How to Care for Aging Parents

One day, our parents won’t be able to drive a car, climb stairs, or maybe even change clothes or feed themselves. As painful as the thought of it may be, we need to prepare to help them feel comfortable and safe in the later stages of their lives. Here’s what to consider.

No one wants to think about their parents at the end of the day, let alone talk about it. In fact, according to a study by Merrill Lynch and Age Wave , 75% of adults did not discuss things like retirement conditions, long-term care, inheritance, and funerals with their parents. But not only we, adult children, avoid “loud conversations” – almost a third of people aged 50 and over have not even spoken to their spouses yet.

This is the elephant in the room. It is also one of the most important and challenging topics that you and your family will ever face. Unfortunately, one day your parents might be okay and the next day they suddenly need serious care, so the better you prepare in advance, the less stress your entire family will be.

Arrange a family meeting for “Conversation”

This is not the kind of conversation you might suddenly have one day on the phone with your parents and siblings: “So Mom, have you thought about moving to a nursing home?” – or during a holiday visit, when stress and family conflicts are more likely. It is best to schedule a family meeting with parents and siblings (if you are not an only child) and prepare for it by reevaluating your own financial situation and feelings. (This can be the hardest part to get over your own grief as you reflect on your parents’ final years and no longer have them in your life. Have a box of tissues handy.)

When setting up a meeting, you might say, “The purpose of this meeting is to talk about how to help Mom and Dad take better care of their needs and wants as they get older” (or something similar, but less awkward). Your parents or your siblings may not want to talk about it, but emphasize that it is important that everyone is involved.

Shelley Sun, CEO and co-founder of BrightStar Care , offers the following tips:

• Talk in person. Video chat, phone, or email will not bring you genuine emotion or feedback.
• Prepare questions ahead of time so you don’t rush or try to collect your thoughts. (See below for some questions.)
• Pay undivided attention during the conversation so that you don’t feel like you are imposing an agenda.
• Write down the important points in a notebook so that you can write down details and refer to them in the future.

Depending on your family, this could be a very hot conversation, a very quiet one, or maybe one that draws in all your emotions. Whatever you do, listen. This might be the best example of when you need to stop thinking about what you have to say next in order to truly listen to what the other person is saying.

Okay, so what do you need to discuss? The big question is where your parents will live until the end of their days and how to pay for it. You will want to talk about: your parents’ current well-being, what their plans or hopes are when they can no longer live on their own, their financial resources, and how you (and your siblings) can help. The information below can help make this awkward discussion smoother.

Find out the needs and wants of your parents

During the discussion, find out what your parents’ plans, if any, are. Do they want to “grow old on the spot” (stay in their own home) or move closer to one of their children? Would it be wiser to move to a less expensive home – perhaps a community of seniors living on their own (also known as a retirement community), where they have more interaction with other seniors? Or is their needs better met in a nursing home or nursing home? (We’ll look at those options in a minute.)

You and your siblings should also monitor your parents’ current health and their ability to live independently so you know if they need help now. Stacy Hilton of the Visiting Angels advises us to look for these warning signs:

• Bad eating habits – weight loss or lack of appetite – can they still cook for themselves? Do they fill their refrigerator with healthy food?
• Poor hygiene – do they have body odor? Do they bathe and change clothes like they used to? Do they neglect their nails and teeth?
• Neglecting their home – isn’t it as clean as you remember?
• Forgetfulness is a good indicator – burnt pots and pans, it shows that they may forget that dinner is being cooked on the stove. Also, do they miss appointments or do they have a lot of unopened mail? Are they losing money, paying bills twice, or hiding money?
• Support system – do they have a strong support system in the city that they can rely on if they need help?
• Mobility and driving – still mobile? Can they get out of bed, climb stairs, and shower without slipping or falling? Can they still travel safely to the grocery store, doctor’s appointment, etc.? (A good way to determine this is to check the car for new dents, scratches, etc.)

One of the most terrifying topics, but which may need to be discussed earlier than others, is “the conversation about the car keys.” If your parents can no longer drive safely, you will need to convince them to hand over their car keys or legally collect them if necessary .

For more information, see This Helpful Safety and Wellness Checklist for Seniors (PDF) from A Place for Mom.

Weigh your care and housing options

Your parents may be quite independent today, but chances are they will need long-term care one day (by some estimates, at least 70% of older adults will need it). There are several types of long-term care solutions, from community-based caregivers to home-based care. Choosing the best one depends on your parents’ health needs, your resources, and your collective wishes.

Nursing Communities (also known as personal care homes) are for seniors who can no longer live safely on their own but do not need 24/7 medical care. Residents live in their own private apartments and services provided include day-to-day assistance, medication, meals in the common dining room and housekeeping. Some take Medicaid, but most are privately paid.

• Median Cost (at LongTermCare.gov ): $ 3,293 per month for a one-bedroom apartment

Nursing homes provide high-quality medical care for the elderly and are the best choice for people with complex medical conditions, as licensed nurses are available 24 hours a day. Permanent residents usually live in the same room (but there are also separate rooms) and eat together in the central dining room. Most people also pay out of pocket for nursing homes, but you may be eligible for Medicaid assistance to cover these (very high) costs if you run out of money.

• Average cost: $ 205 per day or $ 6,235 per month. For a single room: $ 229 per day or $ 6,965 per month.

Home care services allow seniors to stay in their homes by receiving assistance from home health workers with daily activities (ADL) such as bathing, dressing, attending appointments and preparing meals. You can hire personalized home care services once a week, daily, or for 24/7 care.

• Average cost: $ 21 per hour.

Adult Day Care Centers are community centers where seniors can receive health care, social activities and therapeutic services. They offer a respite for family members (especially workers) and a social environment for seniors who do not need 24/7 care.

• Average cost: $ 67 per day

There are other options, including independent residential communities (retirement villages for seniors who are very independent and have few medical concerns) that cost between $ 1,500 and $ 3,500 per month, and temporary care for short stays.

Here are some retirement housing options :

These are just average costs that vary by region. For details for your location, go to this interactive map at Genworth for state and regional average prices.

Once you’ve decided on your type of residence, compare your neighboring seniors’ communities in the following locations:

• Medicare Nursing Homes Comparison: Medicare and Medicaid Certified Nursing Homes, along with Ratings, Review Reports, and Other Quality Metrics
• Eldercare.gov : Service search Social Services for the Elderly Department of Health and Human Services, where you can find day programs for adults, housing options, home services, and other assistance.
• A Place for Mom : A free service that finds older communities according to your needs (FYI, they get paid by their partner communities)

Decide whether to be your parent’s guardian

The numbers above are likely to shock those of us who haven’t thought about parenting needs as they get older. (In New York City, the average cost of a semi-private nursing home ward is over $ 10,000 a month. ) With the cost of long-term care so high – often more than we could earn in a month as a whole – nursing may be the most affordable option. for parents in their own home or moving to yours. If you have a strong relationship with your parents, this is also an option that you might lean towards in the first place, as sending your parents into the house can (unfairly) feel like you’ve been abandoned. But there are some very important considerations here.

Emotional Damage: Being the primary caregiver and living under the same roof with your parents again is a huge role reversal. Now you take care of mom and dad, people on whom you hoped to receive support and strength, but whose health and quality of life may deteriorate before your eyes. Not everyone will have the emotional and physical strength needed for daily chores such as bathing, feeding, or dressing elderly parents, especially if they are frail, seriously ill, or have trouble remembering who you are. Just thinking about it is just awful.

Logistic concerns: On top of that: you may not have much space in your home to begin with, currently you can live and work thousands of miles, and your workplace may not be very flexible over time to take care of yours. parents (who can be considered dependents in the same way as your children). You may have to make a number of sacrifices, similar to those that parents make to their children, but in some ways even more difficult.

Financial Cost: If your parents stay in their home or your home, you still have to hire a home health assistant (perhaps thousands of dollars a month) and do home improvement projects that make life easier for seniors , such as changing your home … a kitchen with cabinets and appliances that reduce the need to bend, or a bathroom remodel that replaces a bathtub or traditional shower with a walk-in shower.

Sharing the “burden”: if you have brothers and sisters, it gets even more difficult: who will take responsibility? A brother or sister who does most of the care can easily take offense at others, and those who do not care for them can feel guilty. In this case, Diane Carbo, RN, proposes to enter into a family care contract in which the family member who takes responsibility for the elderly parents receives payment from family funds. This reduces resentment and may provide other benefits:

Having a formalized contract with a guardian can allow older people to use their assets to stay at home, receive quality care, and financially reward the caregiver. This can provide protection for the caregiver’s family member in the event other family members file a lawsuit following the death of an elderly senior. Unfortunately, this happens more often than you think.

(Why is it so hard to be part of the family ??)

Ultimately, this decision should be most influenced by the health and needs of your parents. If they need 24/7 care or have complex health problems, they are likely to be better off receiving long-term care housing. On the other hand, if you can take care of them, there is something to be said for spending the same amount of time with your parents before they die . Whichever option you choose with your family, remind everyone that it is important to remember your parents’ best interests.

Tidy up property and financial resources

Surprise: Regular health insurance and public health care do not cover long-term care, such as nursing home or nursing dorms (if they do, it usually is only a small fraction). Whether you take care of your parents at home or they stay in the care facility, the financial costs are enormous . To pay for your parents’ care, you need to use their retirement funds and other assets, your own savings, and / or perhaps use long term care insurance or similar products.

Your parents’ property. Now it’s time to have a good overview of your parents’ net on the amount of savings are their pension and other assets (such as their home) minus their debts. Also consider social security, pensions, and any other income. Do they have enough to cover monthly living expenses and additional long-term care costs? You can use this calculator from Mutual of Omaha to determine how long their money will last based on regular findings.

This is also a good time to establish financial oversight on your parents’ accounts: add them as a joint account holder to their bank and investment accounts so you can track suspicious payments and ensure that bills are paid, collecting the most important inheritance planning information. paperwork , and start all this painful preparation .

Own savings. It’s complicated. You are saving money for your retirement – perhaps just a few years from now – and maybe for your kids’ college as well, but you also want to support your parents. If you plan ahead, you will hopefully find some wiggle room in your budget to save money on long-term parenting, or at least allocate windfall revenues such as unexpected bonuses to this fund. Agingcare.com found that about a third of Americans spend $ 300 or more a month out of their own pocket on care costs, including everyday items like groceries and medical co-payments.

Again, if you have siblings, this can be both more difficult or easy. Should you all contribute the same amount for the sake of fairness or on a sliding scale if one brother earns more than the other? This will depend on the dynamics of your family.

Long-term care insurance. Long Term Care (LTC) insurance could cover costs that are not covered by conventional health insurance and Medicaid, such as the huge costs of nursing homes. Janet Perry of Napa Needlepoint says:

We bought it for my mother-in-law when she was healthy and in her late sixties. In the last years of her life, she broke her hip 3 times, which required hospitalization. That would clean out all of her money [without] insurance.

For my mother, it was a long time ago, until she was 80 years old. She moved to a nursing facility that replaced long term care. But she had a broken ankle and several other complications that kept her in the hospital and fell out of it for 13 months. If she was not insured, this would not only use up all of her money, but it would also use up a significant amount of money for my brother and me.

Knowing that they can handle it is of the utmost importance.

The other side of LTC: it’s huge costs. Premiums have skyrocketed over the past few years and some insurers have pulled out of the LTC business altogether due to rising home care costs. In 2012, a healthy 60-year-old couple could pay an average of $ 3,335 a year for a policy that paid out $ 340,000, but that was before 90% surges in premiums became the norm. Consumer Reports offers helpful advice on buying a policy. As with other insurance products, it is about balancing risks.

Forbes recommends considering an annuity instead. The annuity will cover the costs of not only staying in a long-term care facility, but other costs (your parents may not need long-term care), such as rent and groceries, plus you don’t have to fight the insurance company to collect on the policy. Bank Rate offers other alternatives , including life insurance.

Your best bet is probably to consult with a certified financial planner because all of these products have their pros and cons, as well as fine print requirements. Be especially careful with financial products aimed at seniors, such as reverse mortgages, advanced funeral planning, and, yes, long-term care insurance. While they can be helpful, some service providers try to take advantage of families in this delicate situation.

Support your parents emotionally and take care of yourself

Finally, it might not just be one big conversation – it might be a series of them. Both you and your parents and your other family members will probably find it difficult to talk about it because honestly the situation sucks and there are so many things to consider. Candy Wingate, President of Care4Hire, advises:

Be supportive as your parents are more likely to grieve over this process. This transition represents abandoning the home in which they raised their family, embracing the fragility that comes with age, saying goodbye to friends and neighbors, and reconciling (at least in part) with aging and mortality. You and your brothers and sisters may also grieve over this process. Support each other. To love each other. Goodbye freely, as temperament can flare up as an expression of grief. In addition, the support of friends and extended family is critical. The institution your parents are moving to may offer counseling services to help you and your family cope with the upcoming transition.

As with any difficult life decision , the best thing you can do is get information and communicate honestly with those involved – be brave, strong, and patient. While the focus here is on caring for your parents, be sure to take care of yourself during this difficult time.

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