Taking Care of Elderly Relatives

by AustinMom

This topic was triggered by a question asked by a regular recently about what support do you really need to provide the “more healthy” elderly who have their mental capacity and sufficient financial resources. It reminded me that I had that similar question several years ago.

As regulars know, my dad passed away in May 2015 and my mom followed him in April 2016. My mom was 9 years older than my dad, but she was always the healthier one, per their doctors (shared same primary care, cardiologist, and ophthalmologist). My parents were open about discussing both their finances and health care information in the last 5 years before they passed. However, knowing information and stepping in to help or completely manage these things is a big step.

Since my mom passed, I have three acquaintances who have started down this similar path with one or both elderly parents. In each case, the point at which the family member(s) needed to consider downsizing was foreseeable, but then the switch to needing significant participation in caregiving was abrupt and not anticipated.

The “problem” I observed, in my own situation and in theirs, is that when that change takes place you aren’t as prepared as you’d like to be and you are too enmeshed that you don’t have the time to start doing the research. While there is tons of information out there, it all seems to be scattered like parts of a jigsaw puzzle dumped on the floor. No one seems to have that “complete checklist of elder care considerations”, either from the what to do in advance, what to do when you find yourself unexpectedly care-giving, or how to handle the estate upon passing.

From some of the comments on other posts, a number of Totebaggers have recently been, are in the midst of, or can see this coming in their families. If you were asked to contribute to that “complete checklist”, what would you put on it?

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121 thoughts on “Taking Care of Elderly Relatives

  1. 1. What are all of the logins/passwords/security questions to all of the accounts?

    2. What is the entire list of assets, including properties, investments, bank accounts, safe deposit boxes, life insurance, pensions, etc. Same thing for any debts.

    3. Repeat Q 1: to ensure you have full info on each item in 2.

    4. Do they have a will, a living will, a durable power of attorney, a medical directive, or any versions of other paperwork? If not, do they need one? Who is allowed to make specific decisions about health care, spending, etc.?

    5. Who is their estate attorney? If they have trusts, who is the trustee? What doctor(s) do they see for which condition(s)? I.e., who are all the “people” you need to know about?

    6. What access to assets do you have and might you need to cover emergency situations? E.g., if one parent goes downhill rapidly and you need to pay their mortgage, do you have access to their bank account to pay it, and if not, do you have sufficient cash to cover the cost up front?

    7. What medications do they take and for which conditions? What is their follow-up testing/treatment schedule for each condition?

    8. What are the local eldercare resources? People, funds, groups, etc.

    I am sure there is a lot more here.

  2. I’d add “Do you have your funeral planned, or at least your wishes written down?” Many places allow you to pre-pay for expenses (pick out the coffin, music, readings, etc.) so it’s ready to go when you are… (sorry, I have a twisted sense of humor).

  3. I need this list! I’m planning to show my parents this post. My parents do not have a living will. Dad does not want to talk about it. I worry about the eventualities a lot.

    The only item I have to contribute is tech help before the big decline. My son has set things up so we can go into my parents’ computers and take over from our home. Right now it’s mostly useful for when the Mail icon somehow disappears from the home row, but I’m sure more is coming. We also help transfer pictures from camera to computer, deal with phone issues, etc.

  4. Get a general sense of the assisted living and continuing care facilities in your area. You will need more specific research when the time comes, but a general sense of what’s available is a good thing to have on hand. You will have to go to the places and interrogate the salespeople, who will lie to you. Yes, we have transportation to the doctor! On alternate Tuesdays between 10 and 4, they fail to mention. I saw assisted living places where the residents, many with mobility problems, had to go through a cafeteria line to get their food.

    You have to go and look and see. It’s a huge pain, and I was still working full-time when I went through this, and my boss was a total jerk about it even though I had plenty of vacation time. He couldn’t live without me, so firing wasn’t likely, but he was really awful about it. You might be able to pay for some of this info if you contact a geriatric care manager. But you have to go and see — how old and disabled are the residents? What are the facilities really like? What’s the food like? (That’s huge.) Do they have a deal with a medical practices such that MDs and/or NPs come by regularly? Can Mom/Dad get added to that medical practice? Can the staff administer meds? Do they take long-term care insurance? How many executive directors have they burned through lately?

    The most convenient places will have attached skilled nursing facilities. Your parent will need skilled nursing at some point, possibly temporarily. Mom did for a few months. Her regular place could do everything but IV medication and parenteral feeding. Ask if the facility can do those things. PUSH HARD. I repeat: The sales staff will lie to you. Push.

  5. One of my biggest headaches have been around beneficiaries. Who is the beneficiary of life insurance, IRA, pension, etc.? And, are the current? Meaning it doesn’t list a person who has died, an entity that no longer exists, or the person or entity’s name does not exactly match the name on the policy, IRA, pension, etc. And, if the beneficiary of an IRA is a trust, the trust EIN can’t be the same as the deceased person’s SSN.

    Also, cancelling service. It was MUCH easier to tell entities she was moving and disconnecting service that she was dead and needed to disconnect service. For some reason, the customer service was happy to take the story that my mom was downsizing and needed to cancel her phone, but threw up a lot of hoops if her phone service needed to be cancelled because she died.

  6. but threw up a lot of hoops if her phone service needed to be cancelled because she died.

    Oh, yeah, order a couple dozen copies of the death certificate. (I know that’s for later, but still.) All kinds of people who aren’t entitled to them will demand them anyway.

  7. RMS, exactly! Thankfully, my parents picked a place before I had to pick for them. But, yes you must ask all those questions. And, the big one for us was, if you are in independent living, you need to know how the list for assisted living works and what the average wait time for a spot is. The same with skilled nursing attached to the same continuity of care facility.

  8. Saac, it could be that your father actually doesn’t want a living will. I remember years ago when, at my parents’ insistence, I went with them to their T&E lawyer. Their wills were linked, each gave everything to the other then as they mutually directed. Then it came to the living wills and medical directive. My mom dutifully gave all authority to my sibs and me (I refused); my dad declined– he did not want a living will. Well, a brief argument ensued. My father insisted that the LAST people he wanted to decide his fate were his kids. Period. He wasn’t signing anything, and didn’t. Same on the health directive. My mom wanted “no ressitation” (sp?, sorry), my dad wanted to be kept alive at all costs. Another argument; dad persisted.

    Happily, one morning he keeled over and died pretty instantly, so it was no problem. Later when my mom was dying, my sisters who held the powers under her living will fought constantly (I refused to participate) and there are still hard feelings among them.

    We’ll never know how my dad’s wishes would have played out, but it could be he made the right decision for himself.

  9. PTM – My parents had a “living will” that basically laid out their wishes, such as no heroic efforts, etc. that was different from a “medical power of attorney” that gave me (in this case) the ability to make medical decisions on their behalf. Maybe this is due to my state and it is different in other places?

    When it came to in home DNR, my dad kept saying he wanted one, but would never complete the paperwork. Plus, my mom could never have done through with it.

  10. My parents named each other as power of attorney, and I am the back-up on each in the event that parent is unable to make decisions. My parents living will is very specific about the conditions under which they do not want care continued. I made both my siblings a copy so we all know where my parents stand now, when it’s not emotional. (Although my dad has made his wishes crystal clear after they’ve seen multiple friends live their last months in a hospital bed) I am hoping to avoid what PTM describes.

    I might also add to the list, if they are religious, to understand if/how they can attend services from assisted living, and who you should contact at their preferred place of worship when they pass.

    I really think the financial aspects are key, and making sure the surviving spouse understands the finances as well. For at least a decade my dad has been helping various newly widowed women in their neighborhood and church understand how to pay their bills. A surprising number have never done it and have no idea how much money they have to live on each month. Account numbers and passwords are really important.

    My father continues with an as yet undiagnosed degenerative muscle issue, and is now using a walker. It is clearly a matter of time before it will be a wheelchair. They are staying in their house for now, but I can see that the resistance to the coming lack of independence is going to be awful. I’m not sure how to help with that from afar.

  11. Our attorney told us he carries around in his phone copies of the documents needed for medical decisions (living will, medical power of attorney?) for his elderly mother.on his phone. On the issue of death certificates, years ago an airline asked me for one before they’d issue what they used to call a bereavement fare ticket. I don’t know if they still do today.

  12. “My parents living will is very specific about the conditions under which they do not want care continued.” — Hmm, I think ours is rather general, with just a few specific procedures spelled out. What is better, or more common?

  13. Austin, I don’t know the answer to that question. My folks lived in a different state at the time they died. I do know my dad died fully testate, but had no other ancillary documents such as a living will. My mother did. She was papered up the wazoo! In Florida I have a living will, a durable power of attorney and an advance statement of internment, so on and so forth. (The last document is purely precatory. Junior will do exactly with my body after I die as he desires, and if he is a minor when I depart, he can make the decision in conjunction with my tolerable sister who knows my wishes and may or not respect them.)

  14. I don’t really look at a checklist, because the pitfalls arise from basically two sources.

    1. The elderly individuals refuse to cooperate and manage to clean up okay when the kids visit.
    2. The kids are in denial or are simply to far away or too busy to notice the signs.

    The kids can read a lot about what they need to research/encourage for number 1, but if they, as is the usual scenario number 2, completely overestimate the current abilities of the elders, the crisis is upon all before you know it.

    If your parents (pair) have good health and mental acuity and money/pension, about all you can do is ask them to get their paperwork in order. You can investigate what is necessary in their state(s) of residence and give them a list of suggestions. It is much harder to prevail on a married couple to arrange things and involve their children than on a single parent. Old school Mom, even if she was employed outside the home in a significant manner, wants to take care of the day to day, and old school Dad is not about to give up his waning control over every possible non domestic detail. He may also not think Mom is competent to manage the money, so he has already picked some other relative or an attorney to step in at his death, and that may not be the designated caregiver, usually a daughter. And frankly, a couple can muddle along pretty well when either one singly would have been in much greater need of assistance.

  15. I think I’ve bored y’all before with my suggestion that you look at medicare.gov as you are looking at CCRCs. You can get the results of inspections which include such exciting but crucial topics as success in ostomy management and rate of bedsores. I found that there was sometimes a disconnect between the ratings for the assisted living vs. nursing home facilities in the same complex. Most reasonably healthy elderly folks and their adult children really do not expect mom and dad to need the nursing home and don’t bother to check it out. A friend just moved her mother from the nursing facility in her highly rated and expenses CCRC because the leak in the ceiling, dripping on mom’s bed in the nursing home, was not fixed after they tolerated it for a week.

    I think my parents signed living wills because that seemed like what reasonable people do. When it came right down to it, they ignored it and so did my MD sibling. Saac’s dad is probably just more honest than a lot of people. It is very, very hard to call it the end.

  16. Rocky, that’s how I wanted to pick a school for my kid, and therefor a place for us to live.

  17. I’m sure it’s hard for anyone to contemplate, but without going too much into his personal biz & decision making, I can see factors that complicate the living will decision for my dad. Doctors, as a group, tend not to want all the extreme life-prolonging measures. Catholics’ faith does does permit suicide, which might or might not include DNR. That alone can tie a person up in knots.

    Has anyone here worked through the question of a living will with their parents? How did you do it?

  18. In MA, living will provisions are not binding on the health care agent or physicians, even though they are a good indicator of what the person wants. IME the kids are the ones who want to keep the parents alive, despite any living will.

    Austin is right about the beneficiaries. I struggle with that with my clients – it is hard because the retirement plan administrator won’t talk to me as the attorney, so the *client* has to call them and ask who the beneficiaries are, so I have to keep bothering them until they do. :-P

  19. “Junior will do exactly with my body after I die as he desires, and if he is a minor when I depart, he can make the decision in conjunction with my tolerable sister who knows my wishes and may or not respect them”

    I fully expect my sisters to ignore my wishes and my son’s, should I die before he is old enough to take charge. If he is still a minor, I doubt strongly that they would respect my wishes re who should get custody. Yet another reason to shoot for a ripe old age before I go.

  20. Meme – I agree before your parents “need” something it is very hard to get them to do anything they do not want to do. I also agree that when there are two of them, they manage things better than when there is just one of them.

    However, looking back, both at my mom’s decline and dealing with both estates, I found myself thinking if I only knew then what I know now, it would have been a lot easier. Like the beneficiary issue. I didn’t think to ask my mom to write to request who all the beneficiaries were on all her accounts/policiies after my dad died. If we had, we could have fixed a couple of them that would have made the processing much easier after she passed.

    S&M – I found it was easier when the attorney brought up the medical power of attorney. The attorney suggested that my parents do a living will in order provide guidance to the person who holds that MPOA.

  21. On the face of it, DH deals with his parents but for several routine medical issues, I have been the consultant so to speak. I do a lot of the research and just have more of a general awareness, so a lot of “what should we do now” questions fall to me. I also am somewhat of an outside party so I play the role of an oasis in a sandstorm.
    With my own parents, so far they have been more open to advice from my sibling and myself. They downsized and I am glad they did. They have seen senior facilities near me and as RMS and Meme had described you definitely need to be pushy to get the specifics, especially the total cost.
    Right now my parents are managing well enough on their own but a time will come where I will have to offer much more assistance. They thought of moving to an independent living facility but their arrangement of a walkable rental apartment works well and they preferred that to the facilities they saw. I have one more facility in mind which I think they will like.
    I am not sure how this will shake out. Maybe, I will enter the pearly gates before all the seniors in my life make it there.

  22. Oh and none of the seniors wants to be kept alive at all costs nor are any of the kids inclined to do that, so that hopefully is an easy decision.

  23. Seeing what various elderly relatives have endured as they aged, I think I prefer to go as PTM’s dad did – no lingering.

  24. Back in 2014, I think it was the WSJ that ran an article that you needed to have these conversations by either the time the child hit 40 or the parent hit 70 (noting that if there was already a chronic or significant illness this should happen earlier). The point being is you want to have these conversations before there is a crisis so their wishes can be met.

    My parents were both out visiting my family that November and I really pushed to get some answers on the questions that were raised above and sent the answers to both my siblings. I was able to use the fact that I lived over 2000 miles away now and wanted to make sure I was involved and my siblings weren’t overly burdened. It’s taken about 2 years but now we have all pieces in place so I suggest you start early. The conversations can be difficult but worth it. As a result of these conversations and some research, we have a pretty good handle on how they want to live, can discuss any issues with their physicians and know where the paperwork is and all passwords. I’m know pushing my husband to get geared up for these conversations with his parents.

    My book club read Being Mortal by Atul Gawande which I found helpful. And in January Fresh Air interviewed Dr. Haider Warraich who wrote Modern Death: How Medicine Changed the End of Life. I haven’t read the book yet but his interview was riveting and I told my parents that I would be hard pressed to let a feeding tube be inserted given their ages without really understanding what it was going to help.

    http://www.npr.org/podcasts/381444908/fresh-air

  25. I have posted before about my mother and her elder care. My dad (they’re divorced) is still healthy and living in his own house, but increasingly needs help with “tech support” similar to what S&M described above. He has largely kept his affairs very ordered but entirely on paper – no online banking, he even does his taxes with paper and pencil. The problem now is that the company that administers his pension is no longer mailing monthly statements. He got a letter saying his statement will be available online, and similar stuff is happening with other accounts. He’s just not used to doing things online, and doesn’t trust the system, so this is going to be difficult for him.

    For those who are far away from elderly relatives, there’s this. When my mom was still living alone and my brother and I lived 40 minutes and 2 hours away, respectively, we got her one of those call button things – you know, with the “I’ve fallen and I can’t get up!” commercials. In the 5 years or so before we moved her to a CCRC near us, she used it a few times for things like locking herself out of the house and whatnot. It was very inexpensive and worth the extra piece of mind that she wasn’t going to be stranded if she fell or something, and we set it up so that my brother and I would get a phone call anytime she pushed the button, so we would know if she had a situation. But ultimately, moving mom closer to us was the best thing we could have done for her – even if she doesn’t always feel that way.

    On living wills… Neither of my parents has a living will, though they both have estate plans and medical POAs. My mom’s community asks that she fill out a POLST form every year and so far we have always checked the box for provide all care in consultation with her doctor and we’ll continue to do that until it makes sense to change it.

    When we moved mom here, the first thing I did was take her to meet with an estate planning attorney to do her will/trust and POAs. I think it’s important for there to be someone with POA for healthcare and finances (not necessarily the same person). When my mom broke her hip recently, I went to the bank with my mom’s POA (which names me) and spent two hours with the branch manager setting me up with my own user ID and password for my mom’s accounts and the necessary documentation so that I could sign checks on her behalf so that I could pay her bills, etc. This has come in handy since she’s been in skilled nursing recovering from her hip fracture and it’s also given me a better picture of my mom’s overall financial situation.

  26. My mom’s estate attorney not only helped her to update all her paperwork and trust, but also advised her to make all non trust bank accounts joint with me. That meant that they passed to me on death as a matter of law, but if there are multiple sibs and a will, it can be drafted so that the shares are evened out by one means or another. Then I have online access. I simply went online with the credit card she didn’t do online purchasing or record keeping and set up access via a gmail account she had. That is not strictly legal, even tho I had poa.

  27. I am reading a book called The Gene by Siddhartha Mukerjee. Fascinating but a very dense and in depth book.

  28. POLST?

    GFM, having her checkbook is a lot! I was going to suggest something similar for your dad (print and mail statements, bills, etc to him), but surely a sibling can do that.

  29. The initial conversations about these matters are very challenging. For some parents, it can help to involve a neutral and professional third party. MIL has a medical POA and advance directive only because I found a local T&E attorney to prepare a new will after FIL died and she did everything he told her to do.
    When MIL had her crisis physical health issue that revealed her worsening dementia, I remembered something that Meme had posted about geriatric care managers and found one for the family. She was a great fit and helped the family assess the options in a friendly way, but after a few weeks of the at-home care she arranged, BIL decided to have one of his kids provide the care and discontinued their services. This is a guy who changes his own oil and he is not used to paying $100/hr or whatever it was for advice. As the baby boomers age without kids nearby, the geriatric care managers will be a growth industry until there is a Retirement Community Confidential as a source of wisdom on facilities. The lack of such an online research tool is surprising — you can probably get more helpful and accurate reviews on kennels than on assisted living and nursing homes.

    I’ll add that even for attentive and involved adult kids, it can be difficult to stay on top of ever changing medication lists. My dad set up the online portal for his PCP, but his cardiologist and the hospital are on a different system so even if you have online access it isn’t necessarily an easy matter. And online records don’t always include all doctor notes and those critical and casual instructions on evaluating a new med (“call us if this still makes you feel dizzy after a few days”) that may be relevant to scheduling follow up visits.

  30. “Get a general sense of the assisted living and continuing care facilities in your area. You will need more specific research when the time comes, but a general sense of what’s available is a good thing to have on hand.’

    This is behind DW and me for our parents, but…

    “Thankfully, my parents picked a place before I had to pick for them. But, yes you must ask all those questions. “

    It’s on my list of things to do once I’m retired.

    My mom had me take her and my dad to visit the assisted living facility near their house when it first opened (they’d already had extensive experience with the two older facilities in her neighborhood when their parents lived there). After the visit, they both announced that they would fine living there if/when the time came (my dad paid particular attention to the food service), which made it easier when my dad did need to move there.

    Lots of good advice here, but in my case it’s for things for me to do to make sure DW and/or my kids can take over if needed.

  31. If you have an Employee Assistance Program through work they can help with putting together a list of senior living facilities. Also other types of help like the care managers, attorneys etc can be found by them.
    I got a list of facilities in my community using the EAP. Similarly I was referred to a CPA who does international taxes by the EAP. I would have had to call a large list of places or CPA firms to find services that fit my criteria

  32. There is some great advice posted above, and I have to organize some of our stuff plus speak to my parents about several things. Another item for the to do list this summer, but I think I will feel better if I actually get some of this done.

    There was a moment at our Passover seder dinner last week that was tense because a plate that belonged to my grandmother was used by my aunt on the seder table. My mother did not know that my aunt took this plate when they cleaned out my grandmother’s apartment. I convinced my mother that it didn’t matter, but I think that she realized that it is important to give away items that are meaningful while you are still alive, or leave a list since some of these don’t belong in a will. A few years ago after a serious illness, my FIL divided up some of my MIL’s jewelry. Many of the pieces have little financial value, but they have a great deal of sentimental value to my FIL, husband and BIL. It was easier to have this conversation and divide up these items now vs. later when two brothers might have argued about certain things.

    I know that many people are actually waiting until their parents die to throw away a lot of “junk”, but if there is something that you know that one or more children will want to inherit – I think it worth a discussion, or formal mention in a will if it is that important.

  33. Doctors, as a group, tend not to want all the extreme life-prolonging measures.

    That’s because they usually just result in a poor quality of life.

    IME the kids are the ones who want to keep the parents alive, despite any living will.

    Yup. I’ve see way too many “kids” who push to do everything possible for their parents when it’s clear all it’s going to do is prolong very poor quality of life.

  34. Lauren, you’ve just reminded me that I want my dad’s old Underwood typewriter and even older train set.

    DD, besides poor QoL, I’ve seen stats on some “life-saving” measures that say they often don’t work.

  35. Yes but Rhett there are few or no reviews of those places by family members who can provide little tidbits like “there have been 3 dining services managers in 5 years” or “some wings have unreliable wifi”.
    If you sign up for info from one of those “free” outfits like A Place for Mom, you may be barraged by phone calls and emails for months.

  36. I found my mom’s asstd living place through a place for Mom. I knew nothing at the time. I visited three or four facilities, and chose this one. They didn’t have a room when we needed it, so we took the second choice which was much closer to our house. That was a disaster. but then a place opened up at the first choice. We didn’t hire the senior care manager for almost nine months, and that because the facility told me a) I couldn’t take an overseas trip without one and b) she was going to need extra private aides.

    Please excuse the following vent.

    I am just beside myself today about my dear husband. He is not doing as well as I would like. He never exercises – once Medicare stopped paying for cardiac rehab he reverted to his sedentary ways. He is so sedentary he can’t keep a self winding watch going – his wrists don’t even move enough. A few weeks ago he went to a gastroenterologist and did not understand that the instruction to cut out artificial sweeteners meant no diet soda either. He also related the drs instructions to me incorrectly – the printed paper was not available because his appt was at 5 and the desk lady had already left. When it came in the mail (I did not think to check the online portal), I realized that he had been told to take a daily probiotic. He has probably never encountered that term in his life. He heard it as “take (the OTC medicine they had just been discussing in another context) as a daily prophylactic.” The same week a pill bottle appeared on the steps. He had been given another BP med by the cardiologist a couple of weeks before and forgot to tell me or pick it up at the pharmacy. On Sunday he couldn’t handle the walking from the garage to the ballpark, got a bit sick but we managed, and slept for hours and hours on Monday. Today he called me at the grandkids and said he lost his credit card and was driving 35 min to the gas station where he last filled up. I said, wait a minute, I’ll get the phone number you can check on it first. You can do that? Then I asked, did you get the receipt? Yes. So I said, they usually wrap the slip around the card. I was at a self serve pump. Did you put the card in your pants pocket instead of your wallet after swiping? D’oh! When I got home (he is out tonight) I saw he had left his hearing aids and his phone on the desk (not uncommon) and had not taken any of the pills today (missing 2 doses of BP meds among many other things – also not uncommon). And he is only 74 and I am here pretty much all the time to nag and supervise.

  37. Meme, I’m so sorry. Please feel free to vent. We know it’s coming from a place of love!

  38. Meme – That is so frustrating. I am sorry that he is doing poorly. Has he always been forgetful or is this newer? We had to go to a pill minder for my mom when there became too many for her to keep in her head – she was legally blind so trying to read every bottle was tough.

    I am facing something similar with my partner. He complained about shortness of breath. After several tests over about a 2.5 week period, they went into see if a dark spot was a blockage or not. Due to the tests, they were thinking they were being overly cautious. However, the procedure resulted in two stents and some evidence that he had had a heart attack. He came back from his follow up. They are sending him to cardiac rehab next week. His response – he hasn’t been there yet – is that they give everyone a one size fits all “plan”. I’ll make some changes, but nothing drastic. He said the doctor agreed. Well, I wasn’t there, but my response was, what can the doctor say if you say you aren’t open to doing what they tell you? SIGH…he turns 69 in a couple of months. All afternoon I’ve been tempted to say, let’s get all your ducks in a row because you are tempting fate.

  39. Oh Meme and Austin, it is so frustrating and scary to see someone you love hurt themselves by failing to take action–I feel for you both!

  40. Meme & Austin – I feel for you both!

    I am thankful for this thread; reminds me I need to get on the stick with my sister re my mom & stepdad (he’s 90). Just general old person ailments for him, loss of hearing, some memory loss at this point. My mom (almost 83) is doing just fine so far.

  41. Meme and Austin – I’m sorry for what you’re dealing with. Geez, as soon as we think we can take a breather after seeing our parents through their decline, then we have to start dealing with the decline of our significant others. No rest for the weary.

    I actually had a really good experience with A Place for Mom. My mom was at an assisted living place near me for a couple of years. I only picked it because it was so convenient to my house. While she was still somewhat well, it was a fine place for her to live, but when she began to decline, it became a disaster. I learned the hard way that this was a place that really wanted seniors who were still pretty healthy and independent; they had no desire to deal with people who were needy, frail, and/or near death. Once my mother started having mobility issues, they slapped the label of “fall risk” on her, and told me that the only way she could stay in that facility was if I hired a private-duty aide to stay with her 24/7. My mother had enough money for the assisted living place, but certainly not enough for a 24/7 private aide on top of that.

    I was stressed beyond belief — I had no idea where to even begin looking for a new place that could accommodate my mother. I got in touch with A Place for Mom, told them about her condition, and they gave me a list of four places that they thought could be a good match. Two of them I didn’t like, but two of them I did; I placed her in one of those two, and it ended up being a wonderful match for her. This was a place that welcomed frail elders, and was well equipped to deal with them. Even though my mom became totally unable to walk while she lived there, and also went deep into dementia, they never once told me that I had to hire extra help for her. The staff cared for her, and cared for her well, right up until they end.

    So, lesson learned: There are lots of places that call themselves “assisted living,” but they can cater to very different populations. It’s very hard for an outsider to know what a particular facility’s focus is, since on the surface they all look pretty similar. An agency or a geriatric care manager can be very helpful in helping you narrow down the field of choices to places that fit your loved one’s particular needs.

  42. He’s always been impractical and absent minded. But he can still win regional bridge events, so it is not so much cognitive ability as limited blood flow from his weak heart and waning energy to pay attention I can only do so much to keep him going. That’s part of the reason I didn’t oppose the sports car. Let him enjoy it.

  43. Mémé, I hope he got a stick on his sports car. Sounds like the shifting would be a relatively large marginal increase in physical activity, perhaps enough to energize his watch.

  44. “It was very inexpensive and worth the extra piece of mind ”

    Not picking on GFM; I know what you meant, but this caught my attention because “peace of mind,” and “piece of (my) mind,” have such different meanings.

  45. Meme, so sorry you are dealing with this.
    When my dad was released from the hospital for the second time with congestive heart failure, he was contacted by a representative of a free program run by the hospital system. The purpose of the program is to keep CHF patients out of the hospital. He agreed to participate and a personable friendly fellow visited him at home to review the basics of CHF, including tracking sodium and limiting fluids and tracking weight– all simple stuff but having someone outside the family tell him that canned soup is high in sodium and that he needs to take daily walks was much more effective than having us tell him the same.

  46. Meme – I am wondering if having a personal trainer who specializes in senior fitness come in and work with your DH would help. That way, you would be relieved of the need to keep him moving. Just moving even if it is housekeeping, shopping etc. is so important.

  47. I see many younger people who don’t take care of themselves — sedentary, poor diet, and general lack of exercise. I can see how these poor habits can continue and get worse in old age. I’m sorry for what you all are dealing with, and this is a good place to vent and find sympathy.

  48. I think the balance as you age is still keeping up with normal daily activities but having help occasionally. So, for example taking care of your household tasks – cleaning, gardening, maintenance, grocery shopping but having help if there is heavy lifting to be done – so that you don’t injure yourself trying to do too much.

  49. I’m mesmerized by Jane Fonda on Grace and Frankie. She’ll be 80 in 9 months! While there has been talk here about how you age being almost purely a function of genetics, the more I look into it, the more the data says you have a significant amount of control over how you age. Jane being an example of what can be done with good genes, unlimited time, money and executive function.

    To that end, it would seem worth it to spend 2-4 hours a day in retirement on taking care of yourself: strength training, cardio, yoga, PT for your various aches and pains, etc. But I get the impression that few are considering such an aggressive course of action.

  50. Rhett – there will be a segment of the population that will do it. One other aspect I have seen is old injuries flaring up as you age. Those make it difficult to do the whole range of activities you describe. There are periods where there this or that joint will need to be replaced/rested etc, so you will be out of action for some time.

  51. Rhett — the Younger Next Year book is all about that. Worth a read, imho, as is Younger Next Year For Women.

  52. There are periods where there this or that joint will need to be replaced/rested etc, so you will be out of action for some time.

    That’s just the thing though. I’ve seen cranky only man never going to PT after his knee replacement and his wife also having a knee replacement and going to every PT session and doing all the exercises religiously. She’s a good as knew and he has substantially limited mobility and a much lower quality of life.

  53. A quote I saw a while back….Life after 50 is mainly maintenance and repair…seems apt. I agree with Rhett. I saw it first hand with my parents. Similar health conditions, she would take her meds regularly, do the exercises, etc. and she would bounce back and had a much better quality of life. My dad would take his medication if he felt bad, do the exercises for a while, and ingnored most dietary changes. His quality of life was much worse.

  54. Rhett — I exercise at our local Y, and I see lots of retired ladies who spend the better part of their mornings or afternoons exercising. They’ll go to strength class followed by yoga, or barre class followed by a swim. They’re in great shape. I almost never see retired guys doing anything similar, though. I can think of one older man who’s a regular at zumba and pilates, but I can’t think of any others that I see regularly. Maybe women are more diligent about this stuff on average than men?

  55. Rhett is absolutely right. From what I’ve seen, exercise becomes more important as you age because older people lose ability/function so quickly.

    This is finally being recognized as an issue in large nursing homes. Residents can have a hard time walking the long hallways, and need someone to walk with them. But staff doesn’t have time because they need to get everyone to the dining room or wherever, so they push the residents in wheelchairs instead, which leads to a further loss of strength. You end up with a lot of people becoming wheelchair-bound who probably would retain a lot of mobility if they were able to get a little assistance walking regularly. But once they lose it, it becomes very difficult to get it back.

  56. DH is just sedentary, his BMI is 26. He wasn’t amenable to having a personal trainer come in each week, suggestion made long ago. We have the equipment. (He was poor as a child and has trouble spending money. The new car was his only treat to self.) I manage all the pills and we have elaborate daily pill boxes. I prepare all his in house food. No canned soup in the larder.

    And Finn, we don’t live in the UK and he is not left handed, so the watch is on the hand that remains on the steering wheel. The MX-5 has a very compact shift knob, anyway. I have restricted him to hand wind watches, so he just has to wind it up once a day.

    The hardest task for me as part of a dyad, given that unlike AustinMom there are not still children at home, is to remain fully and lovingly engaged with him as my partner. I don’t want to be a nursemaid or a hovering mother. But maintaining a respectful non nagging distance that allows him to make his own decisions about medical compliance has a difficult corollary for me. It seems that a part of me is also gradually preparing for the inevitable and growing a bit more distant as a wife. A great friend and roommate is not the same as a lover, and it is a loss I am beginning to feel.

  57. My advice on joint replacement – don’t put it off. If you qualify now, do it now. For one thing, it’ll improve your quality of life immediately. It’s like magic. For another, and to Rhett’s point, the fake joints last far longer now, so there’s no real concern for any of us over 40 and of reasonable body weight that the fake joint will wear out and need to be replaced itself. It takes a loooooong time and a ton of work to rehab from these surgeries, and we are all far more likely to put in that time and effort while we’re young versus waiting for retirement or later.

  58. I almost never see retired guys doing anything similar…. Maybe women are more diligent about this stuff on average than men?

    I wonder how much that explains how much longer women live than men? I also wonder why older men are so unwilling to put in the effort to take care of themselves physically and also put the effort into building and maintaining social relationships? What’s the block?

  59. Risley — oh, of course it would have to be interval training. Can’t just be a nice 30 minute walk. I loathe interval training, because to do it correctly it really has to hurt. You have to push yourself to exhaustion. I do it, though. And my yoga sculpt classes always include cardio intervals. Haaaaate them though.

    And honestly, both my parents and my in-laws did/do just fine with walking and swimming and not hurting themselves. But whatever.

  60. RMS – ha, yes. Intervals kill. And I get you on the last point, too. Eons ago, my dad exercised daily, but for *many* years he was a total weekend athlete. And he’s 84 and in terrific shape. So why do *I* have to do this blasted HIIT training?

  61. “A great friend and roommate is not the same as a lover, and it is a loss I am beginning to feel.” Meme – sorry to hear that. I will admit, I am somewhat worried about the same thing. My partner’s desire to engage in activities with us has already begun to dwindle, as has a lot of his desire to participate in decision making or supervision of DDs.

  62. My partner’s desire to engage in activities with us has already begun to dwindle

    Is it a sort of vicious cycle? The less you do the less you want to do?

  63. Active old men usually maintain outdoor hobbies. In New England, they often become snowbirds and then play golf all summer when they come back. I wouldn’t expect to see them at the gym or walking the mall.

  64. Rhett, anything I’ve read about exercise for older people says not to overdo it. Dana Torres’ Age is Just a Number is the only one that pops into my head specifically right now, but I bet if you’d google, that’s what you’d find. If it isn’t, I’d be interested to hear that. Maybe I’m just looking at one little corner of the health & fitness world.

  65. play golf all summer when they come back.

    That’s better than nothing but still not a lot in terms of strength, flexibility, cardio etc. especially with a cart.

  66. The hardest task for me as part of a dyad, given that unlike AustinMom there are not still children at home, is to remain fully and lovingly engaged with him as my partner. I don’t want to be a nursemaid or a hovering mother. But maintaining a respectful non nagging distance that allows him to make his own decisions about medical compliance has a difficult corollary for me. It seems that a part of me is also gradually preparing for the inevitable and growing a bit more distant as a wife. A great friend and roommate is not the same as a lover, and it is a loss I am beginning to feel.

    Yes. I can see how you would feel that way, and I think I would find it infuriating because it would feel to a large extent like it’s a choice he’s making, and not entirely the inevitable progression of his disease. I am sorry, because I know this marriage has brought you great joy over the years.

  67. Off the cuff theory: women live longer and take better care of themselves because they are accustomed to high levels of maintenance: hair, makeup, diet, exercise, etc. The high level of maintenance being the result of women being judged more on their physical appearance than men are. While having many downsides, it may result in a longer and better quality of life.

  68. Meme – just now looked back up and saw your post from this morning. I completely agree w/ what Lark just said.

  69. Yes. I can see how you would feel that way, and I think I would find it infuriating because it would feel to a large extent like it’s a choice he’s making, and not entirely the inevitable progression of his disease.

    I felt that way about my mom.

  70. Is it a sort of vicious cycle? The less you do the less you want to do?

    Of course it is. Do less, get more out of shape, have less energy, do even less, etc. The cycle works the other way as well. The problem is it’s a lot harder for most people to be more active than to be less active.

  71. Rhett, that could be. Another common theory is men tend to do the more physically demanding jobs, so their bodies get worn out sooner. They also do more of the higher risk jobs. And they also tend to have the higher stress jobs, which can cause a physical toll.

  72. Rhett – I think it is. With teens, striking the balance of letting them grow up, be responsible, and yet remain involved, while not being a helicopter parent and not pushing back too strongly against their desire to be independent is hard. I think it he is taking this phase of child rearing much more personally and is pulling back completely rather than finding that balance.

  73. Austin, between the disappointment in how little help you received in dealing with your parents and now the disappointment in shared parenting, I can see how this is a really difficult phase of life for you right now. I send hugs and sympathy.

  74. Dh already doesn’t take care of himself to my standards, so I can see it getting worse as he gets older. He’s had a sore tailbone and neck for a month and has not even called the dr. or done any stretching/tried changing his pillow/or used the seat cushion I bought him. It’s infuriating. Also we have three kids and so I sometimes feel like I do not have the bandwidth to also stay on top of his stuff (because he’s a fully functioning grown up).

    I’ve been making him do this T-Tapp workout the past two nights – it’s 15 minutes and it’s supposed to help rehabilitate your body/balance your hormones and he said yesterday he actually felt a lot better. But I have to do it with him to ensure he does it. He also hasn’t slept well for almost a year and so I’ve suggested he make sure he gets outside in the mornings (maybe walk our oldest to school) to try to reset his circadian rhythm but he doesn’t. I think part of it is he feels like he’s too busy to fit this stuff in, but in reality he spends at least an hour every day watching television.

  75. Now that I’ve read the rest of the conversation after Rhett’s “at least a couple hours a day” comment, I want to clarify my response. Staying active and maintaining strength are very important as one ages. But I think 2-3 hrs/day is the max for older people; not the minimum, and that good results are possible with an hour or less.

    I guess I’m lucky that my parents are both the most compliant patients in the world. They both really want to do whatever regime is necessary. With his memory loss, she has to continue being the “executive function” like when we were little. I don’t believe he gives any resistance at all. He can’t wait to get on the tennis court, plays a couple of hours several days a week. She is a nurse by training and can turn that off to enjoy things with him, but he clings to her, which is troubling. She has never really enjoyed exercise, and probably needs someone to push her. I think he used to do that. Right now they are on a tour with old friends. She has said this may be their last one. I hope they have a wonderful time.

    I don’t like HIIT either. I’ve decided not to let perfect be the enemy of good. I like lifting weights, so I do that. I do some cardio, need to increase it. I also notice that stopping yoga was the wrong thing to do. That 75 min once a week really made a difference. I’m going to have to bite the bullet and find a different instructor. The Booty Burner routine I’ve mentioned on here before is great for my entire back. These things should be routine by now, but instead the novelty has worn off and I’m having a hard time losing the last 10-20 lbs/2-3″. Swim workouts are essentially HIIT, especially if you do a lot of sprints. It is hard to find a pool cool enough to work out in. I can’t believe the Y built a new swimming complex with a dedicated lap pool, and that they keep the temp at 82-84! Yes, there are people who put up with it and just swim, and yes, I know I should too.

  76. Dh already doesn’t take care of himself to my standards, so I can see it getting worse as he gets older. He’s had a sore tailbone and neck for a month and has not even called the dr. or done any stretching/tried changing his pillow/or used the seat cushion I bought him.

    A few months ago I went to jog up a couple of stairs and felt a sudden painful twing in the knee that continued to hurt for weeks. The culprit? Age, 30 extra pounds and not enough exercise. Last night I came to the same set of stairs and, 30 pounds lighter and exercising every day, I jogged up them without a hint of pain. I can certainly see how you could spiral down instead with pain leading to inactivity leading to more weight and more pain until you’re barely mobile.

    What’s the mentality behind not trying to maintain a high quality of life?

  77. “a choice he’s making, and not entirely the inevitable progression of his disease.”

    Delression cuts into your ability to make that choice.

  78. Rhett, dude, congrats on the weight loss!
    Like you & the steps, I had a couple of experiences that took all my general griping & recognition that I was too heavy and crystallized them. Pulling my back in July and seeing my son’s fear when the steps at the water park were a lot for me to climb really did it for me.

  79. I can see comments that some of you are making applying to my DH as well. He has gotten better over the years both with respect to diet and exercise. I am not sure how he will handle retirement.
    The family history of stomach issues has affected one of my kids, so now our house is forcing everyone to be ultra healthy as far as diet is concerned. Same thing with exercise. Some of us absolutely have to move and drink plenty of water.
    I lost a couple pounds because although I am fine, I am subject to healthy living as well.

  80. Another thought, in my early 30s I had depression and a related chronic health problem that became quite debilitating. However, between the right treatment for the health problem and the anti-depressants it was a night and day difference within days. I think the predisposes me to think that if I have a problem, there is a solution if you just do what I need to do.

    I can imagine that for someone who was more or less healthy until they were in their 50s and 60s they would have a lot less faith in a given treatment regime.

  81. Sometimes I think DH goes overboard* and veers into what I might consider faddish territory in his goal of staying fit and healthy, but at the moment I realize I should be thankful he puts so much effort into it. We both do HIIT and find it easier than traditional workouts.

    * Organizing and packing his nutritional supplements when he travels is the most time-consuming part of preparing for any trips.

  82. Related to the “spiral[ing] down instead with pain leading to inactivity leading to more weight and more pain until you’re barely mobile”, I found it really hard to get back into working out. I was always kind of athletic (but never a superstar), so not being able to do a squat–at all–after the pulled psoas and feeling “done” after swimming 600 yards were just perplexing to me. How the heck was I supposed to get in shape like that?!?! I was frustrated by trainers who said “you’ve just got to have the discipline” or similar, and didn’t recognize the difficulty in not being able to do what you knew of that would help. Otoh, I recall wondering what people meant when they said recumbent bikes gave you an ab workout and that I used to run up water park steps repeatedly, and now I see the challenges there. Lucky young trainers have never had that experience.

  83. “What’s the mentality behind not trying to maintain a high quality of life?”

    It’s difficult and unpleasant for most people. I am not as fit as most here, because I’d rather sit on the couch and read a book and drink a glass of wine.

  84. “It’s difficult and unpleasant for most people.”

    Absolutely. And don’t discount the real physical limitations many of us encounter as we age. While in many cases there are workarounds, sometimes the alternative exercise options are much less appealing and the pain or discomfort in moving can be severe.

  85. I am not as fit as most here, because I’d rather sit on the couch and read a book and drink a glass of wine.

    But you’d still presumably take your blood pressure medication. I can understand not wanting to exercise. But the stuff that takes 30 seconds a day and can make a huge difference?

  86. My parents lay in wood for the winter and it is their form of HIIT. Pa uses a chain saw to take down trees (thanks national forest!) and then they load the truck with the chunks, unload it, and split it. They have decided in the past two years to get a gas powered splitter, so that does save some of the work. But it still has to be stacked after split. Some of the healthiest older folks that I see are people that have extensive property they need to maintain. Of course, there’s a balance of this, as it all falls apart when suddenly they can’t get wood for the woodstove anymore.

  87. Moderately high blood pressure has no symptoms, and Minnie blood pressure medications have no side effects. It’s hard to take something that makes you feel unwell, when you don’t find the condition itself a problem.

  88. Let me try that again-moderately high blood pressure has no symptoms and many blood pressure medications have significant side effects.

  89. Also I think the difference between men and women, at least for me personally, is I feel like I don’t have time to feel bad so if something hurts I will research ways to make it better because I want to maintain my standard of care for my family (i.e. cooking healthy meals, doing fun things, making sure we have clean laundry. etc.). DH isn’t responsible for all of that so I think he’s more likely to let things slide. If I was only able to sleep for 6 hours like him I would be trying a lot of things to fix it because I know I do not do well with less sleep.

  90. DH isn’t responsible for all of that so I think he’s more likely to let things slide.

    Presumably his job is somewhat demanding.

  91. Let me try that again-moderately high blood pressure has no symptoms and many blood pressure medications have significant side effects.

    My doctors said there are a number of options and different things can be tried to find the best combination. What I’ve seen is when X doesnt’ work, rather than try the 10 other options they just give up*. IIRC one of the leading contributors to CHF is poorly managed high blood pressure. That seems like something it’s worth putting in the effort to avoid.

    * Again I think I benefit from my chronic health problem in that the initial treatment was totally ineffective but the second one was a night and day difference. As a result I may be more willing to try a few different options that others might.

  92. “If I was only able to sleep for 6 hours like him”

    I think the difference in sleep needs is fascinating. My dad needed 7 or maybe 8 hrs a night, really could not understand that I, as a young adult, really needed 9. Some people need as little as 4 or 5. Talk about genetics making a difference in your ability to accomplish things! I don’t think there is any real way to significantly change your own personal sleep requirement. There are plenty of studies that show that even when people become accustomed to less sleep, their bodies and memory function pay a toll, and they revert back to their earlier norm in sleep labs, sometimes after a few days.

  93. This popped up in my FB memories today. It uses the discussion we’re having as an analogy for other things.

    Dalia Mogahed
    April 15, 2016 at 7:50pm ·

    This morning my trainer explained that muscle soreness signaled the need for increased blood flow to that area, which is how the body heals. So taking Advil or any other anti-inflammatory to “not feel sore” causes blood not to flow to that area (what an inflammation is) and thus it slows or prevents healing.

    I thought about all the ways we use to “not feel pain”– food, drugs, work, other people, emotional suppression– our anti-inflammatories that reduce pain temporary, but also slow healing because the process is stunted. We strive to “feel good” vs actually “being healthy”. The absence of pain is not the same as health–sometimes pain is proof of health. Healing and real strength is about getting torn up and working through the pain to grow stronger. This requires discomfort, patience and perseverance. I’m not judging all who can’t bear the pain. Just saying don’t confuse numbing the pain with progress.

  94. Rhett – it is demanding sometimes and his job is part of the problem (a few times per month he’s up until 2 or 3 in the a.m. working and even when he’s not up late working he’s looking at screens until he goes to bed which can interfere with sleep). 6 hours of sleep is not enough for him and I think long term sleep deprivation can lead to serious health problems so why wouldn’t you try something to fix it? Anyway, it’s a fine line between trying to help and being a nag (and too often I think I’m more of the latter). My parents are both compliant with drs. orders and have always exercised and his parents are completely the opposite (except his step father who is very healthy) so maybe there is some parental modeling going on too.

  95. Some people just love to work out and compete. Can you tell which woman is 6 months pregnant? She swam the 50 in 27

  96. “I almost never see retired guys doing anything similar, though.”

    On some of the occasional non-holiday weekday mornings I’ve not had to work over the last few years, I’ve gone to get in a workout.

    At our local HOA rec center’s fitness room, at around 8am, when it first opens, there’s been quite a few retirees working out, pretty evenly split between men and wormen.

    At the gym I belong to, there’ve also been a lot of retirees, split between men and women. The women mostly were in classes or on cardio machines, while most of the men were doing resistance work, some were doing cardio, and very few were in classes.

    Working out 1 to 4 hours a day is something I look forward to in retirement, and I include doing yardwork as working out(side).

  97. “I like lifting weights, so I do that. I do some cardio, need to increase it.”

    Have you considered circuit training?

  98. We had a very nice day today with a lovely lunch out. Blowing off a little steam with you all can make me appreciate the present and the good. I also made myself go to sleep at a decent hour. I handle stress poorly when I stay up with reading or entertainment until I literally keel over in bed.

    Rhett – He takes the following meds, all different, some 2 or 3 times a day, with varying doses at times of day or days of the week. 2 bp meds, 2 diuretics, 2 heart pills and 1 anticoagulant for his heart. One pill each for thyroid (post cancer), gout, diabetes (mild). 2 antidepressant meds. 1 sleep aid. Plus vitamins. He has a low carb, low salt, low dairy diet. He doesn’t refuse the pills, they are carefully laid out in a four times a day pill box, he just doesn’t pay good attention. Why he can’t choose to exercise, I don’t know. I get plenty of exercise, not formally in a gym, but I can’t manage to shed the next 20 pounds. Each person has areas of resistance.

  99. I had rotator cuff major surgery 9 weeks ago and the 3x a week rehab is excruciating. In between it’s still a dull pain. Women all tell me, “my husband couldn’t stick to the 25 weeks of rehab so he never regained full range of motion.” I am so determined to not let that happen, but boy I sure understand wanting that torture to stop….

  100. My dad calls rehab and the physical therapists the physical terrorists. If it wasn’t for my mom, who handles his calendar and drove him to every rehab appointment, he would have quit after a few sessions.

  101. I wonder how many spouses are complicit in people avoiding their PT. When I first saw my dad after his hip replacement, I cried because he was so bent over, using a cane. (I his so he didn’t see). Then when we visited them a couple weeks later, Mom told me not to get things for him–not just in general, but when she saw me seeing that he wanted/needed something, she’d say “don’t get that for him”. It was excruciating to not do it. She was taking the long view Rhett mentioned this morning about people not avoiding CHF by exercising. As I said recently, he was back riding his bike to tennis 4 or 5 months later. It would be so easy to circumvent that by helping in the moment, repeatedly.

  102. I had rotator cuff major surgery 9 weeks ago and the 3x a week rehab is excruciating. In between it’s still a dull pain. Women all tell me, “my husband couldn’t stick to the 25 weeks of rehab so he never regained full range of motion.” I am so determined to not let that happen, but boy I sure understand wanting that torture to stop….

    I had a rotator cuff repair about 2.5 years ago and was not nearly as diligent with my PT and exercises as I should have been. They said it was 6 to 9 months for a full recovery, and it was about a year for me. It’s hard to get to PT three times a week when you are working, dealing with kid/family stuff, and I was still in school. And I was a great example of not spending the 15 minutes a day doing the exercises. I didn’t have time until the end of the day, and I was tired and comfortable on the couch.

  103. DD – If you got to full recovery in a year with that schedule- I’d call it a victory!

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