AgingParents.com provides coaching and consulting programs for those who are having difficulty with aging loved ones or clients. We address issues about loss of financial capacity, family conflicts and other matters of aging. We serve financial service professionals, families, caregivers and those in the elder services industry.
Reaching retirement age is maturity, and a different responsibility for us and to our loved ones. Every person needs a checklist to ensure that their new status includes preparing their families with essential information and paperwork.
1- Decide whom you want to communicate with about your future. Set a date and sit down together.
2- Have a signed, notarized durable power of attorney
3- Have a signed advance health care directive (You can get items 2 & 3 free on the internet)
4- Make a list of all bank accounts, passwords, hard drive backup, investment records, and financial planning you have done, with people to contact. Give written permission to your loved ones to talk with your lawyer, accountant, and financial planner.
5- Make a list of all insurance policies, including life, disability, health, property, earthquake and anything else you own that will protect your heirs.
6- Make a copy of your mortgage statement, any other loans, and debts, financial statements and bank statement. Keep in one place. Update quarterly these change.
7- List your physicians, care providers, and medications. Give written permission for your loved ones to speak with your doctors.
8- Create or have on hand information about your wishes for burial or disposition of your remains.
9- Update your will and/or trust with a local attorney. Laws change and these need to be up to date in your state.
10- Have a family meeting to give items 2-9 to your loved ones and explain them.
Women in our country have gotten a lot of attention lately with focus on sexual harassment, domestic violence and unequal treatment by employers. There is another important area that is not getting attention in the focus on women: the role of caregiver for aging parents. This role, too, spreads responsibility very unequally on women compared with men in many families.
At AgingParents.com, we work with families of aging parents all across the US and in doing so, we see common themes. Most often (in our unofficial poll, it’s about 85-90% of the time), women take the lead in spotting warning signs that an aging parent needs help or is going to need help soon. Responsible women, often successful in business, professions, or any work are the ones to bring this up and let other family members know what they see. The response typically is that other family members say in so many words, “OK, go ahead and take care of it.” Unless these forward-thinking women in families insist on equal participation by all capable siblings or others involved, the burden falls squarely on themselves. They take on the caregiving, they quit jobs to do so, they cut back on work and fill the need in the family.
There are many responsible sons, to be sure. There are many brothers, nephews, and uncles who share the load right along with sisters, but from our admittedly limited perspective, they seem to be in the minority. Here are some typical excuses were given by the less-than-involved that we hear repeatedly:
“She’s better at doing that than I am”
“I’m really busy”
“She lives closer”
“I don’t like to see Mom (or Dad) in that condition”
“I make more money than she does, so it’s better if she’s the one to quit her job to take care of our parents”
“She’s a woman and that’s really her thing, so she should do it”
The last comment, jarring as it is, reflects the gender bias that is so much a part of our society’s view of women. Some things, like taking care of frail aging parents, are “our job” which excuses men, in their minds, from having to do that work. The shirking of the burden of caregiving based on gender should no longer go unquestioned.
Our current political dialogue can be beneficial to anyone facing the care of an aging parent if we take the opportunity to raise awareness of inherent gender bias. It is time to overthrow the status quo here too. Taking on responsibility for the care and safety of aging loved ones is everyone’s responsibility. If a male family member lives farther away than a female family member from the aging parent, and hands-on care is not practical, the more distant person can give money, pay for relief caregivers, or take time off and pitch in on your personal or vacation time from your job. That’s what women often do without being asked.
Those who live at a distance from the aging parent and sometimes from the sibling who is the primary caregiver, can pay toward elders’ support, manage the bills, set up appointments, arrange transportation, offer home maintenance, grocery delivery or whatever is needed that can be handled remotely. The excuses for avoidance do not stand up. Every unimpaired person in a family can do something.
On International Women’s Day let’s turn our attention to how inequality in families affects women in their role as caregivers for aging loved ones right here at home. We can change this, just as we are changing the way women are treated in the workplace. To get there, we must stand up and speak up. It’s time.
To learn more about how we help families sort out the challenges of caregiving, visit our website: www.agingparents.com .We also wrote a book that helps answer all your questions and guide you in the right direction: “The Family Guide To Aging Parents, “click Here to learn more.
Many of us will be impaired at some point late in life. We may need someone to articulate our wishes about healthcare as we near our end. How do we choose the right person or persons? What do they need to know? The American Bar Association offers a free Consumer’s Tool Kit For Advance Healthcare Planning, which most people have never heard about. This is to introduce you to the toolkit. In a series of these posts, I will go through some of the tools in it that I recommend and will discuss how to put them to use. I’ve tried them with my own adult children and we’re on the right track. They work.
Here at AgingParents.com, we see many struggles over these issues in our clients, most of whom are the adult children of aging parents. The parents are in declining health and some have dementia. Most of the adult children are taking some responsibility for their aging loved ones, either financially, with various aspects of caregiving or both. In every case, after addressing the first identified needs they have for advice, we bring up the issue of planning for the end of life issue. Folks squirm in their chairs when this is raised. No wonder. It’s uncomfortable. And talking about it is hard, but we have to do this if we want any sense of control over our journey out of here. Most people do want to feel in control of what happens to them. Help your aging parents and yourself get that sense of control.
Tool # 7 in the Tool Kit is a 10 question quiz that raises various scenarios about which you would want to make a decision or have your assigned person make a decision for you. One example is the possibility of having Alzheimer’s disease and being unable to recognize anyone anymore. It asks if you were in that condition and could not eat, whether you would want to be tube fed. This kind of specificity is exactly what you or your loved ones need to know. Should you be in a position to answer the medical staff’s question on tube feeding about your own aging parent, you will know what to say. I personally had to answer that question for my own mother’s doctor when she was no longer able to speak near the end of her life. I did know what she wanted. It is empowering to know what to do, rather than to let others decide for you. If no one knows what the aging parent wanted, the default position of medical personnel is usually to treat and treat and treat, regardless of what others might guess about what the elder would have wanted. Try it out by downloading the free toolkit with this quiz in it so you can help yourself or the ones you love. It may be uncomfortable but it ultimately brings peace of mind to all involved.
Most of another, or us, at one time, know someone who has to spend time in a long-term care facility. It could be an aging parent, a friend or you yourself. These places are called “rehab”, nursing homes, long-term care homes or skilled nursing facilities. What makes them different from other places where those recovering from surgery or medical events go is that skilled services are available daily. Skilled services can include nursing, physical, occupational and speech therapy and other outsourced specialists who can visit the home.
As one might know about our healthcare system, in general, is that it can be very disjointed, with poor communication among service providers. This can lead to unsatisfactory care or even harm to a resident. Vulnerable residents who can’t speak for themselves are at particular risk. What can the family member or friend do about this?
One option most don’t hear about is to ask for a “care conference”. This must be done at the family or resident’s request and the facility is required to make this available. They likely won’t tell you this, but now you know. I recently made such a request for a disabled brother in a rehab facility who had suffered a heart attack and needed therapy in his recovery. The different therapists there apparently did not talk to each other or read the record. My brother had had a stroke a few years earlier and his speech is impaired. The speech therapist that I’d spoken to a few weeks prior to the conference did not read the record and had seen my brother without knowing that he had impaired speech from a prior stroke! That set off alarm bells. Besides educating him, I realized that a care conference would be needed to get all the people involved together in one room so that all understood my brother’s problems and the rehabilitation goals more clearly.
We set up a time and date for the conference. I asked for all the therapies to be represented, along with the nurse in charge. I flew into town to attend and met another relative on site, one who lived closer and visited more often. A general care review was done and we, the family made suggestions and requests. The staff were cooperative. They needed to understand my brother’s personality and his history, what he historically could do and not do and how he went about things. My hope was that the care conference would correct the ineffective approach some staff were taking and help them be of better service to my brother, who could not communicate very well.
Follow up will include holding them accountable for what happens and to stay on top of meeting his needs as well as possible. We do that with regular phone calls to the charge nurse whose job it is to coordinate care.
The takeaway is that anyone with a loved one in a care facility for rehab needs to know that you have a right to ask about and question care as well as to offer input. One way to do so is by requesting a care conference. You can learn and the staff can learn from you. It is a way of addressing the fragmented communication you are likely to find in any of these facilities. Do not hesitate to exercise this right. It can make a difference. If you’re not sure where to get started and need some help, contact us: firstname.lastname@example.org to set up a consultation.
Visits with your aging parents often are a wake-up call this time of year. Perhaps you haven’t seen your loved ones for some time and when you do, it’s startling. Aging can be a gradual process for some but for others, the changes accelerate so fast it shocks those who haven’t seen them in months.
None of us can predict how we will age. We all wish it were about not having to depend on others, but that not how things normally work. Aging takes its toll on body and mind and we can be forced to rely on others to help us at some point. What is that point?
If you visit your aging loved one, notice these five things. Anyone of them is a red flag. It can be a warning to you that help is needed and a serious discussion is mandatory if you want them to stay safe. Don’t wait for your loved one to bring up a need for help. Too often, they can’t face it and are in denial. Many older people are terrified at the thought of being “put in a home” which they see as a form of imprisonment. Loss of control over their lives is the fear. Those living alone are especially vulnerable as day-to-day, no one is watching.
Unusually unkempt appearance. Forgetting to comb one’s hair is one thing. By itself, it may not mean much. But dirty clothing, lack of basic hygiene, failure to notice grooming and personal appearance are a deeper problem. If a parent was always fastidious and you see a change, don’t dismiss it as unimportant. It is a signal that something has changed.
Inability to track the conversation. An aging parent who was, in the past, able to participate in a discussion about current goings on or any more serious subject and now can’t keep up or follow what is being said is showing you signs of cognitive decline. There may be several explanations for this, but it is not normal and not “just getting old”. Normal aging does not cause us to lose intelligence.
Repeating one’s self over and over again. Older people start to lose short-term memory when dementia is developing and short-term memory loss is a classic sign of cognitive impairment. If your loved one keeps asking the same question you just answered or tells the same story six times an hour, you have a warning that could mean dementia is in process. Your loved one needs a doctor visit to check it out.
Unsteady on her feet, recent falls. If your loved one seems wobbly on her feet and is holding onto the furniture to get around in the house, you are seeing a big red flag. Falls are unfortunately common among elders and are often the trigger that leads to injury, hospitalization, and loss of independence. Perhaps she needs a walker or cane. An evaluation by her physician and a physical therapist can avoid what your aging parent dreads most: losing the ability to be on her own.
Unattended paperwork around the house. This includes unpaid bills, collection and dunning notices, and requests for renewal or information appropriately sent to the home. Your aging parent may be having trouble keeping track of finances. This is a warning that it is time for the adult child to step in. An aging parent may not be set up for automatic bill payment online but you can offer to do this for them. That will enable you to not only track what is going on financially but protect them from things like insurance being terminated, utilities being cut off and worse yet, financial abuse.
Learn more about best ways to help your aging parents as you begin to take more responsibility at AgingParents.com.
Here is a true story about an older person with cognitive decline who was being manipulated by his live-in girlfriend. His son was not sure of what he could do.
Jay is an only child and his dad, Jeremy is 88, in failing health. Jeremy lives with his longtime girlfriend, Wilma. Jay is having a very hard time moving forward to take control of his dad’s finances, which are considerable, even in the face of Wilma manipulating his father. A lot of cash and valuable real estate is at stake. From the look of it, Wilma is getting Jay to sell off things, putting the cash in places she thinks Jay can’t find and trying to keep Jay from ever seeing his father without her present.
Jay doesn’t want to stir things up.
What’s wrong here? The signs of financial elder abuse are popping up and Jay is hesitant to admit that his father is no longer competent. Over a year before the odd financial transactions started, his dad’s doctor warned Jay that his father had dementia, that it was advanced and that he needed to be aware of this problem. Jay took no action.
The warning signs Jay saw: Wilma would not let anyone talk to Jeremy without her listening in or being present. She isolated Jeremy from others. Wilma had persuaded Jeremy, a confused property owner to sell some real estate and she had him put the cash in an account outside Jeremy’s trust.
Jay, whose real name is not used here, sought advice at AgingParents.com where he got expertise he needed to get moving. Here is how that worked.
First, Jay was asked to send all his father’s estate planning documents to us so I could determine what it would take under the terms of his family trust to have Jeremy resign or be removed as trustee of his large estate. The trust provided that a letter from Jeremy’s doctor stating that he knew his patient and knew that Jeremy was incapacitated for managing his finances was needed. Given that the doctor had already told this to Jay in so many words helped. Getting the letter was not a problem. I helped Jay understand what words needed to be on paper to be consistent with what the trust required.
Next, Jay needed to meet with Jeremy’s estate planning attorney to do the paperwork showing that Jay, the appointed successor trustee was now the sole trustee and his father was no longer in that position. That worked well, as he and his father had met with the attorney previously. The attorney knew what Jeremy had wanted.
Third, Jay, with the certificate showing that he was now the trustee in hand, had to go to the banks, and to the property managers working for his father to let them know that he was now the decision-maker. In addition, he had to go to his father’s home and gather up all financial records so that he could regain the control Wilma had sneakily been taking by manipulating Jeremy. Jeremy was easily confused, easily led and afraid to do things without Wilma telling him what to do.
The takeaway from this story is that when your aging parent begins to decline in health and shows signs of dementia, you can’t let that continue without putting your loved one at serious risk of manipulation. Yes, it’s work to change the legal documents. Yes, it all takes your time. And yes, it requires coordination between you, the adult child, the estate planner and the doctor to keep your loved one safe. But if you want to preserve your aging parent’s legacy for your own offspring and yourself, take the time. Note the danger when there is an unmarried companion of your aging parent who can get into a position of diverting wealth from your loved one’s estate.
If you have an aging loved one who ever has to go to a nursing home, beware of a nasty practice in which some of these facilities engage. It is disgusting to think that a nursing home will not only violate the law in refusing to allow its own resident back into the home after going to a hospital, but it will callously separate spouses by doing so. They prey on low-income Medicaid recipients.
That’s what happened to eighty-two-year-old Gloria Single who lived at Pioneer House, a nursing home that accepts Medicaid residents. She and her husband lived there together until she went to a hospital, expecting to return to Pioneer after she was released from the hospital. Instead, after she was medically cleared to return, Pioneer House refused to let her come home, thereby cruelly separating her from her husband. She now is staying in another home, still hoping to be with her husband again. We think this is outrageous!
Ms. Single would have been voiceless but for the advocacy of AARP Foundation, the affiliated charity of AARP. According to Foundation attorney Kelly Bagby who represents Ms. Single, she has a clear legal right to return to the place where she lived, and the nursing home’s practice of dumping her is clearly against the law. The lawsuit alleges that she is a victim of a corporate policy of evicting low-income residents to make room for more lucrative Medicare or private pay residents. In other words, they dump vulnerable people so they can make more money on other residents who are paid by better sources than Medicaid. Having interviewed the attorneys, I learned that they estimate at least 200 such illegal eviction cases in CA alone just in the last year.
If your own aging loved one is ever mistreated or dumped from a nursing home, know that he or she has rights that can be enforced. The place to start is with the Office of the State Long-Term Care Ombudsman. From there, know that attorneys who work at AARP Foundation may take up the cause of your elder to enforce their rights.
It is our hope for her here at AgingParents.com that justice will be done and Ms. Single can be reunited with her husband before it is too late. For professional advice about your vulnerable aging loved ones, contact us at info@AgingParents.com. We care about them and you!
Hurricanes, flooding, wildfires, and earthquakes have all struck families this year. Sometimes your aging parent or other loved one is displaced and adult children must suddenly take them in. If your family member was in a care facility, such as a nursing home or assisted living, you may suddenly face caregiving responsibilities without notice ahead of time. Communication with doctors may be sketchy or cut off when power is out. What should families do?
If you are unexpectedly taking on caregiving for an aging parent because of displacement, whether temporarily or longer term, there are some basics you can consider and do.
If you are able to contact the primary care physician, get a complete list of all medications your parent takes. If your parent has some bottles of pills, compare them with the doctor’s record to be sure you have a complete list and that it is up to date. Order any medications needed. When a vulnerable elder misses doses of essential medication it can quickly lead to a crisis.
If you are unsure of the care routine your parent needs, get a professional evaluation at your home from a geriatric care manager. Care managers, often with nursing or social work backgrounds, can assess your loved one and create a written care plan. The care plan should address your loved one’s physical, social and emotional needs. Recommendations about safety hazards, adjustments, and equipment your loved one needs should be included. The care manager will visit, evaluate and leave you with a written guide as to what needs to be done.
Displacement is traumatic for an older person, just as the sudden responsibility for daily caregiving can be stressful for the family. Encourage your aging parent to talk about it, and ask what might make them feel more comfortable. Your loved one may not want to speak up, feeling that she is being a burden. Offer her your reassurance that you will all get through this difficult transition together.
A care facility where your loved one was living provided structure and opportunities for socialization. Consider whether a local senior center in your community might offer opportunities for making social connections with others and find out if he is willing to give it a try and visit a center. Isolation can be depressing for anyone. Many senior centers have directories of other senior-oriented services available nearby too.
Devote time to yourself when you can. If you can bring in caregivers to help you with tasks for your aging parent, that can give you relief and allow you to go to your job or other activities. Attend to your other important relationships by spending time with them. The sudden addition to your daily lives can stress communication between spouses, partners, and kids still at home. Take breaks.
Most of our aging parents receive Medicare, which is supposed to pay “covered medical costs”. And for the most part, it does. But then there are the mistakes. Are your aging parents helpless when Medicare refuses to pay for something that appears very legitimate? They get a bill for something that is supposed to be covered but instead shows that Medicare covered none of it and your aging parents are responsible for the full amount. Maybe you, the adult child will get a call about this. Here’s what you need to know about wrongful Medicare denials. Not taking action can leave an aging parent with a big bill, which they should not be forced to pay. They are not without recourse. But for an aging loved one, someone else may need to get involved to help them fight back when Medicare makes a mistake.
Medicare is a massive system and when anything that big is run by humans who make errors, sooner or later an expensive mistake can hit your aging parents. It happened in my own family and it is worth sharing how we prevailed in a dispute that should never have happened.
95-year-old Alice, who lives in a seniors’ apartment and normally functions independently was having trouble. She had recently had a bout of pneumonia that landed her in the hospital, close call for anyone that age. She recovered but had a scary memory of what it felt like to have trouble breathing. She was just getting back to her normal routine. Things were stable. But one night she awoke gasping for breath. Trying not to panic, she pressed her emergency alert button on her pendant (which we had finally convinced her to wear!) and the paramedics were summoned. They promptly took her to the ambulance, started oxygen and an IV and rushed her to the emergency department of the nearest hospital. She was admitted, treated, and after a few days she returned home. All seemed ok. Until the ambulance bill came. Medicare denied payment of it for no apparent reason.
Medicare does cover ambulance bills under most circumstances, as well as all ER treatment and the hospitalization itself. That is what the premiums pay for. She had never had this kind of trouble from Medicare before. We got involved because she was frustrated and upset over it. Here’s what family needs to know:
Anyone whose bill is denied by Medicare has a right to appeal the decision. Medicare is required to give the person a letter with the denial, explaining the right to appeal.
The appeal process is tedious, makes little sense and is likely to result in another denial or two. You have to follow the steps in the Medicare letter exactly and persist. This is where the family can help.
With a legitimate bill, like the ambulance bill, Medicare can come up with any screwy basis for the denial they wish to use. In her case, they seemed to imply that she could have gotten to the ER by magic carpet or taxi or some other ridiculous means when she was gasping for breath. Dumb reason.
Persist and ask for a hearing after the next denial. Again, Medicare must inform you in writing of the right to ask for a hearing. It takes place by phone. The judge does not read all about it before taking testimony from the Medicare recipient. After hearing the testimony by phone, the judge then reads what was submitted by the Medicare recipient after the first and second rounds of denial. In Alice’s case that was proof of her diagnosis and admission to the hospital that night as well as a letter from her son, my husband. Alice did just fine. She told the judge what happened after being prepped the day before by us. Telling the truth is not difficult.
The result from a hearing is much more likely to be successful than submitting written proof prior, as we did, that the bill was legitimate. You have to do it to make a record, but perhaps no one actually looks at it during that stage of this process. The judge is required to read the material and presumably considers it. With the earlier repeated denials, one would think that the proof had been submitted to a robot programmed to an automatic “no”.
Medicare has endless rules and ways to deny payment for lots of things ordinary people think should be covered. The takeaway from this is that our aging loved ones are vulnerable to unreasonable denials of legitimate claims to Medicare and that they may need our help in navigating the appeal process. Alice simply could not have managed this journey by herself. She got confused by the letters. She got mad because she really needed the ambulance that night and how dare they say she didn’t?
She didn’t know what to do. With our help she prevailed. We were quite happy that the judge at her hearing got it and did the right thing. The process was a pain. But with it, the bill was paid in full. Have you had this situation or something similar occur with your aging parents? We’d love to hear your story. Comment here or email us: email@example.com
Rhonda is a 91-year-old widow and lives independently. She has a few million in investments and has planned well for retirement. Her two sons are busy and leave her to make decisions about her money independently. What Rhonda’s sons didn’t know was how vulnerable she was to a financial predator. She loved to play sweepstakes and did so regularly, a year before things came to a crisis point.
She got really excited about the prospect of winning. A scammer, who probably purchased her name from the sweepstakes companies, got in touch with her by phone. “You’ve won!” he exclaimed excitedly. He then went on to use a classic scammer’s trick. He told her she could get her million-dollar check if she would just pay the “fee” for transferring the funds. Sometimes the trick is paying the “taxes” or the “insurance fee”. It’s all the same. The scammer, or predator, claims that they will deliver the check in person in exchange for the cash from the mark. Scammers of this sort often target the elderly because they are easier prey.
Luckily, Rhonda’s son found out and he and his brother tried hard to talk their mother out of this. She insisted that they didn’t understand and that “Mr. Banks” (don’t you love the name?) was a good person and that he was going to deliver her winnings to her for real in person soon. No amount of reasoning could persuade her she was about to be victimized.
Her son, Jamie called us at AgingParents.com. “What can I do?” he asked. We had to act fast as “Mr. Banks” was coming the following week to “deliver her winnings” and pick up the check. Rhonda was still the trustee over her multi-millions despite the fact that she had been showing clear signs of cognitive impairment for over two years. No one had taken any steps to keep her safe until this crisis.
We asked Jamie to get her trust and any estate planning documents ASAP. He did so. Reviewing them showed that he was a co-trustee on the trust. It also revealed that Jamie was the “attorney in fact” on her Durable Power of Attorney and that he could act immediately. He got careful step-by-step instructions as to how to stop transactions on her accounts, and how to confront the nefarious “Mr. Banks” when he called to finalize the time to meet with Rhonda.
I personally called Rhonda’s financial advisor to let him know about the imminent abuse, that transactions should be held until either Rhonda resigned as trustee or until Jamie could put a stop to Rhonda’s attempts to get thousands of dollars for the predator. The advisor’s response was: I don’t know of anything I can do”. That shocked me. He could have put a hold on transactions until Jamie was able to get Rhonda to allow Jamie to be a co-signer on the accounts. Jamie did this but with no help from the financial advisor.
Fortunately, the outcome on this matter was successful. Jamie used the power of attorney to stop any transfers out of Rhonda’s account. She was too confused to argue with that action. When “Mr. Banks” called, Jamie was present and asked him “Who are you anyway?” Banks claimed he was a long lost relative and when Jamie told him he was nothing of the kind and to get lost, he actually did. Rhonda did not hear from him again. Whew, close call!
The takeaways for adult children of aging parents from this true case are these:
Stay in contact with your aging parent. Diminished capacity leaves a trail. If you see those little signs of memory loss, consider that your loved one is probably not safe to be the one in sole charge of her finances. Predators love impaired elders. Protect them from abuse by being a co-signer on all accounts.
Get documents in order. Make sure that you have estate-planning documents, including a power of attorney and that someone in the family is appointed to take over in the event of incapacity. When you see incapacity warning signs, pay attention. Don’t just let the elder keep going on alone with their money decisions.
Recognize that your aging parents, age 85 and up are at very high risk for dementia or diminished capacity. The risk is at least one in three. Some experts put it at 50%. Be on the lookout for signs of diminished capacity and have a plan in place to address it. In the earliest stages of dementia, a person loses financial judgment and is a prime target for scammers of all kinds.
Learn more about we can help you protect your aging parent from becoming prey to predatory scammers at AgingParents.com.
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