Aging in Place

Navigating the Maze of Long-Term Care

Mary Mashburn

• Publisher: Morgan James Publishing
• Year: 2018
• ISBN:
  9781683509806
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

An elder care expert offers essential information and advice on how to give your aging parent or loved one the best care possible in this stage of life. Caring for an aging parent or loved one can be overwhelming. From making sure their estate is in order and knowing their wishes are being honored, to more immediate concerns like where they will receive the best care after a hospital stay—there are many questions that are difficult to answer. In Aging in Place, certified senior advisor Mary Mashburn guides you through these and other common concerns so that you can address them with confidence and compassion. Using real life examples, Aging in Place promotes healthy family discourse on important elder care topics. Mary discusses the roadblocks and pitfalls you and your family might encounter, explains many useful planning techniques, and provides information on local and national resources. Whether in the midst of a crisis or just beginning to discuss options with loved ones, Aging in Place offers valuable insight and information on making choices that fit your unique situation.

Chapter One:

“Team Mashburn” – The Back Story

I am a paralegal who has worked with my husband, John Mashburn, in his law practice in the village (now just barely a city) of Groveport, Ohio, located about twelve miles from downtown Columbus, since he opened his office in 1978. During that time, the scope of his practice evolved from a general focus to one that specialized primarily in probate and estate planning as well as real estate law. As his reputation as a probate lawyer continued to grow, he began receiving referrals from the court as well as from his clients. In the spring of 1988, one of the court magistrates invited him to join a panel of attorneys who would be assigned referrals for guardianships from the newly established Franklin County Adult Protective Services agency. For each referral he accepted, he would be responsible for determining whether applying for guardianship would be appropriate. Because that is such a serious step, Ohio law has established an application process that requires that the proposed ward (physically or mentally incompetent person) and that person’s next of kin (who are residents of the state) be served with notice of the hearing on the application of the person asking to be appointed guardian. After the hearing (assuming that the court appointed him to be the guardian), John would begin the process of determining what would be the best course of treatment for the person’s medical issues and what would be the safest and least restrictive living arrangement for the person. In addition, he would need to locate and reregister the person’s assets (bank accounts, real estate, automobiles, stock) and income (usually social security and pensions) in the name of the guardianship. If the person’s assets and income put him or her above the poverty level, John would be paid for his services from that person’s assets (after receiving approval from the court for his fees). If the person had no assets and little income, then he would bill the county monthly for his fees (at a greatly reduced hourly rate). Most of the cases he accepted fell into the latter category.

His first case was Ellen, a widow who lived in her own home about five miles from our office. She suffered from dementia, was not caring for herself properly, and was extremely combative. She had one sister who wanted to be somewhat involved, but not enough to want to be appointed guardian. At that time, placement in a nursing home seemed to be the only course of action (There are a few more options now.). Working with the Adult Protective Services case manager (a licensed social worker), we found a suitable nursing home with an administrator who agreed to send a van and help us coax her into it. Luckily, Ellen had sufficient savings that she could afford to pay for her nursing home expenses privately, at least for the several months it would take until we could complete the guardianship land sale proceeding and find a buyer to purchase her house. Continuing to live in a nursing home, she fought the progression of her Alzheimer’s disease (and the nursing home staff on bath days), and eventually passed away. Like many long-term nursing home residents, Ellen did not outlive her money. During the last two years of her life, she was qualified as a Medicaid recipient. In other words, the state required John to pay all but $40 of her monthly income towards her nursing home expenses. In turn, the state of Ohio, using a combination of Federal and state funds, would pay the difference of her nursing home expenses (based on a state compensation formula) and all of her medical expenses not covered by Medicare. Before she ran out of funds, however, we made arrangements for John to work with her sister to select and purchase an irrevocable prepaid funeral plan at a funeral home her sister selected. Unfortunately, when Ellen’s condition deteriorated to a point at which we could have asked her physician to make a hospice referral, the Medicare hospice benefit was still in its infancy and very limited. Had we been able to enroll her in a hospice program as they exist today, she could have benefited from the extra care and attention hospice programs provide for several months before her passing.

Much has changed since John became Ellen’s guardian in 1988, both in our office caseload and in the services available to older persons. John is currently the guardian of over 190 persons, some of whom suffer from severe mental illness or developmental disabilities, as well as those who are elderly and infirm. For the past four years, Crystal Davis, a licensed social worker with experience working with older individuals both in nursing homes and in the community as an employee of the Franklin County, Ohio, Adult Protective Services Agency, has been a part of our team, as well as other paraprofessionals who help manage the volume of paperwork and arrangements that must be made in handling such a diverse group of individuals.

In addition to the guardianship side of the practice, John continues to practice in the areas of estate planning and Medicaid planning, as well as in the administration of probate estates and real estate. Just recently, we have begun easing into the slow process of retirement with a little more speed than expected as John has entered into a partnership with Steve McGann, an attorney with several years of legal and guardianship experience, who also has a compassionate soul in dealing with persons facing these types of situations. Because I feel it would be a shame for John and me to retire completely when we have so much to offer to help others, I wrote this book with the goal of using our wealth of experience to provide insight and information to families of aging parents who are looking for solutions in helping their parents live as safely and independently as possible and in navigating the often complicated and confusing long-term care system.

Now that you know more about John’s and my experience and ideas, I would like to share with you in the next chapter the stories of two of our dear friends, Florence Karpowicz and Pat Howard. Rather than going into detail about the many issues families face when trying to do the right thing for an aging family member, I believe that reading their stories will give you confidence in understanding that not only do we know what to do, but we are sensitive to your feelings of helplessness and desperation as you face a road full of obstacles in your journey through the maze of long-term care.

Chapter Two:

Flo and Patty Jo

Over the years, John (along with the assistance of his faithful staff) has served as guardian or held power of attorney for nearly 2,000 people, as well as helping countless other families in taking care of their aging or impaired loved one; however, in nearly every case, John and I never knew the persons that we have cared for before their conditions deteriorated. We did not feel the heartache that family and friends experience as they helplessly watch their loved ones deteriorate physically and mentally. The exceptions were the cases of our dear friends, Florence Karpowicz and Patricia Howard. Because of the love I have for these wonderful women, their families have given their wholehearted support to my sharing their stories.

Florence and I met in 1976 in conjunction with my first job in a law firm and immediately became fast friends and partners in crime. Until the last few years, she was a bright, interesting individual whose greatest pleasure was giving of herself to others. She thrived in her profession as a legal secretary to Harold Wonnell, a brilliant and flamboyant Columbus trial lawyer, and dearly loved her husband Joe, her sons, and later her grandchildren. She worked for Mr. Wonnell until his death in 1999 and continued to work for his wife, Nancy, also an attorney, for more than a year until she retired at 75 to care for Joe, who was then suffering from Alzheimer’s disease.

After Joe’s death in 2001, Flo was at first disconsolate and blamed herself for allowing her children to persuade her to place Joe in a nursing home during his final months. In time, however, she began enjoying life again and actively pursued her many interests and socialized with her family and many friends. She called me her “intellectual friend,” and we made many trips to independent movies as well as to the opera and plays. She thoroughly enjoyed accompanying us when we visited our daughter, Sarah, in London during her college semester abroad, and several years later was delighted to spend my birthday weekend with Sarah and me on a whirlwind trip to New York City. She also enjoyed other trips with family and friends, most notably a trip to Poland, the childhood home of both of her parents.

In her mid-80s, Florence began to suffer from mini-strokes, which resulted in a permanent and untreatable vertigo. She felt extremely dizzy and unsteady and very seldom left her home. She was often isolated for days at a time and lost weight as a result of a decreased appetite. I stopped to see her at least once a week and called her every day to give her “human contact.” She insisted that she wanted to remain in her home as long as possible, but was resistant to having anyone come in to help her. I agreed that I would support her in this wish as long as I could. One fall Friday night, I found her in such a weakened state that she could not get up from the sofa to go to the bathroom. Worried that she might possibly need hospitalization, I urged her to call her son Joe whose wife, Gabi, is a nurse. She reluctantly agreed. Joe and Gabi came over immediately and moved her into their home that night. In the process of collecting her things, we discovered that besides being malnourished, she had not been managing her medications correctly and had not bathed properly in some time.

Fortunately, besides her will, Flo had already executed a Financial Durable Power of Attorney, a Living Will, and a Durable Power of Attorney for Health Care (all standard Ohio documents that permitted her sons to handle her affairs). Since Joe and Gabi would be her primary caregivers, they met with John and me to discuss Medicaid planning. They were interested in preserving the house for sentimental reasons because their parents had lived there since their marriage in 1949. At the time, Ohio law stipulated that if an immediate family member provided primary care for the patient for at least two years prior to admission in a nursing home, then the individual is permitted to deed his or her home to the caregiver. In addition, there is a five year lookback (aka penalty) period on any gifts made to third parties.

Accordingly, we prepared a deed transferring Florence’s home to her two sons and recorded it immediately after she signed it. In addition, I urged Joe to begin the process of cashing in Flo’s paid-up life insurance policies and using the proceeds to pay for an irrevocable pre-need funeral plan. Understandably, Joe took his time with this step as it is never easy to make funeral arrangements for a loved one even if that person is still alive.

For more than two years Joe and Gabi provided excellent care for Florence, whose health and memory deteriorated rapidly. I was so relieved that the vascular dementia did not rob Florence of all of her memory and that she still knew her family and me. Having any consequential conversations became nearly impossible, and the best way to talk with her was to tell her stories with the understanding that she might or might not comprehend. Because of the distance between our houses, I did not provide respite for Joe and Gabi as often as I would have liked, but many times I did stay with Flo so they could get away for an evening. It nearly broke my heart knowing that this once strong, capable, and articulate woman was totally dependent on others for all of the activities of daily living.

As I will discuss later, I am an advocate for early admission in hospice care. The earlier a patient enrolls in a hospice program, often the better his or her daily condition becomes. The extra support as well as the medication and equipment which hospice programs provide free of charge to patients and their families is invaluable. I had shared my views on this subject with Joe and Gabi many times and was not surprised when they enrolled Florence in hospi...

Table of contents

• Cover
• Title
• Copyright
• Table of Contents
• Introduction
• Chapter One: “Team Mashburn” – The Back Story
• Chapter Two: Flo and Patty Jo
• Chapter Three: Difficult Conversations
• Chapter Four: Estate Planning
• Chapter Five: Acting as a Fiduciary
• Chapter Six: New Living Arrangements – and How to Pay for Them
• Chapter Seven: Public and Private Resources
• Chapter Eight: Hospice – the Beginning of the End or the End of the Beginning
• Our Family Can Manage This on Our Own
• Conclusion: The Journey of a Thousand Miles
• Acknowledgments
• About the Author
• Thank You