The Talk with Elderly Parents

Those with elderly parents are rightfully concerned about the possible need for long term care and for obtaining government assistance to keep those parents at home, or at a minimum in the least restrictive environment. So before a crisis develops, here are some ideas on how to approach these sensitive matters.

To begin, it’s important if at all possible to have the whole family, parents and children on the same page. Having a discussion with the whole family could be very helpful. Subjects to discuss are where parents would like to live if one of them needs significant care. Home is ideal if the layout is safe, so that use of stairs is minimal or not needed, as falling is the single biggest reason many are forced to move from their home. The second issue is to decide who will be the main person in charge of finances and medical decision making if the parent becomes incapable of making those decisions. For that, it is vital to get a health care directive, often called a living will, and a full power of attorney in place with at least one reliable family member in charge, and at least one or more backups if that reliable family member is no longer able to act due to health issues or death.

Then a thorough review of the parents’ income and assets is a must, because the state is going to see all those financial records and steps can be taken to protect as many assets as are allowed under the Medicaid law. Medicaid will pay for care for those who are eligible, but it won’t pay for living expenses, except in a nursing home, which everyone wants to avoid if at all possible.

If planning is done early enough, and if it is affordable for the family, long term care insurance can be very helpful, but based on long experience it is my opinion that a huge percentage of people just cannot afford it. Another legal strategy can involve special trusts inside a will, called testamentary trusts, which substantially protect the assets of the first spouse who dies. Since who is going to die first is rarely predictable, the wills could be done, and assets roughly divided in half, to insure that at least half the assets get protected if one spouse needs long term care. The key is to get basic documents in place because it is too late if a stroke or fall or other medical event prevents the parents from making decisions themselves.

Another goal of the talk is to ascertain the parents’ wishes, as exploring possible plans with them can help pave the way for easier family decisions if the parent becomes incapable. Adult children, who themselves may be in their 60s or 70s may be more likely to support a parent’s desire to move in with one of the children if the parent has expressed that desire, and if it is practical.

It may sound obvious, but along with getting documents done, it is knowing where they are kept. The parents and a least one or two other family members should know. A will or power of attorney that cannot be found is not useful to anyone. In addition, it is very helpful to have a list of assets with the names and addresses of banks and financial institutions. That can save a frantic rush to find assets if a sudden medical event prevents parents from telling the children where to 
look for financial information. Starting these conversations is important. After that, action should be taken to meet with an elder law attorney who has experience in dealing with long term care issues. An elder law attorney can aid decision making by matching family desires with the funding sources available for long term care. It will maximize the likelihood that the family’s assets and income together with state or federal aid, can keep parents at home or in the best living situation possible, for the remainder of their lives.