In-laws travel for medical care. How long is this doable?

[Anonymous]

MIL and FIL live in a small town an hour and a half away from Tuscon. MIL was recently diagnosed with stage 3 endometrial cancer. She had a total hysterectomy and is now going through chemo. FIL is 83 and MIL is 73. FIL is still recovering from a large wound in his leg ( it got infected in January then he ended up in the hospital with sepsis). He just had his wound vac removed about a month or two ago. MIL takes care of FIL but FIL can still drive.

The in-laws are very resistant to getting medical treatment in their hometown, preferring to travel to Tuscon. They say they don’t like the doctors in their town because many of them are DOs and not MDs.

I’m very worried about all of this driving FIL has to do and their health generally speaking. They’re very independent but both are in terrible shape (overweight, smoke, drink, don’t eat healthy). DH is an only child and we have very young kids and live in the Midwest. If something were to happen, it takes a full day of travel (multiple flights plus driving) to get out there. They have no support system where they are - no friends, no socialization at all. We’ve floated the idea of having them move out to the midwest which is where we currently live but FIL has said he’d never leave Arizona.

As far as finances, DH is largely in the dark. We know they have a pension but they still have a mortgage (they refinanced many times over the years). I don’t believe there is any savings. DH has POA if something were to happen.

My question is what happens if later down the road they can’t travel the hour and a half for medical care? Does Medicare cover any driving? If something happens to my MIL, what do we do with my FIL? I always read about having these conversations ahead of time - before a crisis happens. I’m trying to push DH to have these conversations with his parents but he seems reluctant to do so. I’m not sure they’d be even be open to having these conversations with him.

Do we just have to wait until a crisis happens?

[Anonymous]

OP, you have correctly identified a huge flaw in your in-law's "later stage of life" plans.

There are no easy answers. All I can offer is that you are correct, they are on a slippery slope and since neither one is very stable, are likely to need your husband's help soon.

Work on your husband first. Get him to go through the "what ifs" and see how your finances would handle him taking, say, a 4 week leave of absence to move in there and handle things that need to be handled. Go through his HR and see what he would need to do to submit a request through FMLA. That will start to make it real for him.

If they cannot drive to get to medical care, some communities have volunteers or services that will drive them, but it is certainly easier to schedule the driving if the doctors are closer to home. Look around where your in-laws live to find these kinds of services. Medicare does not typically cover the cost of transportation to doctors visits.

[Anonymous]

If your FIL doesn't want to leave Az maybe they'd be willing to move to an Independent Living facility it Tuscon?

[Anonymous]

Soon they won't have a choice, OP.

It's no use stressing ahead of time if they're not willing to prepare. When they end up in their local ER driven there by ambulance, that's when you have a more serious talk. Which will probably mean hiring an aide if things aren't looking too bad, or refusing to sign the discharge papers and asking the hospital case worker to contact a Medicaid facility.

[Anonymous]

OP even when people live near by, the answer is OFTEN that you just wait for a crisis. Because it’s very rare for people to make a major move towards their own final dependency and death until they have to.

Things you can do are asking them if they have their finances in order and offering to help, and researching nursing care in their area.

[Anonymous]

Your husband needs to have a sit down and approach finances and estate planning from a point of what are your wishes if x, y, or z happens. Through that he will gain a better understanding of their finances and health status. I would also suggest he offer to help pay monthly bills from their accounts and get his name on those before something happens. Even if they don’t agree yet you have laid out a plan for them to discuss. Also make sure he has secondary medical power of attorney in case both become incapacitated at the same time. He can also look into hiring a part time nurse or minimum a driver. Again throw concrete ideas out that you have the ability to execute and if and when they agree you show up and do it. They might not be ready to relinquish any control yet but there are a few things that need to be discussed now if he has poa. The rest will come with time and you have to trust that they know what’s best for each other.

[Anonymous]

Anonymous wrote:OP even when people live near by, the answer is OFTEN that you just wait for a crisis. Because it’s very rare for people to make a major move towards their own final dependency and death until they have to.

Things you can do are asking them if they have their finances in order and offering to help, and researching nursing care in their area.

+1 For now, look into this as if you and your DH are the only one making the decision. In a short time, that may very well be true. At least you've laid the ground work.

[Anonymous]

Yes, I'd begin researching independent/assisted living places in Tucson and near you. My MIL wasn't resistant to move near us, so it was a simpler process, but it was definitely helpful to have some actual numbers to work with.

[Anonymous]

Would they consider moving to Tucson?

[Anonymous]

My parents live in a rural town. We hire medical transport to take them to doctors appointments, but it several hundred dollars but they can afford it. The real issue is a different emergency happens and they call the ambulance, they get taken to the crappy local hospital half an hour way instead of the better hospital an hour way.

They are probably correct about the local doctors sucking. So I wouldn’t argue with them on that. If they don’t have any friends, how attached are they to their current house? Could you get them to move to a retirement community that is closer to good medical care?

[Anonymous]

Op, yes you have to wait. You worry. Try not to worry too much. In many, many cases ... there is no way to anticipate precisely how this is going to go. It was on the same day, my DH and I each had a parent rushed to the hospital for an emergency (long distance, states in different directions). You cope. You cope with The Now.

Btw ... a year later, the "well" parent (the most "well" of four elders), died first.

[Anonymous]

OP - It might serve you both, if DH went out alone to spend some time with his folks, but gave them a heads up that he was coming to go over a few important things with them. Perhaps you could do some research on CCRCs in Tucson ahead of time with prices that DH might at least take them out to lunch in Tucson and then at least drive them by or if open to looking at them show them one or two. There are four aspects to their future care planning:

1- What do they see happening when FIL can’t drive and where do they want to be as more Care is needed?

2- What can they afford from LTC insurance, selfFunded or current income?

3- What could DH do to help them in direct care, any idea of moving them closer in a facility or your home And/or afford to pay for in services?

You and DH need to discuss #3 and be on the same page AND you need to clearly state whether how much you could take on? Do this hard discussion before a time bomb goes off as at least you will know the outlines of the crisis coming in either their unrealistic ideas of aging, expectations of your family involvement and/or having funds to deal with a crisis ir not.

[Anonymous]

As someone who grew up in a rural area, I'll say that they may not be off base to be skeptical of local providers. It's often the case that rural care isn't very good and people with means travel.

[Anonymous]

No doubt they are getting better care in Tucson.

[Anonymous]

Anonymous wrote:My parents live in a rural town. We hire medical transport to take them to doctors appointments, but it several hundred dollars but they can afford it. The real issue is a different emergency happens and they call the ambulance, they get taken to the crappy local hospital half an hour way instead of the better hospital an hour way.

They are probably correct about the local doctors sucking. So I wouldn’t argue with them on that. If they don’t have any friends, how attached are they to their current house? Could you get them to move to a retirement community that is closer to good medical care?

OP here. I would love for them to move to Tuscon - at least there they’d be close to their preferred medical care. The issue is I don’t think they can afford to move. We really don’t know what their financial situation is outside a few comments they’ve made. MIL previously mentioned she looked at assisted living in our Midwest city but it was around $6k/month, which she indicated they couldn’t afford. I thought $6k was rather reasonable. Regardless, FIL has made it clear he doesn’t want to leave AZ so he would have to pass first before she would consider moving closer to us.