any good books on dealing with aging parents?

[mattkime]

My inlaws are getting to the point that they need more help. They live in an independent living retirement community and the time isn't far off when they'll need to move to the assisted living portion of the same facility.

My father in law is doing pretty well but he's lost a fair amount of mental sharpness in the past year or so. Small yet important deals that he would have held firm in the past now slip by. A couple of his siblings eventually died from alzheimer's disease. He knows he should get tested but essentially refuses. We suspect he doesn't want to know the result of the test. Generally speaking, he's reluctant to accept help, seems to proud to admit his limitations even when they're obvious.

My mother in law is in the early stages of kidney failure and has been placed on an array of medications but its impossible to tell if she's taking taking any of it correctly. She regularly cancels home health aide visits for reasons that either insufficient or nonsensical. My sister in law is attempting to manage the situation but its difficult to do in addition to a full work schedule. My father in law at some level is incapable of improving the situation.

This is all to say that they're likely ready to move to the assisted living portion of their retirement community. It would be a physical move in addition to an admission of their declining abilities. They may disagree that they're ready for this but it seems clear that either they can do it sooner and on their terms or later when they're somehow forced.

We're going to visit in a couple of weeks. We're very glad we'll be fully vaccinated by this point. That said, it seems my wife will need to take this as an opportunity to talk to her father and discuss how we see the situation. I guess she'll need to talk to her mother as well but thats a secondary concern for reasons that are both present and historical.

Any advice on how to prepare for such a conversation?

I know a lot of people have been through this so I'm hoping there's some good reading on the topic. It would also be good for us to familiarize ourselves with the details of what this transition would be like.

[Ombligo]

Just remember that it is ultimately their decision until such time that they are declared legally incompetent. When we faced a similar situation, we gave my mother choices and let her decide what she wanted.

Don't take sides or push one option, just lay out the pros/cons from a neutral stance.

I would also discuss a family member getting a healthcare power of attorney for at least your mother-in-law. Once again, it is still their decision and must be respected. Likewise, a trusted family member should be on their bank account.

[rgG]

This is a difficult conversation to have.
I don't know of any books, but I am sure there are many. We were lucky that my FIL volunteered to give up his keys, just before we were going to have to tell him he needed to.
The only thing I can say is to try and stress the positives of doing to on their own terms and not when they are incapacitated. Stress that this gives them plenty of time to get ready and plan, so it can go more slowly and hopefully smoothly.
Try to do it with love and understanding and hope for the best. We will all be there, eventually, and it isn't easy for either side.
At least they are already in a retirement community, so the move should be a little easier.

[GGD]

A related topic to consider.

I don't know how many children they have, but it would be good if one child could assist them with tracking their medical conditions and finances. Possibly even going to doctor appointments with them and understanding their conditions, and treatments, and make sure that they're following up. And understand what medicine they're supposed to be taking, what each is for, and make sure that they're getting them refilled and are taking them as prescribed.

And for finances, understand what all of their bills are, due dates, phone contacts, websites, etc. If the one that has been handling the bills passes away or their ability declines, it's helpful when a child is familiar and can step in to take over.

And maybe even review monthly banks / credit card statements just to make sure that they're not getting caught up in any scams.

[Dennis S]

An AARP subscription would probably be worthwhile.

[Lemon Drop]

GGD wrote:
A related topic to consider.

I don't know how many children they have, but it would be good if one child could assist them with tracking their medical conditions and finances. Possibly even going to doctor appointments with them and understanding their conditions, and treatments, and make sure that they're following up. And understand what medicine they're supposed to be taking, what each is for, and make sure that they're getting them refilled and are taking them as prescribed.

And for finances, understand what all of their bills are, due dates, phone contacts, websites, etc. If the one that has been handling the bills passes away or their ability declines, it's helpful when a child is familiar and can step in to take over.

And maybe even review monthly banks / credit card statements just to make sure that they're not getting caught up in any scams.

Amen to this .We waited a little bit too late to fully support my Mom with her finances and she made some big, regrettable purchases after a lifetime of wise money management. And got taken advantage of a bit by some people who worked at the house.

Communication between siblings is key. It will help the parents tremendously If the adult kids present a united front of support without bickering.

And yes testing is crucial. If either has early stage dementia the sooner you plan around it the better. A good neurology team is invaluable. Make sure adult siblings know about all health issues so they are all managed appropriately. Divide up the tasks amd communicate regularly.

There are many good books on aging, one I found useful is Contented Dementia by Oliver James.

Best of luck and remember to take care of yourself as you care for them. It can get very hard. .

[Don C]

It is possible that the home has a counseling service you can talk to. Undoubtedly many before you have had to make these decisions and the experience of the staff can be a guide.

That is assuming you trust the staff, of course.

[NewtonMP2100]

.......the book.....of life....

[Diana]

Lemon Drop wrote:
[quote=GGD]
A related topic to consider.

I don't know how many children they have, but it would be good if one child could assist them with tracking their medical conditions and finances. Possibly even going to doctor appointments with them and understanding their conditions, and treatments, and make sure that they're following up. And understand what medicine they're supposed to be taking, what each is for, and make sure that they're getting them refilled and are taking them as prescribed.

And for finances, understand what all of their bills are, due dates, phone contacts, websites, etc. If the one that has been handling the bills passes away or their ability declines, it's helpful when a child is familiar and can step in to take over.

And maybe even review monthly banks / credit card statements just to make sure that they're not getting caught up in any scams.

Amen to this .We waited a little bit too late to fully support my Mom with her finances and she made some big, regrettable purchases after a lifetime of wise money management. And got taken advantage of a bit by some people who worked at the house.

Communication between siblings is key. It will help the parents tremendously If the adult kids present a united front of support without bickering.

And yes testing is crucial. If either has early stage dementia the sooner you plan around it the better. A good neurology team is invaluable. Make sure adult siblings know about all health issues so they are all managed appropriately. Divide up the tasks amd communicate regularly.

There are many good books on aging, one I found useful is Contented Dementia by Oliver James.

Best of luck and remember to take care of yourself as you care for them. It can get very hard. .
Very good advice here. Everyone needs to be on the same page; review the bolded passages above. Communication, communication, communication!

It looks like they have considered (to some degree) that they will need to go to an assisted living situation sometime in the future, since they are in the independent side of an independent-to-assisted-living facility. As this appears to be the case, you are in a better situation than others.

This is a road that many have had to tread, whether they wanted to or not. Definitely seek the experience and advice of the staff. Also, if you have a trusted clergy you can rely on, please do so. There are resources found within the state you/they reside. Often, however, they can be difficult to ascertain, difficult to obtain, and just a royal PITA to get on the list. "Not qualified" is the worse you may hear, but not applying for something you may be qualified and YOU NEED is just wrong. Sometimes, these resources are grouped into other services and the other services make it unpalatable to seek out the appropriate resources; as an example, as we age we often need mental health resources which can be grouped together into Medicare (OK, we can deal with that) to Medicaid (often thought of as welfare, and thus unacceptable) or under a psychiatrist (I'm not crazy!) to who knows what. All I can advise is what I have gone through with my mom, and that only really applies in the state I live in if not on a county-by-county basis.

In the independent living vs assisted living spectrum (and yes, here it is a spectrum) we have on one end fully independent living. On the other end is the "nursing home" or what may be termed assisted living. These terms are somewhat fluid and can be confusing to all involved. At least in my state, such facilities that offer the range also offer the occasional nurse/OT/PT person coming in and doing what needs to be done from a medical standpoint. Some facilities offer cooking/housekeeping as well. Your MIL declining the home health services is making it difficult; potentially not taking her medications is quite concerning. It is quite possible that she is suffering from a form of delirium, especially if her kidney function is that far down as the metabolites that normally would be flushed out of the body build up and have rather unpredictable consequences. This is not an uncommon ailment for older sick individuals and if that is the case then she is unable to make rational decisions regarding her health care. Take your FIL over to one side and explain the situation to him: as she gets worse, her memory and cognitive function will possibly (most likely) decline and thus (unfortunately) it will fall on him to make sure that his wife is well taken care of. See my disclaimer below.

The Alzheimer's testing is crucial to understand where he may be on his own path. Is he just at the age-appropriate memory loss stage, or is it worse? An argument can be made that he needs to be tested for his wife's benefit, not his, as she is in need of someone to make the decisions on her healthcare and to make sure she abides by them. As a mother, she may not be wanting to take the advice from one of her kids, but as a wife, she very well may listen to her husband and do as she is told.

DEFINITELY someone needs to be going to the doctor's office(s) with them. This person needs to be put on the disclosure list so that they can call up and discuss the parents' medical issues, medications, etc. This person needs to be the one to (a) remember what the doctor said; and (b) make sure that they can tell, often repeatedly, what the doctor said in plain English to the parents. Don't be afraid to ask the doctor, and if it is clear that what he/she is saying is not getting through to the parent(s) then ask for the same thing in simpler terms. In my own experience, if I don't go to my mom's doctor's appointments and perform just this service, she will often forget what the doctor said or remember just the parts of it that she wants. That becomes quite evident when I ask her what the doctor said, and then I talk to the doctor on the phone. Here lately it is often "I don't remember what he said."

Many of the decisions you (or the caregiver) make will lead to a one-way street: once Medicare gets involved in the assisted living scenario, they don't want to have to be told "no, we don't need you" only to be told "HELP!". My understanding is that once one goes into the assisted living with Medicare paying, there is no coming back out. Independent living is fine, as long as you can pay for it. Once the money runs out, then you go to the assisted living side with Medicare footing the bill. The loss of independence and the concomitant loss of making one's own decisions is difficult for the patient, especially if it appears to be sprung on them all at once.

Ombligo wrote:
Just remember that it is ultimately their decision until such time that they are declared legally incompetent. When we faced a similar situation, we gave my mother choices and let her decide what she wanted.

Don't take sides or push one option, just lay out the pros/cons from a neutral stance.

I would also discuss a family member getting a healthcare power of attorney for at least your mother-in-law. Once again, it is still their decision and must be respected. Likewise, a trusted family member should be on their bank account.

Also, very good advice. The power of attorney is easy enough to get, and only invoked if/when the person is medically incapacitated. If the FIL is unable to adequately provide for the MIL then it can be invoked with a minimal amount of fuss; it is just as easily revoked, as the person signing it can destroy the original document and the POA is now null and void. Get it BEFORE you need it. Emphasize that it is a "just in case" type document, much like life insurance. Again, it is their decision and always will remain their decision unless and until they are judged mentally incompetent. Once they regain their faculties, it again becomes their decision as to what they do. The Medical POA will also allow the named individual access to the bank account(s) to pay the bills, etc., but ONLY when the patient is medically incapacitated. If you wait until it is actually needed, it may be too late and then it involves court proceedings, money and time, particularly if someone has to be appointed guardianship.

Now comes the disclaimer: I'm in much the same boat as the caregiver, and have been since Dad died in 2009. It is getting worse as Mom ages. She is currently in an independent (over 55 yrs old) apartment community, with NO "other side" long-term care. First episode: Between Thanksgiving and Christmas in 2016 Mom had an upper respiratory infection that led to pneumonia. The first round through the hospital led her to a rehabilitation center, where in the course of 12-hours she went from a cognizant individual to a raving lunatic (her first experience with delirium). Back to the hospital, with "can't find anything wrong with her" and sending her to an Alzheimer's unit. Fortunately she had to be checked prior to admission, and that hospital found several things (hospital acquired form of pneumonia, blood electrolytes significantly off, and urinary tract infection) and after they got those things under control, Mom returned from la-la-land. It was during that time that I had to get the medical POA. Second episode: Mom had back surgery just before Christmas last year; this resulted in delirium appearing the day she was discharged and another trip to the hospital and four weeks in a skilled nursing in-patient (physical rehabilitation) center. Her return to reality was slower this time, and she isn't fully back and may never be as it just gets worse with each episode. DELIRIUM IS COMMON AND OFTEN UNDIAGNOSED. It was on this trip that I discovered just how much Mom selectively remembers what she is told. Her memory is significantly degraded. Computer stuff that was simple for her has become difficult. We had to take the car from her, and that has been and continues to be difficult. I have predicted to my siblings that it's going to be a rocky year, and they agree. Additionally, her wallet was taken/stolen/returned with all of her cards but none of her cash money during her time at the skilled nursing facility. The POA allowed me to freeze her bank accounts, get new cards, etc. and deal with the issues that arose.

[Speedy]

Thanks to all who shared their stories and advice. My 93 y.o. father is in the hospital recovering from a UTI and will be transitioning to a rehab facility before returning to his independent living apartment. He is not a happy camper. Now the battle is with his doctors to get him on an antibiotic prophylactically because he gets a UTI every other month because he is cathed all the time.