IN THE SUMMER OF 2001, my father was diagnosed with terminal colon cancer, at the age of eighty. Given only a few weeks to live, he was comfortably and properly situated in a military hospital. Yet despite the fact that he was a retired Air Force officer, hospital management began to pressure my mother, sister, and me to move him to a private nursing facility. I was confused and upset; I knew that he probably had every right to stay put, but I hadn't the faintest idea how to argue his case. So a couple of days later, we found ourselves moving my father to a nursing home, setting up hospice care, and trying to negotiate the labyrinth of Medicare coverage for both. Small wonder that Dad quietly expired in his sleep after his first night in the home; he didn't belong there in the first place.
According to the highly respected Atkinson Dinner Party Poll, I'm not the only one who's been in—or will be in—this predicament. Indeed, it seems many Texans are woefully unprepared for what has become the state's fastest-growing and least appreciated health care problem: taking care of Mom and Dad. Consider these statistics from the Texas Department on Aging (or maybe just consider the fact that Texas has a department on aging): There are 2.7 million Texans over age 60; a third of those are over 75. By 2020, the number of over-60's will have doubled (and then will almost double again by 2040). The vast majority of these seniors will need some form of care before all is said and done, yet the financial picture is frightening. Prescription drug costs continue to escalate, Medicare and Medicaid are in rough shape, and even bad nursing homes can be expensive.
The fact is, sooner or later some degree of responsibility for your parents is going to fall to you. Will you be ready when that time comes? Here are nine rules for navigating this very rocky road.
1.Remember, for you too it's only a matter of time. The first thing everyone can do is plan a little better than many of our parents did for the passage to elderly status. A couple of years ago, my wife and I bought long-term-care policies, which at age fifty or so cost only about $500 per year per person. That's a bargain if you consider that they are adjusted for inflation and will cover most of our care when and if we need to go into a nursing home. We've also had two financial planners review our asset portfolio to see what else we need to do for a worst-case scenario. Both exercises are about as much fun as a root canal, but they're easier for you now than for your loved ones later.
2. Don't panic, and keep your expectations low. One of the main problems with taking care of parents is that we have trouble accepting that they're getting old in the first place—and that a certain degree of falling apart is biologically unavoidable. But just because they can't see or hear or walk or remember as well as they once could doesn't necessarily mean that we need to send them off to the home at the sound of the first dropped dinner plate.
"The thing that confounds this process is respecting the rights of the elderly person," says John Willis, the Texas state ombudsman for long-term care of the elderly and a recognized expert in the field of caregiving. "You need to base your decisions on them, not on you."
Try to remember that our parents have every right to be treated as fairly as we were treated by them when we were young and helpless (or as fairly as we wanted them to, anyway). As I have learned with my mother, the elderly can adapt to their limitations and learn to live safely within them, and frequently this is more easily done in the familiar surroundings of home than in a retirement facility. Besides, in many cases, parents themselves may know best when it's time for a change. In the case of my wife's parents, for example, her mom was the one who finally blew the whistle and introduced the prospect of moving to a retirement home because of their increasing frailty. A good thing too, as within the year my father-in-law was diagnosed with Alzheimer's disease. Obviously, she had sensed the gravity of the problem long before any of us had.
3. It doesn't have to be rocket science. Before the time does come that you need to find additional caregiving for your parents, memorize the phone number of the Texas Department on Aging (800-252-9240; the number automatically rings the office in your region). A real diamond in the rough of a resource, with information on free services for the elderly and Medicare and Medicaid coverage, the TDOA makes do-it-yourself management possible. Their regional ombudsmen can help you find a nursing home by zip code and provide you with its demographics, ownership information, services provided, and most important, any problems the facility has had with tenants or regulatory agencies. That's a lot more than you can easily learn about the average hospital before you go in for surgery, so use it.
4. If it begins to resemble rocket science, hire someone to help. The elder-care marketplace is booming, and as a result, plenty of new businesses are ready to assist you. This may seem like a shirking of some cosmically assigned duty, but third parties can be valuable when dealing with Mom and Dad becomes overwhelming. For example, if you're being strangled by regulatory red tape, you can hire what's called a geriatric case manager. For a fee ($200 up front for an assessment and then anywhere from $200 to $1,000 a month), these professionals can assess your parents' care needs, figure out the best placement within your budget (retirement home, home care, assisted living, nursing home), troubleshoot with Medicare and Medicaid or