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Discussing Long-Term Family Care During Thanksgiving

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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!

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