You are now finding yourself with tasks you never thought you would be in a position to have to do for one or both of your parents such as finding quality health care and the right living situation, advocating for them, and handling legal and financial matters. It is difficult discussing these matters with your parents or even facing the fact that your parents may need help. You need to be able to make informed decisions and you should have a plan in place should an emergency arrive.
The American Association of Retired Persons (AARP) recommends use of a document locator list to ensure papers are in order. This list can then be given to the person(s) who will be responsible in the event that the senior should become incapacitated. Your parent(s) must have certain legal documents in place so the agents they list on the documents may make decisions for them.
Please discuss with your parents, while they are able, the following questions:
- Have you met with an Elder Law Attorney and executed a Power of Attorney, Health Care Proxy, Living Will, Trust and if you have where are the originals of these documents kept? What is the name and address of the attorney that you are working with?
- Who will take responsibility for you in an emergency situation or financial situation?
- What are your wishes regarding life-sustaining medical care and medical directives?
- Do you have a preference over where you would like to reside such as a retirement or independent living community, assisted living or long-term care facility?
This discussion will not be easy and will depend on their mental, emotional, and physical condition along with the relationship they hold with you. It is very easy to put off this conversation to avoid conflict or awkwardness but it is better to have it then to wait for a crisis situation to happen. Remember to share your own feelings, help your parent(s) maintain a sense of control and respect your needs in relationship to what they are expecting of you. You may have a family, work and other obligations. Be honest with them regarding their condition both mentally and physically and their prognosis.
Some Warning Signs You Should Look for to Determine if One or Both Parent(S) Need Extra Help or a Change in Living Arrangements
- Disorientation to time and place such as showing up or calling at odd hours, getting dressed and ready to go to work at a job they retired from years ago, etc.
- General forgetfulness such as not paying bills, missing appointments, consistently forgetting names, and meal times.
- Sudden weight loss or loss of appetite or regularly eating processed foods.
- Lack of hygiene of person and residence.
- Mismanaging medications.
- Extreme suspiciousness or intense ungrounded fears.
- Inappropriate clothing choices such as wearing a winter coat and gloves in the summer.
- Evidence of small fires or soot on walls or ceilings.
- Car accidents and traffic tickets may indicate slowed reflexes, poor vision, physical weakness, or general inability to handle a vehicle.
- Increase in injuries such as broken bones, cuts and bruises, etc.
If one or both of your parents become mentally incapacitated, it is necessary that someone step in to take care of their affairs. Advance planning on the part of both the elderly person and those who care about him/her will facilitate this process and be cheaper than waiting for a crisis when you may have to file for Guardianship. You and/or your parents should consult an Elder Law Attorney. While you or your parents may know a Family Law Attorney or some other attorney that you or they have worked for years with it is best that you obtain the counsel of an Elder Law Attorney who will be knowledgeable in the current laws and regulations in this area.
Before you create a Power of Attorney you should speak to the Elder Law Attorney regarding the powers this document will grant the agent(s) you list. You should also discuss assets and resources, the pros and cons of making accounts joint between you and your parents, and if there is a crisis situation with no legal documents you will need to discuss Guardianship or Conservatorship for the person.
People are living longer thanks to health technology. You have probably read or seen stories of families asking the courts to allow terminally ill family members to be removed from life support systems. The court may ask you what did the person express when they were able to make these decisions. It would be more advantageous to have a medical directive in place such as a Health Care Proxy or Living Will.
While we would all like to age in place in our home that we raised our family in maybe it is just not a safe housing situation or even financially feasible to continue to live there. There are technological advances making it easier to stay in the home but they can be quite costly. You may find adaptive clothing, lightweight wheelchairs, and devices to control appliances. There are security systems with cameras that you may access to see if mom or dad has gotten out of bed, taking their medications, and can even dial you if the system detects changes in behavior. You can have the home adapted with walk-in bathtubs, stair elevators, and many other helpful tools. If there is long-term care insurance, health insurance or private funds you may be able to keep the parent or parents at home with home care services through an agency, Meals on Wheels, transportation to the grocery store or medical appointments, adult day care and even in-home respite care to give the caregiver, such as a spouse, time for themselves to get out for an appointment or even a vacation.
There are several types of housing options for seniors that provide a continuum of assistance from independent living to nursing home services. The communities may be managed by large hotel corporations, independent owners, or not-for-profit or member organizations. It is important to know the scope of care for each, services provided and the cost. Listed below are various types with a brief description for each:
- Adult Congregate Communities are designed for the independent 55 and older senior. Residents may purchase a duplex or condo and pay a monthly fee for maintenance such as gross mowing, leaf raking and snow shoveling.
- Independent Living and Retirement Living are communities designed for the independent senior who does not need full-service assistance. In these communities you may be able to purchase a home, condo or apartment and some may include meals, housekeeping and maintenance services.
- Assisted Living Communities are used to provide seniors with assistance for their basic activities of living (ADL's) such as bathing, grooming and dressing. They offer 2-3 meals a day, housekeeping, laundry and some offer medication assistance and/or reminders. You may have to pay extra for each additional service used such as nursing.
- Life Care and Continuing Care Communities provide a continuum of care from independent living to nursing home care on the premises. If one parent is able to live independently and the other one requires a nursing home this could be the answer; they would remain close to each other and the independent senior could visit and even have meals with their spouse.
- Personal Care Homes or Adult Homes are licensed in many communities to provide shelter, supervision, meals and personal care to a small number of residents.
- Subsidized Housing is offered by the Department of Housing and Urban Development for the elderly as an option for seniors in relatively good health but they have a limited budget. Residents may have access to meals, use of a recreation area or beauty shop but not nursing care.
- Skilled Nursing Facilities provide 24-hour nursing services for people who have serious health care needs but not the intense level of care provided in a hospital. Rehabilitation services may also be provided in this type of setting.
Paying for Long-Term Care
It is important to understand the different types of insurance that are available to older people. Many people believe that Medicare will cover long-term care needs. It will not.
Medicare – is a federal health insurance program that is an entitlement program for Americans over the age of 65. There are two parts to Medicare:
(Part A) Hospital Insurance helps pay the cost of inpatient hospital care. The number of days in the hospital paid for by Medicare is governed by a system based upon patient diagnosis and medical necessity for hospital care. Once it is no longer medically necessary for the person to remain in the hospital, the physician will begin the discharge process. Observation days in the hospital are not covered.
(Part B) Medical Insurance pays for many medically necessary doctors' services, outpatient services, and some other medical services. Enrollees pay a monthly premium.
- Medicaid – is a joint federal-state health care program for people who meet the income and resource criteria and it is not an entitlement program. There are strict income and resource requirements that differ in each state. Medicaid is the major payer of nursing home care. The spouse who remains in the community is allowed a restricted amount of income and resources, but is allowed to remain in and own the community home. Again, the amounts are determined by individual state regulations.
- Other Insurance – Medigap or Supplement Insurance is designed to help cover some of the gaps in Medicare coverage but does not cover long-term care. Long-Term Care Insurance is a private insurance. If this type of insurance is purchased as a partnership plan in another state other than the one where the person requires long-term care the rules for coverage will differ based on the state regulations where the person is receiving the care.
- Veterans – please ask us for our brochure and discuss with us the possible benefits that are available for veterans.
This article is provided for informational purposes only and should not be construed as legal advice. It does not create or continue an attorney client relationship.