Caring for Aging Parents

Caring for your aging parents seems like a daunting task. It involves making decisions about long-term care services and options that most of us know little about.

Elder law, sometimes called "older adult law," is a specialized area of law focusing on legal issues for adults over age 65.

As many as one in four adults are responsible for caring for their older adult parent. Experts expect this number to increase in the future. It is important to start planning as soon as possible. This article provides an in-depth look at how to approach long-term care planning for elderly parents.

Use the links below to explore different sections:

• Discussing Long-Term Care
• Assessing Your Loved One's Desires
• Assessing Medical Needs
• Planning Ahead Financially
• Timeline of Older Adult Care (4 Steps)
• Tips for Children of Aging Parents
• Options for Preparing Legal Forms
• Getting Legal Help

Discussing Long-Term Care Needs

Discussing long-term care needs before it becomes necessary is essential to finding the proper care. Having an open discussion about long-term care should be a priority, though it may be difficult to broach.

Choosing the right type of long-term care is an important decision that shouldn't wait. Doing so risks the chance to discuss such plans with your loved one before they become physically or mentally disabled.

An elderly person likely won't want to discuss it. Talking about end-of-life care can bring up feelings of helplessness and the fear of losing independence. From a family member's perspective, the topic may be difficult because of feelings of guilt and respect for older adults who have always been the caregiver.

But waiting too long to discuss long-term care can lead to even more anxiety and guilt for family members. Planning allows everyone involved to digest what will happen and plan financially (nursing home care is expensive).

Long-Term Care: A Difficult Conversation

The best scenario is to have an open and realistic discussion with your loved one about their long-term care plans and end-of-life wishes.

For family members, the topic is difficult to start for obvious reasons. It is important to frame the discussion around the older adult's desires and wishes for the future. During the discussion, communicate that there will come a time when they will no longer be able to care for themselves. The discussion may be more successful if your elderly parent knows your goal is respecting their end-of-life wishes.

Likely, the first discussion will not be the last one. You may encounter resistance in the beginning. Try to have the discussion comfortably and emphasize that you want to respect their wishes if you cannot care for them.

Using Third Parties to Discuss Long-Term Care

It may be helpful to enlist the aid of third parties not in the family. Third parties may have useful information on the type of care your loved one needs. If appropriate, they may also assist or start the discussion.

Examples of people who may offer such help include:

• Physicians (primary care or geriatric specialists)
• Close friends
• Ministers, rabbis, priests, or other spiritual advisors
• Social workers or other social services networks
• Organizations that specialize in the treatment of certain diseases or disabilities
• Local family service agencies

If your parent rebuffs you, don't let it discourage you. It may take some time for the older adult to accept that they will need help beyond what their family can provide. Once they do, your gentle persistence will pay off in the future by lessening anxiety and respecting the older adult's wishes.

Assessing Your Loved One's Long-Term Care Desires

The first thing you should do is assess the special needs and life care desires of your loved one. There is no "one size fits all" model for long-term care. Instead, you should customize it to the needs of the individual. Long-term care may occur in a home, assisted living facility, retirement community, senior center, or nursing home. The choice depends on the medical care needs and desires of the elderly person and their family.

Consider whether the older adult will need help with only custodial and daily life activities, in which case a home nurse may be appropriate. But if they need more essential functions and constant monitoring, a nursing home may be more appropriate. These needs may change, so you should revisit this assessment periodically.

Your loved one's personality and personal preference should also play a large role in long-term care decision-making. Some people treasure their independence and will go to great lengths to preserve it. Others may be more amenable to accepting an assisted living situation.

If someone is independent, they will likely want a situation customized to fit their lifestyle. If this is the case, they might hire someone to assist them with cleaning and cooking meals instead of going into a retirement community.

Assessing Medical Care Needs

Older adults should consult their primary care physician before making a long-term care decision. This is particularly important if the reason for considering long-term care is due to illness, disease, or other disability. A physician will better understand your future needs based on the nature or progression of the medical issue.

Geriatric specialists are an excellent source of medical and long-term care information. While primary care physicians can diagnose general physical or mental symptoms, geriatric specialists have the training and experience to deal only with older adults.

U.S. health services are increasingly skewed toward older adults as our population grows older. But there are few geriatric specialists. If you can get such a specialist's advice, consider their professional opinion when weighing your decisions.

Planning Ahead Financially

Planning ensures that you and your loved one are financially prepared for long-term care. The cost of long-term care is completely dependent on the type of care necessary, the location of the care, and the length of time that the person needs care.

A hard reality is that even if you plan for a few years of long-term care, in the end, you may need more years with greater care services. Planning can help ease at least some of these burdens.

Some health insurance plans include long-term care or offer options that do so. Others may set aside a specific part of their savings for long-term care. Medicare can help with partial payments for 100 days of nursing facility care for those who qualify. Another option is Medicaid, a government program for those who cannot pay for health care.

It is also important to organize your financial records to prepare for the event of long-term care. For example, suppose you or your loved one become incapacitated or has Alzheimer's. In that case, it is helpful to have bank account information and other financial and legal documents all in one place.

Timeline of Older Adult Care

Planning for your aging parents' care can be more manageable by breaking down the process into pieces and tackling them one step at a time.

Below is a guide, broken down into four sections, to help you figure out what you need to plan for:

• Personal preparation
• Housing preparation
• Medical preparation
• Financial preparation

Step One: Personal 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 an older adult parent expected to need?

While no one can ever know exactly what they will need, important needs to consider are:

• The older adult's existing physical and mental health
• The older adult's family history of medical issues
• The older adult's expected lifestyle

For example, even if the parent is otherwise healthy, you should probably plan accordingly if there is a history of dementia or Alzheimer's in the family.

What can the parent do to maintain health and independence?

Most older adults want to maintain their health and independence as long as possible. Accordingly, part of the plan should involve helping your loved one maintain their freedom and autonomy through physical and social activities.

Who in the family could be eligible to help with caregiving?

Regardless of whether you plan to take care of a parent or expect them to be in long-term care, you should determine whether friends and family members are available for minor caregiving duties or emergencies.

Where should caregiving take place?

Parents and their caregivers must decide where the caregiving will take place. This means deciding whether the parent will go to an assisted living facility or whether the parent will receive in-home care. Deciding where caregiving should take place involves whether a home can provide the caregiving a parent needs. If a parent is significantly disabled, offering caregiving at home may not make sense.

Step Two: Housing Preparation

One of the most delicate and difficult decisions is whether care should be at home, at an assisted care facility, or some combination of both. These decisions will affect the everyday life and happiness of older adults and their families.

If parents and caregivers disagree, it's worth considering a hybrid approach. They can use home care until a certain established point. Then the parent would transition into an assisted care facility.

Many people opt for in-home care. This allows them to stay in their homes while receiving health care. It's best suited for people who need care but don't have critical medical issues.

Residential care is another option. These facilities can supervise aging parents with more critical health care needs or company for those who don't want to be alone. Cost can be an issue, and options such as reverse mortgages and insurance packages are available.

In-home care: What modifications and assistance are needed?

Even if a parent is not significantly disabled, if you plan to offer 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, and grab bars
• Wheelchair access
• Widening doorways
• Adding a new bathroom or bedroom to a first-story floor

Also, consider what sort of basic aid devices the parent need, such as mobility devices, communication devices, and everyday items, like a "grabber," to help an older adult reach items.

What in-home and community services are available?

Even if you plan to provide caregiving at home, explore what in-home and community services are available to assist in parent care. This includes transportation, shopping, housing, and yard chore services.

What kind of assisted-care facilities are available?

Finally, consider what assisted care facilities are available before deciding between in-home and assisted care. Several types of older adult care facilities are available depending on the parent's needs.

The Administration for Community Living can be a good place to start.

Step Three: Medical Preparation

End-of-life care issues are critically important, so consider some of the following to ensure you will fulfill an older adult's medical wishes.

Does the parent have a living will?

To avoid the expenses and complications of probate, an older adult parent must have a will. A living will is a document that provides written instructions for the parent's care if they cannot make decisions for themselves. State law controls the creation of living wills, so check your state's laws and consult an estate planning attorney for legal advice before drafting a living will.

Has the parent appointed a health care agent?

In situations not covered by a living will, an older adult parent should name a health care agent who will make medical decisions for them when they are unable. You can name a health care agent by creating a health care proxy.

The health care agent cannot override the express wishes of a living will and are there to make medical decisions if you become incapacitated. Also, establishing a health care proxy can help prevent the need for a conservatorship, which is a costly and complicated process.

Does the parent want a do-not-resuscitate (DNR) order?

A DNR order is included in a person's medical record and instructs health care providers not to attempt life-saving measures. Cardiopulmonary resuscitation (CPR) during cardiac arrest is an example of this.

This is a quality-of-life issue. To avoid confusion, older adults should set forth their desires on this issue in a DNR.

Does the parent have any final disposition wishes?

Finally, an often-overlooked issue is whether an older adult parent has any final disposition instructions or wishes.

People generally don't like to spend time contemplating their final hours, but if a parent has strong feelings about how they would like to be laid to rest, make sure that they put these wishes down in writing.

Step Four: Financial Preparation

Long-term care can cost a lot of money, so it pays to explore an older adult's finances and devise a plan to pay for caregiving.

What kind of insurance does the parent have?

Most people don't know whether their health care insurance would pay for assisted living facilities or care at home. Take the time to find out. Chances are 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). The exception is if you buy a private policy to cover long-term care.

How will caregiving be paid for?

Once you've answered all the big questions and decided where you want the person to have care and by whom, it's time to decide how you will pay for it. If you plan to buy private insurance, determine whether the parent has enough money.

Shop around for the cost of policies that fit your needs, and then look at the parent's sources of income to determine the kind of care they can afford. Income sources include Social Security, veteran benefits, pensions, investments, and retirement accounts.

Does the parent qualify for any government benefits?

As mentioned above, determining what kind of care you can afford involves understanding what things such as Medicare and Medicaid offer you. The government's long-term care resources can help you figure out exactly what an older adult is eligible to receive, as it's different for everyone.

Has the parent named a financial agent?

Sometimes, a parent cannot make the financial decisions necessary for long-term care or end-of-life issues.

Just as a person should name a health care agent, older adults must name a financial agent who has the authority to make financial decisions when the parent is unable to.

FindLaw allows you to create and download a DIY Power of Attorney.

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 planning in the world won't do any good if no one can find important financial, legal, and medical documents. Keep a list of the locations of important items and documents and include any necessary access information, such as passwords and keys, to help prevent financial issues and disputes.

Tips for Children of Aging Parents

Knowing when to talk to a loved one about lifestyle changes can be daunting for children of aging parents. Millions of adult children are often forced to care for a parent who once cared for them.

To help lessen challenges for children of aging parents, below are six legal steps you can take.

1. Plan Ahead

No one knows whether illness or disability will strike their families. Despite advances in health care technology, an aging parent may have to rely on family, friends, or health care providers to help with the basic activities of daily life. Take the steps necessary to account for one's financial, health care, and living arrangements before it is too late.

2. Help Your Parent Create the Necessary Legal Documents

Planning also includes creating legally valid documents that express one's wishes in writing. This may include having an up-to-date will, creating a durable power of attorney for medical decisions, and creating a living trust to transfer property to selected beneficiaries. Encouraging a parent to make the necessary estate planning documents can save families a lot of stress and challenges later on.

3. Understand Long-Term Care Options

Long-term care can be costly and is often needed when someone suffers from a chronic or disabling condition that requires skilled nursing care or custodial help with common activities of daily living such as bathing, walking, and toileting. Learning about long-term care options is a good way to avoid financial and emotional burdens.

4. Consider Long-Term Health Care Insurance

Unless you or your family members are wealthy, purchasing long-term care insurance for your loved one may be a good idea. A solid long-term care policy can allow your parent or family members to continue the same lifestyle and ensure their assets are properly handled.

5. Make an Advance Directive

There are two main types of advance directives, a living trust and a health care power of attorney. Both documents allow a person to make medical decisions on behalf of someone when they become too sick or disabled to make these decisions independently. Ask your parent or loved one who they want to make their health care decisions in case they become incapacitated.

6. Decide on a Health Care Agent

The health care agent is the person who will communicate the medical wishes and treatment needs to a doctor for someone unable to make decisions on their own due to age, illness, or disability.

Choosing a health care agent can ensure a parent's medical wishes align with their personal and religious beliefs, among other things.

Preparing Legal Forms: Options Available

When someone becomes too ill to make decisions, issues can arise over who should make those decisions for them and what those decisions should be.

Disputes can lead to family arguments, bitter feelings, and lawsuits. Planning and making wishes known is often the best solution for an older adult parent. There are several legal forms available to help:

• Advance health care directives specify a person's desired health care decisions should they become incapacitated

• A living will gives instructions for doctors and family members to follow if someone becomes incapacitated

• A power of attorney for health care grants someone else the authority to make health care and end-of-life decisions. Download a DIY power of attorney form

• A financial power of attorney grants someone the power to manage another person's financial affairs

Getting Legal Help as a Family

If you have legal concerns with elder care law issues, you should speak with an elder law attorney near you.