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When your loved one is no longer independent. What now?

I’ve been working in senior living, including independent living, assisted living and memory care for my entire career. One of the things I’ve noticed is the complete lack of knowledge about this industry and what is involved in advocating for a loved one who is no longer independent. Most people don’t think or want to think about their loved one declining, but we’re living in a society that continues to extend life through medicine. Decline is a natural part of life and death and when it happens, it is different for everyone, yet we don’t talk about it and most people don’t really plan for it.

Let’s start off by understand what “independent” really means. I have noticed that there is a wide range of thought on what being independent looks like. If your loved on is still food shopping, making appointments, taking their medications appropriately, keeping their home clean and updated (themselves or through a service), keeping up with their hygiene, cooking or arranging appropriate meals for themselves, paying their own bills, etc., they are definitely still independent. If any of these falls to the wayside, and you, as the family member or friend has taken over, you definitely want to start making a plan. This individual is no longer independent.

My favorite family member is the one who claims they are in “early stages of looking” when their loved one is clearly way past being independent. We see this a lot!

Don’t be like my favorite family member! The outcome is that you end up in crisis (maybe mom falls and breaks a hip or dad gets COVID and ends up in the hospital for a week followed by four weeks in skilled rehab) with zero understanding of what is involved (believe me, it’s a lot), what’s covered by insurance (believe me, it’s a lot less than you think), and you may end up putting your loved one or yourself in a bad physical or financial situation out of desperation.

Start with a conversation: Most likely, your loved one is aware of the decline, whether mental or physical. Perhaps the house is getting to be too much to keep up with or they get tired and no longer have the energy to bathe or prepare meals. Or you notice a mental decline: perhaps you’re finding bills piled up that they swore they paid, or the electricity or cable gets shut off and they don’t understand why. Maybe there is a change in behavior because they aren’t taking their medications, or they are doubling or tripling up. Either scenario can lead to further exacerbation of physical and mental decline.

Step 1: Intervention

Like any intervention, come prepared with measurable examples of why you’re concerned as well as involving other loved ones who might be able to back up your claims.

Examples: 1. “I noticed that you’re in a lot of pain lately and that you’re not keeping up with your laundry. I took these pictures of your piled up laundry in your bedroom. How long have you been letting the laundry go?”

2. “I’m concerned about you driving because you have now called me three times to tell me you were lost and asked for my help to get home. This happened on October 3rd at 10:00am, October 10th at 4:24pm and yesterday at 8:23am. Here are the call logs on my phone, may I see your phone?”

3. “I found these unpaid and overdue bills on your kitchen table.”

4. “I was in the medicine cabinet to get some dental floss and I noticed all of these full pill bottles for the same prescription medication.”

It’s important that you stay with facts that are measurable. Don’t throw examples that aren’t measurable or can be denied such as, “I noticed that you’re repeating yourself a lot.” or, “Mary from church is worried about you too.” These incidentals might be true but it’s important to stay measurable and factual because they will have a harder time denying.

Step 2: Offer up a solution immediately, even if it’s temporary.

You will come across as accusatory while staging an intervention, but if you have a plan, it can soften the blow. You may start with the measurable concerns; however, you want to offer up measurable solutions also as this is for their well being and your peace of mind. When offering a solution, strategize with other friends or family ahead of time to come up with the best, and most loving way to offer help that will still honor your loves one’s dignity. Some of our loved ones will adamantly deny being helped and they may use the excuse of not wanting to be a burden as the reason why they don’t want help. When this happens, you may suggest that it’s more of a burden to you to worry about them and their safety and that you’re just trying to help out where you can.

Examples: 1. “Would it be okay if I came over and did some laundry for you once a week so it doesn’t get piled up?” or “Mary from church has offered to come over once a week to do laundry and bring you lunch. Does that sound good?”

2. “I would like you to give up driving for now until we get to the bottom of why you’re having a hard time finding your way home. This is a major safety concern and if you’re getting lost, you might not be following the laws of the road and you might hurt someone or yourself. I’ve made an appointment for a neurologist and will help you manage your rides to and from your social club, your doctors appointments, and your synagogue.”

3. “Will you allow me to look through your bills to help you manage your finances? I would like to set up a joint account so I can help you manage the bills.” Or “I have hired a financial planner to help you with your bills.”

4. “I found this app on my phone that can remind you when to take your medications, would you like for me to help you install it on your phone too?” Or “Would you like me to put your pills out in a pill planner for the week?”

Step 3: Offer up a timeline for your plan of correction and follow up steps for the inevitable next sign of decline.

If your loved one is hesitant, which they most likely will be, then give them a deadline for how long the interventions will be in place to see how things go. Also, suggest that they have a legal document drawn up such as a Durable Power of Attorney, Financial Power of Attorney or Heath Care Proxy if you don’t have one already. This is in the case that they can no longer make safe decisions for themselves, you or another trusted advisor can make the choices for them. It’s important to understand that a Power of Attorney does not override individual choice of someone who is of sound mind. Every living person should have this, because we never know when we might be in a situation where we can’t advocate for ourselves and we should have a trusted person that can make decisions for us. Most people wait entirely too long to try to put this in place. If your loved one is deemed unable to sign, you will need to petition for guardianship (each state is different), but that can take months and requires going through the court system and can delay care so it’s not recommended.

Step 4: Check in to see how the interventions are helping or hindering and get a sense of finances if you don’t already know.

Once the timeline is in place, continue to follow up and keep track of how things are going with the plan. Is your loved one receptive to the help, or are they fighting it? Don’t be fooled that the problem is permanently solved because it’s almost guaranteed that even if you’ve solved this problem, something else will come along down the road and the plan will have to change, but at least you have opened the door to intervention.

If you haven’t had a conversation about finances, this is also the time to do it. Even if your loved one is of sound mind, you or a trusted advisor will want to fully understand their income and assets. The reason behind this is that hired care, whether through a home care agency or moving into assisted living or nursing home is expensive (more so now than ever before) and if they do not have appropriate income or assets, there are fewer options available to them. If this is the case, you want to start researching at your local office on aging to find out what Medicaid options are available in your state. If your loved one or their spouse was a Veteran, they may also be eligible for benefits. Just know that health insurance does not pay for non-medical care, and if you or your loved one is lucky enough to have enrolled in long term care insurance, then you will definitely want to take a good look at the policy.

The most important thing is to be mindful of maintaining dignity but also safety for your loved one. It’s a struggle and I don’t envy anyone in this position, but the more you know going forward, the less intimidating the process will be.

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