'I suspect the live-in caregiver is benefiting from my parent's generosity'
"I'm struggling to figure out how to support them without giving up the boundaries I worked hard to set." (Photo subject is a model.)
Dear Quentin,
My father has been declining for a while. Have any of your readers dealt with a parent in early dementia or Alzheimer's who fixates on an old slight and reignites the conflict like it happened yesterday? This particular issue was settled more than six years ago, but yesterday he told me "have a nice life" and hung up.
There's a lot of hurt between us, and I'm struggling to figure out how to support him without giving up the boundaries I worked hard to set. It feels wrong to just excuse this from here on out. He is still an adult, and I think I deserve the same respect I give him. But his decline is probably affecting how he processes things. So where does that leave me?
His decline is probably affecting how he processes things.
I suspect the live-in caregiver is benefiting from my parent's generosity. His debit card is being used for groceries, regular DoorDash orders, subscriptions and a $300 allowance for a granddaughter for "helping around the house," though her responsibilities look minimal. Not all of that is necessarily wrong.
But where's the line between supporting someone who provides care and taking advantage of a vulnerable older adult? And what do you do about it when you're not the one doing the daily care? The hard part is that I really do think my father is better off at home than in a facility. I want him to have the best quality of life possible.
I'm caught between his needs, my own well-being and my worries about what's going on there. How do you tell dementia-driven behavior from longstanding patterns that still hurt? How do you hold boundaries without guilt? And how do you raise money concerns when another family member is the main caregiver? Any advice or commiseration is welcome.
Feeling Powerless
You can email The Moneyist with any financial and ethical questions at qfottrell@marketwatch.com. The Moneyist regrets he cannot reply to questions individually.
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Dementia can make patients angry, or placid, or childlike, or even seem to time travel in their minds to where they believe they are children again.
Dear Powerless,
Respect the man, but try to forgive his illness.
You ask a lot of good questions, but they are almost impossible to answer in general terms. They are eminently answerable if you ask what action needs to take place - or not to happen - to address each situation you describe. You sound overwhelmed by practical, existential, moral and medical dilemmas. Let's deal with them one by one.
How do you know what behavior is the result of dementia and what is the result of past hurt? You don't. The brain is a complicated organ, and it would be nearly impossible to try to solve this mystery in these pages. Alzheimer's is just one form of dementia, and doctors are still trying to understand it. You don't have to excuse it, but you can try to understand it.
Your father may be acting out, which is not unusual for someone whose mental cognition is on the decline. I don't believe you should take this personally, as difficult as that may be. You cannot control what he does or says or believes. His illness may indeed be affecting his ability to temper his emotions or communicate as he once did. That awareness may help you respond with more compassion and equanimity, even if his words hurt.
His gifts to his granddaughter could complicate Medicaid.
Dementia can make patients angry, or placid, or childlike, or even seem to time travel in their minds to where they believe they are children again. It's a devastating, unpredictable illness, so I think you should give your father some grace for his words and actions, and not regard them as representative of how he felt before this disease took hold of his mind.
There may be other contributory factors to any outbursts - including fatigue, lack of sleep, hunger, thirst, pain, infection, medications, bodily functions and irregular routines, among other many variables. We just don't know, and we may never know. Music, family photos and/or a family pet can help restore peace, but it's not always so simple or straightforward. Dementia can intensify feelings and memories, sometimes with unpleasant results.
What is the state of his finances? Memory care costs thousands of dollars a month, and Medicare - unlike Medicaid - doesn't cover long-term care. Examine and preserve his savings, find out if he has long-term-care insurance or veterans' benefits if he served in the military, and whether he might qualify for Medicaid. (Medicaid has a five-year look-back rule for gifts and transfers, so $300 monthly gifts to your niece could complicate an application down the road.)
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Formalizing legal roles in your father's life
If your father hasn't made arrangements for someone trustworthy to help manage his finances and make decisions about his care if he becomes unable to do so, now is the time to seek legal advice. An elder-law attorney can review any existing powers of attorney or other documents, explain who has authority to act on his behalf and also give you advice on your options if you suspect financial exploitation.
If you have concerns about his debit-card transactions, ask for a transparent accounting of his expenses from the relevant party, and how they relate to his care. You don't have to accuse them of wrongdoing to ask reasonable and responsible questions about how his money is being spent. (if there is financial skullduggery taking place, you will have put them on notice.)
The time may have arrived, judging at least from your letter, to formalize the roles family members and employees have in his life, and that comes with accountability. Talk to an elder-care attorney and ask to see the accounts for his debit card and other financial transactions. Hold a family meeting to discuss his care going forward, because in-home care may not be possible for much longer.
Tell yourself every day that you are doing the best you can.
You raise concerns through intervention. You don't have to make accusations about his caregiver misappropriating funds. You can, however, signal that you - and any other siblings, if they exist - are taking a more active role in managing the logistics of his care. It may (or may not) be that the time has come to end the DoorDash orders and $300 payments to the granddaughter.
How do you maintain boundaries without feeling guilty? You do so by putting in place caregivers and a system that meets your father where he's at in his disease. Today, it could involve a caregiver who does not have access to this debit card. Tomorrow, it could be arranging memory care. You do so with the knowledge that you are putting his best interests first.
There's no silver bullet for guilt - it's a daily practice. Your father will be well taken care of, and you need to do the same for yourself, for your sanity and for your own mental health. Watching a loved one descend into dementia is an extremely upsetting, traumatic and powerless place to be. Tell yourself every day that you are doing the best you can.
Take it one conversation, one day at a time.
If you suspect an elderly relative is a victim of elder financial abuse, contact the National Elder Fraud Hotline at 833-372-8311 or legal services and Adult Protective Services and/or the National Center on Elder Abuse, an agency affiliated with the U.S. Administration on Aging; the National Council on Aging advocacy group. Visit the Eldercare Locator or call toll-free at 1-800-677-1116.
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-Quentin Fottrell
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