Domestic Partner of Caregiver/Daughter

spiel612

NOTE: Apologies for a very long first post.

I am reaching out on behalf of my girlfriend, who I've been with for about 3 and a half years. We live together and own a home. We are committed to each other, even though we are not yet married.

My girlfriend's father was diagnosed with early onset in the Fall. He is still mostly lucid, but his short-term memory is really a problem. He can't remember conversations about long-term planning, retirement, etc. 

I have recommended that my girlfriend set him up with a financial planner so they can go over his assets and figure out what he and his wife will need and how best to generally protect himself in the condition he is in. They are not rich, but they do at least have some of what they need to get by over these next few years.  Unfortunately, he doesn't remember these conversations. Thus, it doesn't occur. COVID hasn't helped complications, because her father and mother have not always been the most risk averse when it comes to handling the virus, whereas we are extremely risk averse.

Recently (as in Sunday), he fell while at the grocery store with his wife. It is a miracle they made it home, but he powered through and actually drove them the mile and a half back to their house. He broke his ankle and required surgery the next morning. I do not know how he did it. I once sprained my ankle playing basketball and thought only childbirth could possibly be more painful (lol).

With all this context in mind, I have several questions. My girlfriend, for the record, has been dealing with the hospital visits for the last few days, so I'm trying to take some of the stress off of her and provide her with information. 

1. What type of financial planner is the best for this type of case? I assume there have to be financial planners who specialize in elder care, but I confess I'm completely unfamiliar with this. I want to get that information to her so they can set up a digital meeting (since her dad is going to be immobile for a while with the broken ankle).

2. How do we convince him that he has already agreed to retire? How do we convince him that he has already agreed to meet with a financial planner? How do we convince him that he has already agreed to potentially seek out assisted living or in-home care? He has agreed to all three of those things at one point or another. And, in all three cases, we've had them in writing via text message! Yet he doesn't remember sending the texts, so any time there is an attempt at following up, it goes nowhere. 

3. Not a question, but I'm just looking for any way that I can be helpful. My girlfriend has a lot on her plate: she was laid off because of COVID, is finishing up a master's degree (at double the pace because of all her free time), has a father with alzheimer's and a broken ankle, a mom who is battling severe depression and simply won't leave the home anymore, and a sister thousands of miles away. The sister is helpful and supportive, but ultimately she is still in Oklahoma, while we are in West Virginia and just a short drive from her parents. Outside of what I have asked, what can I do to help? I'm at a loss here. They're on wait lists for basically everything, Adult Protective Services said they really couldn't do anything, and we can only do so much due to COVID. We set them up with a meal delivery service and are in the process of setting them up with a cleaning service. We also want to move them somewhere without floors now, since obviously that's no longer going to be possible. But, yeah, just kind of at a loss and not sure what to do

Thanks for any advice in advance. She and I both appreciate it. 

terei

IMO the first appointment should be made with a certified elder law attorney.   Documents such as DPOA, living wills, medical POAs + financial planning would be addressed.

It sounds as if the wife cannot cope with taking control so it may fall to your partner.

Just seeing a financial planner without all the legal underpinnings in place, especially if the patient cannot remember decisions from day to day is not going to do what needs to be done.

star26

Hi Spiel612, What a nice boyfriend/quasi-son-in-law you are. It sounds like they need your help. 

1. They need an elder law attorney, preferably a certified elder law attorney (CELA), rather than a financial planner right now. Look online and see if you can find CELAs in your area. If not, look for elder law attorneys/estate attorneys (as their only speciality with plenty of experience.) If it's not done already, he/she will set up financial and healthcare POAs and will discuss financial planning for protection and long term care needs including possibly Medicaid down the road. Think about who should be the POA and who will be the backups. If Mom is not capable of taking care of herself or him, don't have her be POA. Ideally the person should live nearby.

2. You can't convince a person with dementia (PWD) of anything or expect him to recall conversations, believe you about past agreements, or use sound judgement. A combination of just doing things that need to be done on your own, along with giving him information on a need-to-know basis in the moment, and creatively tailoring the information you give him according to what he can handle, is what is needed. It sounds like you may have a problem with the mother and not just father. She let him drive them home with a broken ankle and it doesn't sound like she's stepping in and taking charge when needed. Ideally, she would be the person getting him to the CELA appointment.  Her role and ability needs to be honestly explored and addressed. I recommend that you and your girlfriend find the CELA, schedule the appointment, plan to attend with them as a family, "remind" him about it a day in advance with minimal explanation, and pick him up on the day of the appointment and drive him there (or maybe the appointment will be online due to Covid?). This is what I had to do with my parent, because left up to him it would never get done. It's not unusual for PWD to object to seeing an attorney or completing planning paperwork. Lots of people here have dealt with that. If it turns into an issue of the father thinking he doesn't need to make any legal plans, or not believing that there's any problem, you can get ideas from others here about what to say to him to get this done. The legal stuff is crucial and time sensitive since he will not always be considered competent to sign the necessary paperwork. 

3. I think continuing to be the information gatherer and general support person is very valuable at this stage. Since you have the benefit of being a bit removed from the situation and maybe not as overwhelmed or emotional, you may be able to recognize needs and issues before others. Such as when it's no longer safe for Dad to be driving. It's also good for you to know that this is going to get worse, and may take up a lot of your girlfriend's time, mental energy and attention for quite some time.  

King Boo

Step 1:  Find a CERTIFIED Elder Law Attorney (CELA).  Not just someone who advertises elder law.   www.nelf.org

If no CELA available in your area (interview well) naela is an organization of lawyers who profess interest in elder law - but there is no skill guarantee.  Again, interview well.

She should get DPOA/updated wills/ long term care planning via the CELA.

A financial planner would be way secondary to the CELA.

Step 2:  She has to stop expecting 'normal' conversations to work.  Avoid "The Talk". It's about saying what will work, pushing buttons.  "Gee, Dad, you were lucky you didn't really get hurt in your fall.  If you did, Mom would be in a lot of trouble, so let's get some help to figure out how I could help her if that ever happened."

Then let the CELA do the talking. They work with older folk and are pretty good at their work.

Step 3:  Layer in services.  Examine adult day care, home health.

Step 4:  Immediately visit and d one at least temporarily at some point  All are not created equal.

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harshedbuzz

spiel612 wrote:

Hi and welcome. No need to apologize for the length of your post- more information is useful when trying to answer. One question I have is how old your prospective FIL and whether he is still employed. If he's not yet retired or 65, they may want to look into SSDI and early Medicare to bridge the gap until he's 65.

1. What type of financial planner is the best for this type of case? I assume there have to be financial planners who specialize in elder care, but I confess I'm completely unfamiliar with this. I want to get that information to her so they can set up a digital meeting (since her dad is going to be immobile for a while with the broken ankle).

A certified elder law attorney is the specialist for this sort of planning as well as the legal paperwork that would allow someone else of access information and act on his behalf- POAs for both parents. If MIL2B is financially and medically savvy, she could be her husband's agent, their daughter should be agent for Mom (because dad will soon be unable to make reasoned choices) and at least secondary to mom for dad. 

Medicaid is the safety net for those with dementia who need some in-home care or perhaps placement in a MCF or SNF (this is often dependent on the state)

Accept no substitutes-

National Elder Law Foundation (nelf.org)

2. How do we convince him that he has already agreed to retire? How do we convince him that he has already agreed to meet with a financial planner? How do we convince him that he has already agreed to potentially seek out assisted living or in-home care? He has agreed to all three of those things at one point or another. And, in all three cases, we've had them in writing via text message! Yet he doesn't remember sending the texts, so any time there is an attempt at following up, it goes nowhere. 

One of the truths of dementia is that the PWD has a broken reasoner. The time comes when you don't explain, ask permission or try to convince- you just make plans on their behalf and tell them after whatever story it takes to help them be OK with with it. 

In your shoes, I would have MIL2B sit down with daughter and CELA to explain the situation and come up with a plan. Dad can come along for the second appointment to sigh documents. Most CELAs are used to working around people with dementia and can help make them feel heard and respected. Sometime it helps to go to the meeting as a family- you and your betrothed might pose it as getting your paperwork in order ahead of marriage and they should, too. 

You may have "proof" that you've discussed this, but it is seldom a good idea to go down that path. It's likely he has some anosognosia and doesn't not sense there's anything amiss with his mind. Trying to convince him otherwise will just p-ss him off.

3. Not a question, but I'm just looking for any way that I can be helpful. My girlfriend has a lot on her plate: she was laid off because of COVID, is finishing up a master's degree (at double the pace because of all her free time), has a father with alzheimer's and a broken ankle, a mom who is battling severe depression and simply won't leave the home anymore, and a sister thousands of miles away. The sister is helpful and supportive, but ultimately she is still in Oklahoma, while we are in West Virginia and just a short drive from her parents. Outside of what I have asked, what can I do to help? I'm at a loss here. They're on wait lists for basically everything, Adult Protective Services said they really couldn't do anything, and we can only do so much due to COVID. We set them up with a meal delivery service and are in the process of setting them up with a cleaning service. We also want to move them somewhere without floors now, since obviously that's no longer going to be possible. But, yeah, just kind of at a loss and not sure what to do  

Right now, I'd be deciding which SNF/rehab would be best for him to go to after he's discharged to buy you some time to make some hard decisions with his wife before he comes home. I was able to get mom into see her CELA while dad was in rehab and then move them both so that dad moved from the SNF to an apartment near me.

I'd also be looking into day programs and home health services for respite for your MIL2B.

HB

Thanks for any advice in advance. She and I both appreciate it. 

Cynbar

I am going to second all the excellent advice you've gotten so far. This can all seem overwhelming (well, it is), but it can be managed. You and your girlfriend will find a lot of support and advice here from those of us who are living in dementia world.

I don't have a lot to add, but I do want to underscore one thing. Your biggest hurdle here is getting over the idea that you can still reason with your girlfriend's father. You can't --- the rules have changed, his brain is no longer working right. Every time you remind him of things he said in the past, every time you try to reason with him and get him to participate in decision making, will make things worse. It will make him angry, upset, sad and later agitated.It will also leave the rest of you frustrated and exhausted.  It's like you are talking a different language. Instead, your girlfriend and her sister will have to take over the planning ----- they are in charge now. Discuss it with him very little, and don't waste any more energy trying to get him to see the truth. His daughters will need to determine the best plan going forward, don't expect him to agree, he probably thinks he is fine.  It doesn't sound like his wife will be too much help, denial and depression are a toxic combo and she may possibly have some cognitive changes (her judgment seems suspect from your post.) All of this is a seismic shift in how they have always interacted. But it is the kindest thing to do, and also likely the only way to get anything done. Most of us here on these boards have been there, and can attest that stopping the urge to reason with the PWD is best for everybody.

abc123

Hi 1612, welcome to our family! There are many wise and caring people here. Some have many years of experience as caretakers. You have gotten some excellent feedback already. You mentioned that her Dad has Early Onset. It usually progresses much quicker than late onset dementia. Also you mentioned her Mom is depressed and won’t leave the house. If she were my Mom, I’d get medical attention for her too, ASAP. An antidepressant may richly improve her quality of life to the point of not being an extra burden to your GF and maybe even being able to be a valuable member of her husbands care team. 

If her Dad becomes hard to deal with, a geriatric psychiatrist can be invaluable. 

You are a fine and caring man! I’m sure your GF appreciates you. I suggest reading everything you can possibly read on the subject of EO dementia, depression, medication, etc. I wish you and GF much luck on this journey. Remember to take good care of yourselves and of each other.

M1

Your post shows a lot of sensitivity and caring and I am glad your GF and you have such a good strong relationship. It's hard to change the way of relating to her dad, but Cynbar is absolutely right that he is already past logic and reasoning and handling financial matters. Someone needs POA asap to get those things out of his hands, so I agree with all you've been told about CELA being your top priority.

Don't wait: we go Thursday for my partner to finalize some changes to her will, and it's a nailbiter as to whether she understands what she's signing. She seems to, but if you ask her to explain it back to you she can't. You don't want to wait on this any longer.

spiel612

Wow. These responses are AMAZING. I just wanted to say thank you to all of you who did respond.

He's going to be likely off his ankle and in a rehab facility for the next 6 to 8 weeks. We called a CELA today, hopefully going to be able to get to work on setting up an appointment. While I know he has a will and medical POA already, those were done long before his diagnosis. We are all in agreement that my GF and her sister should be POA, but there never seemed to be any agreement on that front from her parents. So we're going to get that process rolling. 

One thing of note: before I was able to relay all of this information, MM (our EO's initials) actaully requested that my GF inform his boss. That occurred before I was able to relay this information, so we'll have to see what happens there. They have a relationship that goes beyond work though, since they (MM and his boss) are friends IRL. 

I'm so relieved to read these responses. We, but particularly my GF, were really struggling with this. COVID has only made it worse. Not that it helps to Monday morning quarterback anything, but we believe that his serious decline may have coincided with the start of COVID (based on information we have gathered) and gone into overdrive during the opening months of the pandemic when everyone was essentially quarantined. It is when we started to notice the most worrying symptoms. At that time, they lived about an hour from us, so we weren't sure what to do. And he didn't finally get the ball rolling on a diagnosis until late Summer. By that point, he had already probably been six months in decline.

Once again, thanks for all the thoughtful responses.