Having a conversation about long-term care with an aging loved one can be very difficult. Initiating a conversation can be awkward or uncomfortable for family members or caregivers. We offer the following hints that may help to begin a conversation about long-term care with your loved one.
A good conversation starter would be to ask when their legal documents have last been reviewed.
Asking this simple question is a good way to get everyone thinking about the future. Many seniors believe that it isn’t necessary to review documents – “Oh I had those prepared years ago….I’m set.” Helping the senior realize their life has “probably changed a lot since they were prepared” is a way to ease into “other changes” you have noticed.
If your loved one says they have no legal documents or they have “a Will”, NOW, before they have a medical emergency or lose mental capacity, is the time to avoid unnecessary legal headaches and fees by getting critical documents in place.
The most important documents everyone should have.
A Durable Power of Attorney (for finances) appoints someone to act on your behalf if you are no longer capable of handling your finances. Without a valid and powerful Durable Power of Attorney, the family will be forced to apply for a Conservatorship through the Probate Court to pay bills and handle investments. Without having in writing who you wish to handle your affairs, the Court may appoint someone you would not have chosen to handle things for you. A powerful and properly drawn Durable Power of Attorney will allow the person you appoint to protect assets for your qualify of life and quality of care.
A Durable Power of Attorney for Health Care Decisions appoints someone to act on your behalf to make health care decisions for you if you are no longer capable of making them yourself. Without this document in place, the family will be forced to apply for a Guardianship through the Probate Court to make health care decisions for you. This is vitally important if it is your desire NOT to be kept alive by artificial nutrition and hydration.
The Probate Court requires a surety Bond for the person appointed Conservator and/or Guardian. The Bond is based on the amount of assets owned by you. It must be renewed annually and is VERY expensive and very cumbersome. A Conservatorship and Guardianship lasts the rest of your life, requiring two annual filings with the Probate Court (continued legal fees) and the Court must approve every dollar spent for, or on, your behalf. The attorney’s fees for a Conservatorship and/or Guardianship, in the FIRST YEAR alone average between $5,000 and $10,000.
If your loved one wishes to avoid a Probate Estate after their passing, they must have some type of a Trust in place. A Last Will and Testament still goes through Probate. A Revocable Living Trust avoids Probate but does not protect any assets from being spent on Medicaid and does not protect their home against Estate Recovery. A Beneficiary Deed does not protect against Estate Recovery either.
ONLY an Asset Protection Trust avoids all of your loved one’s assets from being spent on a nursing home and their home being subject to Estate Recovery by the state. This type of planning is extremely complex and requires consulting with an Elder Law Attorney.
Determine if it’s time to think about long-term care assistance.
Reasons to seek long-term care can vary from person to person. Long-term care is not just about a potentially more comfortable and safer environment for the aging loved one. Long term care can and may be necessary for the mental and physical health of the elder.
To ensure your loved one is able to consider their options without becoming defensive, introduce alternative housing options as early as possible, even when you think your loved one might be in the early stages of needing help. Ask your loved one questions about lifestyle or health-related challenges to introduce the idea that either a home-health provider or senior housing community may be a positive choice. Continuing to engage in this conversation over time by sharing your observations, concerns, and any physical or mental challenges you may notice may make the transition easier when it is time.
Remain sensitive to your loved one’s needs.
Discussing long-term care may be intimidating for you, but it is a difficult topic for your loved one as well. Most of us want to do everything possible to stay in our home as long as possible. Since any decisions that are made will affect your loved one the most, it’s crucial to respect their needs and preferences.
Involve your loved one in as many discussions and meetings as possible, barring any health restrictions. Being left out of a family meeting or doctor’s conference could foster feelings of exclusion or distrust.
Allow time for your loved one to become open and adjust to the idea. If there are no immediate health risks, allow your loved one to set the pace for the discussions.
Make an effort to find solutions that will work for everyone involved. For example, if your loved one feels strongly about maintaining a garden in a new home, expand your search for communities that would be able to provide gardening opportunities. Some communities have Alzheimer’s patients separate from seniors who just need assisted living. If your loved one has Alzheimer’s make sure you check into those communities.
Below you will find a checklist of different symptoms that you may have noticed your loved one is experiencing. If there are several family members that are around your loved one on a regular basis, it might be good to discuss the symptoms they have noticed and compare with what you have seen.
□ Are they able to move around easily given the physical layout of the home? For example, are stairs, carpet, bath/shower or door handles obstacles for mobility? Is the heating and lighting adequate for any sensory impairment including hearing, sight and circulations problems?
□ Are they experiencing balance issues, especially when changing positions? Are you concerned about them falling?
□ If they fell, are you confident he or she would be able to call for help? Is there a reliable source to respond to a call at all times?
□ If they are living alone, is it time to think about LifeAlert?
□ Are they experiencing frequent incontinence? Can they attend to the problem when this happens or is help needed?
□ Is your loved one experiencing frequent, significant sleep disturbances?
□ Are they capable of shopping for and cooking or preparing healthy meals?
□ Do they have trouble operating gadgets or appliances such as a can opener, microwave, stove or telephone?
□ Are finances such as bill payments, deposits, and investments being handled in a timely manner?
□ Is your loved one still driving? If so, are you concerned about his/her and others well being? Is public transportation a safe and viable option?
□ Are they capable and are they adequately doing housekeeping, laundry and wearing clean clothes?
□ Are they regularly bathing?
□ Are prescribed medications obtained and consistently taken as indicated?
Is your loved one demonstrating personality changes, including, but not limited to:
□ Frequent irritability?
□ Insensitivity to others?
□ Disoriented to place and time?
□ Aggressive behaviors?
□ Repetitive behaviors?
□ Communication with inappropriate language?
□ Is your loved one socially withdrawn and not able or not wanting to get together with friends or family? Are there signs of depression?
□ Do they express negative comments about him or herself?
□ Are they demonstrating an inability to make sound decisions or use good judgment?
□ Is your loved one able to understand communication or instructions from others?
Schedule a family meeting.
A family meeting can move the topic of long-term care to a more focused discussion that can lead to a plan. If your loved one agrees, here is a checklist for planning for your family meeting:
□ Determine the family members that should be involved directly or indirectly in decision making. Always include your loved one if he/she is capable of taking part in any decision making.
□ Consider including an independent third party to play the role of mediator. This could be a minister or other member of the clergy, a social worker, or a case manager. If necessary, find a neutral place to hold the meeting.
□ Prepare an agenda to help you stay focused. It may include the following:
~ A medical update
~ Sharing of feelings about the illness and care giving
~ Daily care giving needs
~ Financial concerns
~ Who will make decisions
~ What support role each person will play
~ What support the primary caregiver needs
~ What you consider the next steps of moving forward should be
~ If you are around more than other members of the family write down what you have noticed in terms of declining health or memory issues that other family members might not notice.
Continue to involve the family.
The move to a long-term care community is an immense transition for any family, so it’s important to involve everyone relevant to the person(s) being moved.
Reach out to siblings to secure their input and support. For example, share online information about long-term care communities to secure greater involvement and participation.
Is there an unequal financial or time burden to one family member? If so, acknowledge the distribution of resources and discuss a strategy for achieving a balance that appeals to everyone.
Continue to engage your parent or loved one.
Have ongoing conversations at time when your loved one is feeling best and there are few distractions.
Introduce the idea of an overnight visit to a long-term care facility or an extended afternoon visit to get a feel for the various available options.
Begin researching long-term care options in your area.
□ Go to snapforseniors.com to access a nationwide senior housing database.
□ Call and request a consultation with those communities that interest you.
□ Ask family members to help you prepare a list of questions and concerns for your specific situation with your loved one.