Man, 91, dies after being left alone in Summerland care home

This is the kind of story that makes my stomach hurt, at the same time making me absolutely furious. It's the story of Alfredo Bonaldi, 91, who died recently after being left unattended in an assisted living facility in Summerland, BC for several days. Click here to read the article from the Vancouver Province. And for heaven's sake, don't leave your elderly relatives alone for very long.

People aware of LTC costs but have no real plan to finance

In this blog post, Anthony Cirillo gives some facts and figures about who among us is actually prepared in the event we have to pay for long term care. Click here to read it. In a way, I don't find the procrastination and the unreasonable optimism to be surprising. I find the same attitude among people when talking about making wills; the majority agree that a will is needed, but only a small number have taken steps to get what they need into place.

The cost of end of life care

This is an excellent article from the Wall Street Journal that talks frankly about what to expect in terms of costs for end-of-life care, even when no long term care facility is needed. Click here to read it.

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.

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.

Can those with dementia pre-consent to sex?

This article discusses an issue that balances the right of an individual to refuse to have unwanted sex against giving seniors with dementia their privacy and autonomy. The question is whether a person can be said to have "pre-consented" to having sex simply by the fact that they have always had sex with their spouse. Does this apply when the person is aging and has dementia? As we know, a person with dementia may not even recognize his or her spouse on any particular occasion.

This question is being put before the Supreme Court of Canada. To be, there is only one acceptable answer, though I undertand that it's a complex, emotional question. Nobody should ever have sex they don't fully, willingly consent to having. The idea that the elderly can have "pre-consented" to have sex with someone even though they might now be confused about who the person is, or afraid to refuse, is frightening.

Click here to read the article. I'll be watching for the court decision, which won't be out for a few months, and will let you know what happens.

Medical marijuana raises tough questions in nursing homes

Originally I wasn't going to post this article because it's American, so the information about which states allow medical marijuana use would be of little interest to us. However, the issues raised are the same on both sides of the border. What happens when a person who is legally using marijuana for medicinal purposes moves into a nursing home? Is the person still allowed to take it? What are the logistical problems? You might not be surprised to learn from this article that marijuana kept in a location accessible to many tends to disappear. These issues and the others raised in the article are going to become important as the population ages. Click here to read this story from the New York Times.

Seniors don't have to sign over assets to the facility

This afternoon a client asked me to confirm or deny the latest bit of information making the rounds of seniors. Apparently some are being told that before they will be able to live in a long-term care facility, they will be required to sign over all of their assets to the facility. I was happy to be able to dispel this particular piece of misinformation.

Long-term care facilities will ask a senior who wants to reside there to sign a Personal Directive (also known as Advance Directive or Health Care Proxy) before moving in, if the senior has the capacity to sign legal documents. However, doing so would in no way sign the senior's assets over to the facility or to anyone else. A Personal Directive names someone to make medical, health-care and personal decisions for a senior who can no longer make those decisions alone. It has nothing to do with money.

A long-term care facility might have the senior sign a document that allows the facility to make automatic monthly withdrawals to pay the cost of the senior's care. That's a streamlining of an administrative process that makes sense for everyone involved. However, even this doesn't give the facility any other access to the senior's finances.

A senior would be required to review his or her assets and income with a government intake worker if the senior wanted to request a subsidy for housing, but not to hand over those assets.

Winners and losers in long term care insurance

This article from Investopedia is one of the best I've read at showing me the costs and the value associated with long term care. I always find the statistics somewhat frightening. In this article they rate the insurance companies that carry the insurance. The population figures are American, but of course the whole baby boomer phenomenon is happening here as well. Click here to read the article.

Long term care premiums soar

Apparently insurance companies aren't making as much of a profit as they thought they would with long term care policies and are increasing premiums by huge amounts. Click here to read the story from the Wall Street Journal. Would any financial planners reading this like to tell us whether this changes your opinion on the value and importance of this type of policy for your clients?

Long Term Care Planning: What Is It and Why Should I Care?

I have a treat for you today - a guest blog by Karen Henderson, Hon. B.A., CSA, SM, who is the founder and CEO of Long Term Care Planning Network. Check out Karen's informative article below:

Long Term Care Planning: What Is It and Why Should I Care?

By Karen Henderson

Founder and CEO - Long Term Care Planning Network

We all take delight in planning for vacations and holiday celebrations but when it comes to planning for old age, we literally run the other way. Aging and death only happen to other people, and therefore we don’t need to talk about it – at least not yet. Why is this?

• Canadians have an attitude of entitlement; I am a taxpayer and therefore the government is responsible for caring for me in my old age
• It won’t happen to me
• My spouse will look after me
• The kids will look after me

The reasons we should care about aging are obvious:

• The first wave of Canada’s 10 million boomers started turning 60 in January 2006
• 600+ people turn 65 every day
• By 2038, over 1,125,200,000 Canadians will have Alzheimer Disease or a related dementia unless a cure is found before then. Almost 25 per cent of Canadians now have someone with Alzheimer Disease in their family.

The September dementia series in the Globe and Mail makes it abundantly clear that we all need to plan for old age – and not just financially.  We need to understand the health care system where we live, plan where we wish to age and live out our lives, and communicate our wishes to family members.

The bottom line: Long term care planning needs to be a part of every financial and/or retirement plan written today.

Here’s how to begin:

Step one: Understand and accept the need to plan

Step two: Understand the health care system and care settings and services where you plan to live as you age

Step three: Know whom you can count on for care and support, both from your family and from health care professionals

Step four: Talk with your family about what you want – hold a family meeting. Understand your family history and what chronic conditions you have or may face

Step five: Establish clear legal directions. Complete a will, Powers of Attorney and make copies available to those who need them

Set six: Gather all critical personal, health, legal and financial information and store it in one place for easy access

Step seven: Make a care plan that covers the ‘what ifs’

Step eight: Communicate the plan to your family and update it every year

Creating a care plan will take time and effort, but once it is completed, you will have accomplished two very important goals:

1. You will have added the missing piece to your financial/retirement plan

2. You will have removed a huge burden from your family; over time you all will be thankful that you took the initiative to plan ahead

As the saying goes: Just do it!

Resources

·        Long Term Care Planning Network   www.ltcplanningnetwork.com

·        Rising Tide: The Impact of Dementia on Canadian Society  Alzheimer Society of Canada 2110  http://www.alzheimer.ca/

·        Dementia: Confronting the Crisis: The Globe and Mail September 2010 www.theglobeandmail.com/life/health/dementia

Karen Henderson, a caregiver for her father for 14 years, is the Founder/CEO the Long Term Care Planning Network, Canada’s only national resource centre for aging and long term care. She is a well-known family consultant, speaker, writer, media commentator, publisher and educator who has been published in leading geriatric journals in Canada. Karen works with a variety of Canada’s leading corporations, as well as financial and insurance companies to help educate Canadians about the implications of long term care planning on all aspects of life.

She is the author of several unique resources to guide Canadians through long term

care planning. Visit www.ltcplanningnetwork.com for more information.

Karen’s contact information:

karenh@ltcplanningnetwork.com

416-323-1090

Long term care Readiness Questionnaire

Have you and your family thought about long-term care for an aging parent, or will you wait to learn about it until you're faced with needing it? To get organized, check out this Readiness Questionnaire from Long Term Care Planning Network, which you can download for free.