Nobody Thinks About This Stuff

The title is a quote from the daughter of an elderly couple who were suddenly faced with the need for long term care at home. This can happen to anyone at any time, but of course the probability is much greater the older a person is. That can be due to disease, physical or mental decline or a sudden accident such as falling down the stairs. So what exactly is “this stuff”?

Making Medical & Financial Decisions

First, it is having in place the legal tools so medical and financial decisions can be made by reliable family members or other trusted people. That means having a durable power of attorney in place that allows someone else to handle real estate, stocks, bonds, bank accounts, IRA’s, 401Ks, pensions, and any other types of financial assets. In October 2016 Connecticut significantly changed its power of attorney law. Older ones are grandfathered in, so don’t panic, but the new law gives stronger and more complete powers, so it is critical to have a current power of attorney that can address handling property, and includes transferring assets to family members. For example, spouses can transfer between themselves or to a disabled child at any time without a penalty, even within five years. There is even a provision that allows transfer of a home to a child under 21.

Another legal tool is a living will which designates a health care representative to make medical decisions for you, if you cannot make them yourself. This is a “no brainer” and everyone should name the person they trust to make medical decisions, including end of life decisions, if that situation should ever arise. The person you pick should not only have good judgement, but should also have the emotional ability to make that difficult end of life decision. Some children could never bring themselves to tell the doctor to “pull the plug”, so it’s best to choose a child or another person who could, both for your sake and theirs.

A HIPAA form (that allows people to talk to doctors and medical staff) is important, especially if family members live far away and you want them to be able to get information on your condition if you end up in a hospital without warning and cannot speak.

What About Long Term Planning?

Those are the basic documents, but beyond that there is a world of planning options that families need to think about in case the worst happens and long term care is needed to keep mom or dad safe, in the best living situation possible. If there is one thing everybody says, it’s “I don’t want to end up in a nursing home”. The best chance of not ending up there is to plan ahead. Find out what is available for care at home, and what government assistance is available. That could be VA Aid and Attendance, the Connecticut Home Care Program for Elders, or Medicaid CT (Title 19). At the high end, Medicaid can pay as much as $71,340 per year for care in your own home.

The key is to know the eligibility rules and to plan how your family can satisfy those rules. If care is needed suddenly, planning in advance can make the difference between staying home or having to go to a nursing home. Connecticut has fairly good home care programs, but it is one of the strictest states in terms of eligibility. That puts a premium on evaluating what you can do and should do before the crisis hits.

Saving Your Life Savings…

If the crisis does hit, the options may be fewer without pre planning, but in the case of a husband and wife there are almost always ways to figure out a care plan and preserve the family life savings, even at the last minute. This is also true if nursing home care can’t be avoided and for that families do need to have the legal expertise of an attorney who knows the rules. Those families that do think about “this stuff” and lay the groundwork in case care is needed, have a far better chance of keeping their loved ones out of a nursing home, while preserving the family life savings which are usually needed to pay for living expenses. Title 19 may pay for care, but it does not pay for your living expenses at home. So think about this stuff and get good advice so that your decisions will be based on what really happens, and not on what your cousin said happened to her friend.