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Know elder-care options

As our parents’ health worsens, sometimes we have to make the tough choices

In 1988, my now nearly 80-year-old father suffered a massive stroke. Ever since, he has been fighting to maintain and enjoy a quality of life that might pass as normal and ordinary.

The fight got harder about two years ago when he lost his right leg up to the knee because of diabetes. And it may get even harder still.

At the moment he’s fighting osteomyelitis, an infection of the bone in his leg. If he beats the infection, he gets to keep his left leg. If the infection wins, the doctors say they will have to amputate his left leg to the knee.

I am flying today from Boston to Tampa to meet with his doctors and to serve as best I can as his advocate, provided I can get his HIPAA number.

I am also flying there in hopes of boosting his spirits, to remind him that no matter his condition and state of mind, he remains a hero to my children.

They regard him – despite the difficulty he has speaking because of the stroke, despite the difficulty he has getting about – as a fighter extraordinaire.

They remember the tattoo on his bicep from his days serving in the U.S. Navy during the Korean War. It’s a tattoo of a boxer, which he was for a bit in the Navy, with the words “K.O. Red.”

To them, it’s as if Grandpa is that very same fighter. And today he’s merely fighting another opponent – and he keeps on going.

With hope, he’ll get that message. Because I’m certain the bouts are about to get harder, as the choices and options become fewer over time.

Right now, my stepmother and father are living in an over-50 community. But I’m sure the case manager at the hospital will tell him it’s time to consider a nursing home, and that it’s hard on my stepmother to remain the primary caregiver.

I’m also sure that won’t go over well with my father, who, like many other Americans of his generation, views the nursing home as death’s doorstep – the final stop before the funeral parlor.

There’s another problem with the nursing option, though. My father is married to a woman who is still able-bodied. It would be financially impossible to move them both into a nursing home. Most don’t have rooms for married couples and even when they do, they would have to pay upwards of $400 a day for the chance to stay together.

Could my father move into a nursing home and my stepmother stay in the condo? Yes, but maintaining two residences doesn’t seem all that prudent either.

The other option is an assisted living facility. But the problem with this option is much the same as with the nursing option.

My father would require more care than my mother. And so for them to live together, they would have to move into a room that costs quite a bit more than those for residents who don’t need as much medical attention.

Call it $6,000 a month – $3,000 for her unit and $3,000 for his, give or take.

That leaves us with what I view as the two best options.

One, my father and stepmother stay where they are and hire, as they have already, a home health aide to tend to his needs, to lift him in and out of bed each day using the Hoyer lift. This option is, in many ways, the least costly (say, $20 an hour), but it’s not ideal by any stretch of the imagination.

The benefit is that they maintain the support network, doctors, and health insurance they have in place. The downside is their adult children have to fly down every so often to check in.

The other best option would be for father and stepmother to move back North to be closer to their adult children. But as with the other choices, there are pros and cons.

For instance, they would have to sell the condo in Florida (not an ideal time to do so) and find a place to live up North (either another condo or move in with one of the adult children). They would also have find a doctor or team of doctors who could treat my father in the same or better manner.

As I fly to Tampa, I’m thinking two things: One, the need to create a grid with all the options and the pros and cons, and attempt to weigh the choices in a prudent, unemotional manner.

And two, my desire to read “Caring for Our Parents” by Howard Gleckman, a senior research associate at the Urban Institute.

On his website, Gleckman penned “10 things you must know about caring for your parents.” (Read the entire list here: howardgleckman.com/ gleckman-10things.htm.)

Among those 10 things is this reminder: “The most important thing to know: Caring for an aging and frail parent or disabled relative may be the hardest thing you’ll ever do in your life. But it can also be the most rewarding.”

I believe that to be true as well.

Robert Powell, the editor of Retirement Weekly, has been a journalist covering personal-finance issues for more than 20 years. Follow his tweets here: http://twitter.com/RJPIII.


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