“Anything that can go wrong, will go wrong.” – Murphy’s Law
My experience with elderly family members is what I consider extreme and disproportionate. So, in my opinion, I consider myself somewhat of an “accidental” expert in this field. I have learned enough in the last four years to give myself the title “Counselor on Aging”. It sounds better in Spanish, “Consejera las personas mayors.” Whatever the language, we are never prepared for the sudden on-set of age-related issues of beloved family members. With two elderly parents and an elderly, childless aunt under my watchful eye, my plate is full. Overflowing. Bursting. And, at times, rupturing.
So, here’s my Top 10 “Murphy’s Law” list of what I’ve learned, in reverse order:
|10.||The belief and feeling that “time flies” as we age is universal; it will happen to you.|
|9.||None of us escapes (old age and the aging process) unless we die young.|
|8.||Treat your children well. You will need them when you are elderly and they will not be up for the challenge.|
|7.||You can never ask enough questions – questions of doctors, nurses, caregivers, social workers, eldercare experts, service vendors and providers, financial institutions, even law enforcement agencies. But, our “Privacy Laws” will stand in the way of you getting answers.|
|6.||Good help is hard to find. When you find it, harness it and do everything in your power to keep it.|
|5.||There are no short cuts; just long responsibilities and undertakings you wish were short.|
|4.||They are your elders (your parents), not your children.|
|3.||You can never do enough, because there is too much to do.|
|2.||If you are somewhat prepared, you are not prepared enough.|
|1.||You are never prepared.|
Number 10: The belief and feeling that “time flies” as we age is universal; it will happen to you.
That’s one of the paradoxes of time (see Einstein’s theory of Relativity). Theorists conclude that one reason is mathematical. When you are 2 years old, one year is half your life. When you are 50 years old, that same year is one fiftieth of your life. Also, a 2-year-old lives “in the moment” experiencing new things continually, while a 50-year-old has experienced many things over-and-over-and-over again and they become routine. The brain processes “new” experiences and “routine” experiences in different ways, contributing to the feeling that time flies.
Number 9: None of us escapes (old age and the aging process) unless we die young.
Number 8: Treat your children well. You will need them when you are elderly and they will not be up for the challenge.
Two songs from my generation ring in my ears. “Teach Your Children” written by Graham Nash of Crosby, Stills, Nash & Young and released in 1970 and “Cat’s in the Cradle” written by Harry Chapin and released in 1974. Both iconic, thought-provoking songs of their time, relevant today and transcend generations. If you are unfamiliar with the lyrics, look them up. The aging process is difficult in advanced years and more than likely, you will not have the physical or mental capacity to handle many formerly routine things without the help of your child or children. Having someone you trust to oversee financial affairs, traverse the eldercare world, help with medical decisions and find needed support services will be critical.
Number 7: You can never ask enough questions – questions of doctors, nurses, caregivers, social workers, eldercare experts, service vendors and providers, financial institutions, even law enforcement agencies. But, our “Privacy Laws” will stand in the way of you getting answers.
Also, with that many people involved in one’s life, the answers may conflict with one another, leading to more questions, confusion, disillusionment, and a whole host of other feelings in trying to decide what the “right” thing to do is. Even if you have a Power of Attorney document for your elderly loved-one, it may not be accepted by some entities, creating further angst, more work and sometimes hiring an attorney for assistance. I have many, many examples to share, but these three will give you an idea of the challenges faced because of privacy laws:
(1) Attempting to get information over the phone about the condition of your loved one is problematic because of privacy laws. The experience is wholly unsatisfactory, even if you are Power of Attorney. My parents and aunt have been to the emergency room a minimum of 20+ times in the last three years. I am not exaggerating and I’ve lost count. 99% of the time, the visits have not been “walk-in” visits to the ER, but visits via ambulance. Their age and stage of life, plus their increasing health issues are the reason. In only one instance have I been there at the time of the incident and accompanied the ambulance to the ER (I happened to walk into my father’s care facility a few minutes after paramedics arrived to transport my father to ER. He had fallen and broken his neck). The rest of the time, I have been called after-the-fact (and a couple of times, not called at all). So my advice is, if at all possible, go directly to the hospital yourself and establish yourself right away as the decision-maker for your loved one. Be sure to take a copy of the Power of Attorney document and Advance Care Directive with you. In most instances, you will need to take these documents to the facility each time because they do not keep them on file, i.e., once the patient has been discharged, those documents are filed with the case file and oftentimes not retrievable (a sorely lacking situation on what should be a relatively easy fix – scan the documents and keep them in an electronic file under the patient’s name, rather than under the “incident date”; but I digress).
(2) The Power of Attorney document may not be recognized by some vendors. The various stories about helping my aunt with her financial situation could fill a book. One stock brokerage firm, who shall remain nameless, to this day continues to send my aunt monthly 10-page statements for a $0.51 balance. Again, I’m not kidding. She has $0.51 in that account because she drained the account over a period of years and never closed it herself (an age-related dementia situation). In any event, I sent this brokerage a copy of the POA document with a letter and asked them to close her account. They refused, saying they recognized only THEIR own POA document and we would need to complete that and return it to them. I responded that for $0.51 cents, I was not willing to hire an attorney to review their POA plus pay a notary to have their document signed. We are at an impasse and they continue to kill trees at an alarming rate.
(3) While helping my aunt move from her home into assisted living, I contacted all of the services (phone, cable, water, gas & electric, trash) to close out her accounts. All but one worked with me and all of those bills were settled. The one that would not work with me was the trash vendor, again who will remain nameless, and my aunt was behind in her payments to them. I called to find out the pay-off and close the account. They insisted that I provide them with the original telephone number from when the account was originally opened before they would give me any information. I explained that I was POA and could provide them with a copy of the POA document. Nope; wouldn’t accept it – needed that phone number. My aunt had lived at that location for 23 years and under normal circumstances, this would be an easy fix, because as a general rule, people have home phone numbers for many, many years. However, over the previous 2 years, my aunt had changed her number at least 10 times, changing providers as well (again, an age-related dementia issue). I lost track of her phone numbers, as did other relatives, and I couldn’t provide this vendor with the correct one. I explained the situation over the phone plus later wrote them and provided them with a copy of the POA document. Still no information on the balance owed to them. I even said in one conversation, “I’m trying to do the right thing and pay you money on a balance that’s due to you!” They weren’t swayed. In the end, I assume they wrote this off as a “bad debt” against their bottom line. What a way for a “for profit” entity to operate their business!
Number 6: Good help is hard to find. When you find it, harness it and do everything in your power to keep it.
For an eleven month period of time, my father required 24 hour, 7 days a week care in my parents’ home. He had 17 caregivers during that time – rotating in and out for one reason or the other. My parents are sweet, easy-going people and while I realize that 24/7 care is not an easy career field, in this short period of time, this was a ridiculous number of people traversing through their lives. Some were killing time awaiting “better” career opportunities, so moved on when the opportunity presented itself. Several did not get along with each other (there were ongoing “shift changes” and sometimes, on-coming caregivers would be unhappy with the work or lack of work done by the caregiver rotating off schedule, creating conflicts and unnecessary stress for my parents). Others would just refuse to do things (like a load of laundry when asked) and a few were too aggressive for my parents’ gentle natures. While 24-hour in-home care filled a critical need at the time, personnel management was just unwieldy, even though all of these caregivers were provided by one caregiver service. After 11 months of strife, stress and absolutely no privacy, my parents made the decision to sell their home and move to assisted living.
While there are many fine assisted living facilities in our community, it is not the panacea to an ongoing problem. Although assisted living meets approximately 85% of the needs required by my parents and my aunt, it doesn’t meet 15% of them. They still require help with running errands, going to the doctors, bill payment, clutter control, making informational calls to service vendors, locating misplaced items, etc. Since I work full-time (as do other relatives who live in our community), it is not possible for me to fill all the special needs required by my parents and my aunt. This gap, for my parents, is now filled by a very fine, trust-worthy, caring woman and she charges by the hour. She has her own independent company and is her sole employee. If you are lucky enough to find someone like her, don’t let her go! For my aunt, my niece, Tiffany (the other half of “Toot Sweet 4 Two”) and my aunt’s great-niece, has stepped up. As a “stay-at-home” mom of the Princesses P, she has been able to incorporate into her daily schedule some of the errands needed to keep our aunt comfortable. Without her support and her cheerful willingness to be my “right arm”, I would be as crazy as a loon!
A side note regarding the services provided by assisted living facilities in our area of the country: all that I have toured and interviewed (10), provide a bus for “shopping days” and “doctor days”. Within a certain mile radius, they will drop off the resident at a grocery store, drug store, retail store, the bank, doctor’s office, dental office, etc. and then pick them up. While this works for many, it is not the solution for all. Because of physical ailments, both of my parents and my aunt require an escort and both facilities (they live in two different ones) do not escort; just drop-off and pick-up. Also, the other downside of this arrangement is that oftentimes the resident will finish the errand rather quickly, but will have to wait considerable time to be picked up. Many times there aren’t places for them to sit and wait to be picked up, so they have to stand. At this age and stage of life, standing for long periods of time is incredibly tiring and often not safe, especially if the resident has a balance problem.
Number 5: There are no short cuts; just long responsibilities and undertakings you wish were short.
Transitioning parents or other elderly loved ones into a communal environment is fraught with high emotions creating anxiety and stress for both parent and child. Both of my parents, my aunt and their parents before them always said they wanted to live in their homes until they died. This may have been the “norm” in my grandparents’ generation because multi-generations lived in the same household (Great Depression era) and maybe, residential care facilities weren’t up to par as early as 30 years ago. But in my state, my dealings with residential care facilities have been quite positive (I’ll address those positives in a future post). However, I’m not living in one. Helping your parents to understand that their safety and security are your utmost priority can take quite a long time, with twists and turns along the way. Once those emotional hurdles have been crossed, the other steps of transitioning are equally difficult – finding a facility that meets expectations and requirements, packing and downsizing of personal possessions, moving, selling a home, locating new doctors (if they have moved to a new location and their existing doctors are no longer geographical practical), dealing with insurance (if they are lucky enough to have long-term care insurance), navigating financial hurdles, etc. The list is long. And, once they are moved and settled, the list continues to grow as their health and mental status declines.
Number 4: They are your elders (your parents), not your children.
While I am often tempted to talk to my parents like they are children, because they don’t seem to understand what I’m saying, what my fears and concerns are for them and what I believe is in their best interest, there is a fine-line that is easily crossed in stressful situations. Unfortunately, over the last few years, I have made my parents, particularly my mother, angry while expressing my opinion about what is “best for them.” My intentions, while always honorable, are not always well-received. As we navigate the obstacles involved in the aging process, maintaining the parent-child relationship is challenging because the once clearly defined roles of parent-child often reverse. And, as an elder’s health and mental conditions decline and their “freedoms” (driving, self-administration of medications, meal preparation, dressing and bathing, living alone, managing finances) are taken away one-by-one, they hold on tight to remaining “freedoms” even though they are no longer capable of managing those “freedoms”. The reduction of these “freedoms” often becomes a negotiation between parent and child and while as children we want to bury our head in the sand when these conversations become tense and tough, it’s important for our elders’ safety and security that the conversation continues and we (children) “stay the course.” This delicate dance will probably happen numerous times over the remainder of their lives and recognizing that your own role will reverse (with your children) in the future, provides perspective.
Number 3: You can never do enough, because there is too much to do.
Unless you are lucky enough to ease into the role of caregiver over time, your “to do” list will suddenly explode to the size of a thesis of endless needs and decisions to make. More often than not, clues of your elderly loved one’s increasing physical, emotional, mental and financial needs build-up slowly over time. Recognizing those changes are often brushed aside as we hurry through our own busy lives. Unfortunately, we are rarely prepared for an emergency and an elderly parent’s sudden health crisis leads to endless decisions with countless questions requiring research in multiple areas:
- Their health needs, health history including medications list
- The names of their doctors (at that age, they usually have specialists for every medical condition – my father had 16 doctors when I became his Power of Attorney)
- Their financial situation including their income, financial resources, monthly bills and debt, taxes and tax preparation, home ownership info, etc.
It is possible to be thrust into a decision-making position with absolutely no knowledge of your loved ones’ history in these key areas, thus creating an endless list of “to do’s” as well as increased anxiety.
Number 2: If you are somewhat prepared, you are not prepared enough.
Part of the estate planning process is creating a will, durable power of attorney and advance care directive. However, oftentimes these are done in the early years of marriage and child-rearing or if single, in the early days of career establishment. Once done, we all file them away in a drawer, filing cabinet, safety deposit box and forget about them. Years pass and what was once relevant becomes irrelevant. People chosen to help manage affairs in later life are now often the same age as the ones who established the original documents and no longer able to accept the challenge. Keeping these documents current is hugely important, especially the power of attorney document. In addition, informing the person chosen as your power of attorney is critical. And, telling them where the documents are located is of equal importance. This involves a high level of trust and should be well-considered; if you haven’t asked the person you have chosen to be your Power of Attorney, they may not want the responsibility and refuse to act on your behalf at a critical juncture. In the event of a life-threatening emergency, locating these documents and contacting the power of attorney to act on your behalf may take much longer than expected and will create great anxiety for all involved.
Number 1: You are never prepared.
Do you have a story you’d like to share about eldercare? I’d love to hear it.
Until Next Time,
(other posts on Eldercare)
- A Gifted Man
- A Month of Sundays
- All Roads Lead Home
- Both Sides of Clouds
- Do You Have One of These?
- High Flight
- Many a Winding Turn
- Requiem for My Father
- Running on Empty
- The Gift
- The Sunshine Gang