It takes a lot of resources to grow old.
We all talk about the importance of good healthcare, and it is vitally important, but other factors often are overlooked. These factors sometimes cause even more angst than the medical needs.
Let's talk about these "quality of life" issues.
I always talk to my clients about the "cup of coffee" factor. Meaning, does the older adult have someone to have coffee with on a regular basis – someone to talk to, a place to go outside of the apartment or house, a way to get there, and a reason to put her pants on. Loneliness is a huge problem and often not talked about. Does your mom sit around in her housecoat all day? Perhaps there's simply no reason for her to get dressed – she may go days at a time without any in-person human interaction. You may notice that many homecare agencies offer companionship services. In a crass sense, it's buying a social life, but it works. Moving into a community that has a higher population density than a single family home serves the same purpose. Adult day care, seniors on the go programs, etc. do, too. The important thing here is to make sure to address loneliness and find solutions that fit your family's needs.
Please let me be extremely clear here… it is IMPOSSIBLE for the adult children/grandchildren to provide the entire social support system, especially when we're talking about Baby Boomers taking care of their 80 year old parents and the 40 year old grandchild trying to work full time and raise a family. Nor does it work when everyone says "he's not married, he can take care of Mom." All that happens is that everyone gets stressed out and is unhappy. Each family needs to have a candid discussion about expectations and resources and make decisions based on that discussion. Guilt based caregiving is a recipe for disaster.
Keep in mind that there are many types of support systems – faith based, community based, and fee-based. There's a reason that these systems developed – there was a need. Use them!
Many people underestimate the importance of hiring a good lawyer. It is really important to hire someone who truly is an expert in the challenges facing older adults, so it is vital to do your homework before you hire someone.
Be sure to discuss your family situation, finances, health issues, and geography with your attorney. Do you spend summers in Alaska and winters in Florida? Be sure to tell him/her.
At a minimum, you'll need powers of attorney (both financial and health) to make sure that someone you trust can make those decisions for you if you are incapacitated; a will; and a living will/advanced directive. In many cases, you also might need a DNR (do not resuscitate order AND an EMT form (available from your local emergency services /911 department). This limits the chances of heroic measures if that goes against your wishes.
Growing old takes money – either personal money, family money, state resources, or veteran's resources. Planning is important, too. Here, it is important to remember that Medicaid is not a financial plan, nor does it pay for all of the care options you might choose. It is a method of guaranteeing that people who, due to illness and/or advanced age, do not end up homeless. Medicaid also has a three year (and in some cases, five year) lookback period. Meaning, they can review your financial records for three to five years to make sure that you didn't try to hide money from them. So, if you want to have choices about your care, hire a good financial advisor and plan early.
The stuff of daily living (shopping, transportation, trash, housekeeping, laundry) – all too easily taken for granted until the system crashes. Then, it becomes a crisis. Mom may be able to cook her own meals, but may not be able to drive or walk to the grocery store and get the groceries back into the house. Or, she may not be able to get the trashcan to the curb for pickup. It may seem minor in comparison to the other categories, but this is the stuff that usually pushes the family caregivers over the edge.
There are simple ways to deal with this – like using grocery delivery services, hiring home care agencies, or paying a neighborhood kid to take out the trash once a week. Sometimes, pharmacies deliver…
There are two important things here:
1. make sure that these tasks are taken care of on a regular basis
2. make sure that these tasks are not a way to assuage loneliness. There's a difference between really needing help with groceries and insisting that the adult child bring the groceries. One is a "real" need, and the other is a front for a different need –"I want to see my kids so I'll ask for a legitimate sounding favor and then they'll come to see me."
I also warn my clients that we cannot let their caregiving responsibilities kill them. It's really important to ask for help, put together a team, and plan ahead. Then, we can deal with the crises when they arise!