Making Decisions For Elderly Parents
Relationships can be strained and even broken as the elderly and their adult children negotiate the inevitable reversal of roles and as very difficult decisions are made.
Let’s face it. Each of us wants to be free to make the decisions we want, even if they might sometimes seem self-endangering. The debate in the US over helmet laws for motorcyclists is an example. Yet every day, millions of families agonize over when is the appropriate time to begin stepping in and making decisions on behalf of their older loved ones. For most families, transitioning from the “parent-child” relationship to an “adult-adult” relationship takes place naturally, and once the grown child is married and has children of his or her own, there is usually an unspoken acknowledgement of the “adulthood” of the grown child. In some families, of course, there can still be unhealthy signs of immature emotional dependence on parents (and an unwillingness to speak the truth), or a hurtful need for the elderly parents to dominate, criticize, or even punish their adult children.
Even given the most harmonious relationship between senior adult parents and their grown children, the transition in roles as the parents become increasingly frail is fraught with pitfalls.
The process often begins with observations:
Mom is forgetting to take her medication
Dad is less aware of his surroundings while driving
Mother is not bathing as regularly as she always has
Dad has unusual physical symptoms and refuses to see a doctor
For the adult children, it now becomes obvious that their parents are slipping in some potentially dangerous areas and some interventions are necessary. Here are suggestions of possible steps, beginning with the least intrusive, in an effort to maintain a good relationship.
Start with verbalizing your observations to see how the elderly respond to them. Making observations may lessen the resistance you encounter more than suggestions or directives.
Next, involve the parent in problem solving: “Dad, what do you think would help you to see signs on the highway
Make specific recommendations in the least authoritative way possible. “Mom, do you think it would help you to have a timer medication dispenser?”
If making gentle specific recommendations does not have the desired effect, it will likely be necessary to become more direct in trying to ensure a safe environment for your parent(s), perhaps eventually enlisting the help of a doctor.
Be aware of your parent’s possible feelings of embarrassment, shame and impotence as more decisions are made for them. Use humor, self-deprecation, and a positive outlook to help the elderly from focusing on their loss of independence. Find a positive side of any negative occurrence without belittling what elders are going through.
The pitfalls for caregivers are many. These are situations ripe for misunderstandings, misinterpreted intentions, sibling disagreements, hurt feelings, feelings of powerlessness and constant worry, and the inner conflict of wanting to love and honor our parents while sometimes having to act against their wishes.
I suggest several principles for families facing these caregiving decisions.
Give elderly parents every opportunity to continue to make their own decisions. It may take a crisis, but at some point it will become clear to all involved that a change in level of care is necessary. Hopefully the crisis will not result in permanent physical damage.
Recognize that sweeping changes may not be necessary. Sometimes smaller modifications like Occupational Therapy or a change in medication may be all that is needed.
If someone believes a change in level of care is necessary, call a family meeting that includes the parent(s). Do not try to control the discussion, but see that all medical reports and personal opinions are heard. Ask how each can help in their own way.
Certain family dynamics will almost certainly play out: the daughter living closest will take most responsibility; a son living away will tend to minimize the crisis; the daughter living farthest away will question most intensely the judgment and decisions of the closest caregiver. If you are the closest caregiver, it is important that you not take criticism personally, but stay focused on the facts and the needs of the parent(s).
Get as many medical/social work/home health care opinions as you can for the family meeting. Work towards a decision by consensus. Again, do not try to control or push for a certain outcome, but make sure all facts and opinions are presented and fully discussed.
Be aware of your parent’s possible feelings of embarrassment, shame and impotence as more decisions are made for them. Use humor, self-deprecation, and a positive outlook to help the elderly from focusing on their loss of independence. Find a positive side of any negative occurrence without belittling what elders are going through.
Reminiscing helps the elderly focus on past events and eases the pain from current difficulties. Find happier times to talk about occasionally to ease the tension.
Caring for our aging parents and negotiating that inevitable reversal of roles requires planning, understanding, patience, thick skin, and a sense of humor. And that is undoubtedly what we would want in our caretakers as we approach later life.
Reprinted with permission from Village Streams, an e-News letter of Advent Christian Village. Rob Crankshaw, PhD. is a licensed marriage and family therapist. He is the VP for Youth & Family Services at Advent Christian Village (ACV), a non-profit retirement community that offers a complete continuum of care and is located in north Florida, on the banks of the Suwannee River. To learn more about ACV or to sign up for Village Streams, visit www.acvillage.net.
by Rob Crankshaw, PhD, ACV Vice President Youth & Family Services
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REGISTER HERE for LONG-TERM CARE PLANNINGPower of Attorney
A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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Keystone Elder Law
At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
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