What should you do when your spouse or parent will need long term care? Watch our video or review the text below. Note the next installment covers The Seven Steps to Your Long Term Care Plan.
What you should do when your spouse or parent will need long-term care? I’d like to share with you my experience developing a practical plan that you can use to create your long-term care plan.
INTRODUCTION TO “LONG TERM CARE”
What we mean by long-term care? If you search on YouTube and look up long-term care you’re going to find a lot of videos about long-term care insurance and a lot of videos lawyers talking about the nursing home and Medicaid. That is not what we are addressing.
In the vast majority of cases, long-term care begins in home years before the nursing home. Of course, there are exceptions. I had a client who was 83 years old and fell out of a tree while trimming it. The fall caused serious injury and put him in a nursing home. Before that he was riding a bike before all that too all over town. In most cases of falls that result in nursing home care, there had been many less severe falls in home. These often resulted in a daughter helping her mother to safely go shopping and other out of home business. That help is part of long term care.
There’s two type of people who need long-term care assistance:
There is the mobility impaired person. The impairment may result from a fall or a stroke. This person needs help with Activities of Daily Living (ADLs). They need help getting up from bed or going to bed. They need assistance ambulating, toileting, bathing , dressing, or making meals.
The other kind of long-term care person is somebody who has “cognitive impairment.” It may be Alzheimer’s or other dementia. This person needs help with the Instrumental Activities of Daily Living (IADLs). They need assistance with their business affairs such as paying bills, renewing contracts such as home and health insurance. They need help managing their medical care, making and keeping doctors’ appointments, getting the lab results, getting the prescriptions sorted out and getting the insurance billing sorted out. They may need help in preparing meals, doing laundry and cleaning the house. They may no longer be safe to leave the house for the possibility of getting lost.
HYPOTHETICAL COUPLE: BILL AND MARY
To make some points clear I’m going to use from time to time a hypothetical couple called Bill and Mary let’s say Bill is age 80 has a heart condition generally poor health but he’s the caregiver for his wife Mary who’s 78 physically well but has Alzheimer’s disease. Bill and Mary have four children. The oldest is Carol she’s retired and lives in Massachusetts. Then comes Bill Jr he’s employed doing very well. He lives in Chicago. Then there’s George who’s in the military, currently stationed in San Antonio. He plans to retire in three years. Finally, the only local child is Susan. She is fully employed and has two high schoolers getting ready to go to college. She’s a very busy woman.
Let’s begin with the Seven Common Mistakes you should avoid in making your long-term care plan.
First Common Mistake: Planning for Death
When many people confront long term care, they think of death and their need for a will. This is understandable and good. But. It does not address long term care while the person is alive! A will determines who gets your property, and under what conditions, after you die. A will has no effect as long as you’re alive. That is not to say a will is not important. It is.
A will can be an important part of a long term care plan, but it would only be a part, not the whole plan. In our Bill and Mary example Bill would want to make a will and perhaps a trust to make provisions for Mary if he dies first. It could fully spell out his plans for Mary, including where she might live and under what conditions. For example, if she moved into Carol’s house she might pay rent. Or Bill might give Carol and additional inheritance to take care of her Mom.
Second Common Mistake: Doing Just Enough for Today
It is quite understandable that we might only take care of today’s problem. After all, how can we know what will come tomorrow? The answer is aging produces predictable problems.
Let’s say Bill dies and Mary adds their daughter Sharon to their bank account so that she can pay the bills. Will that allow Sharon to question a bill? No. What if Mary goes to the hospital on emergency? Sharon will have no authority to talk to Mary’s doctors, to make medical appointments, to talk to the insurance company or any of the dozen or more urgent needs that arise. She only has authority to pay a bill.
There’s an additional problem lurking in the background: if you do just enough for today you may end up in the probate court “tomorrow.” How? What if Bill dies and Sharon needs more authority than to just pay bills? And, what if Mary’s Alzheimer’s has advanced so much that she is not be able to sign any legal documents? Sharon will need to go to probate court and become her mother’s guardian. That means supervision of Mary in probate court for the rest of her life. The court may take control of her assets as well.
Third Common Mistake: Planning For the Nursing Home
It is true that many people are in nursing homes because they are in the end stages of Alzheimer’s dementia. Bill and Mary could focus on addressing that end stage, the nursing home. There’s three components to the problem area.
The first is a variation on doing just enough for today. “When she needs a nursing home we’ll take care of it then. Until that happens we’ll just keep things going as they are.” This variation makes no allowance for emergencies that predictably arise. We’ll address this later.
The second component is implied in the first, in that planning for the nursing home means that you’re not planning to AVOID the nursing home. For many people with impairments there are alternatives to nursing homes such as “assisted living” apartments or living with family.
The third component of planning for the nursing home is “Medicaid planning.” In the simplest form it means giving your money away to a trust and after five years, when you go to a nursing home Medicaid will pay for it. A big problem with this approach is that you have very little money left to AVOID the nursing home.
(For More information on this, see our “Don’t Do Medicaid Pre-Planning Till You Read This” )
Fourth Common Mistake: Not Being Aware of Caregiver Problems
This is a big area that’s why we can’t put given a nice concise little title. There’s many components to this one
The first problem is not being aware of the stress of being a 24 hour a day caregiver for years on end without break. The caregiver’s day is controlled by the impaired person. It includes sleeping lightly so that when Mom gets up and tries to go out the door, the caregiver will be there. It includes all the ADLs bathing in the morning, toileting and getting dressed making meals is it making doctor appointments and taking mom to the doctor is it calling and checking on lab results, prescriptions and dealing with all emergencies.
It is stressful and harmful to the health of the caregiver after being on 24 hour duty for months and months that stretch into years without any significant relief. Caregivers most often have to forego employment. Sometimes they have to give up their own home so that the impaired family member can stay in familiar surroundings. They have to deal with mental stress of all the emotions from love anger, joy and despair, a love-hate dynamic. It seems to be an ironclad rule that there is only one caregiver, nobody will alternate for a period of time.
This caregiver stress often produces a separation or alienation in the other children. It’s almost as if the caregiver wraps his or her arms around the patient mom or dad, and seems to push away the other children. I heard time and again “No you can’t visit Mom Saturday, she’s got this going on.” Or “No you can’t come over today, she’s not feeling well .” Now the other children have their issues of guilt for not helping, they feel separated from their parent and they start getting angry. They start questioning “What’s going on?” They see that “She bought herself a new car with mom’s money and she goes everywhere with it when mom’s at home.” It often spirals down from there and the family ends up battling in probate court.
The second component in the area of child caregivers is not having any idea of what the child should receive for the years of 24 hour service to a parent. Many siblings think the caregiver should “do it for love, not for Mom’s money.” This attitude drives caregiver anger especially when one considers the enormous cost of “assisted living” apartments – national average about $50,000 per year – or nursing homes – national average about $100,000 per year. This component can lead to making oral promises of inheritance. See the Sixth Problem below.
The third component is in the area of non-family caregivers. I have often heard of this “lady in the neighborhood used to work in a nursing home, and she’s really good, and she will take care of Mom for cash under the table.” The problem is that under the law she is an employee. As the employer “Mom” must withhold her social security and Medicare taxes and also pay unemployment taxes. If it comes to the attention of the government, the taxes will be assessed against the “employer” with penalties and interest. As an employee the lady is covered under the workers compensation laws in most states. If she’s injured on the job she has the right to workers compensation benefits. For example, what if she’s carrying something down the stairs, falls injures her knee so bad she needs surgery in the hospital? Who is going to pay the medical bills? What about her wage loss for being injured on the job? Homeowner’s insurance does not cover in-house employees. Mom the employer must either have workers compensation insurance or cover these costs herself.
Fifth Common Mistake: Not Involving the Whole Family
We understand that a senior’s affairs are private. I don’t know any senior mom or dad who wants to tell their children their entire financial affairs, medical conditions and treatments. As a result most involve only one child in their plans and often it’s the oldest child.
What’s the problem? We have seen that there is more work than just one person can handle. But more than that when there is an emergency, be it medical or otherwise, more than one person is needed.
In addition many problems are caused by children feeling left out of their parents lives. Also, there are often different opinions on what to do that can lead to serious conflict, especially if the oldest child is not the caregiver. Having a whole family discussion brings all members in and helps settle the question about “Is that what Mom and Dad want?”
Sixth Common Mistake: Making Oral Promises of Inheritance.
This one is not as common as the others, but is guaranteed to create problems after the parent dies. I’ve seen this most often arise when there’s only one caregiver and other children receive a smaller inheritance. For example a mother may add her caregiver daughter’s name as a joint owner of the bank checking and savings account. She tells the daughter that she wants those accounts to be her daughter’s when she dies. Of course the oral statement could apply to any property such as the almost new car, Mom’s house or family heirlooms. When the mother dies, legal battles are all but certain.
The Seventh Common Mistake: Not Consulting with Professionals
As we have indicated in this article there problems that can be avoided if you know the potential in advance. A licensed geriatric social worker can help you avoid the family relation problems. I referenced. An accountant can advise you on tax issues and opportunities in long term care.
I have tried to give you the survey of the most common problems, but there are many others. An elder law attorney can advise you on a wide array of common problems, including those I call “Time Bomb Problems.” So let’s give you one more common mistake. Let’s call it your “free bonus” for making it this far.
Bonus: Eighth Common Mistake: Choosing the Wrong Person to Be Your Agent or Trustee.
Suppose Bill and Mary choose their eldest son Bill Jr., to be their power of attorney agent or trustee of their trust. Now Bill Jr. is a high handed sort of fellow. It’s his way or the highway. He likely would be a poor choice as sole power of attorney agent or as a trustee. Here’s a couple of examples.
Suppose that Bill wants to set up a trust for Mary should he die first. He wants her to stay in the home and be well cared for. What if Bill Jr. says “Dad should put her in a nursing home. She’s too much trouble in home.” Junior would not be a good choice as trustee.
Second problem suppose that Bill Jr says that I think my parents are just completely wrongly invested. I know I could double their investments. That kind of investment strategy may be good for a young person say in their 30s but we’re talking about taking care of somebody in their late 70s or 80s. No! You don’t want to be risking all their money on the gamble. Indeed, it looks like Junior is trying for a bigger inheritance. He would likely be a poor choice as sole trustee or sole agent in a power of attorney.
See you at the Seven Steps to Make Your Long Term Care Plan.