How to convince your elderly parents they need care

The title of this post shouldn't surprise anyone. It isn't news that many seniors refuse all offers of care, whether the offer is to live with one of the kids, to move into long-term care or to find in-home caregivers. The reason for the refusal is that we're all human - some seniors don't want to admit their growing frailties; others think that accepting care is the start of the slippery slope to the grave. Some are worried about the cost, and there are still many who are terrified that they will be "warehoused", abused or forgotten.

So if your aging parent needs care and won't accept it, how do you persuade them to at least consider it? The attached article from www.over50web.net has some tips. Click here to read the article.

I spent quite a bit of time on this topic in my book called "Estate Planning Through Family Meetings (Without Breaking up the Family)". You might find that helpful as well. Click here to order a copy.

Talking to your kids about a senior living transition

You thought all those serious, sit-down talks with the kids were over once they were grown, married and out of the house, didn't you? But there is one talk left to be held: the talk about where you want to live as a senior. This new post from Seniors For Living includes a video about how to have this essential talk with the kids. Click here to read the post and access the video.

Senior with dementia attacks wife with hammer

Last week I spent some time working with an older couple (90 and 87 years old) who have no family or close friends nearby. The wife had a stroke and was taken to hospital. Around the same time, the husband caught pneumonia and was taken to a different hospital. Each of them had named the other as their health-care decision-maker as well as their financial power of attorney. With each of them out of commission, both of them were left with nobody to help them.

This lack of contact with other people is dangerous to older people. Sometimes it leads to the situation I've described above, or other less than ideal situations. For example, seniors might live in their homes with advanced dementia without the proper safeguards, which could be dangerous in a hundred ways. I was very saddened to read this article from the Vancouver Sun which says that an elderly man attacked his wife with a hammer, injuring her severely. They were both suffering from advanced dementia, blindness and deafness according to the article. The wife was taken to the hospital and the husband was taken into police custody.

Who knows what led to the attack. We may never know. All I know is that this poor woman should not have had to suffer this injury, and that an old, blind, deaf man with dementia isn't going to get what he needs in jail. I find the whole story very sad, particularly as I'm sure there are many, many other stories like this just waiting to happen.

Two older people with both physical and mental problems should not be living alone. I don't yet know enough about this case to know whether they have family members who could have stepped in, or whether they had other in-home supports. It's possible they do have family but stubbornly refused to accept help. Most of us know someone who shouldn't live alone but who is too stubborn, fearful or confused to accept the needed assistance.

What if they were alone in the world, as are my clients that I mentioned?  My clients had understood years ago that one of them was going to outlive the other, and had named the trust company where I work as the executor of their estates. When they both landed in hospital, they really didn't know where else to turn so they called us. We were able to visit both of them in hospital, pay their bills, pass messages between them and help them get on a waiting list for an assisted living facility. Not everyone thinks to do this or can afford it. And many just simply refuse to think about what could go wrong.

Each of us needs to be protective about the seniors in our lives and proactive in offering help. This includes understanding that it's dangerous and frightening for people with dementia, especially when that condition is aggravated by physical ailments, to live alone. This idea begs the qustion of whether it is acceptable to force help on older people who refuse it. I believe that sometimes it is ok, when it removes a senior from a dangerous situation.

The conversation of a lifetime

This week I had a conversation with a client who wants to leave his estate almost entirely to charities. His estate is in the tens of millions of dollars. The reason I felt so lucky to be talking with him is that he is thinking of doing "something for seniors" and was casting around for ideas. I actually got to give suggestions that I felt would improve the lives of seniors to someone who was openly listening and was prepared and able to take action on those suggestions.

So far he likes the idea of building affordable homes that are purpose-built for those with mobility issues and other physical limitations. He also likes the idea of advancing financial literacy for seniors and supporting programs that provide seniors with practical information and help.

He isn't looking for praise or thanks or recognition. He just realizes that he has a huge opportunity to improve the lives of thousands of people. I regularly speak with wealthy clients who want to give to charities (Canadians are definitely generous givers) but I don't recall any who specifically wanted to benefit seniors.

I'd sure like to have dozens of clients with this area of interest and similar means of support. However, I suspect I'll probably never have another!

In-laws, outlaws and granny flats

In this article, one of my favourite blogs to visit, Time Goes By, talks about creative ideas for making over small spaces to accommodate family members. The discussion is based on a book called In-Laws, Outlaws and Granny Flats by Michael Litchfield. There are plenty of pictures too. If you're thinking of creating a suite in your house or doing renovations to accommodate an aging parent, click here to read the article first.

Childless seniors forming families

I'm attaching a link to a blog post by lawyer Kyle Krull. The article is about how seniors who don't live in the old-fashioned nuclear family are starting to arrange their own "families" with each other for mutual support and companionship. So far I haven't met any clients who say they are doing this, but it's certainly a topic I'm hearing more and more about. I can see it gaining some real traction as it solves a lot of problems for a lot of people. Click here to read the article.

Bringing my mother to live with me

Click here to read an article by Lesley Dowden, who brought her 84-year-old mother to live with her because her mother was no longer able to live alone. It's touching and informative, and set out in a question-and-answer format.

Can I force my aging parents to leave their home?

The transition from the family home to an alternative living arrangement is not always a pleasant one for aging individuals. Often the change is brought about not by a real desire to move, but by physical and mental impairments that may accompany aging.

When a parent doesn't want to move, it can be a delicate subject. If the aging parent's children see that the parent is struggling with mobility or health or loneliness, they may want to suggest that the parent live in a retirement community or with one of the kids, or if there are daily living issues perhaps in an assisted living facility. Ideally, the parent will agree that the change is necessary and would be beneficial, and will participate fully in finding the right place to live.

But what if the parent doesn't agree? I've certainly run across a few seniors in my practice who dig in their heels and refuse to move, consequences be damned. Depending on the particulars of the situation, it may be possible to find caregivers who will come in to the parent's home to give the needed assistance, but even that may not be enough.

This leaves families at an impasse. The kids know that their parent isn't safe, or is slowly wasting away from lack of exercise and interaction. They are absolutely positive that the parent's life would be vastly improved by a change of address. The parent becomes defensive and upset when the topic is raised. Now what?

This is where the kids begin to wonder if they may have to force the parent to move, for the parent's own good.

Under normal circumstances, nobody can be forced to move out of a house they own and live in without bothering anyone else. A private citizen doesn't lose that right just because he or she is old. Therefore, if you can't persuade your parent to move willingly, you will need some legal authority to make decisions for them before you can take action to make them move against their will.

You can make decisions about where your parent lives if you are appointed by the parent under a Personal Directive (also known as Health Care Directive, Advance Directive, Health Care Proxy, etc). Being named isn't enough; you are also going to have to have your parent declared incompetent by at least one doctor to bring the directive into effect. Each document states what it takes to spring it into effect.

If your parent has not signed a Personal Directive, you may have to apply to the court to become your parent's guardian. This procedure also hinges on the finding of incompetence by a doctor.

For the record, I am not at all in favour of aging parents being forced to do things because their children want them to. However, I know that there are some seniors out there who truly are at terrible physical risk because they refuse to give up their homes, particularly where there isn't much money to pay for in-home caregivers. Hopefully a persistent son or daughter can help the stubborn parent see the advantages of moving.

Mother and daughter together again

There are reality TV shows about everything else - so why not about an elderly parent moving in with her adult child? I like the concept, but in this case the mother and daughter, who happen to be Joan and Melissa Rivers, are hardly ordinary. Haven't I said many times that celebrities have the same family and estate issues that the rest of us do, just with more cameras? I guess we'll find out when this show airs. Click here to read more.

New lives for "dead" suburban malls

Here is an article about another good idea that will help change where and how seniors live. This story is about how old shopping malls that are no longer thriving can be changed into buildings containing services that normally people have to commute to get to. Seems like a great idea. Click here to read it. I know of a centre like that in Edmonton. It used to be a run-of-the-mill shopping mall but is now the Meadowlark Health Centre, with doctors, specialists, surgeons, laboratory, x-rays, pharmacy etc. All of these are within walking distance of the nearby neighbourhoods, making it much easier for seniors to walk, use scooters or take a short drive to access them. It's all under one roof too, which is important when you have an extreme climate like ours.

More on moving

This new article from the New York Times talks about why an aging parent who seems happy to move to a new home or retirement residence might balk at the last minute, and how you can help them. Click here to read the article.

When moving seems impossible

Have you or your parent considered hiring a professional "senior mover" to help with the sale of your parent's home and the move to a new place? This story from the New York Times describes one family's experience with doing so, and gives several interesting facts. Click here to read it. This is an American story and I've encountered several senior movers in the USA, but are there many in Canada? If so, I'd like to know about them, so hopefully they'll leave a comment here or send me an email.

My parent wants me to hold on to the house while they "try out" a care facility

Many people who are dealing with that time of transition during which an aging parent moves out of his or her home into long term care will recognize this scenario. The parent agrees - either reluctantly or otherwise - that he or she can't live alone any longer. A suitable long-term care facility has been located. Now comes the time to move. Your parent balks, and instructs you on no uncertain terms not to sell her home because she might want to move back into it.

Now what?

First of all, realize that this situation is common. It's not just your parent who feels this way and it doesn't mean that you're doing anything wrong. In fact, the majority of seniors that I've encountered at this stage of transition want to hang on to their home as an escape route.

Secondly, understand that for your parent, this could be unbelievably frightening. Your parent is leaving his familiar home, neighbours, shops, sights and sounds. That is stressful enough, but then there is also the fear of what lies ahead. Many parents wonder if they'll be mistreated, forgotten or overly regulated. They feel vulnerable and powerless. This is where they are comforted by the thought that if it's as bad as they think, they can leave and just go back home.

What can you do? While there is no guidebook that's going to work for everyone, here are some ideas:

1.  Show compassion and patience. Try to understand how frightening or disorienting this might be for your parent. Acknowledge his or her feelings and let them talk about them. Stay upbeat.

2.  Explore all options for living arrangements. If your parent is adamantly opposed to living in a facility, look at options such as living with you or one of your siblings, or finding home-care assistance that will allow your parent to stay in his or her home longer. The most suitable option for any individual is always a mix of family dynamics, finances, geography and the specific physical and mental shortcomings experienced by your parent. Your parent should have input into the choice, as long as he or she is capable of doing so.

3.  Assuming that a facility is the best - or only - option, check out the facility thoroughly and let your parent know that you are doing so. Unless your parent's condition requires you to act hastily, take your time. Let them know that you are being careful and thorough on their behalf.

4.  Bring your parent to the facility for a walk-through before moving day. Let your parent see the place, meet some staff and generally have a look around. Get answers to your parent's questions.

5.  Some facilities (usually the higher end, expensive ones) allow seniors to try out the facility by staying over for a few nights before commiting to living there. If at all possible, take advantage of this and stay in close contact with your parent during the try-out. Most, however, do not allow a try-out period as they simply don't have the room or the staff.

6.  Agree with your parent that you'll hang on to the house for a set period as long as they agree to give the facility a real chance. There's no point to this if the parent just suffers through it, counting the hours until he comes home. It has to be a genuine try. Finances will usually dictate that this period must be short, as few seniors can afford to pay for full-time care and keep an empty house.

You must realize that #6 above is not always possible. Some aging individuals are not able to live alone for safety reasons. There is no point in telling someone who can't live alone that he or she can come home if they don't like the facility, because they simply can't. It isn't fair to trick them into moving, so be honest and gently but firmly explain why it's the only option.

7.  During the move-in period, set up a communication plan with your parent. For example, will you drop by each morning at 10:00? Will your siblings call each evening at 7:00? Will you come by for lunch? Make sure your parent knows when to expect to hear from you (or other relatives) so that he or she doesn't feel abandoned. Also ensure that your parent knows she can call you AT ANY TIME if she is abused or frightened or confused and make sure that you respond to any calls of that kind. It may take a bit of time for your parent to become oriented and comfortable.

8.  Help your parent choose and transport some cherished things from home to take to the facility, such as framed photos, favourite books, bedding, decorative items, radio or CD player, craft projects in progress, or small pieces of furniture (e.g. lamp, footstool, bedside table).

9.  Get to know the names of some of the staff at the facility so that you can have conversations with your parent about the people they interact with every day.

10.  When the house is going to be sold, give your parent an opportunity to decide who gets what personal and household items.

My experience has been that many seniors are afraid to make the change to facility living, but that many find that their fears were exaggerated. They actually like living there and their sense of relief is wonderful to see. Once a week or two has passed and the senior knows his way around and knows the staff, his comfort level increases immensely. I've heard a number of seniors report back that now they always have someone to play cards with, or they enjoy watching their favourite tv shows with the other residents, etc.

Emotionally, this is a tough transition for the senior and for his or her children.

Metro Vancouver's seniors population set to skyrocket: communities grapple with housing dilemma

This article from the Vancouver Sun talks about how the growing senior population is bringing about the need for creative housing solutions. Sounds like the BC towns mentioned here are brainstorming, but I still find their solutions limited. Click here to read the article.

Long term care homes a work in progress

This story in the National Post discusses the state of affairs in Ontario long term care facilities, and what the government plans to do about it. Some of the things mentioned here - such as facilities not receiving an inspection in 15 years - just make me shake my head. Click here to read the story.

When to back away from a reverse mortgage

Here is a little sound advice from Kyle E. Krull, estate and financial planning lawyer, about the dangers of reverse mortgages. He doesn't say never to use them; he has some advice about how to use them properly. Click here to read the article.

Alternatives to court-ordered guardianship and trusteeship for an aging parent

The legislation setting out policy and procedures for becoming a guardian and/or a trustee for aging parents is made provincially, not federally, so it differs across the country. One concept that is present in the legislation of most parts of Canada is that a full guardianship and trusteeship is a last resort. Other, less intrusive, means of helping an aging parent should be tried first, or at least considered.

The idea behind this is that taking away full control of a person's money and life is going overboard. It's like doing a major surgery when all you needed was a few stitches. The amount and type of help offered should be appropriate to the person's specific situation.

Now that we've established that looking at alternative solutions is a good idea, let's look more closely. What exactly are those alternative solutions?

Enduring (Continuing/Durable) Power of Attorney - this document allows a senior to choose the person who will make financial decisions once the senior loses the ability to do that for himself. It enables someone to do all of the things - and more - than someone could with a court appointment as trustee. It's cheaper and quicker, but best of all it allows the senior to exercise control over important decisions.

Health Care (Personal/Medical/Advance) Directive - this document allows the appointed person to make decisions about health care, medical procedures, place of residence and many more matters when the senior can no longer do that. Again, it allows the senior to choose who represents him.

Representation agreements/Supported decision making - under this kind of arrangement, the senior can choose someone to help him or her with decision-making to the extent that he or she wants help. Unlike powers of attorney or health directives, this arrangement enables the person to make decisions with the senior, rather than for the senior. This is available in one form or another in BC, Saskatchewan, Yukon and Alberta.

Informal trusteeship - this refers to an arrangement whereby a person gains legal authority over another person's pension or benefit income, to use those income sources on behalf of the person who owns them. He or she may collect the pensions, deposit them and use them to pay the owner's bills. Informal trusteeship is available for Old Age Security, Canada Pension Plan, Guaranteed Income Supplement, Spouse's Allowance, Survivor's Allowance and Veteran's Affairs benefits. I posted about informal trusteeship once before - click here to read it.

In-Home Support - (sometimes also called Aging in Place support) - this refers to any combination of medical services, housekeeping services, companionship and transportation that allows an aging person to continue living in his or her own house rather than moving to a seniors' residence. If the problems are more severe, medically speaking, the in-home care might have to be a full-time live-in caregiver.

Renovations to the senior's home - making appropriate renovations might make it possible for a senior to stay in his or her home longer, particularly when teamed with in-home support. A variation on this is to renovate the home of one of the senior's children and have the senior move in there.

Custodial bank account - this is a type of account offered at most banks that provides additional services, such as managing the investments, getting the annual tax return filed and paying bills.

Joint assets - those of you who read my blog often know that I'm not generally in favour of placing a senior's assets in joint names with anyone but his or her spouse, but from time to time it's the right solution. Placing assets in joint names gives both people a right of survivorship of the assets, so it should only be used when the senior has an opportunity to talk to a lawyer first.

Reverse mortgages: the good, the bad and the ugly

This article by Audrey Miller discusses the pros and cons of a senior taking a reverse mortgage to provide cash to allow the senior to remain longer in his or her own home. Click here to read it. The article raises an interesting point - a reverse mortgage is repaid when the homeowner dies or sells the house, which may leave less money in the estate.

Some parents specifically say that they want to leave as much as possible to their children. Sometimes this is because a child is handicapped and will need to be provided for. Sometimes the child lives with the parent and devotes much of his or her life to helping the parent. In other cases, the parents just want to help the kids in general and make their lives a bit easier. Regardless of the motivation, as a person considering taking a reverse mortgage, the idea of leaving a larger estate is something for you to seriously consider. If leaving the maximum amount in the estate is important to you and there are other ways of affording to live at home, perhaps a reverse mortgage is not the best way to go.

My personal view on this issue is that the senior should do what he or she needs to do to live the way he or she feels safest, happiest and most comfortable. If this means less money for the children later, so be it (with the exception of a handicapped child). I've seen many seniors living in poor conditions, with inadequate nutrition and insufficient assistance, just to leave an enormous estate to the children.

Many parents naturally put their children ahead of themselves, but sometimes they take it too far.

Moving Mom at 80 years old

This is a compassionate story from the Globe and Mail written by a man who recently helped his 80-year-old mom move to a new seniors' residence. It made me think about how something as statistically ordinary as a senior moving to a new place can be a defining moment in an individual life. Definitely worth reading. Click here.

Ontario's new Long Term Care Homes Act

The following is an introduction to, and an explanation of, Ontario's new Long Term Care Homes Act, which consolidates a handful of statutes touching on seniors' accommodation and care. This newsletter from Advocacy Centre for the Elderly sets out the residents' Bill of Rights and explains what has been added to the law in addition to the streamlining of existing provisions. Click here to read it.