Sandra Webb Reed’s Life Care Planning: ‘The Call’ revisited

Attorney Sandra W. Reed answers your life planning questions.

Attorney Sandra W. Reed answers your life planning questions. Photo by Kathryn Jones/GR Current

The first “Life Care Planning” column in this series centered on “The Call,” which Gail Sheehy described in a chapter by that name in her book Passages in Caregiving.  This week my husband, Bob, got the 2013 version of that call in the form of an email from his sister informing him of the current crisis with their 93-year-old mother, Florence.

The Problem

With this “call,” Bob learned that the medical team being furnished through Medicare had determined to move his mother from her home later in the day to a facility for an evaluation to determine the appropriate care for her going forward. Apparently his mother had fallen the night before and a few hours later had been found lying across her bed, naked and screaming. The medical professionals suspect Florence has suffered a stroke.

The incident occurred when Bob’s sister, Florence’s primary family caregiver, was out of the state promoting her latest book on quilting, leaving her 20-something son in charge.  He initially had to handle the emergency alone. The facility the medical team has chosen is at least 30 miles away from where Florence lives.

What Had Been Done

To the extent the disease can be diagnosed, Florence was diagnosed with Alzheimer’s a few years back and her progression with it has proceeded in a relatively predictable fashion. Thus, there has been time to plan for the anticipated medical, financial and caregiving needs expected with that diagnosis.

And fortunately, Florence had made a will, designated an attorney-in-fact to handle her financial affairs with a statutory durable power of attorney, appointed a medical power of attorney to make health care decisions for her and signed a medical directive before she was mentally incapacitated.

The family had arranged for 24-hour caregivers for Florence, primarily in her home.  In addition, they set up a caregiving routine that included a monthly in-home visit from a doctor, a weekly visit from a nurse and an assistant who comes three times a week to bathe Florence.

What Had Not Been Done

Having focused primarily in one direction regarding planning, Bob’s family had neglected to prepare for other contingencies that might put potholes in their road map. Thus, thinking they had harnessed the situation, they face a circumstance for which they have no proactive strategies.

What Woulda, Coulda, Shoulda Been Done

Most psychologists counsel that asking “What if….” after the fact is nonproductive and damaging to the psyche. However, asking “What if….” before a potential problem arises is not only productive, but also can save the psyche, mind and body from enormous stress arises.

What if….. an Alzheimer’s patient doesn’t die from Alzheimer’s?

The fact is that most Alzheimer’s patients do not die of Alzheimer’s. It is true that eventually Alzheimer’s will cause the body to shut down because the brain forgets to tell the body to perform vital functions, such as breathing. However, before this stage arrives many patients die from stroke, heart disease or cancer. Or, they have trouble swallowing and aspirate or inhale food into the airway passages, thereby contracting infections that lead to pneumonia that kills them.

Alzheimer’s often inhibits the immune system so patients can die from infections, especially from urinary tract infections as a complication from catheters inserted to treat incontinence. Alzheimer’s impairs balance so patients fall easily, subjecting them to fractures and head injuries from which they may never recover.

What if ….the Alzheimer’s patient has to go to a facility on an emergency basis?

The family could and should anticipate that at some point before death this contingency is likely.  The family can research what are the best facilities in the area from the standpoint of care, cost and convenience.

What if ….the loved one with Alzheimer’s needs long-term care in a facility?

Families should make contingency plans for the event their in-home care plans will not suffice. This means they need to take a cold, hard look at the cost involved in facility care and determine what they can afford. If an assessment of their finances reveals that adequate funds are not available, they can seek funds from two sources: private insurance or Medicaid, a federally funded program administered by the states to provide for the cost of long-term care.

What if….the family can/cannot afford long-term care?

If funds for the premiums exist, they may be able to secure long-term care insurance to defray a portion of the cost.  They could and should explore the possibility of this and obtain information from licensed insurance professionals who can inform them of what coverage is available in their area and at what premium expense.

If funds are lacking for insurance, they should contact an elder law attorney to assist in qualifying for Medicaid to pay for long-term care.  In some instances, the families may be able to seek partial insurance payment by insurance, supplemented by Medicaid, if they qualify.

What if ….the Alzheimer’s patient has lost all quality of life? 

At some point, hospice care may need to be introduced. When quality of life issues arise, families can seek an evaluation to determine the status of their loved one. If the assessment determines that the patient qualifies for hospice, a hospice team will take charge, stopping all medical treatment for the disease and other ailments except for medications to keep the patient pain free and comfortable.

Medicare will cover certain aspects of hospice care. Families can obtain information regarding what Medicare covers and how the hospice program works from or through contacting a lawyer who specializes in elder law.

Sandra Webb Reed is an attorney of counsel with Katten & Benson, an elder law firm in Fort Worth, Texas.  She lives in and practices in Somervell County, Texas.  Contact her at 254-797-0211 or  Elder law is not just for the elderly.  It is for everyone. Everyone needs Life Care Planning. 




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