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Rooster_Ties

Managing an aging parent's health from 1,000 miles away...

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Where to begin.  I'll be 50 in a few days, and my Dad turns 92 in May (he lives in St. Louis).  He's always been mostly the picture of health, and he STILL lives in the very same house he grew up in (since he was 6 months old).  He did go off to college, and worked in Kansas City briefly after college, and was in the army at the very end of WWII (never went overseas, he was just in basic training and stationed on the West Coast for 6 months).  Then he moved back home after that brief 'internship' (practically what it was) after college.  And bought the house from his own mother, in a deal that might as well have been worked out on the back of a napkin.

Anyway, he's 91, and still drives, and has mostly been doing great all these years.  Brief bout with prostate cancer 20+ years ago (which my Mom managed), and he had to have his appendix out 5 years ago.  But otherwise, he's barely been in the hospital 10 days in his entire life probably.

Then he started having some dizzy-spells now and then about 4 years ago, which is probably Ménière's disease, which has been mostly pretty manageable.  But then in just the last 6-8 weeks, he's had three (3) other kinds of episodes, that he described to me as mini dizzy-spells (lasting 30 seconds, but he'd never loose consciousness).  The most recent one was Wednesday night.  He took a tumble at his Masonic lodge meeting, and picked himself back up again 10-20 seconds later.  But he said it was like all his muscles suddenly stopped working.  Yesterday I found out the same happened last Sunday at home too, in the kitchen, which he hadn't told me (or he told me in such a minimized way, that I didn't realize exactly what it was).  Then another time about 5 weeks ago, he said he felt funny driving for a moment, but then he was fine a few moments later.  He said he just coasted for a moment is all.  I'm not sure what that was, but now (suddenly, in retrospect), I'm wondering if that was maybe the same thing too - ?  [I'm wondering if these are mini-strokes maybe? - just the first thought that occurred to me last night.]

Anyway, the local friend of his who checks in on him -- they trade phone calls every single morning -- yesterday morning she found out about the episode Wednesday night (2 nights before). And he shared with her that it was kinda like the prior Sunday (that event he never mentioned to me at all), and she said he really needed to go to the hospital and get this checked out ASAP.

So he went to the ER yesterday morning, and was admitted overnight.  They're doing all kinds of tests, MRI, CT-scan, EKG, and some other tests (he wasn't sure what those really were, but one involving drinking something with caffeine).

 

ANYWAY, my wife and I live 1,000 miles away in Washington DC.  And my Dad lives all alone, and has been perfectly self-sufficient all these years.  But kind of semi-suddenly we're coming to the realization that we need to figure out how to better manage his healthcare from a distance.

We do have a medical power of attorney set up (which was set up 30 years ago, back when my Mom was still around (she passed in 2003), and it was updated 15 years ago too.  And he has a "living will" too.  We've done all that stuff, eons ago in fact.

 

But what we have practically ZERO experience with, is how in the heck to be more actively involved in his healthcare, and whatever systems could be put in place to get us more in the loop on things.  He has his main general practitioner (GP), and a couple specialists he's been seeing now and then (as needed): primarily for the dizziness thing that started 4 years ago (but which had mostly gone away 2 years ago, and has only come back just recently, in the last 3-4 months I think?).  And a skin-cancer specialist, who has managed various small cases of skin cancer my Dad's had for the last several years (all very manageable, all things considering).  Anyway, we've (my wife and I) have not been directly involved in any of that, primarily because of the distance (1,000 miles).  And there's never been a conduit set up for us to get his medical information from his doctors directly.  I guess we've been derelict in not doing that before now, but with the HIPAA Privacy regulations, we've just never (yet) figured out how to breach that divide (between his doctors, and us).  Also, I'm an only child, and there nobody else in the family really (other than some cousins of mine, who live thousands of miles away too).

Now, suddenly, I think we're going to have to try and figure out how to find someone LOCAL -- more than just his Masonic buddies (we and he have no close relatives anywhere within 400 miles of where he lives).  ...someone local who can help manage his healthcare (someone we'll have to hire, obviously), and then I presume they'll be more of that conduit between my Dad's doctors and us.

 

Anyway, my Dad's extraordinarily good health all these years has really put us at a disadvantage in that we have ZERO practical experience trying to navigate all this, especially from 1,000+ miles away.  When I lived in Kansas City (1994-2011), he was just a 4-5 hour drive away -- but even then, he's practically never had a (significant) sick day in his life.

I might add, he's always been really private about his health, with the world (and with us too).  I *literally* didn't find out that he'd been in the hospital and had his appendix removed 5 years ago, until about 2 weeks after it happened (when he finally told me, "oh, by the way...!" - by phone, after I'd moved to DC).

  • [Side-story -- his Sister, my aunt -- who we were all very close with.  *20 years after the fact*, we learned she had breast cancer back in the 1980's I guess(?), which they must have caught early, and treated 100%.  We only saw them 1-2 times a year back then.  And both my parents and I -- NONE of us ever knew she had breast cancer until 20 years later(!).  And this was my father's closest blood relative.  So being "private" about health/medical stuff is something that runs in the family, I guess you could say.]

 

This is getting really long.  I'm sure I'll have more to say as this thread unfolds.  I guess "health care advocate" is what I'll be Googling this entire weekend, or if anyone else has any good search-keys (or other on-line resources) to suggest, I'm all ears.

BTW, none of the tests have come back yet (from when he was admitted last night).  Not idea if the results are good, bad, or conclusive (or more likely, inconclusive) yet -- all those test results just aren't in yet.  Maybe later today, or tomorrow.  All I'm getting now is what I'm hearing from my Dad on the phone when I call his hospital room, and I'm hoping to figure out if there's some way I can get his doctor to call me.  I'm sure he listed me as next-of-kin, but is that enough to breach the HIPAA divide?  I'm not really sure, to be honest.

My dad's a very independent-minded person, and very reserved.  And he's also probably too timid about asking good follow-up questions about his situation too.  And he's definitely getting older.

All stuff I'm grappling with at the moment.  Thanks for listening.

Edited by Rooster_Ties

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Tom, all hard stuff.  Obviously, your dad would benefit from living in an assisted-living situation at this point, but I assume he is resisting that.  And I understand that resistance for sure.   Probably a home health worker who would visit daily coupled with a monitoring/alerting system such as lifecall may help.  Of course, you want to be VERY careful about contracting home health care workers for safety (physical and financial) sake.   We lived through this with my in-law's through each of their ends-of-life.  There are no simple answers.  Much depends on the financial situation.  So sorry you have to carry this alone.  My parents are aging (89 and 85) and live on their own, but I have four siblings/step-sibling, and am probably considered 3rd or 4th in the pecking order of who should be primarily involved (though we all try to share it).  I'm sure others will have plenty to share as far as both suggestions and their own experiences.

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At his age, if he is falling down he needs a Life Alert or similar system so that if he can't get up he can call for help. They're about $30 a month for monitoring and free equipment. There are obviously systems that work with GPS etc for anywhere, if he can afford it, go for that.  The system for my mother (84, bad knees and back absolutely refuses assisted living) has probably saved her life about 4 times because she cannot get up after falling.

I would recommend a review of all legal documents drawn up such a substantial time ago to be sure they follow all current law.  

And I would push for a teleconference with his doctor so that you get all information that you should have. Even if they don't think it is particularly significant medical issue, you should ask about Assisted Living.  If these 'episodes' don't resolve themselves, he is at significant risk, physical and liability, when he gets in the car.  And if he is so reserved, you should be prepared to ask the questions that need to be asked about his condition and any treatment.

In addition I have learned from my sister that Assisted Living facilities, which are always superior to skilled nursing, can reject an applicant for having too many falls over a period of time. 

Last thing I will mention is never let him be admitted to a hospital for "observation".  If he is, you will fight with Medicare for payment and end up on the hook for all of it. Medicare doesn't recognize that as a covered situation.

Good luck.

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Thanks, both of you.  Yeah, he was admitted just for observation for his overnight stay last night.  No other choice really, I guess?  I mean, he was admitted before I even knew he'd gone to the ER (or was 4 hours into the process of being admitted).

I definitely need to try and get in touch with his doctors, and my father is totally OK with that I'm sure.  But I'm having trouble even figuring out anyone to talk to.  His daily phone-call-contact-person was just in his room when I called my dad 10 minutes ago, so if I can talk to her, then that's at least another set of eyes and ears in the room that I can enlist to help get a message to whomever is his attending nurse (I guess that's the term?), to get me and my wife in the loop.  I think (90%) my father has our cell phone numbers in his wallet, but to be perfectly honest, I'm not 100% sure he does.  If he doesn't, I'm not completely sure he remembers my phone number without looking at it on paper to dial -- so I'm not 100% sure the doctors have my contact info (other than he's surely listed me as next-of-kin).  I also have no idea the names of the doctors treating him at the hospital, or how to contact them directly.

Somewhere at home I might have his GP's contact info, but I'm not totally sure of that come to think, though anyway, there's no way to get ahold of them until Monday.

Sucks being so far away, without enough of a game plan for this sort of thing, I'm (frankly) I guess a little ashamed to have to admit.

About to call him back now.  When I talked to him 10 min ago, some medical person came in to talk to him about something, and he said he had to go, and I said I'd call back in 10-15 minutes.

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Might be time to take some leave time and go back to see for yourself what's  up, and then talk to anybody in the area you trust about who is a good custodial service to look in on him twice a day or something like that. That may or may not be indicated, but until you see for yourself...

If you do it all remotely, you be totally at the mercy of people you've never met. Trust me, that sucks.

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Just had long conversations with his attending nurse, and his case-worker.  Lots more info now.  And talked to his attending doctor at the hospital too.

I'll be home anyway in less than 2 weeks (trip already planned), but I may try to fly home earlier by several days or a whole week.  My dad's going home tomorrow (all his tests came back decent, sort of inconclusive, but "OK" for his age), and a friend is going stay with him to make sure he's ok for the next week.

Lot more than that, but I've gotta go run and meet my wife, and head home finally.

Edited by Rooster_Ties

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My mother passed away two years ago from pulmonary fibrosis, at age 82.  She was on an oxygen machine 24/7 for the last couple years of her life (she never smoked but my dad was a lifelong smoker, and I suspect that contributed at the very least to her lung issues, as well as killing him).

Anyway, she lived in Austin, and I live in Corpus Christi, about 3.5 hours away.  She wasn't willing to consider independent or assisted care living, she wanted to spend her remaining time in her own home and space.  So as she got older and the oxygen became more of an issue, she needed help running basic errands - going to doctor appointments, grocery store, etc.  So my sister and I hired someone to come and spend a few hours with her, a couple times a week, to do those things, and just general companionship.  

As her health worsened and she grew weaker, the hours increased, and eventually turned into daily care, to make her meals etc.  Eventually we got to the point that her doctor said she only had a few months left, and that she needed hospice, so she ended up with 24 hr/day in home care, with nurse visits.  The few months estimate turned into less than a month when she passed away.  It wasn't cheap but it was what was needed at the time.

If your father isn't willing to consider assisted living, maybe in home care may be an option you might consider.  Or consider moving him closer to you (or you closer to him), while there's still time to spend with him.

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I'm sure my dad will ultimately be willing to consider whatever is most appropriate.  The trouble is that he doesn't like change the least little bit.  For instance, he loves (loves, loves) trains - and has his entire life.  He still hasn't entirely gotten over diesel engines replacing steam engines.  I kid, but seriously, my father has always lived a good 20 years in the past --  at every given moment in his entire life.  He's also one of the most risk-adverse people I've ever known.

Four different times today my father told me "things are getting complicated", and what he said next each time (I'm now realizing) didn't really didn't fully elaborate on the kinds of things he was being told by his doctor and his case-worker/social-worker type consult.  But "it's getting complicated" was as much as he could bring himself to tell me.

When I finally spoke to the doctor a couple hours ago, one of the things I asked was whether he had any business ever driving again, and the answer was "no".  That's one of the realities of the situation, and of course it'll have a huge impact on his independence.  I suspect he either also got told that, or he suddenly sees that handwriting on the wall.

The case-worker/social-worker type person said he is really going to have to live somewhere where people can check on him pretty regularly, several times a day.  Not 24/7 assisted living, but definitely a retirement community of some sort. He's been on a blood-thinner for 15-years.  Not a problem in and of itself, but now that he's fallen twice in the last week (because he seems to suddenly loose all control of his muscles, almost like fainting but not losing consciousness).  But then if he fell and cut himself in the process, the bleeding could be, well, very bad.  Likewise, if he goes off the blood thinner, then he's at a much higher susceptibility for a very serious stroke.  (Damned if you do, damned if you don't.)  So he like needs people checking on him 3-4 times a day, so like a retirement community.

My dad won't put up a battle, but this is going to trigger a dozen things -- HUGE CHANGES in his life -- that he does not want to face.  Can't drive.  And he'll have to move from the only place (only house, literally), that he's ever lived in his entire life (save for college, and two other brief 6-month periods).

He knows that house inside and out, and literally everything in between (like in between all the walls). He's personally installed, not one, but TWO new furnaces in that house, with his own hands.  And the first one he pretty much designed and mostly fabricated himself.  He's also personally rewired half the house himself (the rest is all still knob-and-tube), and re-plumbed half that house himself too.  He installed a second hot-water heater in the other end of the basement, so there'd be quicker hot water in the kitchen (and main bathroom), with an ELABORATE crossover system of pipes that allowed either one of the hot-water heaters to INDEPENDENTLY service the ENTIRE house (if either one ever failed), with cross-over valves, and all kinds of stuff.  Holy shit, he had TWO different thermostats that created two COMPLETELY INDEPENDENT heating zones in the house -- 25 fucking years ago, back before that shit was ever done in typical houses.  Did the furnace have two blowers?  Hell if I know. :blink: But it worked.  It was like having two furnaces in the same house, that each ran independently, servicing two different living zones -- but it was all one furnace.  THAT was the first one that I said that he designed him self, and (mostly?) fabricated from scratch, with his own two hands.

THAT'S the house he lives in, and has lived in since 1928.  His father was a dentist, and saw patients at his (my dad's) home 1-2 days a week -- instead of the office downtown.  The house had two front doors, and one went into the "dentist's office" carved out of the corner of the first floor -- that decades later my dad remodeled into private dressing room for my mom.

----

My Dad will do whatever he has to, but I can tell he's scared.  Not so much of any one particular detail -- but of all the god damn change headed for him like a damn train.

I also prayed that my Dad wouldn't ever have to sell that house.  He thinks it's worth a quarter of a million dollars (or a hair more), in part because it's on 3 lots of land.  But it's in a neighborhood that's not in a super desirable area.  It is a nice house, but nothing's been updated on it since 1980, other than all my Dad's totally functional "mechanicals" changes.  But aesthetically, it has a mountain of deferred modernization.  I doubt the house will sell for anything more than $150K, at best.   Or maybe I'm wrong.  But in any case, I was really praying that he'd never have to see that house sold, and all the contents of it -- a LIFETIME of stuff -- all 'disposed' of.  Hell's bells, there's 15-20 years of his dad's dentist records and (his dad's) cancelled checks up in the attic from when his DAD lived there (and ran that house), and that all dates back to the 1940's and 1950's (my dad's dad died young in his mid-50's -- but his mother (my grandmother) lived to be 100).

 

I guess I'm just processing everything myself, I'm sure you can tell.  Lots, and lots, and lots to manage and deal with now, and next week, and next month, and 6 months from now, and I'll be lucky if half of it is done by the end of the calendar year.  Individually all these changes, considered one by one, aren't insurmountable.  But COLLECTIVELY, I'm feeling like the totally of it all -- which just happened in the last less-than-24-hours -- that's all just barely beginning to sink in.

Gotta run, and call my Dad for a bit.  I'm just rambling, I know.  Working things out inside, I guess, and getting it out, or some of it at least.

Edited by Rooster_Ties

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I've seen what happens to loved ones when they get out of their house knowing they can't come back. You want to avoid that if at all possible.

Check into local (state/county/municipal) elderly care agencies, as well as VA benefits (if he qualifies). Also - and tread carefully here, but do tread if need be - a reverse mortgage, properly set up and executed, can really help pay for some expenses that that might arise to keep him in his house. There are very real financial implications to this, so consult anybody/everybody who might be impacted.

Also, and we learned this one the hard way - check into what Missouri laws are regarding elderly care/abuse/etc. In Ohio, for instance, we learned that you cannot force an elderly, failing, relative out of there house and into any kind of facility (even if they are legally blind and bedridden) unless you can prove mental incompetence, and the baseline for meant incompetence is very basic, like, what is your name and who is the president. The philosophy is that all people have rights to make decisions about their life, including bad decisions (I know, don't go there about choices, I know....). In other words, if an old person wants to put themselves at risk by living where they ARE at risk, that's their prerogative. We found out that there are allowances made for extreme conditions, but they were a helluva lot more extreme than seems conscionable to us.

This is tough, and it might go on a while. I've got no parents or in-laws left. With each one, it took a different path. None were "easy", but some were more between-the-lines than others. So be ready, and realize that you're increasingly be called upon to be the "parent". Such is life. Just be engaged as locally and as transparently as is humanly possible. It's a jungle out there, a cesspool, a snake-pit, all of that and more. You know how predators are when they smell death. Some try the long game, some, the short. Just do your damnedest to be sure that you're doing for them as they would have done for you.

Good luck, dude. Stay strong.

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Thanks, Jim.

One other anecdote from today.  When I finally got to speak to the nurse about his condition/situation, ALL IT TOOK to get the nurse to talk to me (in terms of the HIPAA privacy limitations), was to get him to hand her the phone (literally).  He was determined to be of sound mind when he presented himself in the ER, fully able to make decisions for himself, and him just handing her the phone triggered "permission" being granted for her to talk to me openly about his condition.  And that ONE "phone hand-off" triggered consent for ALL his heath-care people at the hospital (and that consent was immediately noted on his chart).  So his attending doctor, and the case-worker/social-worker could suddenly talk to me ad infinitum for the rest of his stay.

I had talked to my dad on the phone 5-6 times before that, and for 24 hours the only information I had was whatever I was getting filtered through his 92-year old understanding of what was going on.  Before that "phone hand-off", we had no way to know who to talk to, or how to interface with the hospital personnel, or any way to know how to trigger that level of communication.  I'm sure he listed me as next of kin, but I didn't know (for sure) if he had my phone number on his admission form (did he have a copy of it in his wallet?).  And every time I'd call, either he'd be all alone in his hospital room.  Or the nurse would be in there to do something for/with/to him, and he'd suddenly say he couldn't talk, and have me call back 15 minutes later and catch him when he could talk.

After that "phone hand-off", the nurse immediately gave me her direct cell-phone number, and the number of her nurses' station.  And she got the case-manager/social-services guy on the phone with me 20 minutes later.  And then he got his particular hospital doctor to all me in less than an hour.

But for 24 hours I was -- not exactly in the dark -- but in a room only lit by my father's impressions of things

To say I've felt helpless in all this, and still half do (and especially from 1,000 miles away), is putting it mildly.

After that first time I talked to the nurse (for 15 minutes), she offered to hand the phone back to my Dad, and suddenly I broke down and just lost it (the dam of tears started flowing).  Had to ask her to give me 15 seconds to get myself together, before I could talk to my Dad, and she kindly stalled and talked to him while I got my shit back together.  I lost it again after I got off the phone with the doctor.  I'd been keeping everything tamped down, and bottled up all day -- really a lot more UNconsciously, than intentionally -- for a whole day since yesterday, and it all decided to come out at once.

 

More rambling, I know.

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I've some experience along the lines of caring for parents. . . not long distance, but from half a mile away--when I realized how badly off my parents were I relocated to be that close to them.

My father was falling too, in his case due to orthostatic hypotension, which may or may not (the neurologists have been waffling on this) be related to MSA (multiple systems atrophy, a degenerative condition similar to Parkinson's, but without cognitive decline). They now think he may not have MSA as it has a decline arc that doesn't fit him, but the fact that he exercise now 11 hours a week may be halting its progress. Anyway, that wasn't the worst of my problems, my most trying problem was my mother was wasting away from dementia and I got to care for her her final two years.

Even with me working for free 15 hour days mostly 7 days a week I needed to hire help so that I could have a semblance of a life outside their care. I found that help was easy to find, good dependable help, through an agency that was well-run and very responsible. I honestly think in your father's case that if you were to hire someone to spend part of the day with him and do some household tasks as well he may be quite fine for a while, depending on his physical condition. This type of assistance is not cheap, but then again it's quite less expensive than relocation and assisted living trust me--it may be the matter of a couple thousand a month to five or six thousand a month in assisted living, or more. It's worth looking into.

Edited by jazzbo

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You should look into getting full Power of Attorney rights - well, your Dad chooses specific areas of living that you have or don't have power over but I am specifically thinking that you should get a PoA set up and get listed on bank accounts.  If he becomes unable to pay bills for any reason I assume you will need access to his accounts to keep the lights on, as it were.  This is sort of basic planning for an elderly parent.

Listen to the social worker and healthcare people about what kind of support he needs in the immediate term.

You're fortunate that he continues to be of sound mind, and he is too because he can state his wishes.  You want to keep him in the house he's known for as long as possible.  It sounds like at the moment you need a home aide for driving him to appointments and for errands, I am just concerned about the falls and the potential for one happening when he is alone and can't get up. So maybe a combination of a health aide and a Life Station system - cell or home-phone based will keep him in a position to stay at home for a while.  So you need some due diligence on companies in St Louis.

(As a personal lines agent I have to wonder how he has insurance on the house with knob and tube electrical present. I have no market whatsoever that accepts that kind of electrical system in Florida.)

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2 hours ago, Dan Gould said:

You should look into getting full Power of Attorney rights...

We do have medical power of attorney, and I'm nearly positive full power of attorney too.  From about 2000-2015, my name was also on the deed to the house, and I know my name is also on his car title.  But then about 4 years ago he got a trust set up, so his estate could avoid probate (for whatever reason, he felt like probate was the worst thing in the world -- I guess because my dad had been the executor for 2 other people, about 15-18 years ago).

But even before that, for the last 20 years at least, my dad designated the bank as his executor, primarily so the sale of the house (and everything in it) could be handled by the bank (so I wouldn't have to do any of that).  We are super close; none of this was to keep me from getting anything after his passing.  His will states that after his passing, I can take anything I want and I suppose that could include the house even.  The whole point of getting an executor was to keep me out of all the logistics and paperwork of dealing with everything.  His funeral, grave-marker, and plot have been paid for, for the last 30 years I think.

What I lack is any practical experience in dealing with all this in exerting all these powers, especially from 1,000 miles away.  My wife and I are looking into home health care options now, and a retirement community that can shift into assisted living when that becomes necessary.  As I said, the trouble has been that my dad's mostly been in excellent health his entire life, and he's always been able to be so fiercely independent until just this month really.

So much suddenly to deal with.

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Tom and Dan, I sympathise with you both.

I think the practical suggestions have all been well dealt with above.

Re wills, I strongly recommend that the executor NOT be a bank, or an attorney. Rather, it should be a family member. Then, the executor can go ahead and dispose of the estate without interference.

I have had some horrendous experiences with family wills. My father-in-law (dead before I met my late wife), in Canada, had a one-page will. It looks dead simple. He left a clay drain tile factory in SW Ontario worth at least a half mill. Unfortunately, the will was administered by a crooked outfit called the Canada Trust, who managed to drag the whole thing out for a staggering forty years! During that time, the "Trust" and the Canadian Feds helped themselves to over 50% of the estate, with "fees" and Federal taxes. Things were not helped by the fact that my mother-in-law died in 1994 and left another one-page nightmare which was like an addendum to her husband's will. When my wife died in 2002, she nominated me as executor and the complications of her parent's wills were still a problem. No longer having any patience with all the bull, I acted quickly and disbursed everything very rapidly. This drew a nasty letter from the Ontario Attorney-General. My sister-in-law (in the Toronto area) had accused me of stealing money that was willed to my children. It was a lie, and I wrote to the Attorney-General with the evidence and soon cleared the matter up. (Of course, not living in Canada at the time, I could have told him to get stuffed.)

So, I strongly advise that executors be family members.

I hope that this is of some use.

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The only thing I'd add about POA is that if you have it already, you should want to be added to his accounts.  This is just in anticipation of some point needing to access his money for whatever, sometime in the future.  Its one thing to have the legal authority but its easier to assert it if Rooster_Ties, POA is on his checks. (This has come in handy for my sister as we have found bills that got ignored or missed.)

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Thanks Shrdlu.  There's no way I could manage his estate myself, even if I lived locally frankly.  I'm horrendous with legal stuff/paperwork/forms/taxes, etc. -- damn near a phobia, if I'm honest.  His entire estate isn't that big at all (I'm sure his house is worth half of what HE thinks it is), and his his non-house assets aren't dramatic either. His executor is the bank he's dealt with for 40 years, and we've met with them every few years, and they seem perfectly straight forward and competent, far as I can tell.  I'm sure they'll just dispose of it with as little drama as possible.

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3 minutes ago, Dan Gould said:

The only thing I'd add about POA is that if you have it already, you should want to be added to his accounts.  This is just in anticipation of some point needing to access his money for whatever, sometime in the future.  Its one thing to have the legal authority but its easier to assert it if Rooster_Ties, POA is on his checks. (This has come in handy for my sister as we have found bills that got ignored or missed.)

I hear you, and my name is already on all his bank accounts, and his CD's (I think?).  I've forgotten the details since we last went all over everything, about 2-3 years ago (I think it's been more like 3 years).

BTW, when my mom died in 2003, it was a sudden aneurysm and she never regained consciousness and passed away a couple days later.  I drove to St. Louis (from Kansas City) immediately, and less than 24 hrs later we made an end-of-life decision.  She had been pretty much in good health before that, certainly nothing that I had any involvement in.

Both my wife's parents are 10-15 years younger, and we haven't had to have any involvement in their health issues yet either.  And frankly, neither my wife or I have ever had any serious health issues ourselves, so we don't even have any personal experience with the two of US either.

I think yesterday was literally the very first time I'd ever talked to any of my Dad's doctors, since he had been able to manage everything up until this point, and he hadn't ever had any significant issues up until this point.  Other than his bout with prostate cancer 20 years ago, he hadn't ever been in the hospital a day in his entire life.  And after that, just appendicitis and getting his appendix out 6 years ago -- which I never even heard about until 2 weeks after the fact. 

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1 hour ago, Rooster_Ties said:

Both my wife's parents are 10-15 years younger, and we haven't had to have any involvement in their health issues yet either.  And frankly, neither my wife or I have ever had any serious health issues ourselves, so we don't even have any personal experience with the two of US either.

Just keep in mind that a cause of death is only sometimes health-related.

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Nothing much to add to what's already been said, except all of this is obviously stressful. You and your wife should make sure you're taking care of yourselves also. Easier said than done, I know.

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Sorry I seemed so freaked out about all this yesterday, and probably still this morning.

I mean, I am still freaked out about it.  But either my ability - or my interest - in better editing my thoughts here, it just isn't there.  It's nice to have a place to, not exactly 'vent' about it, but a pressure-value where I'm frankly just letting off steam about my frustrations.  When I compose myself, and think about this more abstractly, clearly hundreds of thousands of people deal with stuff like this (and worst) every year.

Doesn't help, though, that I'm deathly afraid (almost phobic) about dealing with forms, bureaucracy, taxes, anything like selling a house, investments, and anything of the like.  Terrified is probably too strong a word, but if you saw my natural tenancies to avoid stuff like this in my own personal life, the word "terrified" probably wouldn't seem all that out of line with my ability to try to avoid stuff like this like the plague.  (How to do get by??  Hint: my wife does all our taxes, insurance, and when we bought a house back in Kansas City, etc.  I'm really lucky, in that she works in biggest bureaucracy on planet earth, the Federal Government -- and has for 25+ years.  And she has a law degree.  One of 1,000 reasons I married well.)

I really appreciate being part of this community, and everyone's feedback.  Sorry I'm so all over the map.

It's so weird.  I don't even know why, suddenly having typed all this, I'm suddenly near letting the floodgates of tears again, and I don't even know exactly why - ?? I've been completely even-keeled practically all day.  It's like I'm randomly just letting my guard completely down, and I'm not even clear what specifically is triggering that.

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Believe me, family crises will unleash unrealized emotions and it's a natural thing. It's so hard to be far away from one's family when there is a crisis, and there are all sorts of prods of grief, shame, guilt, fear, wonder and pain that can surface (or not really surface, work on one seemingly unrealized.) When I realized how my father was struggling to get through day to day with my Mom while deteriorating himself I really wanted my brothers, who lived fifteen minutes away, to step up and help. They're both lawyers and busy and they thought coming over to watch a game on Sunday afternoon was good enough. I struggled with my own fears of leaving my friends and a lover and selling my home and leaving my world 1400 miles away to step into a very unknown situation to help. It was almost all or nothing, so little I could do from Austin, and so much I could do in Ohio. I was in a position, widower and retired, that I found I could not excuse myself and turn a blind eye. I stuffed my fears aside, spent months packing up and clearing out, and moved. . . sold my house. . . changed my whole life. That's where those emotions pushed me, but I did not have a job, a wife--ten years earlier I don't know what I would have done, but it's unlikely I would have done the same thing.

You're doing the right thing seeking advice and looking at possibilities and in the process, especially if you can calm for a spell and let it all sink in and assimilate inside you, you'll decide what to do and "git her done." You're a good man, a good son, and that's the skill set needed. You'll get this.

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I went through this with my Mother a few years ago. It was very tough and she lived with us. Don’t have anything more to add than what’s been said but it was a rough situation. Good luck to you as you try to navigate this part of your life. 

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I should add that it was dead easy to execute my late wife's will, which overlaped with her mother's will to some degree. I just grabbed the hardware mentioned and gave it to the recipients. She had an investment in a Canadian bank and some money for our children (from her mother's will), so I had to have the will probated here to clear that. That one issue took a couple of months to settle. And that was it.

Ironically, she willed our (ca. 1910) Heintzmann upright grand piano to my elder son, but it was very difficult to get into this house and virtually impossible to remove. It has a fantastic sound, e.g. if you play the "Maiden Voyage" riff on it: starting on the D below middle C, voice it as D A D G C D. No tinny upright this.

So, don't be scared of executing a will. And think of all the lawyers' or bank fees you will save.

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Gotta say "dead easy to execute my late wife" caught my attention.

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Tom (...or "Rooster" :cool:),

Couple of suggestions, mostly echoing others.

1. I'm not sure it suffices to have your name on your father's financial accounts. In order to avoid probate, you probably need a designation like "Joint and Survivor account" or "Transfer on Death" or "Payable on Death". With something like this in place, the financial institution should only need an official copy of death certificate to transfer the remaining assets to you. I'm not a lawyer, and this very well may vary by state. But this is planning that is worthwhile addressing now. And unless there is some tax burden that gets reduced w trust, I'd avoid them if there is another more direct solution. When that time comes, you will want things to be as simple as possible (and avoid/reduce court/lawyer/trustee costs). If there is an IRA involved, I believe one has to designate an inheritor. Check w bank if this is already set up. 

2. Less urgent, but to simplify life would it make sense to consolidate various financial accounts? Again, you will want a simplified situation.

3. No one else has mentioned it, but have you looked at all into services offered by an Employee Assistance Program? They can be useful for getting some local (to your father) leads on elder law attorneys etc. When it came time to fine such an attorney for my (Ohio) parents' situation, the EAP offered by my wife's employer provided some useful leads. [Like your wife, I am a federal employee, but have not sampled the fed EAP.]

4. Plan on several visits out there. While the opportunity cost of your time and travel expenses should not be ignored, don't plan to get a ton done each time. It is stressful, and it is about stuff most of us encounter only when we are actually facing it for the first time. With my folks (both w dementia), it was a real grind meeting with lawyers, financial advisers, banks, assisted living residences etc. I felt exhausted every evening, despite having a fair amount of dead time most days.

5. Recognize that you have some freedom in how various meetings get scheduled. If St Louis is close by, arrange to be in town when you can take in a performance or something. Obviously, this is much lower priority than your main mission, but you (and your saintly spouse) will benefit from chill mode for a couple of hours. Seriously. Along these lines, if you have friends that still live in the area (or are willing to drive over from KC?), see if a shared meal somewhere can happen without too much logistic/transportation hassle. Again this is mainly for your mental health, and defer that planning to one of those friends. Just put it out there and see.

6. Based on your brief descriptions, your father is a creative force, and pretty damn robust. That is awesome! He is now a bit less robust, and would benefit from your help. Dealing with this from distance is definitely stressful, especially if you don't (yet?) have some local feet on the ground that can check in/help along various dimensions. But you are well organized and have an awesome wife, so this will get solved. Much grinding ahead.

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