Contingency Planning for People with Aging Parents
By Mike Takieddine
Are you responsible for one or both aging folks? Here are some of the consequential elements of the advance planning that will help preserve your sanity at a time of crisis.
Many of us don’t think about transitions, including end-of-life transitions, until these hit us on the head with the subtlety of a sledge hammer. Not being prepared means being torn apart by having to make impromptu decisions on a multitude of fronts.
The triggers that set off truly unsettling events are many. For example, a fall that results in a broken hip, the sudden advent of a nasty pneumonia, or one parent’s unexpected death that leaves a vulnerable spouse in immediate and dire need.
Who’s in charge?
The first order of business would be to get in sync with your siblings and possible others as to who would be in charge, and over what part of the overall responsibility. Do yourself a favor and get that covered sooner rather than later, for it’s so much less stressful to walk into a crisis knowing precisely how others will pitch in rather than having to assign tasks under pressure.
First things first
Where will mom live? Who will look after her? How will we cope with the expenses? What will we do with the house? These and many other core issues will twirl in your head leaving you in a daze –unless of course you are pre-planned and organized. It’s one thing if you’re set on your parent(s) remaining in the comfort of their home, or whether other plans are in the offing. Whichever it is, you would do well to have a few ideas sorted out, ahead of the storm.
One of the commonest of living options is between remaining at home and transferring to an Assisted Living Facility (ALF). Temperamentally, the rule of thumb would be in favor of an ALF when the parent is outgoing and might relish the greater social interactions that an ALF offers. Many elderly folks are, by contrast, reserved and prefer to stay in the familiar setting of home.
As for a general guide with regard to costing considerations, a fairly luxurious ALF that may cost, let us say $6,000 a month, would be equivalent to staying at home with the support of an agency-provided $20/hour home health aide for 10 hours a day, 7 days a week.
Finally, if you are to emerge guilt-free once the dust settles on fateful options of this kind, it is naturally best to have your parent(s) participate in the pros and cons while they still are of relatively sound mind and good health.
If the intent is for them to remain at home for the long term, the house would need to be rendered disabled-friendly: wider doorways, special bath stalls and grab bars, wheelchair accessibility, stairway lift, and many other special features.
If by contrast an ALF, for example, is the preferred option, then a realtor should be brought onboard and given the task of selling the house, a process that may take months. In that scenario, you might wish to start making improvements and getting the house into “showing” condition.
Again, the sooner you document your parents’ legalities and wishes, the better positioned you’ll be in times of crisis. Get your parent(s) to sign (or provide) up-to-date:
HIPAA documents authorizing their physicians to share your parent(s)’ medical information with you and with specified others
A “health care proxy”, allowing you to make medical decisions on their behalf if they are unable to do so themselves
An “advanced health care directive” (aka a living will); this will state to all concerned what your parents wanted -when they were still mentally competent- in regard to resuscitation, artificial life support, and tube feeding
A durable power of attorney (POA) for their house and financial accounts
A list of contacts and account information for advisers and organizations where they have financial or other interests
Long Term Care (LTC) Insurance
If you’ve been living under a rock, brace yourself: Medicare does not pay for long term care, and Medicaid, which does, is a means-tested program that caters only to the very poor. That’s where LTC insurance comes in covering personal care, be that at a long term facility or with home health aides at home.
Insurers (Metlife, Allianz, GE, John Hancock and hundreds others) have extensive menus of programs with cutoff limits, e.g. $20/day for a home health aide for 180 days, or $3,300/month at an Assisted Living Facility for so many months or years. Naturally, the more they pay per day, and the longer their coverage durations, the higher the monthly premium.
You would be well advised to look into this type of insurance for yourself, but also for your parents, although the premiums may have already become prohibitive if they’re in their seventies or eighties.
Your financial consultant
That would be the next critical step, for financial matters are often intimidating. Have a meaningful session with your financial planner to review and take action in regard to your parents’ assets. Your financial planner will:
Examine your parents’ holdings and analyze and evaluate their overall financial status
Listen to your family circumstances and help set a comprehensive course of action that includes financial assets, insurance policies, real estate, social security and cash flow considerations
Help you gather the documents that would enable you to effect the transitional and implementation phases of the plan
Depending on your parents’ net worth, your financial planner may also discuss strategies for wealth preservation and estate planning
Help you make informed decisions and get those kind of issues sorted out
You will also feel determinedly better once you and your financial planner cover all the asset allocations and set a course that is easily understood by you and other family members. That would be one less loose end for you to wrestle with.
The good news
The good news is that all of the above issues –housing, home health aides, living facilities- sooner or later begin to fall in line. Sound counsel would have you set short-term goals, get as organized as you know how, put your willing siblings and other willing family members to work, and you will be able to keep your wits about you. After all, it’s not as if millions of other families do not have to cross those same bridges.
About Mike Takieddine, the writer:
Mine has been a privileged life, first for having traveled all over as son of a diplomatic family, then for having had the opportunity to study at Oxford, and finally for a gratifying career in story-telling and writing about wide-varying issues. I look forward to using this medium to discuss the various topics that are of interest to readers.