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What type of in-home help is there for aging parents who are losing their executive functions for things like answering questions about emails and mail received and talking with lawn care people and finding things in the house? They can't remember previous conversations they have and don't always write things down and then can't really explain their problem to us over the phone because they get confused.


I know what my go-to answer is and that is that it's a child's responsibility; they need a full-time "secretary" or "office manager". But my sister and I are not near our parents and they don't have the ability to have a cohesive, productive conversation over the phone about these subjects anymore so that we can solve things long-distance. Dad will rattle off about 5 things he's got "problems" with. And when you ask for details, he gets confused. He gets himself so worked up that he can't think straight and we end up accomplishing little in phone calls. Then later, I learn that some things worked themselves out when he was calmer and some things linger. He worries excessively about many things that are not even his responsibility to worry about (like me traveling by airplane and renting a car by myself to come see them).


Through this forum and from research and phone calls and friends, I have a good list resources for when medical care is needed in the home, or PT, or comfort and care for my mom (mild dementia) but when it comes to finances, emails, mail, keeping their calendar straight, coming up with words to explain problems, and worry, I don't know what recourse we have as adult children living far away.


Even if they were to move to a continuing care place, these sorts of matters would still need to be "handled". My parents want to continue to live on their own and are independent in many ways. My sister and I feel pretty good about having affairs in order and know their wishes in the case of life-threatening emergencies and like I said, knowing who to call when medical help is needed, getting nourishing meals to them when needed, etc. But it's the day-to-day functioning that is getting unsustainable at a distance. We have a helper coming 3 days per week for my mom, but Dad does not ask or trust her to do anything else. He's got trust issues and is a perfectionist.


As I said in the beginning, my conclusion is that there isn't support for such personal matters that one can necessarily trust except for within family. They are 91 and 92 and a move at this point would be devastating, and we cannot leave our families to go live with them, so we are just hoping there are some of you out there who have found a way to help parents with their day-to-day tasks in their home. Thank you for your time and consideration in this matter!

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When parents develop dementia, it's time for them to either move into Assisted Living or to get help inside the home every day. They're no longer able to deal with the myriad of things that need to be dealt with in a home, and you're seeing clear evidence of that in your phone calls with them! So the answer to your question is: you can't really handle your parent's confusion long distance. Some things have to be handled in person and evaluated that way.

All elders 'want to age in place', and in an ideal world, they'd be able to. Since it's not an ideal world, most aren't able to, and need much more help than they realize. With meals, with bathing, with cleaning, with dressing, and the list goes on and on.

If you are hearing in their phone voices that they can't cope with their lives, the reality is 100x worse in real life.

If you feel they have 'mild dementia', it's probably more like 'moderate' dementia. If I had a dime for every time I read a post here about a loved one with a 'mild cognitive impairment' diagnosis which turned out to be a serious issue, in reality, I'd buy myself a nice steak dinner! By the time you're hearing 'confusion' in an elder's voice, it's past time they need to have help for most all of their daily chores and activities of daily life. Especially when owning a home. I'm 64 and feel overwhelmed at what I need to take care of in my home on a daily basis! And I don't have dementia, or mobility problems, or health issues to set me back. That's the hard truth of the matter, too.

It would be a good idea to go pay them a visit in person to see for yourself what's really going on. Then you can make an assessment and go from there. Trying to evaluate a tricky situation over the phone isn't realistic.

Elizabeth has given you some good advice and resources to start checking out. Your folks are 91 and 92 which is quite up there in years. By that time, I had moved my parents across the country to a senior apartment 4 miles away from me. Dad had to stop driving and mom was on the dementia road by then; dad wasn't, but within a year (when he turned 90), he could no longer keep the finances straight in his head. It happened VERY quickly; overnight, in fact. I had to go over there and take the accordion file of 'important papers' away from him so he could sleep at night, that's how flustered he was about those papers. Soon after that he fell and broke his hip and I had to place both of them in Assisted Living; there was no other choice. The rehab would not release him back to independent living. It was a crisis situation at that point. I thank God every day I had moved them close to me, otherwise, he would have fallen in Florida with me in Colorado and then what? That is what YOU are potentially facing here soon (God forbid). Get the wheels in motion now to set your parents up with the right care or placement so that they're safe in case of an emergency, and you don't have to 'fire sale' their home to place them when the medical doctors insist on it!

Wishing you the best of luck moving forward
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Reply to lealonnie1
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Bevthegreat has very good suggestions. As for finances and medical issues, it's imperative that you have durable power of attorney and health care proxy. I would like to add that although it is hard to visit them, an in home visit is essential to assessing their real needs. You cannot just go on their word. My elderly Mom was a master at phone conversations - and every caller told me how amazing and "with it" she was for her age. In many aspects she was. Yet little did they know how her memory was affecting how she took her meds, how she was forgetting what and when she ate, and how often she was eating sweets and ice cream instead. She left some bills unpaid. If she tripped and fell, she would not tell me until days later. When at the doctors, she would downplay any symptoms she was feeling and try to impress the doctor with how capable she was. She left the water running often. She was hard of hearing and would often not get clear information from important sources. She would take scam callers at their word. I urge you or your sister to take the time to visit for a few days so you can get a CLEAR assessment of exactly what your parents needs are. Until you do - you only have a snapshot of what your parents choose to let you know.
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Reply to NYCmama
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Key factors I found to help this year: 1. get POA - you can speak to lawyers, financial advisors, banks, credit card companies as necessary, 2. Set up online accounts with banks, Comcast, Medicare, email, etc. with your phone # & email as contact. I was able to see a fraudulent charge on a credit card by accessing the bank statement, saw that Dad paid the Geek Squad 3 times for annual subscription, and where he paid the newspaper $800 in advance. I also see every time they try to change their password & call them to help when I receive a security code to do so. I access their email & delete phishing attempts & requests for money or personal info. Despite this, they still had challenges with maintaining a condo. Had the heat on mid-summer in Florida, mold grew on the vents, they called a duct cleaning service who oversold them, then couldn't understand the difference between cleaning the ducts & cleaning the vents. I took down & cleaned every vent on my last visit. My Dad almost bought $4000 in gift cards from Best Buy due to a scam phone call. Their Home Instead aide got in the car with them & got help from staff when they arrived. They've been in AL for a week & are visibly relieved. I'm assuming all financial responsibilities from out-of-state, and they have much less to worry about.
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Reply to Daughter1of3
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All these replies are absolutely correct. I agree that what you are hearing on the phone is the tip of the iceberg of fears, issues and quality of life.

While it is a decision you and your sister need to sit down and discuss a plan. POA is at the top of the list, then pave the way for change.

My mother moved to an assisted facility once I explained to her that I was worried about her if I couldn't help. I offered options, home: you need this and you HAVE to have this type of help. Sell the house and move to local ALF of her choosing. Once she agreed, I moved quickly. Then eventually I saw she needed to be closer. I feared that conversation, but when I said I missed seeing her and would she mind moving closer so we could visit more. THAT was the ticket to move.
I am not going to say that the moving process was smooth, her dementia increased to the point of she is now in MC which she is loving on good days and misses me on bad days. Even if I just saw her the day before or that morning.
The best moment when I knew she was OK was the call to SS to get her direct deposit changed. SS required her to answer questions that involved allowing me to talk to her about her money. I laughed when she told her "She's my daughter, she takes good care of me, why wouldn't l want her to? " with the expression of disbelief that this person would even THINK of asking that question.
BUT..each situation is unique, YOU know your parents, BUT you may be surprised if you give choices and reasons of love and caring for the choices, and MAYBE it will be a relief on all fronts.
My dad always told me to "stop pussy footing around, spit it out" Direct discussion or delicate sidestepping only delays decisions to the emotional emergency "my mind is mush" event. When dad was dying of cancer, he knew he had no options, so he shopped around for the best deal in a funeral after discussing it with mom, knowing she would not make good decisions under stress. I was left to implement his wishes and each time I contacted those who needed to be told of his death, the first words out of each business or service or insurance person was, "Oh, he already contacted us and this is what you need to do." He taught me how to live a life and he taught me how to conclude a life.

Your parents may be hoping for someone to take the reins during the end of life.
Good luck!
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Reply to citymouse
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Hi,
It sounds like they need a higher level of care. Given their dementia, the time for letting your parents determine the best plan for their needs has likely passed, and it may be unproductive to include them in the decision making process. They will not remember your conversations, and you will have the same conversation many times.
Whoever has POA should be activating it and doing their due diligence now-assessing the finances, healthcare maintenance (when was the last Dr.'s app't?), making sure taxes are paid, etc. Doesn't sound likely that your father and mother are able to manage those things. I would also check in with the aide to see if prescriptions and medications are being kept up. (One of the issues with dementia is the inability to track time or remember prior actions, and double dosing meds, or skipping them is common.) If you or your sister are not interested in acting as POA, then an attorney and a geriatric care manager could assist in setting up plans for their future care.

I guarantee that you're only seeing the tip of the iceberg in your conversations with him. You (or your sister) should do a week long visit and assess the situation. It doesn't sound like your dad would be able to rescue himself or your mother if an emergency occurred. Good luck.

http://www.dementiacarestrategies.com/12_pt_Understanding_the_Dementia_Experience.pdf
https://www.alzconnected.org/discussion.aspx?g=topics&f=151
https://www.youtube.com/watch?v=6cZTgG6kDjs
https://www.youtube.com/watch?v=0BlZF_4EKp4
https://tamcummings.com/stages-of-dementia/
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Reply to ElizabethY
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Geaton777 Sep 16, 2021
"I guarantee that you're only seeing the tip of the iceberg..." -- so true! This is why they will need to spend extended periods of time at their home getting things figured out once they see what the extent of the deterioration is.
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There are solutions, just not ones that make everyone involved happy.

- move your parents into an AL with a continuum of care locally to either you or your sister.

- hire more aids for more daytime hours and keep upping the number of hours (into the night) as becomes necessary.

Both of these options are expensive and both will still require management.

Or, you can hire a geriatric care manager in their area.

I'm not sure there's a 4th option. What your parents want and what is realistic don't match up. Someone is going to be disappointed. Your parents "want to continue to live on their own and are independent in many ways" -- except they're already not since you and hired help are starting to orbit around them. With cognitive decline this romanticized notion just devolves into unsafe. And they are less and less able to make sound decisions that they even will remember.

If you or sister lived near them and were willing/able to provide more hands-on daily help I'd be advocating for that. But that's not the case and I don't recommend either of you uproot yourselves to do this. You don't say how old your parents are, but if they're in their 80's or older they could have a catastrophic medical event that would make your moving there a wasted venture.

In an AL they will have far more social exposure to people, activities and events -- something they won't be getting much, if any, cloistered in their own home. You'll have peace of mind and much less to manage and they'll be safe, fed, and protected. It won't be perfect but neither will attempting to keep them in their home.

Hopefully one or both of you are their PoA. (If not, please provide this information as that changes a lot of how you move forward).

If so, take out the paperwork and read up on when the authority is legally activated. If it requires a diagnosis of incapacity, then this is your next assignment. In the near future you sisters will need to take extended trips to help them and move toward whatever solution you arrive at. I can guarantee you won't be able to do all of it from afar. I wish you much success in agreeing on a solution with compromises that work for all, and peace in your heart as you move through this journey with them.
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Reply to Geaton777
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Set up Cameras in some main areas of the home like the Den, Kitchen, ect. I used Nest Cameras and they aren't hard to set up then you can view the areas and here what's going on 24 7 from your phone and laptop.

If not already done, all their bills should be set on Auto Pay with their Bank Account.
They can have on line Banking Set Up so you can go over their Bank Account.
They can add you on to all their accounts, so you would be able to talk to the Bank, Credit Cards, Ect about the Account whenever necessary.

You can have groceries delivered to their house.

If there is a problem, deal with one at a time so as not to confuse your Dad.

Ask your mom about the problem since you said she only has mild dementia.

Have a yard guy and a House Cleaner come every other week.
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Reply to bevthegreat
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This is a small addition to the excellent advice. Our local 911 emergency number now has a register with phone numbers, number of people in the house, age, any disabilities,( hearing problems, mobility, confusion). If your parents area, or in fact your own, has such a system, you could register them using yourselves as the contact. They confirm once a year. That way in some emergencies, they could respond more efficiently. This doesn't replace the care they need, but everyone should access it if possible.
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Reply to Moxies
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If either of you are appointed by them then some day, you will have to take an extended visit. Sure if they have to move it will be for safety.
Here is the take home...ignoring the situation will cause 2 things: a major accident or catastrophic event to the house, or someone will report to the APS of self neglect. Then probate will get involved an appoint a guardian or conservator. Choose to do nothing, a judge will appoint a law office to become their representative. They will charge for professional services until they qualify for Medicaid and LTC in a new home.
You are questioning at this point, so one or both now have to choose who will be proactive
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Reply to MACinCT
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I live 1500 miles away from my brother. I have all his Social Security, Medicare, Medicaid paperwork etc sent to me. As soon I as I saw there were problems I got Power of Attorney. He was agreeable when I explained that, “you know all the stuff I’m doing for you? I want paperwork that says you’re good with that in case people question what I’m doing.” That POA has been open sesame for so much—the light bill, social services, hospitals, hospice, etc. with POA I could talk with all these people. You may need to visit to see in person their paperwork, bills, so you have a better idea of what’s been going on. An assessment by a local geriatric social worker could be of great help. Sitting in on the assessment could help you get a great/sobering idea of how well they’re doing and what you need to do next.
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