OT: MIL just diagnosed with Alzheimer’s

[JesterB]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

 

[greenbean.sixpack]

When my FIL died we moved my MIL close to us. She lived in BFE (two hours away) in an older house with lots of land to keep up. Fortunately the sell of her home funded her townhouse near us. If was a good move.

As far as protection of assets that is complicated. Mine and my wife's parents were both piss poor so it wasn't a big deal and all the children are on the same page. It can get tricky in a hurry and a step daddy makes it even more messy. Contact an estate planning attorney for advice on that issue. We simply divided up our parents only real assets (raw land) among the kids. Property taxes are on the land are low so no big dig.

Medicaid has a 60 month look back period immediately prior to the application for nursing home medicaid, so consult the attorney quickly.

 

[Cantdoitsal]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

God Bless You and Yours My Fellow Bulldog.

 

[Dawgbite]

My grandmother had dementia and lived with us the final years of her life. As children we feel obligated to take care of our parents because they raised us but dementia not only destroys the patient but it will destroy your family trying to care for her. Do what your wife thinks is best but don’t wait too long to seek professional help. My mother lost her eyesight fairly suddenly at 78. She couldn’t adapt to being blind even with therapy and training. We almost killed ourself trying to keep her home, our home was much more confusing for her so that didn’t work. We finally found an assisted living for her and she was so much happier and better cared for. In hindsight we were selfishly trying to keep her home to ease our conscience, we waited too late.

 

[JesterB]

My grandmother had dementia and lived with us the final years of her life. As children we feel obligated to take care of our parents because they raised us but dementia not only destroys the patient but it will destroy your family trying to care for her. Do what your wife thinks is best but don’t wait too long to seek professional help. My mother lost her eyesight fairly suddenly at 78. She couldn’t adapt to being blind even with therapy and training. We almost killed ourself trying to keep her home, our home was much more confusing for her so that didn’t work. We finally found an assisted living for her and she was so much happier and better cared for. In hindsight we were selfishly trying to keep her home to ease our conscience, we waited too late.

I feel that’s the move we make sooner than later. I’d just like to have her here while we get stuff in order so her notforshit husband can’t manipulate her anymore than he already has.

 

[IBleedMaroonDawg]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

God bless you my wife used to work with memory care patients. That's a tough road.

 

[ZombieKissinger]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

I know this space. A lot depends on the current severity and her deficits. I would recommend making that she has her will, advance directive, power of attorney, etc. in place. I would also think about living options for her and hopefully get her to buy in to some of them, even if they aren’t immediate. Some of the medications can help slow progression of deficits initially but the deficits typically catch up, but it’d be worth talking with doctors about options. Dementias will sometimes get misdiagnosed and/or have overlap (e.g., Lewy body, vascular, Alzheimer’s), so there can be different treatments or timelines based on that. Basic things like making sure she’s sleeping at night, making sure she’s getting out of bed during the day, having a calendar that gets updated, etc. can help day to day. Evaluating labs and medications to make sure nothing is correctable and/or that she’s not on meds that’d make cognition worse (e.g., benzos, opioids, anticholinergics). The big thing will be to try to get some buy in early because it’ll often get harder as she gets worse. Try framing it as “even if you don’t need help now, let’s think about what you’d want down the road”. Of course, if she’s doing poor enough to need help now, then you’d need to do that with more urgency. This has been my friendly/non medical advice message board suggestions.

 

[The Cooterpoot]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

Move her in until it gets difficult and then put her in a facility. Sounds cold but it's just how it's best. Make sure assets are all moved before sending to a facility or you'll lose it every bit. Had to do it myself with a parent.

 

[Dawgbite]

Something else to look into. One of the local churches has a once weekly adult daycare for dementia patients. I know people who have utilized it and they say that you can’t fathom what a day off from caregiving can do for you mentally and physically.

 

[Herbert Nenninger]

The 36 hour day is a popular book for family/caregivers.
Keep the blinds open during the day to help maximize day/night awareness.
Regular socialization has as good if not better evidence of helping maintain cognitive function as brain games like crossword puzzles and such.
Try to avoid 1st generation (sedating) antihistamines like Benadryl. And make sure her doc has gone over her meds in general to minimize/avoid anticholinergic meds.

 

[Eleven Bravo]

This is a situation I know all too well. We went through it with my Mom. Daddy died 8 years before Mom died, and the dementia began within 6 months of his passing. Thankfully, I am married to a woman who has worked as the Executive Director (Nursing Home Administrator) of a number of long-term care facilities for 30+ years. She knew exactly what we needed to do (advance directives, power of attorney for property as well as health care decisions, living will, DNR (do not resuscitate), etc. The main thing you have to do is to designate someone to make the decisions if you have a sibling (or siblings). My Mom wanted me to make all the decisions as far as her healthcare decisions went. I have a sister who I love dearly but she is the type of person who will keep a dog around long after it needs to be put down. Mama knew my sister would have a feeding tube put in just to keep Mama alive for as long as possible. Mama didn’t want that-she worked as an RN for nearly 50 years and she didn’t want to be kept alive like that. She knew that ai would allow her to die with her dignity-that was her wish and I guaranteed that she got what she wanted. My sister is still pissed off to this day that we didn’t take any extreme measures to keep Mama alive after she suffered a second catastrophic brain stem stroke. I knew Mama wanted to be allowed to leave this world and I made sure she got her wish. Tough decisions have to be made-and you have to be prepared to make those decisions

 

[Jacknut]

You need power of attorney. Some assisted living places will take memory care patients, but others will not. Can you afford a day nurse to be at your home with her while you guys are working? Went through this with my Mom and those are just a couple of things of the top of my head to consider.

 

[AstroDog]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

Probably first get Power of Attorney for her. If she isn't too far along, you can move her in with/or near you. Once she gets too advanced, look to see if you can get her on Medicaid. She'll have to sell off most of her assets and can only keep a small amount of money. That way, you can get her into a Medicaid approved facility for dementia/Alzheiners patients. You'll likely have to pay a portion of her monthly bill, but Medicaid will pay the heavy amount. Most facilities I have dealt with run around 4-5K PER month. I wouldn't wait too long to start the research process. There are some good facilities around the state. Her disease advancement will accelerate. Don't let it get too far along or you'll have some struggles.

 

[M R DAWGS]

I wouldn’t wish that disease on anybody. Get power of attorney and all legal matters handled as soon as possible, and enjoy the times when she is clear headed and her normal self. Eventually you won’t be able to take care of her, decide which assisted living she will go to, and get her on Medicaid. Prayers for you and your family.

 

[theoriginalSALTYdog]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

Honestly, as far as asset protection goes, you may be too late. Estate plans that essenetially "impoverish" the person have a 5 year looking back clause (this is in MS mind you). With Alzheimer's it's funny. Some don't make it that long and others can live with it for years so you're in a precarious position. We started my parent's asset protection right about the time my Mom was diagnosed with dementia. She lived less than 3 years at home before we had to get some help and admit her to assisted living so we waited too late. It's hard to get your parents to relinquish all they have ever owned or ever will own but trust me, you need to push them into doing it or you could lose it all but it needs to be done before they get ill.

As for the relocation, well I can tell you first hand when you move her to another location that she's not familiar with, she will become more confused. We tried to keep my Mother at home as long as we possibly could but when we moved her to assisted living she declined.

You have your hands full my friend and I wish you guys the best. My Mother passed away last month. Her dementia was very advanced. Truth is, with Alzheimer's and dementia, you lose a parent twice. God Bless.

 

[HailStout]

Not trying to be dark, but this is really important. Have a conversation with her about end of life issues. Specifically code / DNR status. She will reach a point where she will not be able to make her own decisions. If you don’t have the conversation before then, you will have to make the decision for her. I don’t care how much you think you and your wife will be okay with making that decision on your own, you won’t be. I see grown men crumble multiple times a week because they never had that conversation with their parents and it’s falling on them now. There is a peace that comes with following your parent’s wishes. I had to step in and make the decision for my mother when my grandmother died of Alzheimer’s. I have never seen my mother so broken and I would never wish that on anyone.

I’m not suggesting you pile on and talk to her about it right now. That would almost certainly be too much for her and you.

 

[Shmuley]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

Are we just going to gloss over the fact that the woman is married? From a practical standpoint, I don't think her kids or sons-in-law should attempt to step in and take control of the situation without a really clear and direct understanding with the husband about what is being done and why. Otherwise, the family is setting itself up for conflict which will likely get ugly.

Any action that does not immediately involve getting an audience with a recognized, trained, experienced elder attorney for a diagnosis of the entire situation and a recommendation for both a short term and long term plan is a waste of time. There aren't very many in Mississippi who meet those requirements. Unless the lady is on the coast, around Jackson or close to Memphis, she'll be traveling.

You have been warned.

 

[HailStout]

Are we just going to gloss over the fact that the woman is married? From a practical standpoint, I don't think her kids or sons-in-law should attempt to step in and take control of the situation without a really clear and direct understanding with the husband about what is being done and why. Otherwise, the family is setting itself up for conflict which will likely get ugly.

Any action that does not immediately involve getting an audience with a recognized, trained, experienced elder attorney for a diagnosis of the entire situation and a recommendation for both a short term and long term plan is a waste of time. There aren't very many in Mississippi who meet those requirements. Unless the lady is on the coast, around Jackson or close to Memphis, she'll be traveling.

You have been warned.

He’s right. Even if they have only been married a week the husband is going to overrule anything the rest of the family says. That goes for what I said above as well. I strongly recommend trying to get him on your side otherwise it’s going to make a painful situation much worse.

 

[LordMcBuckethead]

Move her in until it gets difficult and then put her in a facility. Sounds cold but it's just how it's best. Make sure assets are all moved before sending to a facility or you'll lose it every bit. Had to do it myself with a parent.

Public Service Announcement to all people with parents over 70.
Talk to an estate lawyer now and get their estate clear of assets now. Hopefully nothing happens to them for the next 5 years and then you can get them the help they need with dementia or whatever without destroying all their assets.

I hate the American healthcare system. Work you entire life, and get dementia or Alzheimer's and it takes all your assets in the process.

 

[LordMcBuckethead]

Are we just going to gloss over the fact that the woman is married? From a practical standpoint, I don't think her kids or sons-in-law should attempt to step in and take control of the situation without a really clear and direct understanding with the husband about what is being done and why. Otherwise, the family is setting itself up for conflict which will likely get ugly.

Any action that does not immediately involve getting an audience with a recognized, trained, experienced elder attorney for a diagnosis of the entire situation and a recommendation for both a short term and long term plan is a waste of time. There aren't very many in Mississippi who meet those requirements. Unless the lady is on the coast, around Jackson or close to Memphis, she'll be traveling.

You have been warned.

The lady is married?..... why the heck are the kids even involved? They literally have zero say in the matter. Zero, none. Sorry bud, buy your mom's care is 100% in the hands of her HUSBAND.

 

[thatsbaseball]

I'm looking at this as someone age wise who is closer to being cared for than being a caretaker. I've always thought and conducted myself that it was very important for us to be sure we've laid the ground work to take care of ourselves rather than to leave that burden with our children(and grandchildren). My in laws were not wealthy but carefully planned for their declining years, my folks, while they had appreciable assets, didn't even leave a will. I hope your MIL realizes how blessed she is to have you and your wife in her life and I hope she will work with you to make this as easy as possible on everyone. I've seen it from both sides and I guess what I'm trying to say is one of the best things parents can do for their children is to make plans that don't include them in their "care taking" if/when their time comes . I know that may not always be possible but it's certainly a worthwhile goal.

 

[Boom Boom]

And we are deer in the headlights. She lives 2 hours away from us and her now husband(wife’s father passed away years ago)is no help. She has a sister who is a little closer, but not much.

The diagnosis is less than a few hours old and the mother-in-law is fighting it. Which was predicted.

My wife is an RN and I have a decent amount of experience as a caregiver so I feel she needs to live with us.

What’s our first move? Getting her relocated? Protection of assets?

I picked a hell of a time to quit drinking.

Went through this with my mother. It's awful is all ill say.

First move is to not panic. It's a slow disease, typically. If you're paying attention, you'll know when next steps are needed.

Second step is assess assets, as others mentioned. Only thing I'll add is that typically the primary home is exempt, so selling it may have adverse affect on asset protection.

When you have a partner caring for you, you can go a long time without assisted care. But that can be hell on the partner. Offer breaks, I wish I had done that more for my dad.

 

[Tigr2ndbase]

Reach out to your local ALZ chapter. They’ll help guide you. They were great when I was dealing with my dad. If you happen to be in the Jackson area shoot me a message and I can connect you with some people.

 

[M R DAWGS]

Went through this with my mother. It's awful is all ill say.

First move is to not panic. It's a slow disease, typically. If you're paying attention, you'll know when next steps are needed.

Second step is assess assets, as others mentioned. Only thing I'll add is that typically the primary home is exempt, so selling it may have adverse affect on asset protection.

When you have a partner caring for you, you can go a long time without assisted care. But that can be hell on the partner. Offer breaks, I wish I had done that more for my dad.

Same situation for me. It is horrible.

 

[JesterB]

Are we just going to gloss over the fact that the woman is married? From a practical standpoint, I don't think her kids or sons-in-law should attempt to step in and take control of the situation without a really clear and direct understanding with the husband about what is being done and why. Otherwise, the family is setting itself up for conflict which will likely get ugly.

Any action that does not immediately involve getting an audience with a recognized, trained, experienced elder attorney for a diagnosis of the entire situation and a recommendation for both a short term and long term plan is a waste of time. There aren't very many in Mississippi who meet those requirements. Unless the lady is on the coast, around Jackson or close to Memphis, she'll be traveling.

You have been warned.

You are very correct. I thought I was going to have to have a very unpleasant, for him, conversation but that seems to not be the case. Step father is on board with helping. So far. He has said he doesn’t want to be on any assets and says he knows his limits of caregiving. We’ll see if we agree with those limits.


I’ve shared this thread with my wife and we’ve both found it very helpful. Thank you to all.

 

[greenbean.sixpack]

Public Service Announcement to all people with parents over 70.
Talk to an estate lawyer now and get their estate clear of assets now. Hopefully nothing happens to them for the next 5 years and then you can get them the help they need with dementia or whatever without destroying all their assets.

I hate the American healthcare system. Work you entire life, and get dementia or Alzheimer's and it takes all your assets in the process.

I urge everyone to do this. If there are a lot of assets and/or all kids are not on the same page and/or there's a new step parent involved, it can be very complicated and contentious. Don't do it yourself (unless there's not much in the way of resources and everyone agrees), meet with any estate lawyer.

 

[The Cooterpoot]

Also start looking into facilities. Good ones are very expensive and hard to get into. Might be a waiting list. It helps to have some political pull. Many will simply medicate them and damn near ignore them. Ive seen abuse. Some faculties will not accept more "aggressive" behavior from patients. Vet them all deeply.

 

[greenbean.sixpack]

Not trying to be dark, but this is really important. Have a conversation with her about end of life issues. Specifically code / DNR status. She will reach a point where she will not be able to make her own decisions. If you don’t have the conversation before then, you will have to make the decision for her. I don’t care how much you think you and your wife will be okay with making that decision on your own, you won’t be. I see grown men crumble multiple times a week because they never had that conversation with their parents and it’s falling on them now. There is a peace that comes with following your parent’s wishes. I had to step in and make the decision for my mother when my grandmother died of Alzheimer’s. I have never seen my mother so broken and I would never wish that on anyone.

I’m not suggesting you pile on and talk to her about it right now. That would almost certainly be too much for her and you.

I'm only late 50s, but made my wife and kids swear a blood oath that if i ever need to go to a NH, they will put a pillow over my head, give me a hand full of pills or inject a deadly does of insulin between my toes. At the least let me go out in the woods. You do not want to go into a nursing home, there are a few good ones (and those will drain your lifetime of resources quickly), but if Medicaid is paying the majority of bill, chances are it will be a bad experience.

 

[Delta_dawg22]

I am a nursing home administrator so I am familiar with your situation. If you or your wife don’t have POA then there isn’t much you can do. MS will recognize her spouse as de facto POA. You need to prepare for the possibility that she will need nursing home care as her disease progresses. Someone in the thread already mentioned the Medicaid look back period of 5 years. That is correct. The battle you face is getting her husband on board with transferring finances into your or your wife’s name. Nursing home costs go up every year. I used to run a 60 bed facility in the delta (moved out of state) and my rate was $260/day for private pay. It varies depending on location and facility. I recommend you and your wife get POA to make dealing with this a lot easier if you can.

 

[NukeDogg]

I am a nursing home administrator so I am familiar with your situation. If you or your wife don’t have POA then there isn’t much you can do. MS will recognize her spouse as de facto POA. You need to prepare for the possibility that she will need nursing home care as her disease progresses. Someone in the thread already mentioned the Medicaid look back period of 5 years. That is correct. The battle you face is getting her husband on board with transferring finances into your or your wife’s name. Nursing home costs go up every year. I used to run a 60 bed facility in the delta (moved out of state) and my rate was $260/day for private pay. It varies depending on location and facility. I recommend you and your wife get POA to make dealing with this a lot easier if you can.

Can you explain what this lookback period is and what it means? Sorry, never dealt with this before but I suspect my dad is headed down this road at some point fairly soon so trying to learn.

 

[Shmuley]

Can you explain what this lookback period is and what it means? Sorry, never dealt with this before but I suspect my dad is headed down this road at some point fairly soon so trying to learn.

The cost of nursing home care is not covered by health insurance. The cost of nursing home care, therefore, will be paid first from the assets available to the patient, or from some other private source (such as a long term care policy, or family members, etc.). Only after the person in need of care has exhausted non-exempt assets will that person be eligible for the cost of nursing home care to be covered from the public trough. There is a process by which an individual can be qualified for eligibility for publicly funded nursing home care. There is an application process through the Division of Medicaid. The application requires the applicant to disclose ALL of their assets, to include any "transfers of assets" out of the ownership of the applicant going back at least 5 years prior to the date of application. This is where the great unwashed get their asses in deep s h i t. With proper planning ahead of time overseen by a qualified elder lawyer, assets can be positioned to create maximum eligibility under medicaid regs. Properly positioned assets will not be considered "non exempt assets" for medicaid qualification. Unfortunately most families wait too late before initiating planning. I've seen dumbasses panic and sell Mom's primary residence (wrongly thinking that the house is not exempt under medicaid regs) only to learn that every dime of value extracted just went from exempt to non-exempt and will have to be used to pay for care before eligibility for publicly funded care kicks in. This s h i t is not DIY. It's complex. Find a highly qualified elder attorney. And the prudent will start early enough so that planning is actually useful and helpful. Once Mama is wandering out in traffic and putting her car keys in the freezer, you've waited too late.