Earlier this week, Fidelity hosted a webinar on the role reversal adult children caregivers experience in caring for their parents. Though focused on adult children caregivers, I think the webinar has lots of useful content for all of us.
A Fidelity estate planning specialist and a psychiatrist addressed these five topics:
– Having a series of conversations to identify the needs and desires of elder(s) in order to create a plan (or roadmap) toward achieving those goals.
– Consulting a legal advisor to learn what documents should be in place to ensure those desires are met.
– Consulting a financial advisor so you can plan in advance for where the elder(s) can afford to live.
– Anticipating the elder’s needs and making modifications to the current situation or moving the elder to someplace affordable, appropriate to his/her needs, and hopefully someplace he/she approves.
– Take care of yourself. Consider the personal and financial impact if you choose to do hands-on care.
Brain Support Network volunteer Denise Dagan attended the webinar and shares her notes (below). Fortunately it wasn’t a sales pitch for Fidelity.
Notes by Denise
Role Reversal: Taking Care of Older Loved Ones
August 16, 2017
Webinar Hosted by Fidelity
Role Reversal = They were there for you and now you need to be there for them.
The impact on caregivers is stress that impacts health, happiness and their financial situation.
Preparing for Care
You can’t gauge how long someone will live based on their parents’ longevity.
Best to have a conversation early about their finances, how they would like to be cared for, and to put all the necessary documents in place with instructions for family to follow when a parent dies.
Trying to have those conversations in the midst of a crisis just makes it more difficult.
Don’t think getting the necessary information and documents in place is a ‘one-and-done’ thing.
Start talking about it during natural gatherings, like holidays. Keep having those conversations until you have everything in place you will need.
Fidelity’s Aging Well Guide – More detailed information than this 1-hour webinar.
Fidelity’s Health Event Checklist – Pretty cool because you can download it and fill it in on your computer to document which documents you have completed and their location, and a summary of your care plan.
Fidelity’s Making Conversations Easier Booklet helps break down the overwhelming nature of the tasks.
1. Getting Grounded – What do you want to get out of the initial conversation? Where are you going with these conversations? Even people who do social work or are lawyers feel overwhelmed.
2. Get set – Specific conversations, even involving grandchildren, because it is a teachable moment. Approach these conversations as a family or team effort. Don’t give up if there is disagreement. Divide the tasks or research and come back together with new information to see if everyone can agree or compromise.
3. Get started – Pick a natural place to have a conversation that has no distractions, especially if you can find neutral territory. Involve distant participants through Skype or Google Hangouts. Verbalize your hope to put any family divides behind you by coming together to help a needy family member as a team.
Four Steps to Prepare:
1- Identify signals – unpaid bills, messy household, etc. are red flags they need help.
2- Push for autopilot – auto bill pay, etc.
3- Include both parents
4- Be part of meetings – meet their financial advisor, lawyer, but also neighbors and friends.
* Power of Attorney – designates someone to be your health care proxy and/or legal proxy.
* Health Care Proxy – who has authority to make health care decisions for you if you are unable.
* Living Will – instructions for the health care proxy
* Will or Revocable Living Trust – an elder law attorney will help you know which is best for you.
* Documents you sign in the hospital only apply to that procedure and do not follow you forward, even at the same hospital.
Do all of these in advance. During a crisis is too late!
Managing & Paying
As soon as you finish one stack of paperwork, there’s another added to the pile.
Someone is ready for discharge from the hospital, but the family is unprepared to handle their care.
Do you have enough money to pay for care?
Where should an aging person live? Most people want to stay in their own home.
What would family have to sacrifice or give up in order to enable someone to remain in their own home?
You can put in your living will where you prefer to live.
Home Features for Added Safety:
– No-step entry
– Single Floor living
– Extra-wide doorways and halls
– Accessible electrical outlets
Build the cost or retrofitting a house for seniors or disability into a long-term budget.
Recognize that if you want to leave a financial legacy, you may be unable to do so.
Long-term care insurance considerations:
– Who are you buying the policy for? Consider the health spouse.
– Where are they likely to get care? Where do they want to live? Who’s going to provide that care?
– How will you fund long-term care insurance premiums as well as living expenses of the preferred location?
Continuing Care Communities combine standard living units with assisted living, memory units, and/or skilled nursing on one campus. It is ideal for spouses with very different care needs. Have a lawyer and financial advisor go over the cost/benefit of one of these places.
What about having elders move in with you?
– Maintaining privacy, grab bars, help with activities of daily living, etc.
– Many family members take this on themselves to the detriment of their own health and financial situation.
– You may be eligible for tax breaks if they qualify as a dependent.
– Flexible spending account may work for you. Talk with a financial advisor. It is not the same as a Health Savings Account.
– Does the care recipient qualify for veterans benefits?
Be aware of the stress you are taking on when you take in a loved one, especially if you are doing hands-on care, yourself. If you feel the stress talk to the care recipient, your doctor, your family, your religious leader. Brainstorm ways to relieve the stress for both caregiver and care recipient.
If you see the signs that your aging loved one need assistance, like unpaid bills, messy homes, body odor, etc. AND you don’t already have a plan in place, it is time to begin addressing the most urgent need first. Carve out some time to talk about those priorities and how they would like to handle it. It might be a private or a family meeting. This is the time you need to have (or get) your documents in place, before their ability to participate slips even further.
Know what documents your family member has already done. Where are those documents, who helped prepare them? Go meet the people who have helped put those documents together. It would be best to create a letter of instruction and suggestions for your inheritors to know where everything is and what to do in what order after you die. Hand it to your inheritors to be opened after you die.
Build the plan proactively. Done in an emergency they are not well thought out and are usually more expensive.
Understand Medicare doesn’t pay for long-term care, and never pays for lodging except in skilled nursing. Often, this leaves the well spouse bankrupt because they did not financially plan in advance and understand what their expenses will be in their elder and unwell years.
Taking Care of Yourself
Having others you can rely on, talk to, help make decisions with are really helpful.
Find some time for yourself every day to feed your own needs (nutrition, exercise, sleep, relaxation).
If your own health declines, you cannot be available to care for someone else.
More and more millennials are taking care of elders which often means leaving full time work, passing up promotions, depleting 401K contributions.
Caregiver burnout is a real thing that damages your health, when demands overwhelm your resources with respect to your energy and time. Who is the likely person to take over for you, but sometimes they live far away. They can still help financially, or by taking the time to find you local resources. Be sure to include some reserves in your financial plan for someone to step in if/when the primary caregiver becomes unavailable.
Be sure to have your elder sign a HIPAA form so you can have access to their medical information when they become unable to explain their medical circumstances, personally.
Getting all these things in place are also teachable moments for the youngest generation in your family.
Use these conversations as a way to connect with your elder, share family stories, what they want their legacy to be, etc. It can really bring families together when they take this good side with all the hassle and frustration of arranging documents and putting a plan in place.
– Take time to listen
– Ask, don’t assume
– Lean into your own well being
– Know your resources
Think broadly about getting documents together, not just about the unwell person but their well dependents.
Build a roadmap to ensure there’s a plan in place. No plan is perfect, but it guides you when things come up.
Have the conversation to tell people what you’ve done and where to find things
Take stock of who’s “family”? Who might come to depend on you and who do you depend on?
Identify documents and gaps
Put a team together to fill those gaps
Put the emergency plan in place.
Fidelity has documents and resources they recommend to address both financial and long-term care plans.