This just isn't "pretty." It's difficult to think about what happens when we get old, sick or disabled. Most people would prefer to read happy, uplifting news, Hollywood gossip, financial market analysis or even political happenings. What led me to write this blog post was a sobering conversation that I had with Tom Begley, Jr., one of the nation's leading elder care and long-term planning attorneys. He has spent more than 40 years in the field helping families, from the poorest to the wealthiest, in navigating the precarious road to providing viable, reliable, cost-effective, long-term care. When Tom began telling me about some of his clients and their plights, he commented, "We go through a lot of Kleenex in our office." Wow! This is further complicated by the huge emotional burden of a promise made to a loved one (most often a spouse of 50-plus years) that they will never put them in a facility! If only a long-term plan had been started at the time of the promise...
If you have clicked through my blog and are reading this piece, it probably means that you have some personal experience with caregiving. That's what motivated Tom Begley, Jr. He was a young, practicing attorney when he needed to deal with his own parent's care. The field was barely established some 30 years ago. Today, there is formal certification for elder law attorneys, thereby providing an extra layer of protection in the caregiving minefield. This "minefield" is laiden with a variety of dangerous explosives, including emotional, financial, and legal bombs. Don't walk alone; its impossible to understand the laws, rules and unwritten rules that pervade this bumpy, fragmented world of long-term care. Engage some expert advice from a certified elder care attorney before the crisis happens.
During our chat, Tom frequently made the distinction between a "crisis client" and a "planned client." As you might guess, he estimates up to 90 percent of his clients are "crisis-clients." A disastrous health event has already occurred and things are spirally out of control. If only a long-term care plan had been made...
In order to help clients, Tom (and other certified elder care attorneys) drafts a detailed step-wise plan. One of the most important action items is to identify assets and create a spend-down plan to protect assets while qualifying for the all-important and comprehensive Medicaid benefits. Tom says, "Medicaid benefits are meant for the public. It gives me great satisfaction to help families preserve their life savings." "Spending down" is a method of deploying assets towards necessary expenses, including paying the attorney for this work, pre-paying funeral expenses, making home improvements, buying a new car, etc. The idea of "spending down" is the one of the most controversial aspects of a long-term plan. Most middle-income families are proud of their life's savings, which may represent 50-plus years of work. The notion of "giving" away money to children and other family member's creates an emotional reaction of "No, it's my money and I saved it for my retirement." This is a knee-jerk reaction to the perception that they are no longer in "control" of their money, life, etc., and that they are now on "public assistance." Nothing could be farther from the truth! Long-term planning and gifting assets legally can assure more control and longer at home care as a result of preserving the caregiver's health and well-being through planning rather than crisis control. Medicaid, Medicare and veteran's benefits are for the benefit of the public, and that means you!
Here are the five essential steps of long-term care planning:
1) Define your goals. What is the level of care desired? Usually remaining at home, when possible.
2) Buy long-term care insurance, if possible. Recently, Metropolitan Life announced a discontinuance of this type of coverage. Others will surely follow suit.
3) Hire home aides through an agency. They will be screened, bonded and supervised by an agency whose business relies on providing such caregivers. Get references!
4) Consider hiring a geriatric care manager to independently assess caregiving needs, create a plan of care, monitor and make changes to the plan as needed. This outsourcing will remove considerable burden from the family.
5) Retain a certified elder law attorney and to assist in financial and legal planning and, most importantly, to help in accessing public benefits like Medicaid, Medicare and veteran's benefits.
While each of these steps does cost money now, it can insure the best-quality long-term care and save you money in the long run. This is not easy! This isn't a fluffy story about finding a lost dog, the latest antics of the Kardashians, NASDAQ quotes or even Obama's current ratings; this is hard news and tough love. I blog about this because I feel compelled to alert others to the tsunami of caregiving that will occur as the burgeoning population ages, and this wave will continue for many years to come.
As a mother, I can tell you that providing guidance to your children in anticipation of life's challenges is good parenting: I strive for the goal of preparing my children for life's ups and downs. You are a child, parent, aunt, uncle, mother, father, sister, brother or grandparent or some combinations of these roles. I urge you to talk to your family this Thanksgiving and begin the conversation of "What will our family's long-term plan look like?"
At that point, you will see which family members will push their plates away and which will begin to overeat! Please pass the turkey!
Follow April Rudin on Twitter: www.twitter.com/TheRudinGroup
Marguerite Manteau-Rao: Seniors at the Top: Moving Toward a New Paradigm of Institutional Elder Care
Marki Flannery: Home Health Aides: On the Front Lines of Caregiving
Kate McGovern: The Good Silver
April Rudin: Life After Caregiving: Reclaiming Yourself And Picking Up The Pieces
Buy a policy that meets the federal guidelines-that's called a "tax-qualified policy."
Buy a policy that meets your state's guidelines-that's called a "Partnership-qualified policy” (unless you live in CA or NY).
Buy a Daily Benefit that is high enough to cover most of the cost of care in your area.
If home care is important to you, make sure the policy allows for all of the Daily Benefit to be used for care at home.
As a general rule, buy a policy that has a "Policy Limit" that is equal to the amount of your net worth that you want to protect for yourself, spouse, or heirs.
If you’re healthy, you should probably purchase a policy on your own, rather than through your employer.
Lastly, shop around. LTC insurance premiums vary a lot from one company to the next. Your age, health, and choice of benefits have a big impact in determining the premium. Get quotes from at least 9 of the top companies before choosing your policy.
Scott A. Olson
www.LTCShop.com
http://www.pbs.org/wgbh/pages/frontline/facing-death/?utm_campaign=homepage&utm_medium=bigimage&utm_source=bigimage.
Dustin Rudolph
www.PursueAHealthyYou.com
She doesn't want to go on if her mind goes, and she's not sure about going on when she can no longer care for herself. She's seen how "long term care facilities" generally treat their "clients", and I wouldn't wish that on a cat (even a cat I didn't like), let alone a person.
Everyone who knows me knows that if my mind goes, sit me in a car with the garage door closed and the car running for an hour and the problem will take care of itself.
I would rather die than be a burden to anybody.
I was a long-term caregiver for my mother who had Alzheimer's. She was truly a precious soul, and we made the best of it. She never complained. She appreciated everything that was done for her. I respected her choices and wanted to help her face the increasing disability. i had more problem with sibling disagreement over care. And, I was shocked at how common that problem is. So much is due to not communicating with each other earlier in the experience.
While I believe that consulting with an elder law attorney is a good idea, there is something I would do even before that--make a living will and designate someone as your health care representative who could make decisions for you if you weren't able. You can probably get the forms at your doctor's office and tell your doctor of your intent. For those who don't have such forms made out...well, consider the horror of the Teri Schiavo case in Florida.
Somehow we have to convince people of the seriousness of such considerations...the importance of minimizing those crisis situations when you suddenly have to deal with the disability or death of a loved one.
I know the two most beneficial aids we shared were love and laughter. It's also enriching to tell your loved one--"I will be with you no matter what."
May we all find a clear path and course of action for our later years.
My husband died last year 2009 from Alzheimers. I am younger, and we had only been married for 10 years when he was diagnosed.
I'm just appalled by how many people in their 40s or 50s are CLUELESS about how their family member really IS.
My husband was the sweetest and smartest man I ever met. We both had grown kids (7 between us) and were so proud that all 7 owned his/her own home before they were 30 years old.
But my husband lucked out when he got a wife like me. I am alert to stuff; I'm a professional AND INTERESTED, and I was physically able.
I cared for Don here at home until he died. But I'll never forget how clueless his grown kids were.
I would NEVER have let any of them have signing rights to anything.
Our kids in their 50s acted like it was all THEORETICAL. Trying to reason with grown kids on the phone was like talking to 3 year olds.
Its scary when I think most of you out there think you are doing something great when you sign some papers, then hire an Attendant.
There's tons of stuff kids just don't get.
God Bless your family members soul. They're going to need it.
The Holiday Season is a quality time to talk with your family about your life planning. Many things in life can be planned so when the unexpected occurs (and it will) there are plans and benefits in place to meet that need.
Thank-you with writing your thoughts and articulating what we all need to do from time to time....planning and sharing with family financial and personal thoughts which not only effect us but will have an effect on our children; family; and friends.
Raymond Lavine
Gig Harbor, Washington