My daughter, only child w/fiance in Germany, came home temporarily to set up care for her father who is 69 and had a sudden bad illness-diabetes and heart failure. She wants to set up a good home healthcare system. Her father is weak and must have oxygen and a walker. Has 4 different doctors to see. Has not been managing his insulin. And is sweetly stubborn. He also has beloved house dogs. He is now incontinent. She is feeling overwhelmed. Any advice or ideas on how to set things up? He is my ex-husband. My daughter from another husband is a good organizer and has tried to help, but lives and works 6 hours away.
Trying to coordinate all this from even a few hours away would be a logistical nightmare. From halfway around the world, yikes! See if you or your other daughter can locate some geriatric care managers in the area where he lives and get estimates from them. Quick lookup says they can charge quite a bit by the hour, but they won't be the one working full time caring for him. You'd have to inquire how many hours, on average, they spend "managing" a person's affairs. It would be their job to assess the needs, make a plan, coordinate and implement the plan and then supervise in some way to ensure there is coverage and the plan is being followed.
A lot will depend on what he can afford as well. If he's fairly well off, this shouldn't be a huge problem. If there aren't assets to cover care, then forget the care manager - neither Medicare or Medicaid covers this and in general LTC policies don't either. If he doesn't have enough assets, how will he pay for either in home care or facility care? Medicare doesn't cover this and he may not qualify for Medicaid (income over the pittance limits) or the NHs (generally Medicaid only covers NH, not AL or MC and one must need NH services.)
Just imagine if there was a fire or power outage. What then?
I’d try to get her to look at a tiered facility. By “tiered” I mean one that runs from IL to AL, has MC and SNF aka a NH & perhaps with 2 tiers in NH (as lots of residents need loads of help with medication management but otherwise still kinda ok on ADLs) and with some type of hospice wing. So he moves along their system as his needs increase. If he gets a “needs assessment” done that will be invaluable to determine what level he needs to enter in on. Some facilities often have an assessment team of an RN & SW that is sent out to evaluate future residents that cannot come in for in person assessment. Sometimes you can contact your local Area Council on Aging to find health professionals who do need assessments. Any facility that’s worthwhile is going to want an assessment done imho. Nothing worse than getting an elder moved into AL only to get a call 5 weeks later that elder needs to ove to a higher level of care ASAP.
On the pups, well unless he has a s-ton of $ to do private pay forever, and they are trained service pups, the dogs will themselves need a new home. This could be quite emotionally difficult. If there's anyway you or her stepsister could possibly take them, that would make all this more palatable. Even if it ends up you have to find a forever home, 3 months from now for them. It gets him & the pups over the hurdle till he’s living in a new place.
Also she should speak with an atty while she’s in the states. If she’s living abroad, she may not be able to do things as his DPOA if she’s abroad. It will be hard to verify in real time that she is who she says she is should a financial or state entity require this. At a minimum, daughter will want to have bank accounts for him and for her at a bank that is available on line the US & EU or that is a “correspondent” bank for Germany. Your ex may want to appoint his atty as a coDPOA just in case there are glitches.
He might be better off with an ultralong acting insulin that nurse can give at a weekly visit.
Hire a dogwalker to come twice a day to feed and walk dogs (and check on dad). If dad seems off, he can call her pronto.