Thursday, 1 January 2015

Elderly and dependent ~ preparation, an overview to finding the way forward ~

Increasing frailty in old age can be frightening and the power of choice seem to rapidly diminish.  However, there are a number of straightforward steps that can be taken at any stage which can make the transition from independent living to dependent care a whole lot easier and increase the range of choice.

This article is particularly directed to elderly readers who are considering plans for the future, but is just as relevant to those likely to be helping them.

I expect to write about these topics individually, but want first to give an overview of useful points:
  • The labelling of clothing and other personal items that you may wish to have with you either in hospital or in a rest home: if the need for these seems remote consider the cost of labels as a small investment against furture need, and a likely preventative of future worry.  Start with basic items such as underclothes and nightwear.  I have already written further about this:
  • Get things straight with your doctor / General Practitioner: it may be helpful to have a consultation with him or her to go over contingency plans and to establish what choices are available for additional care in your own home as well as finding out the criteria for rest home care.  Ones choice of doctor is very personal and some doctors will suit some people and not others.  If you have any doubts as to the compatibility of yourself and your present doctor you could ask around for recommendations for a different one.  
    • In New Zealand your GP is the king pin in refering you to health service providers as funded by the government; he or she also is the authority in deciding whether or not you are still mentally capable of making your own decisions, so it's very important that your relationship is one of mutual trust and respect.
  • Establish adequate legal protection for yourself and your property: here again, your solicitor / lawyer may play a very large part in keeping you safe and ensuring that your wishes are carried out.  As with your doctor, be sure that your relationship with this person is one of mutual trust and respect.  If you are not entirely comfortable with them, consider switching to someone who suits you better.
    • Make sure you have a will and that it is up to date, reflects your circumstances and future contingencies.  Does it include the possibility of changed circumstances, such as marrying again, or having sold your home and living in a rest home?  However remote these possibilities may seem, they can happen all of a sudden and if we are incapacitated (or die!) we may not be able to alter them suitably.
    • Set up Power of Attorney authorities to act for you in the event of not being able to handle your own affairs.  In New Zealand there are two levels of these: one relating to property and the other relating to personal care.  When considering who to place in these roles it is vitally important to look carefully at such matters as individual suitability, family dynamics, and the responsibilities that individuals are already commited to elsewhere.  Once a Power of Attorney is activated it is likely to lead directly to a lot of work for those holding this role, as well as being a relationship requiring a huge level of trust so consider it very carefully before commiting to it.  Talk to your solicitor / lawyer about it, discuss it with friends and ask for their opinions, and above all talk to the people you are considering asking to act on your behalf in this capacity.  You can change those named, but it is fairly costly to do so, and if, through illness or infirmity your doctor judges you to have lost the capability to make your own decisions these cannot be revoked except through court order, requiring lengthy and no doubt costly proceedings.  Once you have these established keep 'Certified True' copies on file, on paper as well as in electronic format if you have this facility.  
    • You can find my article about acting in this capacity here: 
  • Check funeral insurance or other arrangements for your funeral and costs: this is a purely practical matter and can best be treated as just another piece of paperwork, such as ensuring one has other forms of adequate insurance or budgeted funds set aside for the purpose.  This website may be useful:
  • Organise paperwork, payments and filing systems - or get someone else to do it, so that they are orderly and can be handled by others.  Bear in mind that once the power of attorney authorities are activated service providers will need copies of Power or Attorney documents on file, usually in electronic format. 
  • Update address lists - personal, professional and medical: in setting up Ellen's I included customer / client and policy and other reference numbers, etc, which has made business dealings much easier.
  • Look at rest homes in your area as well as others that are further away: you may or may not need to make an appointment.  Ask to be shown over the complex.  I suggest you allow up to an hour: if you rapidly decide the place is unsuitable you won't need it, but if it seems a possibility it may be sensible to spend time going into financial requirements and finding exactly what level of accommodation can be expected.  Although standard rates apply to rest home residency in New Zealand I was staggered to discover that this does not in the least mean that the same standard of accommodation is offered.  For example, there may be an additional daily charge in having an adjacent toilet / ensuite.  
    • A GP offered this advice about choosing a rest home: if you like the room and don't like the manager, don't even consider the room.  I agree wholeheartedly as in my observation the personality and attitude of the manager / proprietor has a great influence on the whole establishment.
    • Take friends and or family with you and give yourself time to consider the facts and reflect on how you feel about each place.
  • Look into every subsidy and concesssion available for your care.  You may have plenty of funds and assets at present but once you require substantial levels of care these are likely to be rapidly eroded.  In New Zealand you may be eligible for some or all of the following; there will no doubt be others:
    • Community Services Card - from WINZ
    • Disability Allowance - funding towards itemised health costs, paid for by WINZ
    • Taxi / mobility vouchers, subsidised taxi fares - funded by local authorities in conjunction with central government but applied for through your doctor
    • Mobility parking cards, which allow free parking in Disabled Parking areas - these are personal to the disabled person and very helpful to whoever is driving
    • High Use Health Cards - usually applied for by one's doctor / GP, which gives the medical practice additional funding for the delivery of their services.  They may or may not use it to subsidise individual consultations.
Above all, discuss these things with your family and friends and see what they have to say about them.

Working through these points before substantial change becomes necessary will hopefully alleviate fears about the future, allowing you time to do the groundwork at your own pace while you have the leisure to do so, and to stay as much in charge as possible as circumstances alter.

Click on the link below to find a complete list of articles in this series:

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