What We Owe Our Elders

by Sky

My husband and I both come from large families with several childless aunts and uncles. Over the past few years, we’ve learned that some of them have put us in charge of their affairs as well as our parents’.

For geographic and professional reasons, we are the obvious choice to be someone’s executor or to hold the power of attorney.

But they are all within a decade of each other, and the prospect of managing the care of 6 or more 80-somethings across a few states is daunting. Better than the alternative, of course, but still daunting.

What have you needed to do for your older relatives? Other than making sure the documents are in order, what recommendations do you have?

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116 thoughts on “What We Owe Our Elders

  1. OK, so today I’m going to be sitting back and listening.

    From what I’ve seen with my mother, the hardest part isn’t all the “stuff” — most of us here could jump in and execute with no real problems. It is figuring out what part of the “stuff” you can and should take over/dictate, while still acknowledging that the elder is an independent individual with some capabilities left who wants to make some of those decisions — and, most specifically, how to handle it when that relative’s decision differs from what you think is in their best interest.

    The other hard part, I think, is when you need to fit this in with a job and kids and everything else. So my only standard advice would be to try to plan for this as you would any other life event, as best you can — i.e., save money so if you need to cut back on/take a break from work, you can; look for/be aware of flexible job opportunities; etc.

  2. Am I a beneficiary of the will? Are they people of means. If yes to both, I can provide faithful service to many old folks simultaneously. I would do the same for even a broke parent, of course. And the same for one broke uncle. But two broke uncles? We’d have to talk.

  3. I have no advice. However, I’m wondering how I will navigate these issues when the time comes. The biggest issue is the personal dynamics. MIL has a strong personality and DH is an only child. Since I am the DIL, caretaking should traditionally fall to me.

    I fantasize about assigning DH the role of taking care of his parents, while I take care of mine. My mom has a strong personality as well, but we have a stronger relationship that makes me not mind so much.

  4. If you have several relatives to take care of at the same time, the biggest two things (for medical care and also for local banking, etc.) are proximity and access You can’t manage an elder’s medical care from afar if you want to go to their appointments with them, or check up on the nursing home. You will also need to go to their bank and bring the POA to get access to their accounts, etc.

    Some states have additional hoops to jump through for out-of-state executors, so that is something else to check. The administration can be managed (except for the inventorying and selling of THINGS) from somewhere else if you have an attorney to advise the estate. ;)

  5. Look around now for places that provide either assisted living and/or nursing care. Talk to them and find out what they can afford. I would be upfront and tell them that you can’t do long distance care giving – even if they have in home help – my FIL and his two brothers tried that with their mother and one of them had to make an emergency visit after a call from the police that she was wandering the streets and was hungry (her caregiver walked out). It is one thing if they are incapacitated from an operation and should recover – another if it is the slippery slope. Have them come visit if they are able and look at options close to your home.

    The 10 weeks I was in Florida with my FIL caused problems for my family – I had to give up my job, my son was only 17 and still needed care and someone to drive him to practices and games, they had horrible meals and my house was a disaster when I came home. My FIL did not want to take an ambulance plane to our area – he thought it was too expensive – not really when you considered the knock my family took. Do not put your family second and try to meet the demands of the old – they are not going to move willingly.

    I told my kids do what they have to do. The old can be very set in their ways and selfish (even if they were not that way in their earlier life) and not care about the impact on others.

    Luck to all of you!

  6. Since both my parents have passed away, I sadly do not need to worry about this. My mother passed away so unexpectedly, and was so healthy and vibrant at the time, that we kids never even had a chance to think about these issues. My father’s situation was a little more complex, but he was still able to manage his affairs until the very end. My DH’s mother is the only one left on his side, but he is the youngest of many siblings, and they are doing most of the eldercare – which is very little because at 90, she is still completely healthy, intelligent, mobile, and even drives around town.

  7. This is a timely and touchy topic for us as we learned 3 years ago that my FIL had no retirement savings beyond social security which is not enough to meet his financial needs after a lifetime of poor decisions. We have spent approximately $30K per year over the past few years supporting him. As he lives some distance away and is now suffering from dementia, it is hard to really know what is going on. Things are further complicated by the fact that his long-time companion does not have a great command of English and she and DH don’t really get along. I would like to put that $ toward college/retirement savings but we feel obligated to support FIL. It is one hot mess but it has made my very determined not to be a financial burden to my kids.

  8. “You can’t manage an elder’s medical care from afar” — this was exactly my mom’s issue with her aunt. The last @5 years of her life she really needed to be in a continuing care community of some sort, because my mom was 1,000 miles away and employed full-time. But she refused, instead expecting my mom to move down to take care of her; my mom (very reasonably) refused but couldn’t force her to sell the house and move. And without assets from selling the house, my great-aunt ended up using Medicare, getting admitted to the hospital repeatedly, and sent to Medicare-level nursing homes for recovery before being sent home. Eventually she ended up in a bad one and died from what I think-but-could-not-prove is neglect (people were telling us she had been ringing for her breathing treatment for a couple hours before they found her dead).

    In the end, my great-aunt would have likely lived several years longer if my mom had been nearby to provide oversight, or if she’d been willing to take my mom’s advice from afar and let someone else provide that on-site supervision. But my great-aunt was still mentally together, and you can’t prevent another reasonably competent adult from making her own decisions, no matter how stupid you think they are.

  9. my FIL had no retirement savings beyond social security which is not enough to meet his financial needs after a lifetime of poor decisions. We have spent approximately $30K per year over the past few years supporting him.

    Choices have consequences – cut the bastard loose.

  10. I most worry about my older sister, even though she is not yet elderly. However, she is in her 50’s, overweight, in poor health, single with no kids, and doesn’t really have any friends. She also has a history of depression and is stubborn as a mule. The only saving grace is that she does have some savings, although not nearly enough. Oh, and she lives in a completely different geographic area. She seems to be struggling right now with depression, but I am too far away to really know what is going on. I am not sure what to do about this.

  11. Rhett, I knew I could count on you for some perspective. My DH and I have discussed at length and, while we know we can’t be a source of unlimited support on a long term basis, we will keep up the funding for now. It is a tangled web of drama with lots of ugly family history involved. Thank goodness my parents have their act together. My DH jokes that my dad already has his date of death scheduled.

  12. Anon, may I ask why you continue to financially support him when Medicare/Medicaid may be able to provide services? I understand that assistance may not be up to your standards of care, but it was his decision years ago to let the government take care of him. I’ve never been in your shoes, but I wonder if the cost of his care is worth sacrificing your own retirement and children’s college monies.

    I have several great aunts in their late 90s. Some have the money to live in the nice retirement assisted living communities, and a few others are in medicare paid nursing homes. My aunts and uncles with their mothers in the nursing homes don’t seem to be bothered by these homes, although they do seem to spend time trying to get them into the better ones. The alternative would be to pay the assisted living prices, but they don’t want to spend down their retirement accounts.

  13. To Anon: If your FIL has dementia look for a good nursing home that accepts Medicaid and get started on the process to have him go on Medicaid. Gather all his financial records and go through to find any assets as the social worker will want a thorough look into his finances. You will not be on the hook for his care.

  14. Anon: Please keep in mind that your FIL’s expenses will increase with time, as he needs more care. So, it will be very difficult to cut him off later. Best of luck–what a terrible situation.

  15. One of the hardest parts of elder care is the stairstep decline. They’re fine for awhile, then there’s a crisis; they maintain at the new, lower level for awhile, and then there’s another crisis, and so on. The crises can come thick and fast in the final few years. Can you contact some geriatric care managers near the various relatives and get to know them? You’re going to need help. You can also maybe explain to the relatives that they need to be setting aside some money for the care managers.

  16. Lemon – My MIL was in a high end assisted living (over $ 6,000) per month that had turned from assisted living to more nursing home care as the residents aged in place. Because it was set up as assisted living it had lots of nice soft furnishings – unfortunately these furnishings help odors and smelled worse than nursing homes. Nursing was limited and most of the aides were not trained in elder care. She ran out of money and they wouldn’t accept Medicaid and she moved to a brand new facility that was lovely. I was very impressed with the care the patients received and the fact that it did not smell. As long as the residents are kept clean, nursing professionals look after their health and the facility is clean, Medicaid patients can receive quality care. The one thing to do is visit on a regular basis in case their are problems.

  17. Anon – I agree with Rhett and OLD MOM. Do the legwork now to enroll him in Medicaid, etc., and then when more decline comes you will be set. I would put that time into getting him off the gravy train NOW so that the $30K/year isn’t suddenly a $60K hospital bill all at once.

  18. Sky, I suggest you ask each of them to compile a list of all accounts, insurance information, will and trust info, POA, safe deposit box info, etc, and let you know where you can access all that information in case it is needed.

    Any thought to trying to identify a single facility with multiple levels of care, into which you could try to consolidate?

  19. Don’t hesitate to outsource, if possible. A good geriatric care manager can provide quite a bit of help with the health-related stuff. Regarding finances, try to put bills on auto-pay so that you don’t have to deal with them. Do anything you can to get things off your plate. Don’t feel at all guilty about not doing it all yourself. You can’t do it all yourself.

    Make sure the power of attorney is on file with the banks or investment companies or whoever holds the elder’s assets (best to do this while the elder is still well, and can vouch for the authenticity of the document). Make sure the elder’s physician(s) have the health care proxy on file. You don’t want to be scrambling around trying to locate and send documents in a crisis situation.

    If an elder is amendable to the idea, think about having them gather their assets into a trust. If you are a co-trustee or a successor trustee, you will be able to manage the assets easily if the elder becomes sick or incapacitated. Having the assets in a trust can also make the distribution of assets after death more streamlined than it would otherwise be. Of course, the elder should consult with a competent attorney to get this done.

    Understand that eldercare can essentially be like a job, in terms of hours and demands. When my mother was ill, I basically saw myself as having two jobs — my lawyer job, and my eldercare job. I knew I couldn’t do both full-time, so I essentially made each one a regular, part-time job. Each week I would arrange my schedule, slotting time into each of the two jobs. Sometimes the schedule had to change due to eldercare emergencies — dealing with emergencies is part and parcel of eldercare. I have my own law practice, so my schedule is pretty flexible, and I was able to cobble together a two-job routine. But if you have a traditional, unflexible job that you need to keep, be realistic in understanding that you are not going to be able to be a consistent hands-on caregiver. So do your best, outsource as much as you can, and forgive yourself for not doing more.

    And I would suggest that you put yourself, your marriage, and your minor children first. Don’t martyr yourself. Do the best you can, but cut yourself slack if you feel that your best isn’t all that great. I know this is much easier said than done. Emotionally, I feel some guilt about not having done more for my mother. But I take comfort in the fact that realistically, I did my best in a difficult situation to balance a lot of important, competing priorities.

    Good luck, Sky — it’s not easy.

  20. Old Mom, I guess that explains why my aunts don’t seem to care that their mothers are in these nursing homes. Interesting tidbit about my grandmother’s place. It is located in an area that has a very large ethnic population that traditionally values elders. A lot of the staff are young women that have an unbelievable amount of patience and respect for the residents, and the turnover is way less than you would expect in a low paying job. In the dining room they will spend 10 minutes with one resident while she tries to decide what to eat and will calmly help her make a decision while at the same time listen to her tell a story about getting the bones from the butcher during the depression.

  21. This is timely for me because I am seeing my mother tonight, and she has been helping a lot of my friends with elder care issues. She works in a hospital in the division that is responsible for the care of patients after they leave the hospital to go home, nursing home etc etc. She has a ton of connections so my friends are always asking for help.

    She was recently a little critical of one friend that took her father to the ER of a major hospital in the city, and the ER doctor accused my friend of elder abuse. It demonstrates that this can happen to anyone because my friend that accompanied him to the ER is an attorney, one brother is a radiologist and the other brother is a corporate lawyer. The doctor brother just saw the father two weeks earlier and he was fine. The dad was lying to them on the phone and it took a biweekly visit from my friend to realize that he had stopped eating and was in trouble. He is 87 and his health declined rapidly in a very short time.

    The question arose about how often should she see her dad because she works full time as an attorney, but she lives in NY metro. The brothers live outside of NY. She is taking care of everything now…one brother said he she does the “scut” work – he will pay for everything that is out of pocket. She finally asked the ER doctor about elder patients that have no family. What happens?? They explained the idea of elder orphans to her, but I’ve been discussing this with my mom because this is going to b a serious problem in the future. The stats prove that more and more people don’t have kids. I guess many rely on a niece or nephew, but that doesn’t seem like a real solution to me.

    It must be my age, but this keeps coming up over and over. My friends have transitioned from discussing 100% child issues to at least once a week someone is dealing with a parent concern.

  22. If you are ever involved in the process of choosing an assisted living facility or nursing home for an elder, I think the smell test is critical. If you walk in the door and the place smells like urine, avoid placing the elder there, if at all possible. At my mother’s first assisted living (which presented itself as a high-end place, and had prices to match), my mother’s room consistently smelled like urine. I talked to the staff many times about this, but it never really got better. At her second assisted living, by contrast, the staff kept her room really clean and nice-smelling, even though at that point she was totally incontinent. Different places really are very different in the level of care and concern that the staff has for residents.

  23. SSK – in the case of elder care, profiling may very useful. It takes a special person that is for sure.

  24. I’ve also heard (and my uncle is an EMT/fireman in a major city) that the local fire station is a good place to stop by for a candid opinion of local care options. Take food. :)

  25. I would try to visit any potential place without an appointment. I’ve seen a lot of nursing homes, acute rehabs and assisted living places because my grandmother is still alive (late 90s). She is actually back in her own apartment with an aide, but she has spent time in several facilities due to different life events. She never went to the assisted living places that we found because my mother/aunt decided to keep her in her own home.

    It is a sad fact, but most of these places seem to have little to no security. If you act like you belong, you can walk in without an appt.

  26. Very timely! My parents both gave me POA, Medical POA and set up a living trust that appears to be working the way it was designed. They moved, after some encouragement, to a continuity of care facility about 2 years ago. Now that my dad passed, with my mom being legally blind and has hearing aids that help, but do not fully correct, my recommendations are:
    1. Make a list of all current financial assets and liablities and update it at least annually. This is taking time and effort – tax return helps, statements help, having passwords to at least some online accounts helps, and he kept “stuff”, but it is not very well organized and is taking time to figure out when things were last paid (most recent checkbook MIA).
    2. Make a list of websites and passwords to important sites (financial especially). We have too many lists and its hard to tell which is the most up to date.
    3. Make a list of “important” people – Neighbors, doctors, attorney, financial planner, etc. with current contact information. Especially with so many people going to cell phones only, it is much harder to track down people.
    4. Plan to attend doctors’ appointments & Make a list of drugs (prescription and over the counter) that they take. Some OTC drugs can interfere with prescriptions, so it is really important even if you are thinking, its only a multivitamen.
    5. Know where important papers are – files at home, safety deposit box (where is the key), etc. As they get older, it is a good idea to double check the birth certificate, marriage license, and/or divorce decrees. For some of the older folks, these are harder to come by.
    6. Be aware of adjustment periods and slippery slopes – This is SUPER hard. The first 1.5 weeks after my dad died, I thought my mom would have to do to assisted living. I didn’t bring it up because there were too many things going on that were taxing her physically and emotionally. She has really bounced back in the last 1.5 weeks, but we are facing a fairly long haul of sorting and organizing so that she can manage on her own. For example, he did the laundry, so now she has to learn how to run the washing machine by touch as she can’t see the dials.
    7. Talk to them early and often about where they are and what is the plan – moving out of their home, moving closer to children, etc. What do they see as mile markers for the next step – can’t drive? fell more than once? Everyone is different, but if they commit to some of these early it is a little easier.
    8. Find your support network – Dealing with elderly relatives is taxing, especially when you have kids, spouse, and/or a job. You need a place to vent when they drive you crazy and to share when they’ve done something touching. This may not always be your spouse or one person.
    9. Be clear about your care-giving boundaries – what can you afford or not afford to do? My mom wants me to have lunch with her often. I am limiting it to once a week because it is a 2.5 hour event at her community’s restaurant. Their goal is to keep residents in the dining room for at least an hour – they have them sit with others and it ensures some level of social engagement. But, when you are on a schedule, it is hard.

  27. POLST/MOLST forms!! Let me shout it from the rooftops!

    These are the medical forms (Physician’s Orders for Life Sustaining Treatment) that can actually be used to limit or stop care in an Emergency Department/ambulance or hospital ward. Clearly, I have a bias here. All the living wills I have ever seen do not stop aggressive, immediate resuscitation. They usually include some variation that, “if two doctors agree that my condition is irrecoverable, then life continuing measures should be stopped.” Well, when you roll into an ER with severe shortness of breath, or a heart going so slow that you need CPR to assist you, no one knows if your condition is recoverable. Certainly no doctor is going to withhold care based on a 16 page document that is written in legal language.

    A POLST is actually a set of orders, signed by the patient (or legal representative) and the physician. It is usually printed on brilliant yellow-green or pink cardstock. It has 3 multiple choice questions (in some places I have seen optional, additional pages, which are usually not particularly helpful).
    1: Heart Stopped? CPR/no CPR?
    2: Problem, but heart beating? Comfort measures/Limited additional treatment/Full treatment?
    3: Artificial Nutrition?

    A POLST is fully revocable and changeable at any time (some people will not operate on a patient with a no CPR order in place) .Also, section 2 deals with nursing home transfers to hospitals – it gives them a out to not transfer a patient. Someone here mentioned that the home once told them that they had to transfer for every concern — no true with an appropriately signed POLST.

    Get yours today!!

  28. This topic is really hard for me. What I don’t like is elders expecting you to be the point person when there are issues yet never being grateful and thankful to you for what you are doing. I don’t believe culture or duty or expectations (call it what you may) should give you a pass from showing appreciation to the people who are thrust into the care giver/care manager role.

  29. Back to our discussion the other day:

    Sir Tim, 72, who was awarded the Nobel prize in physiology or medicine in 2001 for his work on how cells divide, reportedly told the World Conference of Science Journalists: “Let me tell you about my trouble with girls. Three things happen when they are in the lab: you fall in love with them, they fall in love with you, and when you criticise them they cry.”

    http://www.bbc.com/news/uk-33077107

  30. Wanted to add that I agree with the smell test for nursing homes and contacting your local first responders (EMS/Fire) — they will know who is kind and good or not.

    MediCARE cares for the old, MedicAID aids the indigent. There are no Medicare nursing homes, and Medicare does not pay for nursing home care.

    In certain circumstances (after three midnights in the hospital) Medicare will pay for up to 100 days of rehab in a certified skilled nursing facility. However, once the time is up, or rehabilitation has reached a plateau, Medicare stops paying. Medicaid will pay for a home, if you are indigent.

  31. Ah, crap, thanks Ada — yes, my great-aunt was on Medicaid, not Medicare.

  32. To respond to some comments:

    Anon: definitely get going on the meidicaid/medicare benefits he is eligible for. There is no reason for you to keep spending that kind of money. Nursing homes don’t differentiate care based on who is on medicaid and who is private pay. The only difference is in getting a private room. Of course it can be harder to get a spot in a decent place on medicaid because of the demand.

    I completely agree with the smell test as a general rule. But make several visits because there can be occasional accidents that can create a really bad odor as a rare occurrence.

    Security can be an issue. Usually there is only a receptionist at the desk. And if you have an official looking ID and act like you know where you are going, you can just walk right past and nobody will stop you.

    Every person admitted to a nursing home will have a POLST form (it’s called a MOST form in Colorado) filled out. You absolutely can request no hospitalizations.

    And it really does help to visit regularly and get to know the staff. I hate to say it, but the staff will give extra attention to residents when they know the family is involved.

  33. ITA on the med forms. And take them with you!! My stepdad’s stroke was on the plane home from Europe, and they diverted to a city several hours from home. Luckily, my mom had all their forms with them, and they had given copies to all of the kids and my stepsis had time to fly out with her copy as well. The forms wouldn’t have helped much if they were locked up in the safe deposit box at their local bank.

  34. LfB,

    Do the forms need to be notarized originals or are copies OK? Could you just scan them and e-mail them to your gmail so you could pull them up anytime you needed them?

  35. A POLST is valid if photocopied or scanned. The original must be signed by a physician. In my experience, they are not notarized.

    Most ER docs are looking for ways to not perform futile interventions on older folks (though our definition of futile may fluctuate with the level of burnout). If there is a reasonable copy of something that looks legitimate, most docs are going to honor it. I suppose this is open to abuse. In reality, it is the doc on the ground who makes the decision to start or stop CPR and in general those decisions are questioned (it is not an area of my practice that I worry about litigation, though I do worry about doing the right thing).

  36. All of the relatives I have had in nursing homes suffered some degree of physical abuse, whether privately paid or Medicaid.

    Right now I know we are the point people for six people, and expect at least two or three more on the list. Widely varying life philosophies, level of assets, and willingness to do advance paperwork.

    The furthest is a three hour drive, and knows I want him to sell up and move closer when he turns 80.

  37. Wow. Sky, that sounds like far more than a full time job.

    Another suggestion is that you have them start consolidating accounts, and minimizing the number of accounts they have. E.g., do they really need accounts at more than one bank, or more than one brokerage? With that many people, you might also want to steer them to the same bank and brokerage, especially if you have a personal banker/broker that provides excellent service. Especially while they’re able to handle their own affairs, have them do that legwork. If they have retirement accounts and/or life insurance policies, have the make sure they have the correct beneficiaries.

    Also, don’t forget to get their passwords once you have POA.

    Question for lawyers: would POA allow you to legally access their email and social media accounts?

  38. Rhett – that story is so nuts. It has been going on a while. Old lady is crazy. When rich neighbor offers to pay for something on your property, you say thank you and run in to the house and bake him some cookies. And, if instead, you want to control the neighborhood, buy up all the property. Otherwise, STFU.

  39. Rhett — I used regular photocopies of my mother’s health care proxy many times, at many different facilities, and never had a problem.

    The MOLST form is indeed critical. It’s important to emphasize, though, that this is a form that is generated by a doctor — not by a lawyer. So it’s not going to be part of an estate planning package that you get from an attorney.

    If an elder is mentally incapacitated and unable to sign the MOLST on his or her own, then it is critically important to have the health care proxy in place, since that is the document that will authorize you to sign the MOLST on behalf of the incapacitated elder.

    I have to say, signing the MOLST forms for my mother when it was clear that she was near the end of her life was one of the hardest things I’ve ever done, emotionally speaking. Intellectually, I was fine with it — I knew with 100% certainty that my mother would have wanted the order in place, since we had discussed end-of-life issues many times when she was well. But on a gut level, I felt like somehow I was failing her by signing away her chance at medical intervention. Sometimes in elder care you really need to steel yourself to think with your head, and not with your emotions. It is really challenging.

  40. She has a website. I am not going to link it here, but it is her name.com. She dislikes lots of things and has strong feelings about a lot of stupid stuff. I am usually sympathetic to people who have lived in neighborhoods for a long time and get upset when the new rich comes in and knocks things down. But she needs to just sit down.

  41. Finn — I believe that in many, if not most, cases, you’re technically breaking the law if you use someone else’s login and password information to get into their online lives. That said, if someone has left password information for you, and taken the extra step of putting specific language in a power of attorney, will and/or trust that you have their explicit permission to access their accounts, I’m not sure anyone would ever prosecute you. But then again, who knows.

    This is an area where the law just hasn’t caught up with the reality of people’s day-to-day lives. Many states are starting to pass laws regarding digital assets, and there is a national commission that is trying to get some national standard in place, but it’s a real challenge.

    L, you know more about this than I do — can you chime in?

  42. I wonder if she has any kids. If one of my parents acted like this, I would try to force a psychiatrist.

    She does make the rich people look sympathetic, so kudos to her for doing something few can do.

  43. Thanks for all the advice and good thoughts. FIL will not agree to leave his house which he transferred to companion a few years ago. He insists he will die if he moves to assisted living/nursing home and he may be right. We are paying for home health aides to cover while his companion is at work. They also just let us know that they have an IRS notice saying they owe $5K in taxes. We are trying to get to the bottom of this as it seems impossible given the fact they are basically destitute. A hot mess indeed.

  44. How do you decide whether to ask your relative to live with you or put them in a skilled nursing facility when they get older and need help with basic functions (i.e. cooking, driving, etc.)?

  45. NoB, would that also apply to online access to financial accounts of someone who has granted your POA? It would be a lot easier for Sky to manage the accounts of so many people if she could have online access to their accounts.

  46. NoB – 100% correct. It is against the TOS for most providers and may be against the Computer Fraud and Abuse Act to access someone else’s email. Other accounts – not sure. Again, the TOS governs because there is no law regulating this stuff. It MAY be OK if explicit consent is put in the POA.

    In real life? THIS IS NOT LEGAL ADVICE. Write down all the passwords and put language in the POA, and call it good – NoB is correct that they won’t prosecute regular people. As a side note, this is why it is more efficient to have a family executor/PR rather than a bank.

  47. I suspect there is one in every town. If I ever become that batty, I hope my kids put an end to that crap, Legal documentation or not.

  48. Houston, NoB has good advice:

    ” I would suggest that you put yourself, your marriage, and your minor children first.”

    Make sure having your relative move in won’t turn your lives upside down before asking that relative to live with you.

  49. So how do you keep sibling strife from blowing up? My mom has been ill for few months and is recovering slowly. One sibling has been handling all the appointments and care and prefers to be the go-to person. I’m overseas so I can’t do much but provide support and advice, if requested. My other sibling is also local but is typically more hands off. However, this sibling seems to be more demanding as of late. The latest uproar had the caretaker sibling emailing the 2 of us which gave an update on the latest dr. appointment, set some boundaries as to when updates will occur and let us know the caretaker sibling also had children to take care of. I’m thinking “What the #### did I do?” It turns out the my non-caretaker sibling tried to get an update from my mom (who doesn’t fully understand or remember things being said by the doctor). My mom couldn’t answer the questions so caretaker sibling was admonished for not emailing an update soon after the appointment. The caretaker pushed back and the other sibling backed down but their different personalities are clashing. I’m hoping this is not the beginning of hard feelings but this situation makes me a bit uneasy.

  50. Houston — My mother’s mother lived with us for 20+ years. Given my parents’ and grandparents’ culture of origin, it would have been unthinkable for an elderly widow to not live with a child. It was actually my father’s decision to have my mother’s mother come to live with us, instead of with one of my mother’s other siblings (and, since he was the man of the house, he had the final say). However, it was hard on our family, and especially on my mother (my grandmother, God rest her soul, was not an easy person to live with). Having gone through that experience, my mother became adamant that she would not, under any circumstances, live with my brother or me in her old age.

    So I would say, think twice and three times before making that kind of commitment, if you have any choice in the matter. It might end up being the right decision for you, but make sure you go into it as fully informed as possible.

  51. NOB: Thanks for your feedback. I don’t want to have my relatives live with us, but there is a strong cultural expectation that they do so. In our culture, the extended family is still the norm. I will take your good advice to heart, when the time comes.

  52. overseas anon– I’m not sure how you avoid it except talk about it and set expectations. My grandma had a fairly fast decline with Alzheimer’s, and my aunt became the point person. I think there was a lot of second guessing her going on. At some point some relative called to ask my opinion about some change and I commented that I was far away and didn’t have all the information, but I know my aunt adored our grandma and was doing the best she could. I couldn’t offer to do the work, so I was going to shut up and back her. Maybe a conversation about what jobs (if any) the non-caretaker sibling wants to take on? Our family got past it without major fireworks, but what little I saw from the no-drama side of the family made me see that it is probably a big flash-point in a lot of families.

  53. but there is a strong cultural expectation that they do so.

    When in Rome…put them in a home.

  54. Rhett: I might call on you for moral support when the time comes. Of course, I fully expect us to be here, chatting it up, for the next 20 years. : )

  55. Although overseeing the financial and legal affairs of an elderly person is an important responsibility, professionals do it for many clients in the course of a week, month, or year, and a go-to family member could probably take care of similar affairs for quite a few family members, as long as there were not contentious cousins or sibs who assume that she is a bad steward and is going to rip off the elder or make choices that reduce an expected inheritance.

    But no one with normal responsibilities for school aged children, much less someone who works for money at anything other than a completely flexible part time job without deadlines could responsibly be the holder of EIGHT medical powers of attorney, the person who helps select the SIX residences (two couples assumed), who is expected to go to FORTY to EIGHTY doctor’s appts per year or at least arrange transport both ways, who stops in no less often than twice a month and has to have SIX hour long conversations and a cup of tea just to make sure things are okay (at least until the grandkids/nieces/nephews are old enough to drive and start helping out), who is the one who MUST go to the emergency room EVERY TIME one of the EIGHT 80 year olds ends up there.

    Believe me. I am not exaggerating. Even if it is half as bad as the above at the worst (and if so, it will likely drag out at a lower rate over 20 years) it is too much. Even the most dedicated stay at home with a very understanding spouse and self reliant teens would be a basket case under those circumstances.

  56. Rhett, studio or 1BR cottages in the back yard have been pretty common here for quite a while. While they are often built with parents in mind, they are also used as rental units. Several of my friends lived in such units right after getting married.

    However, from the referenced website:
    “Delivery anywhere in the United States isn’t expected to be a problem.”

    I beg to differ.

  57. What Meme said. I find it hard to understand how a person could manage the care of more than a couple of elderly relatives without it becoming a hardship that materially affects the caregiver’s immediate family.

    I’ve known of two instances where younger relatives have helped care for elderly childless aunts. The first case involved lots of frantic calls and several visits, but she was rewarded with a small but significant inheritance that enabled one of her kids to buy a house. The second case involved a niece who moved in with her wealthy widowed aunt. The aunt was relatively active and healthy up until a couple of years before she died at age 101. This niece received a substantial estate, and her aunt had been very generous to her for many years before (paid for her college education).

  58. Houston – I should have known that Rhett would beat me to it! I was just going to suggest that you think about a garage apartment for your MIL. Hopefully having her near but not in your personal space would make it bearable, if it ever comes to pass. What does your DH think about it?

  59. Rhett – that cute Med Cottage is $40,000 – and has a lot of neat gizmos that are useful to an elderly person. I will be interested to see if they become popular.

    BTW – on the topic of my question about Linked In accounts for college students, I asked DS if he was going to set one up, and he informed me that he already has one, so you were right!

  60. Random hijack…my daughter is trying out for a public high school sport team. There is summer conditioning and a number of fundraisers she is supposed to participate in, all of which occur before she finds out if she makes the team. Today, she came home from summer conditioning with tickets to a wine tasting event that she is supposed to sell. As it happens, she is not the best player and has a 50/50 chance of making the team. So, of course, she will sell the tickets or we will buy them. I am, to put it mildly, irked. I don’t like the pay to play aspect of the fundraiser or team, part of me wonders exactly where the money is going, I don’t think it is really appropriate for high school athletes to be holding a wine tasting event. The coach for the high school team also runs a travel team, year round. My daughter doesn’t play on the travel team, which negatively impacts her chances of making the team.

    Is this just the way of the world?

  61. First, what Meme said. You will really need to set boundaries on what managing 8 peoples need are.

    Second, @Houston – Skilled Nursing Facilities are for people who need toileting help. Adult family home or Assisted Living is for people who need someone to cook, clean and possibly groom them. The difference in cost is 5k for Assisted Living per month and 50k per month for SNF.

  62. I don’t think it is really appropriate for high school athletes to be holding a wine tasting event.

    They use special totebag approved wine glasses so it’s fine:

  63. Murphy– Our local teams sell anything and everything, but only once kids made the team. Selling stuff before you are even on the team sounds off to me too.

    Rhett– I have no space for one of those med homes, but that is a really cool idea.

  64. “Milo,

    You’ll love this:”

    She’s quite a character. If I were the Schwartzes, during the months I was spending away in Palm Beach (just guessing), I would hire George Zimmerman to live in the Maryland house as caretaker.

  65. “How do you decide whether to ask your relative to live with you or put them in a skilled nursing facility”

    Ask myself if I will take them out before nature does.

    Re: Overseas: First, recognize that you can’t stop it. People will be who they are + they will be the worst part of themselves under stress + everything will be interpreted in the worst possible way given family history/childhood slights. Nothing you do will change this, and assigning yourself the responsibility of trying to make it better will just add major stress to your life without improving the situation one iota.

    We had a huge blowup when SIL imposed a visitation schedule for hospital visits for their mom, completely excluded me from the schedule despite multiple offers, and then yelled at DH for stopping by when it was “her” time. They have always had a somewhat rocky relationship, but DH just decided that he was done with her after that. OK, not a lot I can do to fix it — and lord knows DH has contributed his share to the family angst.

    I think all you can do is try to interpret each act from the kindest possible motive/meaning. Not because it will change anyone’s view, just for your own peace of mind so you don’t find yourself sucked into taking sides. Do what you have to do, give the benefit of the doubt wherever possible, and disengage from all the rest.

  66. Ada, thanks so much for mentioning the POLST form. I just sent it to my mother, who has been trying to manage my grandmother’s skilled nursing care from a continent away.

  67. Murphy: I’d be irked, too. Fundraising should be restricted to team members. Good luck to your DD on making the team, though if she does, I see many more fundraisers in your future. : )

  68. Murphy, at our public schools it is considered a conflict of interest for a school team coach to also coach team members in another capacity, just as it is a conflict of interest for teachers to provide private tutoring to their students. A recent example of this was a tennis coach also providing private lessons (for pay) to one of the team members.

    WRT pay to play, I think it’s fine, actually preferable, for public schools, especially for teams that have cuts. I don’t see why taxpayers should subsidize those teams. But I also think the pay part of pay to play should be transparent, and fundraising should not be mandatory; if anything, fundraising should be an option for kids who can’t pay cash.

    I think a fee for summer conditioning and practices prior to cuts, and then another fee for kids who make the team, is reasonable.

  69. overseas, I don’t know how to keep it from blowing up, but I empathize. I somehow antagonized my caretaker sibling, leading to an extremely strained relationship.

    Part of it ties back to the OP; we also had a childless uncle, and my sibs and I were the only nieces and nephews, so it fell to us to take care of him when he couldn’t take care of himself, and fell mostly on the caretaker sib due to geographic considerations.

    BTW, welcome, and I hope you continue to contribute to our discussions here.

  70. This is a good topic. My only childless uncle passed away two years ago, and my MIL within a couple of months of him. My SIL had moved in with her as caretaker, and in return my MIL signed her house over to SIL, so she was able to avoid going into a home until the very end when her dementia became bad. We were fortunate, as she was a bit cantakerous, and it would have been quite a challenge for us to take her in.

    My brother and his wife have no kids, and they have no nieces and nephews on the other side, so I have already told my kids I will expect them (in conjunction with their three cousins) to care for them when they are older if I am not around, so to always have that in the back of their mind. There should (barring anything unforeseen) be sufficient funds, and they are both delightful people who tell great stories. They are both in the entertainment industry, so have sort of honed the craft of storytelling. My kids adore them in their current form — hopefully they will be equally endearing as old people.

    My parents have no children left in the state we grew up in. They are in reasonably good health, but do not tell us until the last minute when there are health issues. My siblings and I used to all go at the same time to visit them so we could see each other, too, but have just agreed this year to space our visits so we can check on my parents more throughout the year. That makes me a little sad because I don’t get to see my sibs enough. They have toured assisted living places recently and chose a “Plan B” if they are forced to leave their home due to illness or accident, but they chose a place in the city they live. After my mother’s sister suffered a fall and has been in and out of rehab places since April, and is now home with a different one of her children staying over every night, I got frank with my mother and told her they need to choose a Plan B place in Houston or Chicago. Sadly, all of their close friends are dying off. The demographic of their church is changing, with a small group of their cohort and half the masses in Spanish. The reasons to stay there are getting fewer, and if they leave their home for a new place, then even fewer. I’d like them to come here because it’s their choice, but if it comes down to them needing more constant support, I will insist. My mom will come willingly. You don’t insist with my dad, so I’m trying to plant the idea now, so over the next couple of years it can become his idea. They joke that their “plan” is to go together, instantly, in a painless accident, after having spent all of our inheritance. From their lips to God’s ears.

  71. Unfortunately we are anticipating a train wreck due to ongoing bad decisions by aging family members. Our advice and good efforts have been steadfastly ignored or rejected. They will expect us to save them when the crash occurs. I think my DH has written them off. I don’t know what course of action will lead to the fewest regrets.

  72. Great topic, Sky. This is not terribly far off for my sibs and I, and when it happens, 1 of us will be stuck with most of the work (sister) because 2 of us live much further away (brother and I). Inspired by this discussion, I just sent my sibs an email to discuss this future issue. So, thanks!

  73. I use further for physical distances, and farther for other cases. That may be mostly correct, but don’t take my word for it.

    I really hope I don’t get (more) ornery when I get older. I’ve actually mellowed out in middle age, but maybe my stubbornness will return in old age.

  74. “That may be mostly correct, but don’t take my word for it.”

    Reminded myself of this:

  75. “I use further for physical distances, and farther for other cases.”

    I’ve learned that it’s the other way around. Farther – distance, further – extent.

    Also, while we’re at it, “for my siblings or ME”

  76. Oh shoot – that’s right, Milo. Should have been ME.

    So, I have now heard back from my sibs on this and it’s been great. Everyone’s on the same page, everyone appreciates the early discussion about it and my brother reports he has already had talks with our parents along these lines. (They’re going to start staying down in his tropical paradise for a few months each winter. He has a separate building for this, which will makes things nice for everyone).

    My SIL also wrote to say my email to my brother has inspired her to write one to her two sibs. (her folks will also start wintering down there and happily, they are fast friends with my folks so any overlap won’t be an issue).

    So, my sister will be the main medical person and my brother and SIL will be the Extended Cocktail Hour / Boat Cruise people, I guess. Must find a job for myself.

    I so appreciate you all raising the issue (esp Sky). I’ve benefitted so much from this group.

  77. Appreciate the insights of everyone who has written in on this, as we’re just now getting to the point. It’s made me realize that I take physical proximity for granted, and how important that has been even for the “young/healthy elder” demographic. Since my stepdad died, I can’t even remember the number of times my ridiculously-competent mom has suddenly needed help with something not-really-that-challenging, whether it’s a phone tree or the cable box is out or the computer won’t print or the dishwasher broke and spewed water all over the floor or whatever (literally every major appliance has broken since my stepdad died). Nothing that she’s not capable of doing, but all stuff she never *had* to do with my stepdad around to help with — and some of it is just wanting to bounce ideas/discuss options with another human being (many, many conversations over the new car options). DH is racking up a ridiculous amount of brownie points jumping in to help with a lot of those things — it’s a good thing he’s an engineer and likes to solve problems, because otherwise I’d be running at a permanent deficit. :-)

  78. MedCottage is a Virginia company, so please buy them!
    Guest houses, garages apartments, etc. are very common in some places, but I have heard that MedCottage has run into some problems with zoning. Particularly in newer planned residential developments, there might be convenants written into the zoning regulations that prohibit outbuildings. And even in older neighborhoods, there could be occupancy limits, building setbacks, fire access, and other issues.

  79. My own experience included only one elder who required intense care as she became frail and had memory issues in her final years, provided at first by me, an empty nest daughter a short flight away, then with the help of a 23 year old granddaughter in the same metro area, then finally a forced move to assisted living near me. And she had, as we discovered when we were allowed to look, plenty of money and there were no sibling issues, and it was still a lot of work. You can never be without a phone on your hip on vibrate. Never.

    But my horror post above is based on my 62 year old cousin, who had all four parents (hers and her husband’s) to care for. His were very ill early on, when she was in her 40s, they are gone at least ten years. My aunt had Alzheimer’s early and died five years ago. My 90 year old uncle, who is legally blind, is in a nursing home and luckily has his wits. You can call him on the phone. She and her husband were able to convince them all to go to the same elder complex. (She has a psychological practice. Her husband helped more with the kids when they were still at home, but he has Crohn’s disease so he has to manage stress carefully.) We are flying down for a visit next month – with our busy family year we couldn’t manage our usual car trip to the area. Other local family visit as well, her sib has money when needed, but the care falls on her. It is getting to the 20 year mark.

  80. My parents recently did some estate planning and purchased long-term care insurance. I wish I had listened more carefully when they were telling me the plan, but I know they want to stay at home or move into a nearby continuing care community if needed. They need to be near their church and other activities as long as possible. The problem for me will be how to handle emergencies after the first one of them passes since I’m a 4-hour drive away. I think I’m secretly hoping my brother & SIL will move back home by then! If not, I’ll have to have a cousin on-call, which should be a fair trade since I’ll have our childless aunt & uncle retiring in my town.

  81. “Prof. Sophie Scott of University College London, who researches the neuroscience of voices, speech and laughter, wrote on Twitter: “I am in the office, but I can’t do my science work as I saw a photograph of Tim Hunt and now I’m in love, dammit.””

    Snort. Now I’m in love. . . .

  82. L,

    I think winning a Nobel Prize often results in one loosing the ability to self sensor.

  83. The problem, nice Totebag guys and husbands and straight arrow Totebag ladies who have been sheltered from all this, is that most women suspect that the elite protected guys who let these words escape their lips in public actually speak for the majority of men, especially men over 40 or from a less egalitarian culture, who simply don’t have the opportunity or bad manners to say this stuff outside a men-only gathering, especially one fueled by a few drinks and a shared bonding activity. In addition to my own experiences over the years, I had a closeted gay friend who told me more than I ever want to know.

  84. “Meme, that’s one sentence that I can not follow.”

    Women believe most guys think this, they’ve just learned not to admit it in mixed company.

  85. Milo –

    I’ll try again. Sometimes I have too many clauses in each sentence.

    Women know that there are nice guys out there. We are usually married to them. (But we may not so sure about our sister in law’s Neanderthal brother.) But time and again powerful (in context) men let slip public comments like those made by the Nobel Prize winner, or Cat’s client, or Rocky’s hiring Prof, or my Big 6 partners. So a lot of women have a nagging suspicion that many if not most men, especially older US men and men from traditional cultures, in their heart of hearts agree with those who marginalize women professionally. But most US born men don’t have the freedom or bad manners to say that stuff out loud – they save such comments for male only gatherings, often alcohol fueled. And I had a closeted gay friend who was privy to the sort of unguarded comments men make among themselves, and shared with me some doozies.

    The majority of people who contribute regularly to the Totebag are such totally decent and cautious folks that they find it hard to understand that many if not most of the People Like Us they encounter every day have hidden depths, and I don’t mean that in a nice way.

  86. Meme – totally agree. I can see flashes of the hidden depths sometimes among the more bro-y or sales-douchey guys, but otherwise they usually keep it tamped down. I still wish I had had a recording of the conversation in which I got fired, which had some real gems.

  87. My husband works with a guy that says horrible stuff all of the time. About women, gay people, people of every ethnic group. He says it all. I just can’t believe that no one ever reports him.
    This guy is a jerk, but he survived two world trade center attacks and he is going to say whatever he wants in the office.

  88. Meme – When WCE makes comments about cultural expectations at a place like Harvard and biases against middle-America/religious conservatives, whether from the admissions board or just in general, you’ve been somewhat dismissive of that in the past (in a nice way). Do you think that this would be analagous?

  89. Agree with Meme. I think nearly all guys, given the right circumstances (whether that be in a room where all eyes are on you, because of alcohol or when hanging out in Vegas with your college friends), will say shitty things about women. Most have learned to keep themselves on the straight and narrow when it matters. Some (like Mr. Hunt) either misjudge the situation or just.don’t.care.

  90. And I don’t equate things like not switching the channel when Kate Upton bounces across the screen or looking openly at the SI Swimsuit issue with failing the nice decent guy test. I consider that normal behavior for a straight man, unless he has taken a religious vow, and a woman who makes that a litmus test is silly.

  91. Milo – I have to go out now so I’ll answer that later. I take your question seriously.

  92. Meme, there is just no good way to say no, because for some of these relatives there is no one else. I really wish some of the cousins were more stable totebag types, though!

    Maybe DH and I should try to buy up 4-5 condos in the same complex as investment properties for now, and everyone can live in one at a nominal rent starting at age 80. Dentist appointments can be done on the first Monday of the month, GP on second Tuesday, opthalmologist third Wednesday, and if it’s not an emergency you can take a cab….

  93. Thanks for your responses about the team fundraiser question. Part of what irks me is that the fundraiser is, intentionally or not, designed to keep the wrong type of kids off the team. “People like us” go to wine tasting and/or can pay for the tickets without much difficulty. I live in a very diverse community with a huge socioeconomic range and this type of fundraiser serves to distinguish them from us. It is what it is, and DH and I will play along so that DD has a chance.

    I am really starting/continuing to hate sports.

  94. Milo –

    Leaving for the left coast soon, so this is all I can manage.

    1. I don’t see any similarity at all. The actual and suspected reduction of women by men to emotions and body parts takes place behind closed doors (usually). It is in fact an unpleasant surprise to many otherwise worldly women when they get a peek behind the curtain or someone blurts something out. The lack of respect shown at many universities and SLAC’s, elite and non elite, toward conservative religious and social views, especially those expressed by white people from the heartland, is not in the least covert. It is not just young people acting badly toward other young people. It is actively fostered by faculty. The administration’s figleaf about respect for all and acceptance of all views is made of cellophane. Good manners, civility and fear of reprisal apply only to the group being ridiculed, in this case. It is a piece of open information that actively discourages many students from enrolling, and who can blame them? There are at most leading universities significant communities of conservative Protestant Christians who are happy to be there, who stand up for their beliefs, band together and often have alliances with other conservative religious or social groups that they would never have met or seen as allies in their communities of origin. There are also the opportunities for folks on both sides to make friends and become more broadminded people, but the onus lies on those with establishment views to take the first step.

    2. I am not going to revisit the admissions back-and-forth from many years ago because I have a statute of limitations on dredging up discussions that ended unpleasantly.

    3. WCE and I have a robust private correspondence and have discussed these issues at length affectionately and with nuance.

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