Wednesday, December 4, 2019

How to Have A Family Conversation with Aging Parents at the Holiday

Happy Holidays! 

Is It Time to Have a Conversation About Long-term Care with an Aging Parent?

Like many families, mine is scattered all over the United States.  Work and other commitments make it difficult to visit distant loved ones more than a few times a year.  When visiting, it is hard to gauge the health and safety of family members because they are often not going about their normal daily activities. 

A few years ago, while visiting my dad in Oregon, I noticed that there was something not quite right with him.  He was repeating himself and telling stories about his history that I was pretty sure were not true.  He and his partner covered for each other, finishing sentences when the other couldn’t come up with the words and reminding each other what they had done during the day.  When I asked whether they had eaten lunch, his partner asked what time it was. When told that it was 2:00p.m, they said that they must have eaten lunch since they always ate at 12:00.  They couldn’t tell me what they had for lunch, however. His partner did tell me that my father had gotten lost for several hours while driving. I also learned that my father had been paying his rent twice each month, because he could no longer figure out how to keep track of his checks.

After that visit, my siblings and I decided to have a conversation with him to discuss his plans for the future.  We were apprehensive about the conversation because my father was very protective of his independence, secretive about his affairs, and he also had a bit of a temper.

We started the conversation by asking Dad if we could talk about his plans for the future.  We assured him that we were not trying to take over, but that we wanted to make sure he was safe and that we knew what he wanted to do in the future.  After he agreed to have the conversation, we asked Dad if he knew where his will and powers of attorney were stored.  He showed us a notebook with a will and a power of attorney, both over ten years old and prepared in another state.   I wasn’t sure those documents would work in Oregon, so we agreed that I would make an appointment with an Oregon elder law attorney to draw up some new documents.

We discussed our concerns about his health, and asked if he had thought about where he would like to live, should he and his partner no longer be able to live in their own home.  He mentioned that he had noticed a senior living facility a few blocks away that we could visit. Next, I asked Dad to tell me what money he had available for future living expenses. He showed me his long-term care policy and told me that he had a pension and social security, along with some savings. 

Finally, I asked Dad if I could set up an appointment with his doctor and accompany him to that appointment.

In the next few months, we met with the attorney who then drafted a trust, a pour-over will, a financial power of attorney, and a health care power of attorney. Once we had the trust and powers of attorney signed, Dad and I visited his bank and his financial advisor’s office to introduce me and to give them copies of the trust and power of attorney.

Dad and I visited his doctor, who diagnosed Alzheimer’s disease.  With that diagnosis, I realized I needed help finding the right living situation for him.   We hired a geriatric care manager to assess him, and to recommend appropriate placement.  The geriatric care manager recommended that we hire home care for a while, followed by placement in an assisted living facility when and if it became necessary.  The geriatric care manager provided us with a list of her preferred facilities so we could start visiting them.

Ultimately, that meeting provided us with the plan we needed to help my dad as he gradually needed more assistance and as he and his partner later made the transition to a memory care facility. 

Here are a few things to consider when having the conversation with aging loved ones:

Who should be in the conversation?

In our case, it was just Dad and the adult children, but you might need to have significant others involved.  In our case, the partner was not really able to participate, though her wishes certainly colored our decisions about our dad’s care.

A truly productive meeting might include caregivers, attorneys and financial professionals.

What should you talk about?

Discuss the person’s vision of their later years and encourage them to express the thinks they definitely don’t want. 

Ask about legal documents.  The three most important documents are a will, a durable financial power of attorney, and an advanced directive for healthcare.  The documents should be fairly recent.  If they are over five years old or were executed in another state, you might want to suggest a visit to the attorney’s office for a review.  An elder law attorney can also discuss public benefits that might be available for care in the future and how to qualify for such benefits.

Ask about the person’s financial situation and ask to see their financial statements.  Discuss the cost of long-term care to determine whether there will be enough money for the future.  If there is not likely to be enough money available for care in the future, talk about other resources that might be available through public benefits, family members or friends. 

Are there any health issues?  Find out what health insurance the person has.  Do they have a Medicare supplement?  Get the name of the primary care physician, as well as any specialists.  Also, discuss what prescription medicines the person is taking, and what the person thinks they are taking the medications for. 

If care is needed now, discuss who will provide the care?  How will care be paid for?  If care is to be provided in the home, is the home safe?

What care facilities are in the area or close to family members?  Will the person have to move to another state to be near family or friends?  Visit some care facilities to get a feel for what the person may be comfortable with.  Discuss whether the person will be more comfortable in a large facility with lots of residents or in a smaller facility and whether there are activities the person wants to participate in, such as swimming, dance, bingo, etc., or will they be happier with fewer activities?

After the meeting, you can develop a written plan to refer to in the future.

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