A close friend with an aging father who lives out of state recently asked me for advice on how to broach the topic of his care.
My friend had just returned from her annual holiday visit and was alarmed at her father’s decline in health – his trouble with routine activities and tendency to ask the same questions repeatedly. She felt badly about leaving him to return to California, not to mention guilty that she didn’t discuss his care while with him because she was afraid of insulting him.
“I felt like I missed a crucial opportunity,” she told me. “How could I have done it differently?”
I explained to her that indeed this is one of life’s most delicate dances – talking as an adult child with one’s elderly parents about their long-term care, finances, legal, health and medical issues.
I asked her a very pointed question: Had she taken care of the very things in her life that she wanted to discuss with her parents? Did she have a living will or an advanced directive? Did she balance her own checkbook? And if not, how could she give credible advice to a parent if she hadn’t followed it herself?
I helped her see the situation as an opportunity to explore the issues together by getting her father’s input on what she should do with her own children. I suggested that she ask him what legal documents she should get in place, and that they approach it as a project they could do together. He could offer his life’s wisdom and experience, and she could use her organizational skills to ensure that they both took care of these things.
Getting started is the hardest part. There are numerous areas to address, and they can’t all be accomplished at once. Following is a quick overview of key areas that should be addressed. The issues are usually interrelated, but I suggest setting an appropriate timetable for tackling the most important things first, based on the deficiencies in your family’s planning.
• Short term: Managing checkbooks, bank accounts, investment and retirement accounts, credit cards, expenses, getting medical reimbursements, securing valuables such as jewelry, preventing fraud scams and tax preparation.
• Mid to long term: Managing assets and investments to provide income for living expenses, medical and nonmedical care and housing, as well as tax and financial estate planning.
• Estate planning issues such as establishing a living trust to designate disposition of assets after death.
• Incapacity planning that provides instructions on health and financial decisions prior to passing away. Advanced directives, Physicians Orders for Life Sustaining Treatment and other written directives are important to clearly articulate one’s wishes.
• Medi-Cal planning to help structure assets properly.
• Regular physician checkups, medication reviews and medication setup and monitoring.
• Medicare and health insurance – compare supplemental plans, make sure reimbursements are being paid.
• The right medical team: Is it time to move from your family’s internist to a geriatrician?
Residence and custodial care
Chances are high that you will need some form of nonmedical care to provide assistance with activities of daily living. It usually comes as a surprise to many that Medicare doesn’t pay for this type of care, so the onus falls on family members or an outside party. Home care agencies like mine provide assistance in the home as well as at independent-living facilities. Assisted-living facilities provide some level of care that may need to be supplemented by an outside entity like a home care agency or privately hired caregiver.
Mental and physical health
Perhaps the most challenging of all of these subjects is maintaining and improving one’s health. I have learned over time that the best way one can maintain his or her health is with the support of friends and family, including making dates to walk, participating in hobbies and listening to music together. Crossword puzzles keep us mentally sharp. Explore your individual interests and get others involved in doing them with you.
I’ll be writing more in-depth columns this year to delve deeper into each of these topics, with the goal of providing a framework for families to think about the issues they should address and ways to kick-start those efforts.
Greg Hartwell is managing director of Homecare California, 885 N. San Antonio Road, Suite R, Los Altos. He is a frequent guest speaker on elder care issues. For more information, call 324-2600, email [email protected] or visit homecare-california.com.