Caring for your aging parents can seem like a daunting task. It involves understanding and making decisions about services and options that most of us know little about. Currently as many as one in four adults is primarily responsible for caring for their elderly parent and the number is expected to increase in the future. It's important that you begin planning as soon and possible and not put it off.
To make planning for your aging parents' care more manageable, it may help to break the process up into pieces and tackle them one at a time. Below is an overall guide to help you figure out what you need to plan for, broken into four basic sections: personal preparation, housing preparation, medical preparation, and financial preparation.
The first step in caring for aging parents is to get both parties to sit down and answer some basic questions, and then compare answers:
- What kind of long-term care is the elderly parent expected to need: The answer to this question will drive answers for a lot of the subsequent questions below. While no one can ever know for certain what they will need, important things to consider are the parent's existing physical and mental condition, the family's history of medical issues, and the parent's expected lifestyle. For example, even if the parent is otherwise healthy, if there is a strong history of dementia in the family, you should probably plan accordingly.
- What can the parent do to maintain health and independence: Most elderly parents want to maintain as much of their health and independence as possible. Accordingly, part of the planning should involve making a plan to help a parent maintain that freedom as much as possible through physical activity, social activity, etc.
- Who in the family could be eligible to help with caregiving: Regardless of whether you are planning to take care of a parent or expect them to be in managed care, you need to evaluate whether any family members are available for minor caregiving duties or in emergency situations.
- Where should caregiving take place: Both parties, parents and their caregivers, need to decide where any caregiving will take place. This means deciding whether the parent will need to be moved, or whether caregiving will come to the parent.
One of the most delicate and difficult decisions to make is whether care should be given at home, at an assisted care facility, or some combination of both. If parents and caregivers disagree, it's worth considering a hybrid approach where homecare will be offered up until a certain, established point, upon which the parent will transition into assisted care:
- Can the parent stay home, or does he or she need to move: Part of making the decision about where caregiving should take place involves addressing whether a home is capable of providing the caregiving a parent needs. If a parent is significantly disabled, it may not make sense to offer caregiving at home.
- If the plan is to stay home, what modifications and assistance will be needed: Even if a parent is not significantly disabled, if you plan on offering care in a parent's home or your own home, the house will likely need significant modifications. Modifications can include installing new door and sink handles, handrails, grab bars, wheelchair access, widening doorways, and adding a new bathroom or bedroom to a first-story floor. Also consider what sort of basic assistance devices will be needed including mobility devices, communication devices, and everyday items, such as a "grabber", to help an elderly parent reach items.
- If the plan is to stay home, what in-home and community services are available: Even if you plan on providing caregiving in-home, explore what in-home and community services are available to assist in the care of a parent. This can include transportation services, shopping services, and housing and yard chore services.
- What kind of assisted care facilities are available: Finally, look around at what kind of assisted care facilities are available before making a decision between in-home and assisted care. There are several different types of eldercare facilities available, depending on the needs of the parent. A good place to explore is the government's long-term care website at: www.longtermcare.gov.
End of life care issues are critically important to address, so consider some of the following to ensure that an elderly parent's medical wishes will be fulfilled:
- Does the parent have a living will: It is imperative that an elderly parent has a living will, also known as a medical directive. This document provides written instructions for the care of the parent if they are not able to make decisions for themselves (such as being in a coma). State law controls the creation of living wills, so check your state's laws when drafting a living will. You can create a DIY living will with a downloadable form.
- Has the parent appointed a health care agent: In case of situations not covered by a living will, an elderly parent should name a health care agent, who will make medical decisions for them when they are not able. The health care agent cannot override the express wishes of a living will, but rather is there to make decisions when situations and complications arise that are not covered by a living will.
- Does the parent want a Do Not Resuscitate (DNR) order: A DNR order is a physician's order that is written in a person's medical record instructing health care providers to not attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest. This is a quality of life issue, and to avoid confusion the elderly parent should set forth his or her desires on this issue in a DNR order.
- Does the parent have any final disposition wishes: Finally, an often overlooked area is whether the elderly parent has any final disposition instructions or wishes. People, in general, don't like to spend time contemplating their final hours, but if a parent has strong feelings about how he or she should be laid to rest, make sure that he or she puts these wishes down in writing.
Long term care can cost a lot of money, so it pays to explore an elderly parents' finances, and come up with a plan to pay for caregiving:
- What kind of insurance does the parent have: Most people don't know whether their current health care insurance would pay for assisted living facilities or care at home. Take the time to find out - chances are that, unless you specifically buy a private policy to cover long term care, your existing insurance will provide little if any coverage for long term care (Medicare and Medicaid, for example, typically don't provide much in the way of long term care).
- How will caregiving be paid for: Once you've answered all of the big questions and decided where you want care to be provided, and by whom, it's time to decide how it's going to be paid for. If you plan on buying private insurance, determine whether the parent has enough money to do so. Shop around for the cost of policies that fit your need, and then look at the parent's sources of income, such as Social Security, pensions, investments, retirement accounts, etc. to determine what kind of care he or she can afford.
- Does the parent qualify for any government benefits: As mentioned above, part of determining what kind of care you can afford involves understanding what things such as Medicare and Medicaid offer you. The government's website at: www.longtermcare.gov will help you figure out exactly what the elderly parent is eligible to receive, as it's different for everyone.
- Has the parent named a financial agent: At some point, a parent will be unable to make the financial decisions necessary either for long-term care or for end-of-life issues. Just as a person should name a health care agent, it is critical that the elderly parent name a financial agent who is given the authority to make financial decisions when the parent is unable to. You can create a DIY Power of Attorney with a downloadable form.
- Has the parent provided a list of where to find important documents and passwords: Finally, part of good financial planning is keeping organized. All the organizations in the world won't do any good if no one can find important financial, legal, and medical documents or if the necessary parties don't know the passwords to access such information. Keep a list of where important items are located and include any necessary access information, such as passwords and keys, to help expedite financial and other issues.
If you are not sure where to start, contact an Elder Law attorney to discuss any legal concerns you have.