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HELP: Sorting Out Hospice for Grandpop.

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  • HELP: Sorting Out Hospice for Grandpop.

    Background: I am primary caregiver for 85 year old grandfather who has hepatorenal syndrome type 2 and qualified for in-home hospice which were his wishes. Currently not able to make decisions on his own. My mother is financial POA, but in reality I am since my mother is not capable for making these financial decision or analyses so she deferred to me.

    Medical Prognosis: Initially thought just a few weeks but doing much better in all facets including mentation, nutritional intake, pain management, urine output. Possible that he lives several more months.

    Logistical Issues: I have few family members that I can count on to be with him alone and he needs 24/7 care given his has nearly no mobility (can transfer at times to bedside commode and wheelchair). I fear that certain people in my family may steal from him or take his opioid pain medications. Therefore, I calculate that we need 31 hours/week of outside help.

    Financial Issues: The outside help costs $15-25/hr which makes monthly expense $1,860.00-$3,100.00. I will lay out the current financial status to navigate.

    Assets:

    Liquid:



















    Savings $37,434.06
    IRA $1,800.00
    Cash $2,136.00
    Total $41,370.06

     

    Savings- Crappy 0.01% APR Savings Account and big name Brick and Mortar Bank

    tIRA- Traditional IRA locked up in 0.05% APR CD with maturity date 4/28/2020. Penalty for early withdrawal: $50 + 182 days of interest.

    Cash- All that I could find squirreled away. He is a child of the Great Depression so I am sure he has more hid really well.

    Illiquid Assets

    Paid off home- Probably worth $150k. No liens I am aware of.

    Car- 1999 Ford Escort. Runs. Maybe worth $300-500.

     

    Current Income:



















    $/month
    Pension $221.00
    Social security $1,633.70
    Total $1,854.70

    Current Expenses







































    $/Month
    BGE $140.00
    Health insurance $130.00
    Cable bill $175.61
    Water bill $20.00
    Phone $36.41
    Property tax $100.00
    Home insurance $53.36
    Total $655.38

    Current Net Monthly Income before healthcare expenses: +$1,199.32

    Estimated Net Monthly Income after healthcare costs: -$660.68 to -$1,900.68

    Estimated Time to Ruin (i.e. liquid assets to 0): 21.77-62.62 months

     

    GamePlan:

    1. Hire the cheapest, but still trustworthy help

    2. Attempt to find family/friends that can be trusted to help more

    3. Transfer his Savings to Ally or higher interest bank

    4. tIRA- Cancel CD. Cash out tIRA and place in Savings Account

    5. Slash Cable Bill and Phone costs. He derives a great bit of enjoyment from certain TV channels and he is able to enjoy them now so I won't outright cancel but the cost is absurd.

    6. Sell Car

     

    I am a planner, so I have to be prepared for the situation if he does survive for several months and I need more help than the current plan. This will help me to enjoy the time I have left with him. He provided a home to me when I had no place to live and I am very close with him. It is not a typical grandson-grandfather relationship since I lived with him for 7 years in my adulthood.

    When I go back to work I am going to be doing my busy practice and administrative tasks while spending probably 70 hours being his primary care taker (I am moving back in with him to be there overnights most days of the week-- I has a air mattress next to his hospital bed in the living room). I know this is not long term sustainable.

     

    Sorry for this: I just want to make sure that my analysis and calculations are correct. It seems like based on the math that we can use his nest-egg to make sure he gets adequate care. I may be able to get more hired-help if it becomes to burdensome for my own sanity.

     

    Just need outsiders brutal and honest insight. Thank you all.

  • #2
    I'm sorry that you're in this situation and that he's sick, however, it sounds like he's had a very long life and I'm sure has many great memories. Given his savings, it appears he's got enough to last through the end of life while getting to stay at home per his wishes. I wouldn't necessarily cheap out on the help. An extra $5-10/hour can really be a drastic difference in the kind of help he can get. This amount of money will be negligible in the long run and it will benefit everybody.

    Comment


    • #3
      Don't sweat the phone/cable bill.  If it gives him a couple hours a month of enjoyment (and keeps the caregivers happy and you at work), it is worth it.  And those caregivers will also use it.

      Don't go too cheap on the help.  You'll be the one mopping up if things go off the rails...you get what you pay for.  Might also be worth it to your practice/family if you are not there every night...there is no question in my mind that it will be "burdensome for my own sanity."

      Given your description of the relationship, I'd have no problem financing a shortfall out of my pocket.

      I probably wouldn't bother with chasing yield (moving the savings) given the timeframe.

      Reverse mortgage?

      Good luck.

      Comment


      • #4

        • KEEP THE CABLE! This is and the occassional companionship or conversation is all the remains for his quality of life.

        • Sell the car.

        • Not critical, but what is the plan with the house? Reverse mortgages are expensive, but that is your main source of cash. I know you are attempting to shelter his assets. But no sense paying expenses letting that asset go to someone else.




        • qualified for in-home hospice which were his wishes.
          Click to expand...


          What did he qualify for? There are usually funds provided as long as the residence is used as security. Did not see what funds he qualified for. Hospice is one thing, home living assistance is another. The savings would be a problem with any medicaid type help.

        • Title the house with a Transfer on Death Deed to keep it out of probate. The person will either need to pay the Reverse Mortgage or sell the house when he passes.

        • Use all of his funds before you contribute a penny. Your contribution will be to someone else or the state.

        • Make sure all accounts have beneficiaries.

        • Find out his wishes and make them happen (including distribution of any remaining assets).

        • No reason to cash out the tIRA early.

        • Hire help for a break when you need it. Pure and simple.

        • Reimburse and pay every thing out of his funds with receipts. Simple documents for any family questions or government questions. Don't be surprised if some come wanting something later. Solely to protect your self.

        • Good luck. Put bills on autopilot as much as possible.

        • Get yourself some backup. You will need time off to decompress and recover. Grandpop needs you in great shape. Best for both in the longer run.

        Comment


        • #5
          Is inpatient hospice not an option?  This are sounding less and less safe at home, so while his wishes were to stay at home, if it’s going to compromise his and your mother’s safety it’s reasonable to move him to a hospice house type situation.

          Im very sorry you are going through this!

          Comment


          • #6
            In our county hospice picks up a lot of the home health bills. You probably already explored these options but it is worth a shot. Inpatient is another good choice if available.
            Remember 24/7 care is more than 3 full time jobs and that doesn't even consider the emotional strain. This sounds like one of those times where money is well spent.
            Good luck.

            Comment


            • #7
              “Currently not able to make decisions on his own. My mother is financial POA, but in reality I am since my mother is not capable for making these financial decision or analyses so she deferred to me.”

              This is unfortunately a “typical” EOL situation, or at least common. The reality is that the OP has ZERO legal authority. This will be a HUGE obstacle.
              Every call on Grandpa’s behalf will be met with “privacy restrictions”. YOU NEED TO IMMEDIATELY GET IT PAPERED.
              • Financial and health power of attorney’s.
              • Social Security, Medicare, Supplement, Drug Coverage
              • Bank and Brokerage accounts
              • Get copies of every ID and card.
              You have two paths: legal guardianship or the practical path.
              Get the forms signed, notarized, witnesses as needed.
              Unfettered access to discuss issues on his behalf requires “authorization on file”. Hint: you may need to use a “mobile notary public “ or your “branch manager” may need to kindly ask, “Grandpa, do you want grandson to be joint owner on you accounts? Sign here.”
              You are not set up to speak or sign for him. It WILL unravel when you need it. Something as simple as a medication or home owners insurance payment or question. Make a list and attack it. Lack of authority will send off alarms and freeze you out from access and needed cooperation.
              One form on file gets you, “How may I help you?”
              Then you can get back to solving the problems.
              • From a sanity viewpoint, you are not alone, the support system will not come from services, this is an EOL phase that will be difficult but will pass. “Not authorized” is extremely frustrating and actually harmful. Fix that immediately.

              Comment


              • #8
                Title the house with a Transfer on Death Deed to keep it out of probate. —- this is something that we would have to change with the deed correct? My grandmother whose been deceased 15 years is still listed on deed. I imagine my mom would be able to do this now she has POA.

                I have no plan for tapping into the home equity. Today, as I’m writing this I’m noticing his urine output significantly slowing down and his edema from liver disease third spacing increasing. He had an excellent honeymoon phase as he was so happy to be home and out of the hospital. But as it stands now I think that his time is short. I think we are looking at weeks now instead of months. I’m a neurologist so I don’t know how to prognosticate this though. Just making sure his pain and suffering is managed now.

                After his death- my mom gets the house and property as listed in his will.

                Inpatient hospice is an option at $300/day. Will only be able to do this in the event he is suffering and we are unable to control his pain/distress at home. I would prefer to have done inpatient but he did not qualify at time of discharge from hospital.

                Hospice is pretty amazing they are covering a lot. They just don’t provide 24/7 care which is our responsibility. My grandpa has never tapped into his VA benefits. I am calling the VA since he served in Korean War in the Army. I will see what additional assistance they can provide.

                To Tim: Grandpa is not in state of mind to allow me to take over. When he was of sound mind he elected my mother to be not only his financial but his primary healthcare POA. He is the closest with my mom, but she is not emotionally or cognitively able to make these decisions. I love her but she’s a house cleaner and has limited math/finance/healthcare knowledge. My wife and I are running the show. It has already proven to be a huge barrier. I’m not sure how to remedy this situation. I don’t think my mom would relinquish control of the situation since she would feel “[she] isn’t respecting his wishes”

                As an aside, this whole situation has shown me even more how absolutely lucky I am to have my wife. She’s the only one I can count on and she So amazing in this crisis situation. I am so lucky and happy to have her.

                Comment


                • #9
                  Oh and we are definitely not cheating out on the care. We are looking to hire a live-in caregiver. No one outside of me is able to even change him and wipe his butt. My family is loving but, my God, they are so useless right now from a practical standpoint. They are trying but making this even harder. The time I took to go home clean up the house and relax I have to come back to get him up to bedside commode and clean up the stool he got on himself when blowing out the diaper.

                  Comment


                  • #10
                    You definitely won the grandson of the year award from me!
                    I hope you can keep him comfortable in his remaining days.
                    If you have kids I hope they are learning about how to care for their elders.

                    Comment


                    • #11


                      Grandpa is not in state of mind to allow me to take over.
                      Click to expand...


                      That is not the issue. If he can scribble a signature is the issue.


                      I don’t think my mom would relinquish control of the situation since she would feel “[she] isn’t respecting his wishes”
                      Click to expand...


                      That is a cognitive issue with your Mom.


                      Transfer on Death Deed
                      Click to expand...


                      Preprinted two part form fill in the blank. Part 1 signed and filed with County property office. Part 2 signed by the beneficiary and filed when the dead occurs.

                      The risk with your mothers name, is then it passes to her estate. Do you or mom want the proceeds used for purchasing drugs (which seems to be a risk). You are "better off" straigtening out the title issues first while granddad and your mom are still alive. It only gets more expensive. Take care of it.

                      Your options are live signatures or probate. No more no less. The forms are needed to simply achieve "signature on file". I would fight that battle any day and win. You are no"stealing" anything. Find out what your Mom wants to do with her estate as well.

                      If you are "protecting the assets", you can get the paper done. Pure and simple, get it signed while both Grandpa and your mom are alive.

                       

                       

                       

                      Comment


                      • #12
                        •“We are looking to hire a live-in caregiver. “
                        Reminder, YOU are.
                        •“No one outside of me is able to even change him and wipe his butt.”
                        Reminder, YOU are incorrect.
                        • You started out with a budget issue that is clearly a care issue. The premise was 31.5 hrs per week. Morphed to live-in.
                        • He did NOT qualify for in patient.

                        You mentioned your spouse. Beware, this is a 24/7 responsibility but not 24/7 care. Schedule it! The emotional toll will multiply exponentially as well as financially.
                        Daily needs:
                        Medication
                        Nourishments
                        Hygiene
                        Safety
                        Companionship
                        You need to leverage every free task possible. Part of the issue is “drop ins” visit and either choose or are incapable of doing a task (changing a diaper, bed linens etc.). This can stretch for years, EOL is unpredictable and progressive. Both you and your spouse will “burnout” and be greatly disappointed in the character of family. I wish you well. Your life can become dominated (can’t go out of town) by responsibilities to Grandpa.
                        Sorry for the rant. Went through a similar situation for over four years. Screw the “competence”, get the signatures, train the “family workers”, assign the tasks, until they “quit”. And they will quit, some without notice.

                        Comment


                        • #13




                          “Currently not able to make decisions on his own. My mother is financial POA, but in reality I am since my mother is not capable for making these financial decision or analyses so she deferred to me.”

                          This is unfortunately a “typical” EOL situation, or at least common. The reality is that the OP has ZERO legal authority. This will be a HUGE obstacle.
                          Every call on Grandpa’s behalf will be met with “privacy restrictions”. YOU NEED TO IMMEDIATELY GET IT PAPERED.
                          • Financial and health power of attorney’s.
                          • Social Security, Medicare, Supplement, Drug Coverage
                          • Bank and Brokerage accounts
                          • Get copies of every ID and card.
                          You have two paths: legal guardianship or the practical path.
                          Get the forms signed, notarized, witnesses as needed.
                          Unfettered access to discuss issues on his behalf requires “authorization on file”. Hint: you may need to use a “mobile notary public “ or your “branch manager” may need to kindly ask, “Grandpa, do you want grandson to be joint owner on you accounts? Sign here.”
                          You are not set up to speak or sign for him. It WILL unravel when you need it. Something as simple as a medication or home owners insurance payment or question. Make a list and attack it. Lack of authority will send off alarms and freeze you out from access and needed cooperation.
                          One form on file gets you, “How may I help you?”
                          Then you can get back to solving the problems.
                          • From a sanity viewpoint, you are not alone, the support system will not come from services, this is an EOL phase that will be difficult but will pass. “Not authorized” is extremely frustrating and actually harmful. Fix that immediately.
                          Click to expand...


                          When will you write a guest post on this???

                          https://www.whitecoatinvestor.com/contact/guest-post-policy/

                           

                          Comment

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