Caring for Aging Parents

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

Currently, as many as one in four adults is primarily responsible for caring for their older adult parent, and the number is expected to increase in the future. You must begin planning as soon as possible and not put it off. This article looks in-depth at how to approach long-term care for aging parents. 

Table of Contents

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

Discussing Long-Term Care

Discussing long-term care types before it becomes necessary is essential to finding the proper care.

Choosing the right type of long-term care is an important decision regarding caring for older adults that shouldn't be put off. Doing so risks the loss of ability to discuss if an older adult becomes physically or mentally disabled.

Because caring for older adults is such an important issue, having an open discussion should be a priority, though it may be a difficult topic to broach.

From the perspective of an older adult person, such a discussion may be unwanted because it engenders feelings of helplessness, of being a burden on others, or fear of losing their independence. And from a family member's perspective, the topic may be difficult to bring up because of feelings of guilt, anxiety, or respect for older adults who have always been caregivers and breadwinners.

But waiting too long to have the discussion can lead to results that take the decision out of an older adult's hands and lead to even more anxiety and guilt for family members. Planning gives everyone involved time to contemplate decisions, digest what will happen, and plan financially (long-term care is expensive).

Long-Term Care: A Difficult Conversation

The optimal scenario is to have a discussion (most likely a series of discussions) where all parties discuss the long-term care options openly and realistically. Such an evaluation is more likely to result in a decision that respects the older adult's wishes and calms their loved one's anxiety and fears.

For family members, the topic is difficult to initiate for obvious reasons. You will want to frame the discussion in terms of the older adult's desires and wishes for the future, a time when you may not be able to provide the care they need, and they may not be able to care for themselves. If the older adult knows that you're talking about future care (not tomorrow) and wish to discuss it to respect their wishes, the discussion may be more fruitful.

Likely, the first discussion will not be the last one. You may encounter great resistance from the older adult, which is natural. Try to have the discussion(s) in a comfortable setting 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 also be helpful to enlist the aid of third parties who are not in the family. These parties may also have useful information on the type of care the older adult desires and how best to bring up the subject. If appropriate, they may also assist or initiate the discussion.

Examples of people who may offer such assistance include:

• Physicians (primary care or geriatric specialists)
• Close friends of the older adult
• 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 can certainly provide information on long-term care and associated issues if they cannot assist in the discussion.

Whatever method you employ to initiate and continue the conversation regarding caring for older adults, don't be discouraged if your attempts are rebuffed several times. It may take some time for the older adult to accept that they will need assistance beyond what their family can provide. Once they do, your gentle persistence will pay dividends in the future by lessening anxiety by respecting the older adult's wishes.

Assessing Your Loved One's Desires

The first thing you should do is assess the needs and desires of older adults. There is no "one size fits all" model for long-term care. Rather, 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 needs and desires of the individual and the family.

Consider whether the older adult will need assistance with only custodial and daily life activities, in which case a home nurse may be appropriate, or if their needs touch more intimate and essential functions for which they'll need constant monitoring. These needs may change over time, so you should revisit this assessment periodically.

In assessing the needs of the older adult, their personality and personal preference play a large role. Some people treasure their independence and are willing to go to great lengths to preserve it, whereas others may be more amenable to accepting an assisted living situation. If someone is fiercely independent, they will likely want a situation customized to fit their lifestyle. They can have someone assist them with cleaning, organizing, cooking meals, etc., rather than have a live-in nurse or be placed in a retirement community.

Because personality is such a large factor in the decision-making process, it should be collaborative. Family members and older adults may not initially agree on plans for long-term care. That's why discussions about caring for older adults be made before services are needed.

Assessing Medical Needs

Aside from self-assessments, older adults and family members should also consult with their primary care physician, particularly if the reason for considering long-term care is due to illness, disease, or other disability. A physician will have a better sense of 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 describe general physical or mental symptoms likely to occur, geriatric specialists have the training and experience to deal exclusively with older adults.

Health services in the U.S. are increasingly skewed toward older adults as our population grows older, yet there are fewer geriatric specialists. If you can get the advice of such a specialist, you would do well to listen carefully to their professional opinion in weighing your decisions.

Planning Ahead Financially

It's also critical to plan so that you're better prepared financially. The difficult aspect of long-term care (from a financial perspective) is that the cost is completely dependent on the type of care necessary, the location of the care, and the length of time required.

A hard reality is that you may plan for a few years of long-term care. But, in the end, you may need more years with greater care services. Planning can help alleviate 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 portion of their savings for long-term care. Medicare can help with partial payments for 100 days of nursing facility care for those who qualify. Medicaid, a government program for those who cannot pay for health care, is another option. Be sure to organize your financial records to prepare for the event of long-term care.

Timeline of Older Adult Care

Making planning for your aging parents' care more manageable may help 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
• 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 what they will need, important things to consider are:

• The parent's existing physical and mental condition
• The family's history of medical issues
• The parent's expected lifestyle

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

What Can the Parent Do To Maintain Health and Independence?

Most older adult parents want to maintain their health and independence as much as possible. Accordingly, part of the planning should involve planning 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 plan to take care of a parent or expect them to be in managed care, you need to evaluate whether family members are available for minor caregiving duties or emergencies.

Where Should Caregiving Take Place?

Both parties, parents and their caregivers, must decide where any caregiving will occur. This means deciding whether the parent needs to be moved or caregiving will come to the parent.

Step Two: Housing Preparation

One of the most delicate and difficult decisions is whether care should be given 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. Homecare will be offered until a certain established point, upon which the parent will transition into assisted care.

Many people opt to receive in-home care. This allows them to stay in their home while receiving health care assistance. It's best suited for people who need care but don't have critical issues. There are other options available, such as adult daycare. Many groups and services also support older adults living in their homes.

Residential care is another option. These facilities can provide supervision for aging parents with more critical healthcare 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.

Can the Parent Stay Home, or Do They Need To Move?

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.

If the Plan Is To Stay Home: What Modifications and Assistance Are 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 older adult 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 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. Depending on the parent's needs, several different types of older adult care facilities are available.

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?

It is imperative that an older adult parent has a living will, also known as a medical directive. This document provides written instructions for the parent's care if they cannot 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 situations not covered by a living will, an older adult parent should name a healthcare agent who will make medical decisions for them when they are unable. The health care agent cannot override the express wishes of a living will. Rather they are 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. It is written in a person's medical record instructing 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. Older adults should set forth their desires on this issue in a DNR order to avoid confusion.

Does the Parent Have Any Final Disposition Wishes?

Finally, an often overlooked area 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 should 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 current 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 care to be provided and by whom, it's time to decide how you will pay for it. If you plan on buying private insurance, determine whether the parent has enough money.

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 they can afford.

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?

At some point, a parent will be unable to make the financial decisions necessary for long-term care or end-of-life issues.

Just as a person should name a health care agent, it is critical that older adults 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.

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 -- or even more challenging -- take care of an aging parent and their own children simultaneously.

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

Tip #1: Plan Ahead

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

Tip #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 create the necessary estate planning documents can save families a lot of stress and challenges later on. You can create a DIY living trust.

Tip #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 assistance 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.

Tip #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 end up in the proper hands.

Tip #5: Make an Advance Directive

There are two main types of advance directives, the living trust and health care power of attorney. Both documents allow someone to make medical decisions and appoint someone to look after their medical affairs. This is handy if they become too sick or disabled to make these decisions independently. Review with your parent who they might wish to make health care decisions if they cannot.

Tip #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 healthcare 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 or infirm 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 desired health care decisions should someone become incapacitated. They mostly state desires for the benefit of doctors and family members and are not always legally binding).
• A living will sets out instructions for doctors and family members to follow if someone becomes incapacitated. Download a DIY living will form.
• 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 financial affairs.
• Legal guardians can make all sorts of decisions, from health care to living arrangements.

Getting Legal Help As a Family

If you have legal concerns with any older adult law issues, your first step can be to speak with an older adult law attorney. Many offer free consultations to review your concerns.