/7 care and cost him nothing.
Re As another said: Medicaid to pay for them in LTC."
DO KNOW THAT ALL THESE GOVERNMENT benefits are - or will be - drastically changin / cut (seniors, disabled, poor, hungry children do not matter to this administration).
Get set up what you can now before too many nursing homes close and/or Medicaid benefits are reduced or unavailable.
You advocate as best you can knowing you are - and have been - doing the best you can.
Alternatively, if the LO has legal authority over their decision making and they want to remain home, without the needed care, they will suffer the consequences accordingly. It is their decision 'if' they have their mental facilities / cognitive functioning - and do not have dementia. You really have to set boundaries, care and respect YOURSELF, and do what you can within their / LOs means.
As Little Orchid says below:
"Children who are of retirement age should not take on the work of caring for those who need significant help." - - - - - Yes, I 100% agree.
YOU also want to be very aware of not giving up your life for caring for another. You could have a breakdown or unable to function 'enough' for yourself or the LO. You must set boundaries.
If you need forgiveness for doing what LO NOW needs vs what they requested, ask God or the Universe to forgive you ... as well, ask for the peace of mind to be able to move on to have a life of your own. Guilt is a nasty one. Meditate ... do whatever you have to do. Just don't try to ' toss it under the rug.' It will fester into mold and grow ... you have to deal with whatever IT is to process / get through it. As the saying goes: "there is no way out but through."
All these areas are messy and difficult.
1st: You care for yourself FIRST.
2nd: Then you make the best decisions possible for the LO.
3rd: Then go out for a cocktail with your family or friends.
Gena / Touch Matters
My sisters and I did the best we could but eventually we had no choice but to place them in a SNF. They were burning through their money paying caregivers and it was running out quickly. We had other family obligations and there were grandchildren who we wanted to have relationships with.
I am going to plan my final exit. I will not make my daughter have to deal with my decrepitude,
This is another reason many elders want to stay in their homes, in many facilities, places to sit outside are very limited. way less then the amount of residents in the facility.
I promise I will not put you in a Home. Today.
I cannot make a promise for the future. None of us know what the future will bring.
In fact, we don't have to use words like 'putting someone in a Home'. We can discuss what your preferences would be.
I once saw a Living Will that was set out like a questionaire;
Q1. What are important ideas & statements about you?
A1. To be independant. To live in my own home. I NEVER want to be put in a nursing home.
Q2. If you couldn't be looked after in your home, what are your preferences?
A2. For my children to pick a very NICE care home, close to one of them.
Just like that. A wall broken through. Fear prompts that need for a promise. But keeping the ability to choose can hopefully lessen the fears.
In other words, I told them the Truth from the get go. There were no misunderstandings, no broken promises, no hurt feelings, no nuthin. Just grown adults going about their lives with the clear boundaries I'd set down long ago. And I managed to save relationships along the way, too, because had my mother EVER moved in with me, fuggetaboutit. We were oil and water, she and I.
I still wound up doing a TON for them over a 10+ year period, however.
Always make realistic promises you know you can keep. And visit an Elder Care attorney to make a plan for the future regarding Medicaid too. That was the best idea for me, even though i never wound up needing to use it. It was there if needed.
I said many years ago that I would not put my parents in a facility. My mom passed away before getting to that point. After she passed away, I took care of my dad as best I could. I even retired to be more available for doctors appointments and etc. But his needs became too great and I began to struggle financially. Long story short, he is now in a facility because it was the best thing for him and me. We also tried at home help but it did not work, one reason being it is expensive to hire someone to help out all day every day. I would talk to them about other options. Sometimes we intend not to do or to do things but life requires us to change our minds.
However, look for all the volunteer help you can get - to start with their current needs. Ask family, friends, neighbors, your and their community of faith, local scouts (and other groups that have volunteering as part of their membership requirements), local government, province/county and federal resources. Ask for hands-on help with their needs as well as caring for home, yard, transportation, and groceries/food. Many people are willing to help on a limited basis for a specific area - as in bring a meal once a week on a certain day.
This is a good idea. I always say about people being willing to help but it has to be on their terms. I will not 'help' by doing any hands-on caregiving. I will not elder-sit and I will not allow anyone to be moved into my house. What I will do is help someone get homecare, state resouces, and/or find placement in a decent LTC or AL to meet their needs.