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Old 01-24-2016, 09:14 AM
Location: NC
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Just wondering. Suppose you are single, never married, no kids, and elderly, with no long time friends nearby. Suppose you become incapacitated in some way and cannot advocate for yourself either for a short time or forever. Is there some way to set up a virtual advocate who looks out for you, your money, your resources? Someone to whom you give health care power of attorney, or who finds the best assisted living or nursing home for you when you can't do it yourself? Are there resources for low-income people? Are there resources for people with adequate retirement savings who can pay their way?

I would estimate 5 or 10% of the elderly would fall into this category at some point.
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Old 01-24-2016, 10:28 AM
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You must be your own advocate.

Ideally, you set this up for yourself long before you are incapacitated. You choose someone to be a medical/financial power of attorney, make a living will and regular will. You do the research ahead of time, if possible. If not, honestly.... no one looks out for you like a caring family member does. It could be hard.

Hiring a professional care manager can be very expensive. They are also hard to find. But certainly can be done if you are suddenly looking for nursing home, for example, and you need expertise quite quickly. There are also websites like "A Place for Mom" that can help step you through the process.

You retire to a community that is known for having good health care and social services for seniors. For example, in my father's community there are free lunches for seniors which can also be delivered to your home if you are home bound, free (or pay $1) shuttle bus service that can pick you up at your home and drop you off at the doctor's office/store/appointments etc..., and a social worker that will come to your home to evaluate your needs and let you know what state/city sponsored resources are open to you. Often, there are quite a few resources available if you are very poor. These can range from subsidized senior housing, free (state pays) homemaker visits to the home, freezes on property taxes and utility costs etc... It all depends upon where you live. Find the phone number for your local Department of Aging, and set up an appointment to get knowledgeable about all resources. But if you have a higher income, the resources can be more limited. You need to plan.

If you suddenly become ill and you are in a hospital, there is a social worker and case manager that will assist in setting up basic services for you once you leave. But they are often NOT focused on finding you the best Nursing Home etc.. Their goal is to get you out of the hospital.

There are many in Nursing Homes that do not have advocates. Their lives are often very poor. And many of them have family! A family is not a guarantee of having an advocate.
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Old 01-24-2016, 05:58 PM
Location: NC
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Thanks. That is not what we like to hear, is it? What a great business opportunity, or an add-on to something that insurance companies or law offices might set up. It is always disturbing to me that people with low-income are offered services that people with moderate income cannot even find. Should there not be similar services for all, even if people with moderate income are expected to pay (or maybe to have insurance for)?
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Old 01-24-2016, 07:50 PM
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Well.... I think each of us should do a decent job at thinking ahead about our future.... regardless of whether you have a family or not. But many of us don't.

There is such a thing as long term care insurance. Many people don't know about it, and it is expensive so many do not have it.

I do know one very good Elder Care lawyer who also has a Case Manager/Social worker that provides such services. While the lawyer charges $350 per hour, the Case Manager charges.... $100 per hour.

There aren't a lot of people jumping to pay those prices. But honestly, it could be the best investment they could make.

Many communities have social workers that will help advise you for free about available services. But they are often constrained and are NOT supposed to steer you towards one company/nursing home/assisted living facility etc... So often they can only give general advice.

People who are very low income are just eligible for more subsidized services (ex. housing, homemaker visits). Ideally, there would be a wide, income based ladder that would help subsidized such care/assistance when you need it later in life. This could improve the quality of life of many more seniors. But the income limit cut offs for subsidies are often kept quite low because of financial limits by each state. It is expensive to provide services. It is the voters of each state that choose the politicians who determine how tax money is raised and allocated, and therefore determine these limits. So I guess we can only blame ourselves if we don't like the system!

I do think we should and could have better alternatives to traditional Nursing Homes.
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Old 01-25-2016, 06:51 AM
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Originally Posted by luv4horses View Post
Thanks. That is not what we like to hear, is it? What a great business opportunity, or an add-on to something that insurance companies or law offices might set up. It is always disturbing to me that people with low-income are offered services that people with moderate income cannot even find. Should there not be similar services for all, even if people with moderate income are expected to pay (or maybe to have insurance for)?
What services do you mean? Aging services, including home delivered meals and transportation, are typically available to all. Home health care services can be purchased privately. In nursing homes, Medicaid beds can be impossible to find, at least in reputable and quality facilities. Private pay and Medicare beds are easier to find with better choice.

But yes, affordable health care advocacy services for the middle class -- those for whom an elder attorney is out of the question -- should be more available.
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Old 01-25-2016, 07:55 AM
Location: NC
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The services I am writing about are not the ones you are mentioning, Sicilee, but rather services that would guide an individual to getting optimal care, given their finances and circumstances. Not the meals-on-wheels per se, but one that signs you up for meals-on-wheels. Not the bed in the advanced care facility, but one that selects the best advanced care facility for you, just as a loved one would do if there was a loved one advocating for you. Perhaps the 'loved-one' is totally incapacited too, or the person is the last of his family line, or the kids won't lift a finger to help the parent.

We have brokerage houses that help us to invest our money, but why can't there be ethical organizations that help us spend our money on the best care for which we are eligible given our finances? And organizations (highly regulated of course) that advocate for the guy with a million dollars in the bank if he needs an advocate.
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Old 01-25-2016, 08:28 AM
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Most people do not hire reputable investment advisors. Many people also get "mislead" with regard to their investments....

Social workers/case managers can be at the hospital, your doctor's clinic (especially dementia clinics or oncology clinics), your local community Senior Services offices and state Department of Aging, Elder care lawyer offices and local non-profit health clinics are all places to go for information. All of those will be free visits or covered by insurance except for the Elder care lawyer office. There are very few private case managers that have their own offices, independent from all of the listed situations. And they will be expensive. There are some people who specifically help relocate seniors to assisted living facilities, and they sometimes get their payment from the facility.... not from the individual. I always wondered if they were truly impartial in their recommendations, or if they were influenced by payments they receive from the facilities...

The best source of information, I have found, comes from other individuals you meet at caregiver support groups.

And honestly..... there are very few "best" Nursing Homes that anyone is going to be anxious to go to. Even the good places have problems. The most expensive, luxury assisted living facility in my town just had an outbreak of scabies and is known to have poor food. And that's the best.... You can't have everything.
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Old 01-25-2016, 08:54 AM
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Let me give you the Cliff notes version of how bad it can get. My sister and husband retired and moved to a small town close to a major city. That was 10 years ago and they made a lot of close friends during that time. A couple of months ago he died suddenly. He had managed the finances but was juggling huge credit card debts and a home equity loan. Before the grieving had even started my sister faced bankruptcy and losing the house. She escaped that barely due to insurance but has a very minimal income. The stress set off some hidden and serious medical conditions. She has been in the hospital 5 times in 2 months with high BP, dangerously low potassium and last time a stroke. She needs 3 major surgeries including open heart but the expertise is not available in the nearby city and she will need to go back and forth for a 3 hour trip to a major medical center. There have been 3 trips so far just beginning the evaluation and presurgical planning. Due to the medical issues my sister cannot drive and really cannot even safely live alone. Friends and neighbors have been great but they cannot carry this burden. My wife is trying to avoid a surgery with antibiotics and other remedies so I am not able to travel. My sister has a son and daughter a day's drive away. Both have visited for short periods. The son is trying to arrange a month's worth of leave to help with one of the surgeries. No one myself included has any idea of how to provide the many months of help needed. Her medical team even discussed the possibility of doing nothing; i.e., going home and waiting to die due to stroke, burst aneurysm or other causes. That may happen anyway since they are still trying to decide which initial surgery is least risky and no surgeries will be scheduled for at least a month or two. BTW, my sister just turned 65 and her husband was only a few years older.

This is a long and depressing story. I have no solution to this problem. I post this as a warning to others. When we first retire, we can come up with ambitious plans including moving away from friends, relatives and other support. Maybe that makes sense but thinking and planning for our future health needs is also important. Maybe the brother in law who died suddenly and unexpectedly was the lucky one.
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Old 01-25-2016, 08:58 AM
Location: Loudon, TN
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In addition to helping someone find these facilities, there is a further need to assist elders in actually moving to facilities, and then becoming their medical and financial advocate. We act in this capacity for my MIL, but I can see that with an older husband, no children, and siblings that will be gone before me, that I may be on my own someday. If it weren't for us, I really can't say what would have happened to my MIL. Her other son is ZERO help. He writes or calls maybe once a year. MIL has dementia, so from day to day she can swing from almost full cognition to not knowing what state she is in, or who is alive or dead. Without us to recognize her problems and physically pack up her stuff and move her to assisted living, she would probably have accidently killed herself by overdosing on her meds. After a fall, she was so disoriented that for 3 weeks she hated on us and cursed us for "treating her this way". She can't keep track of cash or credit cards, so we handle all her bills and medical insurance issues. We go with her into her doctor's appointments because she often can't remember why she is even there, let alone what the doctor said to her, or what he prescribed or that she needs to pass the prescription on to her AL staff. This stuff can be a lot of work. I just don't know that there is anyone who will do this for me, or any other elder without close relatives. I can see a need for someone who can be like a surrogate daughter and act in this way, but it's a huge responsibility.

As I get older, I guess I will have to train one of my nieces or nephews and then leave them a chunk of money when I'm gone. I don't really even know if I'm kidding or not when I say this.
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Old 01-25-2016, 09:44 AM
Location: too far from the sea
19,830 posts, read 18,839,234 times
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I had an aunt who researched the nursing homes in her area and chose three. When the time came (in her 90s after a fall on the ice) her daughter raced around and did finally get her into one of the three chosen nursing homes, where, eventually she died peacefully and well cared for.

In my own mother's case, she was discharged from the hospital into a lovely new nursing home. It turned out to be a nightmare. Thank goodness my dh and I were able to go there, he on his lunch hour, and me on my days off or at night. Those workers were abusive to my mother. It was the night workers: they barely spoke English, swore at my mother, told her to wet the bed because they weren't going to help her to the bathroom. They wouldn't even bring her a blanket when she was cold!

My mother never caused them any trouble at all. She was a sweet person but that's how they treated her.

So I think my aunt's idea of researching the nursing homes ahead of time was smart. (She also wrote her own obituary!) In both cases family was needed though. So there's the problem if you don't have family.
my posts as moderator will be in red. Moderator: Health&Wellness~Genealogy. The Rules--read here>>> TOS. If someone attacks you, do not reply. Hit REPORT.
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