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Helping Older Relatives Articulate Their
Long-Term Care Wishes
In the best of all situations, helping an older relative or a
parent plan for long-term care and other end-of-life issues
happens when they're healthy and various options can be
considered with adequate time to do so. Unfortunately, events
can sometimes intervene and make an elder's need for assistance
an emergency.
This is why it's so important for adult children and younger
relatives to gather up the courage and preparation to begin a
series of important conversations when elders are healthy. Once
stricken, older relatives may be unable to understand questions
or express their wishes in proper detail. If there is no plan,
family members grasp at responsibilities — or shirk them —
without any idea of what the older relative would really want.
These talks actually should go far beyond money. There should
be discussions about independence and basic preferences for the
way individuals want to live or die. Demographers believe that
with the rising number of single Americans — those divorced or
never married — these conversations will become increasingly
complicated as they fall to nieces and nephews, younger friends
or designated representatives.
Want to avoid a worst-case scenario? Start the conversation
now. Here are some ideas:
Start with the most important priorities. Maybe this
first conversation isn't just about where the will or health
care power of attorney is, though you'll eventually have to get
to that. Maybe this conversation is about you noticing that a
parent or loved one is moving slower, is more forgetful, is
clearly looking like their health has taken a turn for the worse —
and maybe that's why you want to know where the will is.
Jumping into money issues first is usually a mistake. Deal with
immediate health and lifestyle issues first.
Prepare your questions in advance. When a parent or
relative is unconscious or unresponsive, the younger relative is
immediately in the drivers' seat. That's why it's critical to
make a list of questions for the elderly relative to answer in
detail while they have the capacity to address them. The basics:
Where important papers are, how household expenses are paid, who
doctors and specialists are, what medicines are being taken and
whether there's a will, an advanced directive and a funeral plan
(and money or insurance proceeds to pay for it). There may be
dozens more questions beyond these based on your family's
personal circumstances. But in creating this list, ask yourself:
"What do I need to know if my family member suddenly
becomes sick or dies?"
Turn the conversation to affording long-term care. One
of the greatest continuing fallacies about long-term care is
that Medicare pays for it — it pays for a significant amount of
medical care associated with it, but not for the actual cost of
home-based or nursing home-based care. In 2009, private room
nursing home care averaged more than $60,000 a year. Long-term
care insurance is something that should be purchased in one's
50s for the best chance at affordability, but the conversation
needs to be a mixture of preferences and finances. If an elder
cannot afford top-quality care, families need to plan
alternatives, especially if it means pitching in.
Be patient. In some families, having a successful
financial discussion means several attempts and some
frustration. Don't become angry or frustrated if this happens.
Just keep starting the conversation until it catches on. It
might make sense to say something like, "You've always been
so independent, Mom. I just want you to give us the right
instructions so we do exactly what you want."
Offer to get some qualified advice. If you don't fully
understand your relative's financial affairs, it might make
sense for you both to talk to an attorney or a tax or financial
advisor, including a CERTIFIED FINANCIAL PLANNER professional. A
qualified advisor can help you straighten out whatever confusion
exists and can help you put specific legal documents in place
and set up ways to pay medical and household bills if they're
unable to do so. If you can, involve your elder in that
conversation — an impartial third party can sometimes move
things along. Above all, an elder should have a current will and
health power of attorney documents in place — either making or
reviewing those documents can be a good starting point for
making sure other necessary plans are in place.
Plan a care-giving strategy together. You should
discuss the relative's preferences and trigger points for
various stages of health care. An individual always wants to
stay in his or her home, but you should have an honest
discussion about how much you can do at home as a caregiver and
whether various services (home health aide, geriatric care
manager, assisted living) should be introduced at various
stages. Talking through what a parent will be able to live with
at various health stages, and putting that information in
writing, will save plenty of doubt and bitterness later.
Discuss what should happen with the home. If an
elderly relative becomes sick and irreversibly incapacitated,
the equity in his or her home may come under consideration as a
resource to pay uncovered medical or household maintenance.
Since the home is both a major asset and an emotional focal
point, it's best to get good advice and spell out specifically
what the elderly relative wants done with his property and under
what conditions.
Make sure everyone knows the plan. Once you settle on
a strategy, make sure all family and friends understand the plan
and their assignments.
February 2010 — This column is produced by the Financial
Planning Association, the membership organization for the
financial planning community, and is provided by Don McCarty of
Financial Decision Partners, a local member of the FPA.
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