Growing Older / Liz Taylor
Home care for Alzheimer's patients is a major health risk for caregiver spouse

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Q: You helped a friend find a placement for her mother who had Alzheimer's disease. My father-in-law is 87, has Alzheimer's, and currently lives at home in Tacoma with my mother-in-law (age 80). His neurologist told her to keep him at home and not put him in assisted living. But he's too much for her to handle, and it's wearing her out. Can you tell us how to find someone who knows about services in her area that will help her make the right decisions?

A: I'm sorry a neurologist gave your mother-in-law such bum advice. Getting him the right care could well save her life.

Research shows that older caregivers have a 63 percent chance of dying prematurely — before their counterparts who don't provide care — precisely because of the stress, depression, physical strain and unrelenting responsibilities of caregiving.

Caregiving is a major health risk, right up there with smoking. No family should dismiss an older person's caregiving burdens without exploring all available options.

While living at home, your father-in-law could attend an adult day center during the day while your mother-in-law has a break. For a list, contact the Washington Adult Day Services Association in Seattle at 206-461-3899 or toll-free at 888-609-2372, or go online to www.adultday.org.

Another excellent option is assisted living. Perhaps the neurologist had a bad experience with an assisted-living facility that claimed it could care for someone with dementia — but couldn't. How to distinguish? Nancy Werner of Aegis Assisted Living of Shoreline suggests you ask:

• Is the care staff specifically trained in dementia care? Because Alzheimer's and other dementing illnesses are unlike anything most of us ever experience, they require special training.

• Are the spaces wide and bright? Are the bathrooms large enough to accommodate a caregiver and resident at the same time? Avoid hallways that are long and dark. An apartment with numerous rooms is also often not appropriate.

• Are activities specially designed for people with memory loss?

• Is staff awake and available 24 hours a day?
 
Good dementia care is expensive because it's highly labor-intensive. According to research by the Urban Institute, how someone pays for care determines his or her choices — diagnosis and care needs are secondary. Those funded by Medicaid end up in nursing homes, while those who pay privately — from savings or long-term care insurance — tend to live in assisted living. You can read this study at aspe.hhs.gov/daltcp/reports/riskest.pdf.

Finally, to find a geriatric care manager to help your mother-in-law make good decisions, call Senior Information & Assistance, a free telephone-referral service throughout the country, and ask for a list of these consultants. The number in Pierce, King, Kitsap and Snohomish counties is 888-435-3377.

For other areas, call the same number and give the ZIP code of the area you need, or call the Eldercare Locator office at 800-677-1116 or go online to www.eldercare.gov.

Q: I'm an only child, raised in Italy. I married a U.S. citizen and moved to America, where we have two children. My parents came here in 2000 in their late 70s to spend their last years near us. Both have multiple, serious health problems, and their pensions from home don't go far.

Unbeknownst to us, in 1996, the federal law changed to exclude all legal immigrants from receiving any federal benefits, including Medicaid, for five years from their date of residency. To become eligible after that, they must become U.S. citizens, passing an English-language and a citizenship test.

I'm afraid their increasing dementia will make them unable to pass. In addition, to get my parents here, my husband and I had to sign an Affidavit of Support, promising to support them for five years or until they become citizens, return home or die (the law now requires 10 years).

Our income is automatically assumed to be theirs, making them ineligible for benefits. My parents are not the only ones in this predicament — they go to senior centers and meet people in similar situations. To put it mildly, my parents' arrival has had an unexpected negative impact on our family's financial well-being. Please warn your readers about this.

A: There are enormous barriers awaiting older immigrants who need help paying for health, housing and care services in America. The rules for immigrants to qualify for most benefits are difficult and complicated, says Romy Schmalz, an attorney who focuses on family-sponsored immigration, asylum, and immigration cases with the Elliott Bay Law Group, PC, in Seattle.

The Affidavit of Support, which is a binding contract, requires families to take financial responsibility for their relatives once they're here — and cannot be broken.

While younger immigrants have their lifetimes to work toward getting on their feet and becoming citizens, older immigrants do not. Before any family invites older relatives to move to America from abroad, it's critical to understand the long-term implications.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist on aging and long-term care, she consults with individuals and teaches workshops on how to plan for one's aging — and aging parents. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.

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