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.

Medicaid rules in Connecticut are very strict and with nursing home costs reaching $18,000 a month, it is a frightening thought for families whose loved ones are at an age where full care might be needed. There are numerous exceptions to the rules, such as not counting the family home (up to $955,000) if one spouse is living in it. But there are numerous sellers of “trusts” hinting that if you buy their trust, assets can be protected. In my experience, this is almost never true because most of these trusts are revocable, and that means the money put into it can be returned to the person who needs it during their lifetime.

When one spouse needs long term care, at home or in a nursing home, the other spouse is termed the “community spouse.” Then the Medicaid rules set out what the “community spouse” can keep for income and assets. The intent of the laws and regulations is to allow the community spouse to have enough income and assets so that he or she has enough income and assets to continue to live at home, whether that be a home, an apartment, or other living place.n.

A wonderful couple recently met with me about taking care of the wife’s parents. They have been dedicating all their spare time and more to help the parents at home and were frank that giving care full time is not an easy job. Another comment they made is that it is a big learning curve, which is true. It not only involves the physical, but the financial and legal aspects as well.

The physical part is what kind of care is needed and how much. Is it simply helping with household and personal tasks due to mobility, or cognitive issues? Or is it help with bathing, dressing, feeding, and more? If the parent is fully on board with getting help, that is a big plus. But if the parent is resistant to accepting help, that can be a big strain. And that often happens, because it is not easy for anyone to admit to themselves that they cannot do certain things safely or properly. It is a sign they are losing their independence and no one likes that. So the child caregiver has to learn how to suggest, encourage and motivate that parent who raised the child decades ago, to limit certain activities, such as using a stove, or going up and down stairs, or
bathing without supervision due to risk of a fall..

When a married couple is faced with long term care for one of them, whether at home or in a nursing home, the fear of financial ruin is strong. But Congress has passed what is called the spousal impoverishment rules, which is the opposite of how it sounds. The are designed to protect a significant portion of your life’s savings, and if used properly, these laws will protect most of a typical family’s assets, but they must be transferred into the healthy spouse’s name. That may require having the all important Power of Attorney if the sick spouse cannot sign.

Many families needing in home care for a parent use children or other relatives to provide that care. The family members often feel they should do that care without compensation, out of love and loyalty. But if they cannot afford to go without pay, that can cause much financial harm and distress for them. It is often a difficult subject to discuss if that elderly family member needs help with bathing, dressing, toileting or transferring from bed or chair to another place.