I receive a call yesterday from a friend, Mary, whose mother was just placed on hospice care. Mary is in the process of finding an assisted living for her father who will not be able to live alone. The situation is now an emerging crisis. Three months ago it was a train wreck waiting to happen, but Mary’s mother wasn’t going anywhere. By that I mean she wasn’t about to move out of the house. Her husband, the more practical of the two, clearly saw the reality of the situation and would have moved in a heartbeat. He was exhausted providing care for his wife however he didn’t want to make waves. Mary tried to talk to her mother about the situation but mom just wouldn’t listen and dug in her heels. Now Mary is in a position where quick decisions must be made and the burden of care has been placed on her shoulders and she’s a little angry. Her father feels guilty because he can’t be of more assistance to Mary and regrets giving in to his wife’s stubbornness months ago. They might not be where they are today if they had moved to an assisted living community.
Archive for October, 2008
Confusion abounds between the terms long term disability and long term care insurance. Many employees with long term disability insurance through their employer believe they have long term care insurance — they don’t understand the difference between the two. Disability insurance, short or long term is intended to replace income lost by the ability to work. Disability insurance only applies to individuals who work; once you retire disability insurance no longer applies. This is where long term care insurance takes over. Long term care insurance pays for your care when you become chronically ill and need assistance with activities of daily living that include bathing, continence, dressing, eating, toileting and transferring. Medicare or other health insurance after age 65 does not pay for long term care. If you don’t have insurance you pay for your care up to rates of $70,000 annually for skilled care. Didn’t save enough? Then Medicaid or public assistance is the route you’ll take. Do yourself a favor, look into Medicaid and see what and how it provides. You’ll decide that long term care insurance is a much better alternative to give you the choice of how and where you’ll receive care when you need it in your latter years.
If you’re married, do you have life insurance? How much? Most of us think of insurance as a necessary evil. Home insurance, auto insurance, health insurance, and so on. Many working individuals have life insurance through their employer, which is perfect if they pass away while employed? What happens after 65 when the life insurance offered through employment doesn’t continue? Most people don’t think about this. Then a spouse dies and the surviving spouse is wondering how they will pay the bills without the spouse’s income or how they will even afford to bury or cremate the spouse. This is where life insurance becomes important. Sure, it’s just one more monthly, quarterly or annual expense, but it’s certain to pay off. After all, we all have a 100% probability of dying. Don’t think it’s not possible.
Enabling situations are complicated and those receiving the help often become angry and resentful when the helpful person stops helping. The best way is not to put yourself in a helping situation to begin with, however if you’ve already done this and are wondering how to remove yourself you might begin by having an honest discussion with the person. Let them know that you meant to be helpful but now realize how dependent they’ve become on your assistance and offer to help find them other options for assistance. The difficulty here is that the individual, now dependent, is not going to want to make any changes because they’ve been pampered by your help. Know that their desire not to change is their choice. They must make a choice to make changes in their life to accommodate the change of you not being there constantly. In the long term independence is better than dependence. Keep a stiff upper lip and make the changes you need to make the person you enabled will have to do the same. After all, they lived independently before you arrived on the scene.
Helping others is in your nature, whether it be a family member, friend, co-worker or employee. But what happens when you’ve “enabled” someone to become dependent on you and now you don’t know how to remove yourself from the situation? Examples of this are many and always begin innocently, “I thought I was helping,” I hear many people say. From the paid home care worker who stops by outside their shift just to visit or to make an extra meal. What happens to the person when this person changes jobs, moves or has a change in their lifestyle? The person who became dependent on this innocent expression of caring suffers because they no longer have someone doing those little extra things. What happens to the employer who has paid wages while someone was off work for several months even though that person was not entitled to any disability payments? How do they stop paying when this person will never return to work since they’ve set a precedent by already paying?
I recently met with a family member who became involved in the care of his cousin because she is the only remaining family member. She and her cousin have not spoken in years and she is not inclined to accept long term responsibility for her cousin. I admire her ability to see the situation and know what she can and cannot do. These situations are extremely difficult and become more so when a family member feels they have no option but to be the responsible party for a person they hardly know. Depending on many factors, including resources, an independent person may be appointed financial and medical power of attorney for the cousin. If it’s gone beyond this point and the cousin is mentally unable to understand what is best then guardianship and conservatorship are the next courses of action. Know that if you find yourself in a similar situation there are options. And if you’ve lived alone for many years, don’t have any close family members or friends and want to make sure that you’re taken care of if this ever occurs, make your plans now and avoid others having to do this for you later. Think about it, do you know someone, who if asked, would gladly accept the responsibility to make decisions about your financial and healthcare needs for the remainder of your life and that you trust explicitly? Not an easy question or an easy task.
Many family members with loved ones in life communities (personal care boarding homes, assisted living and skilled nursing facilities) often find themselves at odds with the community because of miscommunication or assumptions about care. Admittedly, at the time a loved one moves into one of these communities it’s usually under stressful conditions; however this is truly the time to make sure that you understand what the community can provide and how you can support your loved one. I see many individuals move into communities who then have to move again six months later because their needs have changed. On the flip side, these communities want to fill vacancies so they may tell you what you want to hear. However you also need to know at what point your loved one will be asked to leave and what happens if and when they run out of money? Crises planning that results in more crises and expense later is not good for you or your family member. Plan for the long term and ask the right questions to avoid issues down the road.
Let’s talk about one more group, the National Arthritis Foundation at http://www.arthritis.org.sg Arthritis is a general term for many types of medical conditions that result in joint pain: gout, osteoarthritis, osteoporosis, psoriatic arthritis, rheumatoid arthritis, scleroderma, Sjogren’s syndrome, and soft tissue rheumatism. I’ll bet most of you didn’t know there were so many different forms of what we all call arthritis. I continue to learn more each day about the various chronic diseases that many of my clients live with daily. Another source is the U.S. Arthritis Foundation at http://www.arthritis.org Arthritis, in general, is not just an older person’s disease, most people develop it between the ages of 15 and 65. If you have arthritis and haven’t been to a specialist, called a rheumatologist, you might consider an appointment. These physicians are well versed in the condition and can offer more specific advice and treatment than a general physician. Remember, knowledge about chronic disease gives individuals power to manage the disease not react to the disease.
While I’m on the topic of being as educated as possible about chronic disease, I want to mention yet another association that offers education and support, the Rocky Mountain Stroke Association, at http://www.strokecolorado.org When we think of stroke many of us think of physical disability, however often a stroke involves an injury to the brain. The local association in addition to education offers many programs: physical therapy, pool therapy, caregiver support, and other support groups specific to the needs of stroke victims for example,“aphasia” group for those with speech difficulties due to stroke. Brain injuries can be very complex and affect individuals in different ways. Education can help individuals and families copy with the complexities of daily living after stroke.
We’ve all heard that knowledge is power. This is especially relevant when referencing knowledge about a particular condition or disease. For example the American Parkinson Disease Association, http://www.adaparkinson.org offers a substantial amount of information and educational materials on the website. The organization has been in existence nearly fifty years and serves to “ease the burden and find a cure” for Parkinson Disease. The local website for the Denver area is http://www.parkinsonrockies.org the office located off Colorado and I-25 offers a wealth of free resources. They have a lending library where one can check out books about Parkinson Disease and return them just like a regular library. On the website and in the office they can provide individuals with lists of information on exercise classes, support, groups, education etc. There is no reason that anyone should ever not be informed or knowledgeable about Parkinson Disease when these wonderful resources exist. The best way to be kept up to date is by joining the organization for a reasonable annual fee. This entitles members to receive the quarterly newsletter and other benefits. If you or someone you know has a Parkinson diagnosis do them a favor and purchase a membership, call the local association for information or visit the association office. You’ll be glad you did.
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