A Long Term Care Memorandum

To:  LTC Tree
From: Joe Houston, M.Ed., retired Licensed Professional Counselor and Certified Rehabilitation Counselor 
Re: When the Long Term Care patient comes home, then what?
 

First, thanks for the Long Term Care policy you sold me.  It has been a life-saver in my wife’s situation.  This memo is based on my personal and extensive professional experience, and I think it will be of some benefit to many of your long term care insurance customers.
 

When people become disabled it is usually an earth-shattering event in their lives, and the older they are the more difficult it is for them to make the necessary adjustments to continue with a regular life.  Often they are injured or suffer some calamitous medical event, are hospitalized, maybe transition to temporary nursing or rehab care, and after stabilization, return home.  At this point, the spouse or other family member is usually called upon to provide extensive help with their long term care needs.
 

Now, depending on the type of Long Term Care Insurance policy your customer has purchased, the amount of assistance required from the family member may be a little or a lot.  If the client does not have an unlimited long term care insurance policy customers will likely want to provide as many activities of daily living services in order to conserve as much of their benefit fund as possible for future use.  That was true in my case.
 

If the disabling condition is physical it will affect activities of daily living, which are eating, bathing, dressing, toileting, transferring, maintaining continence, shopping, transportation, etc. These are activities that able-bodied people take for granted, but for those unable to do them without assistance, they can be devastating.  So you step in and begin to help at home, usually with a glad and loving heart. You, the helper, make adjustments in your routine and schedule and begin assisting.  Now you are doing many things for your loved one that he/she used to do for many years.  In effect the roles have changed. If you’re a man, perhaps you used to do all the yard work and your wife did the cooking, laundry and housecleaning.  Suddenly you find that you have to cook, wash the clothes and clean the house. There is now little time for your hobbies and leisure activities, and you are faced with hiring out your yard work, expending funds you’d prefer to spend elsewhere.  Now you find you wife is getting short-tempered and irritable with you, because you don’t do things on her schedule, nor do you do them the way she would like.  But what she is really angry about is not being able to do what she wants to do.  Soon you begin to get irritable and angry, and you often feel guilty about this. But what can you do?
 

Or, suppose the disabling condition is more mental in nature, perhaps due to a stroke, Alzheimer’s, dementia, mental illness or alcohol/drug abuse.  Assuming the proper medical and psychiatric care has been provided, your home care is simpler in some ways, but you will be more dependent on other professionals in most cases.  Still many of the needs of the physically disabled will apply to this group as well. But what can you do?
 

First you have to objectively evaluate your feelings, behavior and thought processes of you and your loved one.  Then you should develop mutual goals to try to achieve together.  And don’t forget to develop some individual goals that are important to each of you.  It’s not critical as to which should come first, but individual and mutual goals need to be agreed upon.  If you find yourselves unable to do this, and then seek help from your doctors, nurses or other professionals with whom you are involved. Occasionally, these people may be unable to assist you, so I would advise you to then seek help from a licensed counselor, psychologist or certified rehabilitation counselor.  A few sessions should be sufficient.

As you and your loved one go about your daily lives the main bugaboos that are likely to cause problems are the emotional ones: anger, sadness, fear or anxiety, guilt and shame.  Unresolved problems around these emotions may have been lurking in your relationship for years, and may have been minor and not critical to be dealt with, but the added pressure and stress of your new situation may demand that you do something.  For example, some long term care disabilities drop in on us out of the blue, and are not directly our fault, such as accidental physical trauma, strokes, heart attacks, genetic diseases, etc.  However, some conditions like alcohol/drug abuse, obesity, smoking related diseases, etc. are based on unfortunate choices over a lifetime, were preventable by the individual and can have direct links to a current unfortunate condition.  An obese person may have suffered a stroke or have a diabetic condition that required a leg amputation, and that person may or may not feel guilty about it (depending on personality characteristics), but you may find yourself angry that he/she didn’t take better care of themselves, and put all this extra burden on your.  Also you may resent that now all your grand retirement plans have to be changed.  These feelings are common because now the burden of providing long term care rests in the family’s lap and hopefully a long term care insurance policy if one was purchased.  Or suppose your spouse drank heavily and smoked like a furnace for years, now has cancer and emphysema, can’t work, but is okay physically otherwise.  What’s worse, this spouse refuses to follow treatment recommendations to the letter, leaving you with the anxiety and worry about what the future holds for both of you.

An important aspect about unresolved emotional problems among couples is that they “take it out” on each other in ways they would never do in the general public.  And the reason for this is that it is “safe” to do so, because they know you’ll tolerate it for an extended period, whereas a stranger will not. However, over time this behavior can be quiet destructive.  So if you’re caught in this trap, learn assertive behavior techniques or get professional help.
 

Another scenario that often arises is when the disabled person that you are providing long term care  for insists on doing the things that he/she has always done, but can no longer do them safely or effectively.  This gets especially touchy when the brain has been affected in some manner and the person has lost perspective about things.  Despite your protestations, they tend to insist on continuing the old way, even when it is totally dysfunctional. This will probably go against all your good efforts, frustrating and angering you.  Basically the disabled person is not unusual in this regard because the older all of us get the more set in our ways we tend to become. It’s the old- dog-new- tricks thing.

Finally, the one thing that you can do, even though your spouse may be strongly opposed, is to make sure all medications are taken as prescribed and all rehabilitation directions followed.  You should insist on this no matter what. If this level of assertiveness is alien to you, then enlist the help of someone who can back you up.

A common solution in avoiding these common missteps is to plan ahead and buy a long term care insurance policy that will provide adequate coverage, but at the same time fit into your budget.  Our typical client’s plan is not going to be an unlimited plan with all the bells and whistles, it will be insuring against the average risk of needing long term care which 95% of the time will last 5 years or less.  If you’d like to learn more please take a moment to fill out the form below.  Either way we really appreciate you reading our latest blog today.