Parenting Your Aging Parents

Dear Robert:

My aging parents are concerned about what might happen to their quality of life if they become chronically ill and need long-term care. Naturally, they’re interested in finding out more about long-term care insurance, if only as a way to obtain care at home instead of having to move into a nursing home.

But I’ve heard there are some problems with these types of policies, and that you often don’t get your money’s worth when you place a claim.

Should I let them buy such coverage, or should I try to stop them?

Signed, Long-Term Worries Over Long-Term Care Insurance

Dear Long-Term Worries:

The point of long-term care insurance, like fire insurance, is not to make a profit on the insurance, but to provide some protection against a financial calamity on top of a personal tragedy. And of course, for a given level of benefits, you want to pay as little as possible.

In theory, long-term care insurance makes a great deal of sense. But let’s face it: there have been some unsettling problems in this area of the insurance industry. A few years ago, for example, certain insurance sales people were found to be fast-talking older folks into buying additional long-term care insurance policies even after they already were paying on one, two, or even three existing policies. Not surprisingly, the coverage on the multiple policies overlapped – so these older folks wound up paying multiple times for coverage they could collect only once.

More recently, insurance companies sold a lot of long-term care insurance policies at unrealistically low premiums, and are now discovering that it costs a whole lot more to provide the insurance benefits than they originally anticipated. As a result, they are jacking up insurance premiums so far and so fast that many people are canceling their long-term care policies – effectively throwing away the money they have already invested in this coverage.

In addition, the companies are writing newer policies so restrictively that policy holders are frequently buying a lot less coverage than they believe they are.

All these problems are unfortunate, because there is a good chance your parents will want to draw on the benefits of their long-term care insurance. So they ought to be careful not only about the benefits they are paying for, but also about how easily they can access those benefits in the event of a chronic health care problem.

Anyone interested in the basics of long-term care insurance can ask us for a pamphlet we have put together on the topic by e-mailing us at: robertm@keypubs.com. You can also find some detailed information about avoiding fraud in long-term care insurance at the following Web site: http://consumerlawpage.com/article/insure.shtml.

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Dear Robert:

My parents are beginning to need some kind of help. But I’m not sure if their problems are physical, mental, emotional, or something else.

I feel I personally need help in assessing their difficulties and deciding what kind of help to obtain for them. Where can I find a professional to guide me? How much do you think they would charge? How much are we talking about in total fees for helping me get things set up?

Signed, Don’t Know Where To Begin

Dear Don’t Know:

There is no single group of professionals who can guide you in everything. But most “agencies on aging”, nursing homes, geriatricians, and lawyers who specialize in working with the elderly are good entry points for you to begin finding the specific help you want and need.

Most of the care managers, lawyers, and other professionals you’ll want to work with will charge you by the hour. Their rates will range from $50 or $75 per hour for a Care Manager to several hundred dollars per hour for a specialized attorney.

For this reason, at each stage and on each topic or task you’ll want to be sure you’re working with appropriate professional. In other words, don’t talk to your lawyer about your aging parents’ physical limitations, and don’t expect your care manager to give you advice on legal documents like Wills and Durable Health Care Powers Of Attorney.

The total cost of professional help can vary from just a few hundred dollars for an initial assessment and referrals to agencies from a care manager, to several thousand dollars for extensive legal work by a knowledgeable attorney. If you want ongoing support and guidance, you can expect to be charged several hundred or even thousands of dollars more each year.

One good source of information on professional geriatric care managers is the Web site of the National Association of Professional Geriatric Care Managers. You can find it at: http://www.caremanager.org. Or you can telephone them at 520-881-8008.

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Dear Robert:

My aging father is in a nursing home, and I’m worried. Last week, he had a mildly adverse reaction to a drug the staff administered to him by mistake.

Is this a common problem? Should we be worried? Is there anything we can do to eliminate the danger of such errors in the future?

Signed, Drugs Can Be Dangerous

Dear Drugs Can Be Dangerous:

You’re right to be worried. Drug-induced problems are all too common, particularly in hospitals and nursing homes.

According to a recent study funded by the National Institute on Aging and published in the August 1 issue of the American Journal of Medicine, there were nearly 550 medication-related injuries in the 18 community nursing homes studied during the 12 month period under review.

This extrapolates out to about 350,000 adverse drug events across the U.S. every year.

Most often, the problem resulted from caregivers who monitor patients inadequately, including substandard monitoring of drug therapies. But there was also frequent failure or delay in responding to important symptoms or signs of drug toxicity, such as nausea or vomiting, over-sedation, mental confusion, hallucinations, delirium, falls and bleeding.

Right up there alongside inadequate monitoring was flat-out mistakes in ordering medications for nursing home patients. These errors included both incorrect dosages, and ordering medications that began producing harmful interactions with other medications already being administered to the patient.

Another major source of problems was simply administering the wrong drug.

The medications most likely to be involved in these problems included antipsychotics, antidepressants, sedatives and hypnotics, all of which happen to be among the most frequently used medications for older patients.

We're not saying you should prevent your aging father from taking these drugs. We’re simply suggesting that you spend time looking at your father’s chart, talking with the medical staff, and monitoring on a random schedule to be sure the caregivers at your dad’s nursing home monitor him frequently enough to spot any adverse reactions he may have to the drugs they order and actually administer to him.

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Dear Robert:

Mom is beginning to have difficulties remembering what she is talking about, or what point she is trying to make. Sometimes, she forgets where she is and why she came there. Last week, she even forgot my name and the names of my brothers and sisters.

We’re pretty well convinced she’s suffering from Alzheimer’s. Naturally, we’re very upset and discouraged by this.

We’re writing to ask if there is any cure for Alzheimer’s, and if we can do anything to bring her back from this terrible disease?

Signed, Fearing The Long Steep Slide

Dear Fearing:

No. As we write this, there is no known treatment or cure for Alzheimer’s, and no way to reverse the memory loss usually associated with the disease.

But don’t give up hope. Not every instance of memory loss is proof positive of Alzheimer’s. Many times, the kind of memory loss you’re describing results from a series of small but devastating strokes that happen deep within the brain. And if they are treated, the trend toward greater and greater memory loss can be stopped, and possibly even reversed.

A recent article in the Annals of Neurology discussed a small but important study that illuminates some of the differences between classic symptoms of Alzheimer’s and apparently similar memory loss that results from preventable causes in elderly patients.

With Alzheimer’s, the disease attacks the basic mechanisms the brain uses for coding and storing memories. This disruption of brain processes usually occurs deep within the temporal lobe and hippocampus. But other forms of memory loss can be induced simply by strokes, which reduce brain activity in the frontal cortex, the part of the brain used for “paying attention”.

Until research results like this came along, many families and physicians mistakenly believed that strokes could “push people over the edge” into Alzheimer’s disease, with the permanent memory loss that usually results. As a result of this hopelessness and despair, patients with mild symptoms of memory loss were sometimes left untreated – a major mistake.

But with this new evidence, it’s now clear that symptoms of mild memory loss should trigger vigorous diagnostic efforts, and – if warranted – aggressive treatment. If tests show evidence of “deep strokes” within the brain, treatments to halt and prevent strokes can go a long way toward helping your aging mother maintain her current quality of life.

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Dear Robert:

My Dad, 81, was in a car accident and spent 6 weeks in the hospital. When he got out he immediately went to get a license to drive again! Fortunately, he failed. But my Mom, who is 78 and has Parkinson’s, has kept her license and now wants to buy a car and take off driving!

They won't listen to me. Now that I think about it, they have never listened. It is always their way or the highway!

What is an adult child to do with aging parents like this? Please help!

Signed, Discouraging Driving

Dear Discouraging Driving:

In this case, it seems your aging parents want their way to be the highway. But based on what you say about their health conditions, driving is a very bad idea.

Of course, giving up driving is difficult for most aging parents to do. It brings up many issues they’d rather not face, and it forces a trade-off between independence and safety. Still, most seniors are OK with giving up their licenses when they finally face the dangers and safety issues head on.

Although your parents have never listened to you, it’s your responsibility to be the voice of reason in this matter.

First, discuss the dangers of driving when older. For example, a 50-year-old driver needs twice as much light to see as a 30-year-old. Older people driving at night experience reduced depth perception, impaired color recognition, and decreased peripheral vision. Age tends to impair eye-hand coordination, too.

When Parkinson’s Disease is involved, the case for not driving becomes much stronger. Sufferers can experience not only tremors, but rigid muscles and significantly slower or limited movements required for driving a car safely. Sadly, Parkinson’s tends to get worse as time goes on.

Second, tell Mom and Dad about your personal concerns about their safety. Other family members should weigh in on this, too. Let your parents know your worries and how you’ll feel every time they get behind the wheel. And your worst fears are not overblown: Drivers over 85 are nine times more likely to be killed in a crash than younger drivers, according to the US Department of Transportation.

Third, get your parents to understand the costs and the financial risks that driving entails. Cars are not cheap, and car insurance can be even costlier. In the event of an accident, the financial loss, pain and suffering, trauma inflicted on others, and feelings of guilt can be literally unbearable.

Fourth, offer an alternative transportation plan to help them get around. This might include using taxicabs (with our without discount coupons available from their municipal government), arranging for rides from family and friends, hiring a driver, or scheduling paratransit or community-based senior transportation services.

The AAA Foundation for Traffic Safety, based in Washington, DC, offers an online self-test for older drivers at www.aaafts.org. Taking this test might help your parents objectively evaluate their ability to continue driving. The Foundation also offers a free booklet called “Helping Older Drivers.”

You might also want to ask your parents’ doctors to talk to Mom and Dad about the real dangers of driving, considering their health conditions and the medications they’re taking.

When all is said and done, you’ll have to rely on your parents to voluntarily give up driving because, in most states, there’s little room for you to interfere in the relationship between your parents and the state motor vehicle department. If they can convince the state they’re qualified to drive, it’s very difficult for you to get the state to deny them a license simply because you’re worried. You can, of course, provide letters from their doctors stating they are not healthy enough to have a license. But it’s difficult to be sure those letters will be considered. Still, it won’t hurt to ask their doctors to write those letters, which you should send to the DMV, making sure you identify your parents in detail.

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Dear Robert:

My aging Mom was recently diagnosed with colon cancer, and underwent immediate surgery, which the doctor says went well. She was supposed to follow up with six months of chemotherapy, but during the first phase of this treatment she had a violently toxic reaction to the drugs and nearly died. She was placed in intensive care for two weeks, and is now housebound.

She has been home for a month, and she’s still weak and unable to care for herself. She’ll need many more months to recover, and may never get back to her previous level of strength and independence.

Her doctor still thinks she could benefit from continuing the chemotherapy, with a suitable modification of the regimen to prevent a recurrence of her toxic reaction. But Mom says she will never consider having any more chemotherapy, no matter what the consequences.

I want my Mom to live as long as possible, and I’m worried that not having the chemotherapy will shorten her life. What should I do?

Signed, Not Ready To Give Up

Dear Not Ready To Give Up:

Everyone who is mentally competent is entitled to make their own decisions on these matters. Your mom has been through a terrifying experience. So have you and the rest of the family. It is bound to color your future judgments.

Once your mom has recovered enough strength to go out to a doctor’s appointment, go with her to the oncologist and openly discuss her options.

Ask all the questions you have, and press for specific, concrete answers on issues like the statistics on longevity, and the likely consequences of each possible course of action. She may not be facing a simple matter of life and death.

Even without the chemotherapy, she may be one who can expect to live quite a few years in good shape. If the chemotherapy is going to significantly reduce her quality of life, the extra time she might gain may be too uncomfortable and limited for her to appreciate.

It’s perfectly understandable that your mom may want to live more actively and independently right now, rather than more dependent and uncomfortable for what might possibly be a longer period.

You should talk about all these issues with Mom, and with other family members, as appropriate. Make sure she knows your concerns and preferences. But ultimately, the decision is hers. She alone knows how much she is willing to endure, and you must recognize that she has the right to make this decision.