“FAMILY COMES FIRST” – Season 4, 2011 – Belmonte Family

Vincent: Welcome everyone to Family Comes First. I’m Vincent J. Russo.

Victoria: And I’m Victoria Roberts Drogin. Thank you for joining us.

When you’re young, you think your parents are going to live forever. But as you age, we begin to realize that eternal youth is just the stuff of movies. Inevitably, parents need the love and care they gave us when we were young.

Vincent: It can be so difficult. But I can share some good news –that my Mom and Dad just celebrated their 64th wedding anniversary.

Victoria: Congratulations to them and to you!

Vincent: Thanks. I, along with my seven siblings, find it hard to believe they’re in their eighties. And they may need care in the future.

Victoria: Back in 2008, Peter Belmonte was a guest of Family Comes First and he shared his story of caring for his aging parents. He had to make the difficult decision at that time to place his father in a nursing home. A little later we will be speaking with Peter.

Vincent: It is challenging, especially when trying to make sure your parents receive the care they deserve. Thank goodness we have elder care experts who can help navigate these waters. Joining us now are Marianne Bee, a private geriatric care manager, and Deanna Eble, an elder law attorney with my law firm.

Victoria: Welcome. Thank you both so much for being here.

Marianne/Deanna: Thank you for having us.

Vincent: Great to have you. Marianne, it seems like every family is touched with elder care issues as we’re all getting older. What does it mean to be a private geriatric care manager?

Marianne: A private geriatric care manager is usually a health care or human services professional that addresses adult needs as they’re aging. We go into the home to see how they’re faring and doing assessments to be able to identify some of the problems that they’re having.

Vincent: So, you’re an independent, so to speak, stepping in.

Marianne: I have my own private practice. And, yes, I go in and do the assessments.

Vincent: And the name of your practice?

Marianne: Bee Well Elder Care Services.

Victoria: What sort of services do you provide to families?

Marianne: I provide an array of services. Typically, my first step would be to do a very comprehensive assessment. I look at health status. I look at psycho-social issues. I look at medication. I do a complete assessment of the home. So, I can start putting services into place. I often coordinate home care. We put home care into the house. I do medication reconciliations and sometimes do medication referrals. I provide referrals to elder care attorneys and entitlement programs. I like to see that my clients are socializing, and usually recommend adult day care health programs and other activities that they can participate in.

Vincent: You’re doing a lot. You’re really stepping in, almost like a child, but with all the knowledge and experience that most children don’t have as caregivers. And, I know from our experience in our law firm … we get so many calls … and the caregivers just have no idea where to go or how to start. And, perhaps, they’re not sure how to introduce the discussion with their parents about their needs. So, I would think you step into that role sometimes as well?

Marianne: Absolutely. I do communicate with the children. In fact, the children are the people who are usually calling me. The elder person is not, but the children are. We work with the older adult and with the children, teaching them how to take care.

Victoria: Deanna, there are many legal aspects to planning for long-term care. First of all, who pays for this?

Deanna: We do an assessment to see what kind of assets the elder person, mom or dad, has. Then, depending on what they have, it might be private pay it could be Medicare contribute a little bit to pay for some of the costs. Or, if they have long-term care insurance, that might cover some of it. And, the last thing that would pay would be Medicaid.

Vincent: We start with private pay, maybe a little Medicare, and then insurance. I would think at this time that most seniors in their seventies and eighties don’t have long-term care insurance. Then, it’s that government program – Medicaid. We could spend the whole show on Medicaid. So, let me just ask you one or two questions, Deanna. One, does Medicaid cover home care? And, does Medicaid cover nursing home care?

Deanna: Medicaid does cover home care. However, what I usually do is an assessment with my clients to see if home care is the right choice, because they do put some restrictions with regard to income. You want to do a cost/benefit analysis to make sure that it’s the right decision based on any assets or income they may have. Medicaid absolutely covers nursing home care. With the cost of nursing homes, we definitely encourage anybody that has an extended stay at a nursing home to seek counsel with an elder law attorney to help get them eligible for that program.

Vincent: As part of the process of assessing, I’m sensing that you may be calling Marianne or someone like Marianne, a private geriatric care manager, to help figure out what those needs are at home?

Deanna: Absolutely because in the home care world, especially, I don’t always get to meet the client to know what their needs are. We want to make sure they’re at home in a safe environment, and that they’re getting what they need in the home. Because you know if it’s not safe, then maybe a nursing home might be the better choice. We need the help of a geriatric care manager in order to understand what their needs really are.

Vincent: Is it difficult to qualify for Medicaid home care?

Deanna: No, not at all. It’s actually very easy to qualify for Medicaid home care. You just need to have the right person directing you.

Victoria: There is the financial aspect of the picture, and then there is the actual physical, mental, emotional and practical needs that are both very important to the equation. What happens if your loved one lacks the capacity to make some of these decisions? How can you help mom and dad if they can’t?

Deanna: The first thing we do is ask the family if mom or dad ever did a Power of Attorney or Health Care Proxy. If they hadn’t done those documents which they are so important, anyone over the age of 18 needs them, then we have to do an assessment to see if they have the capacity to do them now. If they don’t … unfortunately, there are some families that have reached that point … then, you’re looking at a guardianship.

Vincent: What happens if there’s no one in the family to step in and help? We have clients who are aging and they’re in their seventies and eighties and living alone. How would you deal with that kind of situation? Let’s say a spouse contacts you and says, I’m having trouble taking care of myself. My wife may have Alzheimer’s. We’re struggling at home. And, we don’t have any family support.

Deanna: We absolutely get geriatric care managers involved in a case like that. We want to make sure there is enough support for the spouse, because they’re trying to take care of themselves and their ill spouse. The geriatric care manager is crucial in that situation.

Vincent: Yes, we want answers and solutions. What do you do in that situation?

Deanna: Well, I actually work with the courts a lot. A judge will appoint me as a geriatric care manager. Then, I’ll go into the home environment to see if it’s safe. I start with the initial assessment and see what’s going on.

Vincent: You may have to bring a court proceeding, a guardianship proceeding?

Deanna: Correct.

Vincent: Sometimes that happens and sometimes it doesn’t, I would think?

Deanna: Yes.

Vincent: When you’re trying to figure out where to go, in terms of how to provide care … and the couple are having difficulties of their own … you mentioned that you can go into court, and maybe a geriatric care manager like yourself would be appointed by the court to go in and help. Or, are you just working directly with the two of them?

Deanna: Correct. Depending on the need, I put the services in the house. Usually it’s with home care but then I see clients that are not keeping up with the grocery shopping. They’re losing the ability to get out of the house, as well as manage the household environment. It sometimes progresses to another level where they’re having even more difficulties. We might have to extend the home care more frequently than it had been previously. And, sometimes, people need some additional supervision, and assisted living might be an option for them.

Vincent: I would think you would hear it all the time, and we do as elder law attorneys – everyone wants to stay at home. No one wants to leave their home. I think the coordination of the private geriatric care manager and the elder law attorney working together is the best formula for a successful outcome. We’re going to wrap up now. Maybe you can just quickly give us a suggestion or parting tips that you’d like to share with our viewers if they are a caregiver. What should they do?

Deanna: It can be a very stressful situation for them. They could have increased amounts of illness and stress, and therefore, really they need some respite. Caregivers need to get out of the situation for a little while, to make sure that they’re not going to suffer from the extended care giving that they have to do.

Vincent: Thank you both so much for being with us on Family Comes First today.

Victoria: One of our first programs in 2008 featured Peter Belmonte and his parents. Before we visit with Peter today, we’ll take a look back at what they were facing at that time …

Deodata Belmonte: My husband had his first stroke on November 1, 1997. I believed my husband would talk and walk again. But by the time he had his second stroke in 2003, in Italy, it was finished. My life today … I don’t drive. I don’t want to depend on my kids, but I want to go see my husband every day. Now, I say, God, keep me healthy to support my husband. The cross … I put it on my shoulders, because I want to go over there. I see other people there who are younger than my husband … in very bad shape.

Peter: We decided to put him in a nursing home. It was very hard at the beginning, because it was actually my decision to do that. My father left me in trust with his life. It was my decision to put him in the nursing home. I didn’t want to burden my mother with that. So, it’s a guilt that you carry yourself at the beginning. But then after awhile, you start realizing that he’s really better off being taken care of there.

We just do our best to always be a part of his life every day of every weekend. It took me a little while to figure out how to be a friend, a father and a husband. But after awhile, you think what’s more important … if my wife is sick and needs to go to the doctor and I know my father is in a nursing home comfortable, then that becomes a priority. It’s important that you go visit them, and just give five minutes of time to see how things are going. The caregiver and the person in the nursing home misses those people.

Deodata Belmonte: When my husband comes home, I feel normal. But when I bring him back every night, I suffer when I leave him there. I pray to God when I’m feeling down and not so good. I say, God, give me strength because I want to go … my kids say not to go every day. I say, I want to go see my husband. One day I cry … one day I laugh.

Victoria: We are talking today about how to take care of mom or dad, either at home or in a nursing home.

Vincent: About three years ago, Peter was our guest as he, along with his mother, had to make the tough decision to place his father in a nursing home. Now he’s back to give us an update on his family.

We’re now joined by Peter Belmonte. Thank you so much for being here.

Peter: Thank you both for having me.

Vincent: Peter, I have to start first by offering our deepest condolences for your father passing away earlier this year.

Peter: Thank you very much. I appreciate it. It was best that happened, because he was suffering so. God took him at the right time.

Victoria: And your mom, now? There have been a lot of changes. How is she doing?

Peter: Unfortunately, she just got diagnosed with multiple myeloma. I thought these were going to be the years where she could relax and enjoy life, but she’s got a great personality. She takes whatever God thinks she can handle. And she’s doing a great job at it. She just started her treatment. She comes home and starts baking and cooking. She’s got a good attitude. I think she’s going to be with us for a long time. Thank God.

Victoria: That’s wonderful. You can see from the interview we did a few years ago that she’s very vibrant and full of life.

Peter: As you know, my father passed away on June 5. We had arranged the viewing and the funeral, which we had in this country. His final wish was to be shipped back to Italy, his homeland. So, that’s what we did. We organized it and flew my mother and I, and his body, back to Italy for another viewing there, and a funeral. It was wonderful.

We had it in a chapel in a small town in southern Italy. All his friends and his family came. It was an all-day event from 9:00 in the morning till 5:00 p.m. We had a mass from 5:00 to 6:00 p.m. Then, we walked behind the casket throughout the whole town. I had the privilege of doing that. It was probably one of my most proud moments – accompanying him to his final resting place and watching all his friends stand along the sidewalk in the town and salute him and give us strength and their condolences.

Victoria: That’s an incredible story.

Vincent: What a wonderful tribute to give your father, to follow though with his wishes.

Peter: Even though he had passed away, but it was a great feeling that I knew he was there again. And his friends were around him. That’s what he wanted. So, I knew he was happy.

Victoria: It must have been very meaningful for your mom and also the grandchildren. How are they with all of this? I know you have a very connected family.

Peter: They were very upset when he passed away, but they saw the seven years of suffering he endured. He really couldn’t move. Towards the last two years, he couldn’t even speak. He was really going down, down, down. They kind of felt sorry for him. As much as a loss to them, they knew it was the best for him.

Unfortunately, for seven years they only saw him in pajamas and a robe. As crazy as this may sound, when he was laid out in his casket, it was the first time my children had seen him in a wonderful suit. After seven years, he looked magnificent!

Vincent: Peter, he was in a nursing home over seven years, and I know there was home care before that. The average stay in a nursing home is a little under three years. I truly believe that your mom visiting him every day, ensuring the quality of care …

Can you talk a little about the experience that you and your mom went through as caregivers?

Peter: Sure, first we researched a lot of nursing homes. We found one that we really appreciated. We promised him that if he was going to stay there, we were going to be part of his life … every day, almost every day … as much as we could. And it was every day. My mother used to go there seven days a week, from noon until 5:30 or 6:00 p.m., playing bingo with Dad and making sure he was okay. For seven years straight.

Victoria: Incredible.

Peter: If she was sick and couldn’t go, then either I would take over or my sister, but somebody was there. She became very good friends with all the people in the nursing home. They became family.

Victoria: You told us that she still goes and she’s still connected.

Peter: She is still connected to them. She still invites them over to her home. She cooks for them. She sews their clothes when they rip or need a hem. She loves it. She’s gone back once or twice to visit and spends the day with them. They will pick her up and take her. She’s connected with all the people. She used to bake for them … making cookies for the patients. And she use to feed them.

There are wonderful aids there that take care of them. They’re from the island of Jamaica. They got her interested in Jamaican music. Now we’ve got a couple of CDs that she listens to. She loves it.

Victoria: She sounds like she embraces life.

Peter: She does. She’s going to be 84 this December. She always worked all her life, and she just loves it. She still keeps going.

Victoria: What do you see as some of the challenges in taking care of her over these next few years? Planning, etc.

Peter: We’re pretty much all planned, thanks to Vincent, both of them are taken care of in that sense. We just want to make sure that she’s going to get the best care. We’ve taken her to the best doctors. She may be moving in with my sister now … downstairs … she has an apartment. She’ll be in company all the time, instead of living alone. She doesn’t want to move. She wants to stay in her own home.

Vincent: Everybody wants to stay at home.

Peter: Now, she understands her limits better. She needs to be in a home with somebody, in the building at least, in case she needs assistance. We’re pretty much all set. We just have to make sure she is getting good care from doctors, that she’s not in pain, and that she’s in good health and taking her medicine. We check up on her every day and make sure she takes her pills, and take care of whatever she needs done. We’ll just keep following the doctor’s instructions to make sure she’s here with us for a while.

Vincent: Is there a quick message that you’d like to give our viewers reflecting on your experience as a caregiver? What would you say to those who are in a situation similar to yours?

Peter: I came to you in crisis, and you shouldn’t do that. You should really sit down with your parents or your children now and explain to them that if something happens to me when I get older, this is what I want. This is what I need. This is how I want it done … so everybody is on the same page together. Go see an elder care attorney and get everything in order. That way, you don’t have to think at the last minute and get your papers in order when you’re trying to take care of somebody who’s ill. You really should think ahead.

I didn’t do that. I wish I had. I waited until the last minute. Then, when my father got sick, it was a lot of running around. It was very stressful in my house for a while. I had my own family to take care of, as well as my Dad. I had to get all his paperwork in order. My wife, Theresa, sat me down and said, we have to do A, B, C and D. She said to take it easy, because something could happen to me. Then, I could be 6 feet under and they’d still be living. She was a big help to me. So, we got everything in order. Life is just a lot easier now.

Vincent: I really appreciate you sharing your family, your mom and your dad, and your entire family with us. Thank you so much for joining us today on Family Comes First and our best regards to your mom.

Peter: Thank you both for having me.

Victoria: Now we turn to Monsignor McNamara for a spiritual reflection.

MM: Come to me, all you who are weary and burdened, and I will give you rest. This spiritual invitation from Jesus applies to several families in this new series of Family Comes First. In this story, Mrs. Belmonte, in her beautiful Italian accent, asks God to keep her strong so that she can continue to care for her husband, who has had a severe stroke. She cared for him at home as long as she could. Then, she visited him faithfully while he was in the nursing home before he died.

Her reliance upon God is instructive to each of us as we face the challenges of daily life. The decision to put Mr. Belmonte in a nursing home was a difficult decision. The family found it hard to leave him there, but they were faithful to the end. May the Lord Jesus keep this family strong.

Victoria: Vincent, there are so many possible scenarios when thinking about taking care of a parent as they age. As a follow-up to the questions that we asked Deanna … If your loved one is in a crisis, what steps can we take to protect their assets?

Vincent: When they’re in a crisis, it can be really difficult. The first step is to take action. Contact a private geriatric care manager. Contact an elder law attorney. Have those professionals come in and sort things out for you, and then lay out a plan of action.

Typically, as the elder law attorney, we’re confronted with the issues of how to access quality care, and how to pay for it. We heard earlier from Deanna about Medicaid. Often, because nursing home care services can be so expensive, Medicaid is the only government program that’s going to help pay for those services … without losing everything you have. Planning, then, has to be implemented in the crisis. And, it’s better to do it in advance.

Victoria: Optimally, you don’t want to be in that situation.

Vincent: Exactly.

Victoria: What can you do if your parents are not willing or ready to have these conversations?

Vincent: First, I would suggest that you don’t throw up your hands and walk away from the problem … especially, if you think there’s a problem or an issue there. Often, bringing in independent professionals can be so helpful. Sometimes, I get a call and the caregiver says their parents will never meet with me, and are not going to be willing to do this or that.

We have ways to conduct the conversation to ensure that the parents are comfortable. Planning steps need to be taken. First, a Durable Power of Attorney and a Health Care Proxy should be implemented. In case they need long-term care, and a way to pay for it, you should look at the government program – Medicaid.

Victoria: Sometimes, parents don’t want to give up control, because they’re still young and vibrant.

Vincent: No one wants to give up control.

Victoria: None of us.

Vincent: None of us do. We don’t want to ever have the parents feel like they’ve lost their independence. We want to empower the parents and family in a partnership, so they can live the life they deserve.

Victoria: And know they’re protected.

Vincent: Yes.

Victoria: So the planning can change over time. You can start in one place and …

Vincent: Planning is never one time. Planning is ongoing, because life changes and things happen.

Victoria: The good news is that we’re living longer. On the other hand, the likelihood of needing long-term care continues to increase as we age.

Vincent: This can be a trying and emotional time, but we have family, friends and a community of resources that can help.

Victoria: For a list of these resources for elder care and legal services, please visit www.vjrussolaw.com.

Vincent: We should all be as loving and caring as Peter Belmonte and his family. Thanks to all our viewers for joining us. Remember, family truly does come first.