Gail Answers Your Questions

SHEEHY: Q&A No. 4

By: Gail Sheehy | Source: AARP.org | April 2009

Q: Having cared for my mother (who had multiple health problems and dementia) in my home for 12 years, I am well aware of the blessings and the challenges. Although Mom had a pension and medical insurance, I had to work in a lower-paying job to be closer during the day and could not afford help during the evenings or weekends. Although I wouldn't change my decision, I don't want the same future for my daughter.

My daughter is a nurse who used to work in nursing homes and has declared her determination to care for me if and when the time comes. I am still young, and, except for having a stent placed three years ago, I'm healthy, but now is the time to plan. I will have a pension and Social Security, and I have long-term care insurance. Is there any other way I can plan now to ensure that my daughter has more freedom and monetary support for my care than I did? I know there are limitations on reimbursement for care by family members, but she is an experienced nurse. Will that make a difference?

—Judy C.
Rochester, N.Y.

Gail: Dear Judy, When seasoned women gather to talk turkey about aging, I've heard the same joke more than once: "The best long-term health care plan is a daughter." It's wonderful that your daughter wants to take care of you. Being a medical professional, she will be invaluable as your advocate—and that's what we need most of all.

Here are three ideas:

1. It's worth it to call your insurer to ask what services the company offers to supplement family caregivers. Some cover care managers. If you know what’s covered, you can prepare for what isn’t.
2. Consult with an attorney who specializes in eldercare law. Get your advanced directives in order. See if there’s any way to protect your assets so that your daughter will get them. Perhaps setting up a trust, or revising your will would ensure that happens.
3. Since you are healthy and young, develop a positive action plan for preventive medicine—small, regular decisions that affect health, diet, exercise, and lifestyle. The top two from my experience are: 1) regular sleep, seven hours; and 2) regular aerobic exercise and strength training. (I combine the last two in yoga.)

Congratulations on talking NOW with your daughter and other family members. We should all start that conversation after age 60. I call it Preventive Caregiving. Good luck!

Q: I have Power of Attorney for finance and health from my mother. She is in a nursing home and will never be capable of moving back into her home because of dementia and stroke-related problems. She has not been declared incompetent, but she is incapable of making decisions. I want to sell the house to help pay for the nursing-home care. She has good days and bad days for comprehension. Do I need permission from her to sell the house? Should I consult her attorney?

—James S.
Tucson, Ariz.

Gail: Hello, James, Yes, you need permission, but you may already have it. The agent only has the authority and/or permission to do what the principal wants the agent to do. If the permission is not there, the agent can't do it.
 
The first step is to look at the powers, or "permissions" granted in the power of attorney for finance. Is there language in the POA that shows that the principal (your mother) gave the agent (you) the authority to sell real estate? If Mom was competent when she signed the POA and the document authorizes the sale of real estate, then you could proceed to sell the house. This is written evidence of "permission" to sell. The POA would be filed with the deed of sale to document that you had the authority to sell the home on behalf of the principal (your mother).
 
If the POA doesn't mention anything specific about giving your permission to sell the home, then it gets more complicated. On a "good" day, which could be documented by a written doctor's opinion, when Mom understands the need to sell the home and that she wants to give you authority to sell it, she might be able to sign a new power of attorney giving authority for the sale. The need for medical assessment of her legal capacity to sign the POA at the time she signs it is essential to avoid further complications.
 
If she doesn’t have the capacity to sign a new power of attorney, then you will need to get a limited guardianship for the purpose of selling the home. By this method, the court gives you "permission" to sell, because the mother is not legally able to do so.
 
Oral permission under these circumstances will not be enough. You will need to be able to document, in writing, how you obtained the authority to sell on behalf of the mother—either with a valid POA or court order. Yes, do talk with an elder-law attorney about these complicated issues.

Q: Is there any way for a caregiver to get paid? I am a patient navigator with the American Cancer Society and get this question a lot.
Thank you.

—Polly J.
Wooster, Ohio

Gail: Dear Polly, In my state, New York, there is no payment. I don't know of any other state that has yet passed such legislation, though there is legislation pending in Congress. To confirm the resources in your state, call your local Area Agency on Aging. You will find contact information on the Eldercare Locator [LINK: www.eldercare.gov ] or by calling, toll-free, 800-677-1116.

Q: Which is better for a 92-year-old woman who has just recovered from a broken hip: hardwood floors or wall-to-wall carpet? Where can I find more information on how to make a home safe for her?

—Susan G.
North Collins, N.Y.

Gail: Dear Susan, One in every three people age 65 and older falls each year, and half of those who survive a fall never return to their prior level of mobility or independence. So I’m pleased to learn the woman you mention in your inquiry has recovered from her broken hip. 

When choosing flooring that will help an older person stay safe, it is best to use non-glare, slip-resistant flooring material. This includes tight, very low pile carpeting, but be sure to avoid bold, elaborate patterns that could cause perception confusion. Natural materials like bamboo or cork, which are softer and have some cushioning, are another good choice, but be sure there is no height difference when making a transition between flooring materials. Do not use a transition strip, as it can lead to tripping or falling.

The AARP Web site provides information on home improvements you can do to make a home safer and more comfortable for residents of all ages. Be sure to check the AARP Home Fit Guide and Taking Steps to Prevent Falling Head Over Heels. The Home Safety Council®, a national nonprofit dedicated to preventing home-related injuries, is another good resource.

If you're interested in hiring a contractor to make these changes, there are companies that are Certified Aging-in-Place Specialists.

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Q: I have become a caregiver for my father-in-law. My husband drives a truck and I drive a small subcompact. Neither seems suitable for Dad to get in and out of. Can you suggest a vehicle, other than a van, that would be easy for Dad to access? The truck handles our gravel roads and chores. The car gives me good mileage to visit family. Help! Thank You!

—Karla W.
Yates Center, Kan.

Gail: I found out from one of AARP's mobility experts that you might want to reconsider a van to help transport your father in law. Many manufacturers offer "crossover" models—vehicles that include many of the popular features of SUVs and minivans both. There are compact and midsize versions in price ranges from the high teens to well past $30,000, and both domestic and international manufacturers offer something in this line. Most have at least as much ground clearance as your economy car. Given your father-in-law's limitations, I think the side-opening door would be a big advantage for him. A vehicle with center opening doors might also come in handy. Good luck! One thing we can say about the current economy: It’s a great time to get a good deal on a vehicle.

—Christine J.
Butler, Wisc.

Gail: Dear Christine, Your mother is like the six out of every 10 people with Alzheimer’s disease who wander. She might become disoriented and lost, even in her own neighborhood.

The Alzheimer’s Association has partnered to help save lives with MedicAlert + Alzheimer’s Association Safe Return. The wanderer wears a medical ID bracelet or pendant. Either you or your dad will need to ask neighbors, friends, police, and eyes on the street to use the bracelet to activate the community-support network. They call the toll-free, 24-hour emergency response number on the identification product, and the individual’s family or caregivers are contacted.

The nearest Alzheimer's Association office provides support during search and rescue efforts. In addition, should medical attention be required, access to a personal health record (PHR) is immediately available. The enrollment fee is $49.95 with an annual renewal fee of $25.

As a short-term, easy fix, a simpler way to discourage her from wandering is to hide her shoes and only let her wear them when she’s accompanied.

There are other products available, as well. BrickHouse Security sells a "Wanderer One-Person Monitoring System" [LINK: http://www.brickhousesecurity.com/alzheimermedicalalertbracelet-wa900.html] for a one-time fee of about $600. A wireless pendant is worn by the person with dementia, and the pendant sends signals to a stationary Alert unit. If the person wanders too far, you can program the unit to sound an alarm, or call a phone, cell phone, or pager.

Most of the products known because of the commercial, "I've fallen and I can't get up!" depend on the person in distress to push a button on a pendant or a wristwatch, and some people with dementia might wander quite a distance before anyone would consider pushing the button, including the wanderer. This is why something like a motion detector near doors to the outside might be a better choice.

Other suggestions to think about:

• Hide her shoes and only let her wear them when she’s accompanied.
• Disguise exit doors with curtains or posters so they look less like exits.
• Keep yards fenced and locked.
• Install bells on doors leading outside, so that they ring when someone goes outside or comes inside.

Good luck! 

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