Fascinating, Paul...philosophy, medicine AND banking...you must have a very broad range of interests!

We need to get together for coffee some day. I bet you could hold a conversation on just about anything! ...but let's not talk about money, okay? Numbers give me the heebee-jeebies

Seriously, though, I hope your social worker friend can get you moving in the right direction. Those folks know all sorts of things that it would take a normal human being half a life-time to discover on his own!

Good call to consult with a social worker friend. He or she should be able to direct you to resources that you might not otherwise know about, even another social worker who specializes in elder issues.

You might be able to "sell" them on this as a way to PRESERVE their independent instead of giving it up. Our LO resisted mightily, but the truth is that she was able to do more for herself with the type of assistance set up at assisted living than before. They have regular (chaperoned) shuttles to various shopping and activities. They can have friend, play cards, etc.

I will suggest that since they are a couple, you pay special attention to the continuing care facilities, that is places where there is both assisted living and nursing home on the same site. In the case of your grandparents, should one need even a short term stay in the nursing home, the other could visit and spend the days with their spouse if they choose to do so. There is one little couple at our LO's facility where the husband is permitted to take his wife to their AL apartment in her wheelchair, then return her to the nursing area for diaper changes, etc. They can watch television together and have some private time together that way. The prospect of being able to stay TOGETHER, no matter what comes, may be a good selling point.

Dang, Paul! I sure wish MY 25 year old had been an investment banker!

Communicating with our elderly relatives is a science unto itself. "Discussing," as one would normally do with another adult peer goes out the window. You are no longer peers (if they ever even accepted you as an adult and not just their grandkid), so having peer-to-peer communications is doomed to fail. This causes much strife in family caregiving because parents and grandparents view their adult progeny as "kids." I'm in my mid-50s and haven't been a kid for some time, yet parents and grandparents tend to view us that way. This puts communication on a difficult footing from the get-go. YOU can't talk to them "that way" because they view you as their familial inferior - a kid! I had some problems with this with my own mom before we got things settled.

Gradually you must stop asking them questions. "Do you think we should...", "would you like to..." "what do you want..." kind of questions all lead to a bad place because they no longer can truly answer those questions! Make statements, instead. If you give choices, make sure it's only one or two or structure the question so that they will pick the correct choice. Here's an example:

"Gramps, I have checked out a couple of assisted living places for you & Gram while I am away in Alaska at med school. You can move in next month."

You didn't ask him a danged thing - you told him not only that you had checked out a new residence FOR him, but that you will be pursuing other goals.

"Would you prefer a garden apartment where you can grow your own tomatoes or would you like a townhouse with a view of Manhatten?"

Now you know your grandparents well enough to make that choice for them, but to help them feel included in the decision-making process, let them pick between place A and place B. Don't offer any other choices. If place A is a 10th floor townhouse and way too expensive and you KNOW your grandparents are afraid of heights, offer them the choice between THAT place and the one you think they should choose. You have structured the choices so that they pick the "correct" answer.

Your anecdote of whether one needs cash and how much is a PERFECT example of trying to reason with folks whose reasoner's are not working reliably. And your solution is the one we all use - you simply didn't ask, made the decision yourself and took care of it.
"Here's your cash just in case you need something, Gramps." Problem solved - no muss, no fuss. You seem to innately understand that these folks are not children - they are full-fledged adults who are coming unwound. There's a WORLD of difference between handling kids and handling adults with diminished capacity.

BTW, in case you are unaware of them, the Lighthouse for the Blind (Lighthouse International)(I just posted their URL in a different thread in the last couple of weeks) has recently opened a clinic in the NYC area for psychological issues of blindness. You are lucky because you live in an area RICH with outreach programs and benefits! Those folks are WONDERFUL!

Of course, they would prefer to die in the place where they have lived for so long and I don't blame them one little bit, but it is MUCH more difficult to find reliable, trustworthy, competent live-in help (which is essentially what they need now) than it is to find a decent assisted living residence, especially if you will be out of state or unable to monitor the hired help at least weekly. Moving them NOW way ahead of your leaving the area is the best choice. You need to be sure they are settled in, do your spy missions to ensure that they ARE receiving the kinds and level of care promised in the brochures, etc. Visiting at off-hours, way early in the morning and way late at night are a caregiver's best surveillance tools short of having one's own in-house spy. It may sound a little paranoid, but there are not many great residential places for seniors; there are a few more pretty good ones; many are satisfactory but nothing to write home about; and the rest are so lacking in services or deficient in care and competency of employees that you would not even want to leave your neighbor's annoying dog to reside there!

It's a tough decision for you, but taking care of them does NOT mean that YOU have to perform every single task. You can arrange for their care and oversee things and still fulfill your promise to your dad as well as your obligation to them.

I feel sure your social worker contact will have many more suggestions for you and will be familiar with local services as well. Best of luck!

Again, thanks everyone for some great insight.

I often feel that few (if any) people in my life understand the nature of my duty to my family, it's great to know that there are others out there who understand my role.

My father passed unexpectedly and he asked me to take care of his parents. After my father's passing, I inherited the care of my grandparents and my mom, who was largely dependent upon my father for financial guidance and support. Having worked in the finance industry (former investment banker) it was natural for me to become the financial / legal caretaker of my mom and grandparents. I'm incredibly loyal to my family and I've always been close to my parents and grandparents. My parents and grandparents have supported me with love and finances and without them, I would not have been able to pursue my goals. Over the years, my mother has become independent and she would be fine if I were to move away from home. My grandparents still help me pay for school (at over $50,000 a year w/ living expenses) and that has made it very difficult for me to 'abandon' them, I would feel horrible about it. I know that I have done more for them than the average son or even grandson would have and I recognize that their current living situation isn't the best for them.

They complain constantly about how difficult things are, yet whenever I suggest that we make changes, they scoff at the idea and repeat 'we're gonna live here until we die.' It's difficult to argue with two tough Polish people who survived The Great Depression and have had to fight many battles in their lives.

The bottom line is that they are unable to make decisions for themselves. I haven't maintained a formal journal, but there is no question that their physical and mental state has been deteriorating progressively over time. They are at a stage when doing almost ANYTHING requires a fight. For example, they can no longer make simple decisions such as when they need cash around the house for groceries, etc. I've given up on asking them at this point, I just go to the bank and make a withdrawal. Simple, routine tasks become monumental endeavors.

There is no question that my grandparents suffer from some form of dementia. My grandfather (a brilliant mechanical engineer) has been dealing with the psychological issues associated with losing his vision. His frustration drives everyone crazy, including myself.

Anyway... I've placed a call into my social work contact, hopefully I can get the ball rolling now. I have the summer off from school, so there's no better time than the present to deal with this. Things will only get more complicated and I'm not getting any younger.

Welcome, Paul. Sorry I am a little late in welcoming you and joining the conversation.

quote:

I have both DPA and POA, but as we all know, I'm not really empowered until either or both of my grandparents becomes incapacitated...
If I were to be incapacitated, my grandparents would be in bad shape. Problem is, my grandparents (at their age) don't have the capacity to understand this. They no longer have the ability to understand a cogent argument. A heart-to-heart discussion with them about my future is a waste of time. I've tried it before, they just don't understand. It's almost as if they are no longer capable of even basic logic. They dwell and obsess on basic, immaterial things and fail to think about the big picture.

DPOA is exactly for your kind of situation. Because your grandparents are MENTALLY incompetent to make wise decisions for themselves, your DPOA SHOULD be invoked. Speak with a social worker or eldercare attorney about this...

I understand family obligation but you are too young to be sacrificing your FUTURE because of an unfair promise to care for your grandparents. Caring for people does not mean having to do every solitary thing PERSONALLY. Somehow, a loving, kind situation has twisted over time into a stranglehold where your grandparents cannot get the MONITORING they need of their moment-to-moment activities and your life is lived between attending to them.

Future Physician, heal thyself! You can clearly see that this situation is untenable, yet emotion and duty binds you to an unwise path. Hire some in-home help for the grands or put them in assisted living. You cannot do it all for two people, even if you had no aspirations for a career. It is simply TOO MUCH for one person.

quote:

Before I can apply to schools, I need to give admission committees the assurance that I have been relieved of the responsibility of caring for my grandparents.

I don't think the committees are your problem, dear. They know only what YOU tell them... The problem is YOUR sense of duty. Your DPOA gives you certain rights under the law. When patients have lost the capacity to make rational decisions, others make those decisions for them. Despite the legal piece of paper, this is very difficult. Dealing with dementia is a maddening thing for anyone of any age. I suspect, at your tender age, you have not known nor had to deal with too many dementia sufferers. Loved ones make excuses for their incapacity (as if it were a choice or something!) and refuse to look at how all-pervasive their dysfunction is because they seem okay enough most of the time... Sure, they are still getting along, but scratch the surface and those folks are helpless to care for themselves or their personal business. You must free yourself of the co-dependence going on here... You cannot do ALL their living for them! You already see to most of their daily and long-term needs, keep their house fixed, do their shopping, etc.
As you said:

quote:

Medical school requires a 100% commitment. Caring for my grandparents is a huge distraction and worse, they are a future liability.

Caring for incapacitated adults requires a 100% commitment also. The numbers don't add up. You are REQUIRED to have a life by virtue of your age. Not to do so will postpone your life's goals in a way that will be irreparable. Good physicians have to be able to see the big picture if they are worth a flip. To even become an MD, you must learn how to see the big picture, but a caregiver has to go one step further: You must ACT on what you see. The most difficult thing many of us do is to overrule the wants and desires of our demented loved ones and make decisions for them that are fair to everyone concerned, especially them! It's a tough row to hoe with much wringing of hands and gnashing of teeth. Doctors, lawyers, social workers all recommend, but caregivers must DECIDE.

Pardon me for sounding a little gruff - believe me, it's NOT because of you. I am having to swallow RAGE at parents leaving a responsibility of this magnitude to a 21 year old kid (although you sound like you were an EXTRAORDINARY kid). I am gonna try real hard to press my lips firmly together and force my fingers not to type about it, but I will say that YOU, m'dear, have been shafted by BOTH of your parents in this. I have to wonder what the hell was wrong with BOTH of their minds in setting this onto your shoulders at age 21...

That your mom would even ALLOW you to assume this responsibility is a shame on her. She was the adult when your father died and it looks like she abdicated one heckuva lot of responsibility to her kid instead of shouldering it herself so that her son could grow up and get himself a life and career before having to tackle such weighty responsibilities as eldercare.

Oops - sorry. I couldn't help myself... Just be SURE that your mom gives DPOA for herself to your sister and not to you! You've done your family obligation many times over.

PLEASE seek out the counsel of a social worker experienced with eldercare issues. You desperately need help to see the forest through the trees before your life's opportunities shrink up and dissipate.

That you have been saddled with this responsibility for the past TEN years and have stepped up to the plate so admirably brings tears to my eyes. Get yourself some GOOD counsel on this issue and take action immediately. Your grands are so lucky to have had your loving care, and I know they love and trust you, but your responsibility to yourself comes first in life. Without it, you won't have much of a future. You are a man now and it's time to make man-sized decisions in this matter. Your continuing to care for them EVEN if they reside in a facility, can be overwhelming (even if you work at Burger King - not to mention med school!) - just ask some of the caregivers here who have folks in residential care! You, as their attorney-in-fact (DPOA), can direct their care, residential situation and employ others to oversee their finances. PLEASE read through some of the experiences here - even in assisted living, elderly folks keep us busy and frequently overburdened. You must delegate a LOT of responsibilities so that you can pursue your career. At age 88 and 91, things can become a nightmare in one moment - you MUST get yourself out of the line of fire so that you can continue the life they dreamed of for you!

Paul I have to agree with BC here. With what you are relating now about your GP's sounds...well like classic signs of Dementia maybe? But it could be other things lets not lump them in there yet.
When was the last time they were seen by their PCP?
Paul you care for them most of the time correct, have you kept any kind of journal on them at all?
Changes in behaviors, forgetfulness, getting lost, deficits in skills such as taking care of bills/accounts, putting things away in their proper places, leaving a stove on, not being able to keep track of things like pills, dates/times, things like that.
What are you witnessing?
Write this down and when you take them to the doctor privately go over this list with him/her so that you can start on the road to evaluation. Each person is different remember that.
Im giving you things that happened with my MIL, but early on I didnt recognize it as a problem only that she may have been having a bad day. So try and look at this in a detached manner you know what I mean.
Sometimes we just simply overlook things and chalk it up to a bad day or heck even a month when there really is something wrong. Thats not a bad thing though dont get me wrong we just see them as invincible nothing could ever happen to them unfortunately thats not always the case.

you sure are remarkable. the medical world can use people like you with personal experience , with so much character and commitment. i guess advice wise all i have to bring to the table is 55 years of hard experience. i think you know what you need to do but it takes a great deal of courage to follow through. it sounds like you are on to some good resouces to give you food for thought. remember, no one is irreplaceable. there is entire field of professionals to deal with your grandparents care needs and they are loving, compassionate people. i hear what you're saying about their inability to accept what you try to tell them. you might as well talk to a brick wall, you'll get just about as far. as i mentione before, if anything happened to you plans would be made very quickly and they would be cared for and life would go on, certainly a great loss of a caring, courageous young man but it would go on. you said they had no ability to see the greater picture concept. what about you? you might need to visualize yourself GONE for you to see the future. sorry, it's a good view from up on my soapbox. just don't be guilted into choices. you say you inherited your grandparents. it was pretty much thrust on your young shoulders and i'd say you carried the burden for much longer than most young men would.not everyone has choices. you are very fortunate that you do. i think i need a shrink. this issue sure brings out the passion in me. sorry, i have become very preachy. maybe i'm just old but i don't think they make them like you anymore!! good luck.

All Pau, If they can't manage a logical conversation, and are so totally dependent on you, perhaps they HAVE reached THAT point . Use your social worker contacts and see what kind of official evaluation can be made. Certainly they are afraid of change at this time, as you should be of Not changing at this time.

But as you make this choice, OWN it, it will always be with you. I ,for one would look forward to your contributions as a DR or researcher, but you will make wonderful contributions to society, whatever you do. You just are that type of person. Some of us are a bit quieter with our impact, it is on a smaller scale. If you feel a true vocation for medicine, You will work this out.

This message has been edited. Last edited by: Bobcat,

Thanks everyone for your thoughtful responses to my post, it really makes me feel better to know that I'm not truly alone in this experience. My only regret is not reaching out before. Bless all of you for taking the time to read my post and offering your kind advice.

Some great points have been made. Bobcat, thanks for that link, I've already begun to explore it. Looks like there are more resources available to me than I had thought. I'm feeling more hopeful already. I'd like to investigate whether or not I can use the State of NY to determine whether my grandparents are fit to live by themselves. Ironically, my grandparents won't take my advice but if a state official were to tell them to move, they would probably listen. I need to look into this. I have some social worker contacts at a local hospital in Manhattan who could probably help me here. I need to reach out to them.

Now, to answer some of your questions.

I have both DPOA and a health care proxy is in place, but as we all know, I'm not really empowered until either or both of my grandparents becomes incapacitated. God forbid, but the incapacitation of one or both of my grandparents will actually give me the ability to make the changes that I need to make all of our lives easier (i.e. sell the house, place them in an assisted living facility, etc.) The problem is that they are both marginally able to live quasi-independently, yet they still require a significant amount of assistance from me.

Somebody raised a good point. If I were to be incapacitated, my grandparents would be in bad shape. Problem is, my grandparents (at their age) don't have the capacity to understand this. They no longer have the ability to understand a cogent argument. A heart-to-heart discussion with them about my future is a waste of time. I've tried it before, they just don't understand. It's almost as if they are no longer capable of even basic logic. They dwell and obsess on basic, immaterial things and fail to think about the big picture. Part of my frustration is that they ignore my recommendations and suggestions. They are excessively stubborn, almost like two 13 year old children.

As for my education, I'll say this. In May, I graduated from a post-bacc premedical program (basically a second undergrad degree, my first undergraduate degree was in philosophy) at Columbia University and during my second year, my grandmother was hospitalized for several weeks. Overnight, my life was turned upside-down. My grandparents live about an hour from school and everyday, I had to commute to their place to cook for my grandfather. Needless to say, I almost failed out that year. Prior to that year, I had an almost perfect GPA. This past year, I took upper-level science courses and with my time commitment to my grandparents, I barely achieved a B+ average. While all of my colleagues were studying on their days off, I was at my grandparents' place taking care of them. My responsibilities had a negative impact on my performance, for certain. Going forward, if one of my grandparents were to get sick during medical school, failing out would not be an option. Also, I'm fairly certain that it will be difficult to do well in medical school with this part-time job of taking care of my grandparents. My advisors, mentors and friends who are medical students all agree that I need to resolve this situation before proceeding with medical school. Medical school requires a 100% commitment. Caring for my grandparents is a huge distraction and worse, they are a future liability. If one were to get sick again, my life would again be turned upside-down. I can't afford it.

I should be applying to schools as we speak, but because of my situation, I'm not prepared to apply to med schools. Even though my grades are solid, I'll need to apply to at least 20 schools (fairly standard practice). As things are now, I won't be able to apply to more than the 3-4 medical schools in the NYC metro area because I can't be far from my grandparents. I feel handcuffed, so say the least. I have a year or two to resolve the situation with my grandparents. I need resolution before I can apply, in good faith, to medical schools. My work with my grandparents is an important part of my story as a physician-to-be and medical schools will be aware of the responsibility. I need to assure them that a repeat of my second year at Columbia will not occur. I need a solution and I need a good place to start.

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Maria, Hugs to you. You have a full life and I hope you have no serious regrets how you are living it. I , for one am glad you have time for me. One single change in the past, and the present as we know it would not exist.

All Pau, please realize that this moment will be in your past one day, and will make your future. There is a path open for you, you will always have something worthwhile to do, where ever you are, and what ever you become. Your grandparents should not be an excuse you use later as to why you are not what you could have been. When you make a choice, it is yours forever. Did you choose this roll? (no matter) Do you choose it now? There are ways to make it work, but you will have to choose.

Psssst.... another thought for you:

When I was about 19 and in school pursuing a degree in Speech Pathology and Audiology, I worked for a group of Otolaryngologists and Facial Plastic Surgeons. I guess I showed way more interest in treatment, medicine, theory, and our doctors' experiences in medical school than the average employee. I was always full of questions.

One day after assisting in an un-anethstitized myringotomy with tubes for an infant (I had to hold the head!!!), one of the doctors asked me whether I was planning to go to medical school---he said he would be happy to mentor me! In those days I had a zero med-school-confidence-level, and I hurriedly made obvious by my blushing and astonishment that I had no intention of applying to med-school. He seemed disappointed, and I was doubly astonished.

So, by way of that story, I'm just wondering whether you have a doctor-friend? I'm certain that every single doctor out there remembers painfully/fondly how difficult it was to apply and complete his education. Of those, I'm sure there are quite a few who would give helpful advice and maybe even mentor you through the whole process.

Certainly, many of them would have the necessary experience to offer you some wisdom in the decisions you are now facing!, but you might have to ask

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Whoa, completely in awe of FD&H's remark, What would happen to them if you cannot do for them? Aweful to say. People live into their 100s rarely , but they do. Still we are talking of you in your forties, and your potential unfulfilled. Yes, they are afraid of change, and move, and it will get worse everyday that this goes on.. The sacrifices you contemplate making are phenominal.

You say that mentally they are healthy. If so, a genuine heart to heart about your dreams as their grandchild may be in order. To aleave their fears, the better prepared this talk, with options available for them, the better.

Paul welcome in.
I only see a few options for you here and that is assisted living or a full time in home Caregiver.
You say they have resources but this is going to get pretty expensive...no joke.
Are your Grandparents really "with it" that you could sit down and have an open and honest conversation with them concerning your schooling?
If so do it, be honest this is your life. Get a Social worker involved to help you present options to your GP's The site BC gave will assist you towards that.
Please let us know how it turns out too Im routing for you!

Hi, Paul. Welcome to ECO I'm sure you'll get lots of good ideas here---and plenty of sturdy shoulders, too, while you're making these tough decisions.

Paul, you said that you have Power of Attorney over your grandparents assests. Do you have a general Durable Power of Attorney for all of their medical care as well? If not, you really need to get that in place as soon as possible. It will be needed soon enough, and it will prove to be an invaluable tool for you in your ability to juggle things in favor of all concerned parties.

While I don't have any suggestions for you as yet, I would like to say a couple of things regarding your situation.

By the time I both realized that I would have liked to become a Family Practitioner, and that I actually had enough confidence and intelligence to make it through school; I was about 35 years old, had a house full of children, and was heavily involved in helping to care for my ailing father. The only thing I really regret about all of that is that my realizations came so incredibly late.

You, I assume, are not in such a position. You are at a mature age yet still very young, you must have completed your undergraduate studies by now, and you have a wonderful and worthy dream!

There is a way, Paul. There is no way for you to do it ALL, though—especially all by yourself.

I’m sure if you hang out here a bit, and help us by answering some questions which are particular to you and your grandparents, you will receive some very good ideas about how to get through this without abandoning either your dreams or your grandparents! Neither would be acceptable.

Please come back and let us get to know you.
God bless,
maria

you are in a difficult situation and i'm not sure what to say. i don't know the laws in NY but is possible to have a professional come in to evaluate their competency to live one their own. i feel that it is important for you to pursue your life and move forward without guilt. you devoted a good part of your young life already to seeing after them. you are young and med school is a major commitment that will affect the rest of your life.you are already getting a later start than most. whatever their objections please look out for yourself at this point and without guilt. if they have the resources they can be mmoved to an independent living facility with hired care to come in for errands, cleaning, etc., the things you currently. if you look at a progressive facility that will move them to full assisted care when the time comes they would already be assured a place. i urge to to take your opportunity now. sometimes with education we really don't get a second chance, especiallly when the road you are looking to travel takes more time. please do not get guilted into something because you are the only one who can do it and because of their disagreeable personalities. they have options that many don't. tell me, imagine you get hit by a NY bus and are no longer on the scene. what would happen? sorry to say that arrangements of some kind would be made and life would go on, maybe not the same without a person like you with the character you have shown at such a young age, but it would go on. please think of yourself now. i have tried to save the world and after years sometimes i feel the efforts were wasted and so were many opportunities. i'm not bitter, but like everyone i have regrets and would have done things differently. many times i have thought that if i had taken a path of education in what i love to do, and that is helping people i could have made a bigger difference to so many. don't get me wrong, i would still be working with people but possibly in a different capacity. look into legal aspects, involve the family, get them on board and move forward. i guess i have lectured enough. looks like you just happened to hit a sensitive button in me. sorry. go for it SOON. there are many good people out there who are capable of providing them with the same services you are providing. boy i sure come across as heartless but i feel it would take a great deal of selfishness for family to deny you your opportunity to pursue your goals.

Hi, All Pau, I grant you this isn't the usual situation here, but it is very good to meet you. Some one who cares as you do and whose life is on hold for care giving is very dear to my heart.
May be some one else will jump in here and fill me in. Is it normal for Med Schools to tell you you can't have other responsabilities??
I can understand where they would want your full attention, though. And best if you can give it. In fact, if you cannot concentrate on this, the investment is in jeapordy, both theirs and yours.
I'm not getting much of a hint here about their financial resources, and please, don't go into details, this is the web. You are probably way more saavy than I am about the web.
You say you would pay, but please contact their area council on aging.

A start http://www.aging.state.ny.us/news/2007honorees.htm:]

There are meals programs, daycare sites, attorneys,

I could be wrong, but I think I share a belief with at least some other members here, that the future is of true value. And with your attitude about caring for elders, You could make a contribution for us all, and we might all suffer if your education was cut off.

Do you actually have POA and DPOA for them?

This message has been edited. Last edited by: Bobcat,