We all dread the day when we may be faced with making important life decisions on behalf of our aging parents. It’s never an easy road deciding how to best care for the people who used to care for us, and there are plenty of variables that should be considered to ensure that were providing the most comfortable, professional, and healthy environment so they can live out their final years in relative peace. With that in mind, here are some important tips on managing long-term care for elderly patients, including educated insight from a few experts.
Start with a Family Meeting. Schedule a family meeting that involves every adult who has a stake in this decision. If possible, this meeting also should include the parents as well. It’s their future the family is discussing, so it’s ideal to have all hands on deck well before a tragedy leaves the parent incapacitated. According to Jack Halpern, CEO and founder of My Elder Advocate, “When your parent is in their 60s or early 70s, it’s time to discuss their plans for their elder years,” he says. “Many parents can be reluctant to have this discussion. But I’ve found that bringing in a professional helps seniors open up more. It also helps address issues parents might be uncomfortable talking about with their kids.”
Access Your Parents’ Medical History. “Elderly parents’ health can take a turn for the worse at any moment, and it’s your responsibility to be as prepared as possible so they can receive the best care possible. Part of that preparation is to have Mom and Dad’s medical records handy,” says Halpern. “This should include diagnosis, medication and allergies, hospitalizations, names of doctors and other health care professionals, lab work, and surgeries. And be sure to keep this information on a USB drive, so that it’s easily accessible to doctors in an emergency situation.”
Get Legal Documents in Order. It’s important to discuss with your parents in advance if they’ll allow a responsible family member to have a healthcare power of attorney. That allows you to make important decisions as they arise. Halpern, who has seen his fair share of devastation to families who didn’t have documents in order, suggests you “start by consulting a trust and estates attorney to help you and your parents with the legal documents. You should also create a living will, which details such things as the circumstances in which you wouldn’t want a feeding tube to keep you alive.”
Consider Your Options. Many people decide to care for their elderly parent in their own home. But it’s important to recognize that this is often an emotional, physical, mental, and financial burden. For this reason it may be better to leave it to professionals. Relationship expert April Masini warns against acting impulsively. “While you may think that it’s a great idea,” she says, “your spouse may not be on board. As a result, your own marriage may be on the line if you create a relationship obstacle by taking in or taking on an elderly parent, when your spouse is against it.”
Tour Facilities. If you decide to go with a dedicated long-term care facility, consider these two important questions:
- Will my parent receive the best possible care here?
- Does this facility provide peace of mind that my parent is being well-cared for?
Steve Moran, publisher of the Senior Housing Forum, says it’s important to understand what good and bad looks like. He also suggests visiting facilities in the morning, late afternoons, and weekends when there is lots of activity. He says you should also talk to family members about what they like – and don’t like.
Be Realistic. Long-term care facilities aren’t cheap, and covering the cost could be a financial burden on you and/or your siblings. Do your parents have long-term care insurance? Do they have ready cash? If not, how will you pay for this? How will the cost affect your finances? There are under-the-radar fees that could drive up costs, so prepare for those as well. For example, Rick Lauber, author of the Caregivers Guide for Canadians notes that, “Private rooms and provided extras such as additional meals, laundry, and haircare can cost a family much more.”
Use Bargaining Chips. Moran notes that all is not lost if your parents have just a little in the way of assets. In fact, he says, “You can use that as a bargaining chip to get into a better-skilled nursing care facility when the money runs out and their care is covered by Medicaid,” he says.
Assign a Main Point of Contact. Healthcare consultant Melissa Kahn, principal at Kahn HealthCare Consulting, recommends “designating a family spokesperson to handle health care matters, as well as the financial and legal side of things. Involve more family members so you can avoid caregiver burnout, mistakes and miscommunication.”
Keep Parents Socially Active. It’s important that your parent(s) stay socially active and otherwise mentally stimulated to ensure the best quality of life. So consider the social aspect of long-term care when choosing the facility. Important questions you should consider include:
- Will your parent get along with the other residents?
- Are there events in which they can participate?
- Is the staff friendly and engaged?
- Is there technology available that allows them to keep in touch with you and other family members?
Recognize Elder Care Abuse. Elder care abuse is an unfortunate reality. That’s why attorney Jonathan Rosenfeld says, “Adult children need to educate themselves and their parents about their rights, common long-term care scams, and how to avoid them.” Rosenfeld also offers a few telltale signs of elder care abuse or neglect:
- Tension or frequent complaints by parents about the caregivers/staff
- Changes in personality, depression, and withdrawal from normal activities
- Weight loss, dehydration, and shortening of muscles due to inactivity
- Physical injuries ranging from bruises and burns to bed sores, falls, and broken bones, with unlikely or unclear explanations
“Knowing the signs and understanding your rights for you and your elderly parents is key to preventing elderly neglect and abuse,” Rosenfeld says.
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Talking finances and health care with parents can be tough one. I grew up in a family that really doesn’t talk openly about money and as such, now that my parents are older, it is tough opening that door. Its important for everyone to be on the same page and have all the information so that the best choices can be made.
Thank God, my mother had the good sense to purchase long term care insurance. She had the wherewithal to pay for it and now that she is in assisted living, it pays for her care for six years. While she is receiving those benefits, her assets are invested for when LTC runs out and if she is still alive after her assets are depleted, then I guess we will have to turn to Medicaid. She was always very open with me about her finances and she has all of the wills, durable POA and medical POA and medical directives in place with me as the control point. I know many elderly are reluctant to share these detail with their kids which is a shame. I was very fortunate that my mom planned ahead.
Yes, you are very lucky, Kathy. Most people are not so fortunate!
Be aware that LTC insurance may not cover the entire per-day cost of the facility. And when applying for Medicaid coverage, you will need several years of financial and bank statements for your parent’s accounts (in NY it’s 5 years) and have to account for all large expenditures/withdrawals.
Wow. I didn’t know that, Barb. Good to know.
Communication with family is key before parents go into Long Term Care facility. Our mother developed Alzheimer’s and my dad was sharp enough to get LTC insurance while she slowly showing signs of confusion. (They wouldn’t provide it if she was in late stages). He and I reviewed and visited numerous facilities before finding one that seemed to fit her needs. One area which should have been addressed is that one son was left as sole POA for all her matters (dad didn’t clearly tell the other two which were more involved with their own lives). Now legal issues have to be addressed as both parents are now dead and other two sons fill slighted by youngest son given sole POA. In summary elderly parent needing LTC needs is an -incredible amount of work – Not just medical and financial, but emotional work as well.
I really like the suggestions to tour the facilities before deciding on a retirement home for your parents. If possible, it is also a great idea to let your parents tour the home with you so they can see first hand what it has to offer instead of relying on word of mouth. When my sister moved our parents to a nursing home, my dad was very reluctant until he got a chance to really look around and find out what they had to offer. It made the move a lot easier for him.
Great post, with a lot of essential ways to care for the long term. Thanks for given information.
Excellent information. Where I live all LTC facilities operate under Govt mandate that sets a standard level of care and certification regardless of a resident’s income. Obviously, people can opt for a full private facility but God help them if something seriously develops like difficult dementia or Alzheimer’s. They are then often asked to leave. Anyway, I am on my 4th go around with this, first my mom, then in laws, and now a neighbour/friend who has no family. The community health care workers were a treasure of information and guidance. I had already obtained enduring power of attorney and made sure he had a current will, but the support supervisor insisted I get on his bank accounts and notify his pension that I was the contact person for problems. I also ensure his taxes are properly done every year and am the watchman/guard for any so-called friends who have tried to borrow money from him. (It happened). I also contacted a long time friend of his that I share all information with regarding his finances, health decisions, etc. The finances are complicated. The cost structure is mandated by law that lower income folks pay 80% of their net retirement income. It comes off by direct deposit. For this amount residents receive a very nice private room with a large bathroom, all meals in a dining room with other residents and personal care, baths, etc, and there is also a full time nurse on duty 24/7. He has his same family doctor. We pay extra for dental care visits, approx $50 per month for subsidised medications, and we even have a foot care specialist come in every few months. He also has a phone and TV in his room. I live 50 miles away so we chat on the phone, or he calls me when he is worried about something. There are also activities and social outings. I meet with an in-house social worker every so often and with the entire care team once per year and pretty much follow their advice.
The big thing is someone has to be an alternate decision maker on finances. My friend now has dementia. He is no more capable of making financial decisions than he is of becoming an astronaut. Before he declined we went through his will and he decided exactly where his money will go to as he has no family. All his estate will be shared with the local search and rescue operation that came to his aid when he was having falls and accidents, and the local fish and game club. He is simply giving back to his community.
My advice: Get the financial stuff set up ahead of decline or it will be a nightmare. Yes, these are difficult conversations to have but it has to be done. I also had a few tough decisions to make which caused a lot of conflict. One, I had to take away his guns. I just did it one morning when he was talking about self harm. The other was when I had to take his car away because he was no longer safe on the road. It was not a fun time but he later understood, and was thankful. And beware of meddlers sticking their oar in. Find some trustworthy decent people to share information with and help make the hard decisions.