Eldercare Planning and Cost Issues

Many of you, at some point in your life, will play the role of caretaker to an elderly parent or relative. Your increased role may happen gradually or it may happen overnight. Either way, stepping up to help with parental health and financial decisions most likely won't be familiar territory. Usually, only on-the-job training has been available. I hope to change that.

I think it's vitally important to discuss things with your older relative. They need to understand that you want them to be safe and comfortable. It's difficult sometimes to express your concerns, but I bet you'll find once you raise an issue, it will be the start of a constructive dialogue. If your parent has become cognitively impaired, you've probably waited too late to start discussing things. Here's some issues to keep in mind:

• Your parent still needs to make his or her own decisions
• Be patient and talk in a normal tone of voice
• Be positive and do not argue
• Listen to your parent's concerns and don't minimize his or her fears
• Discuss your concerns with your parent's doctor, lawyer or clergy

Do Your Homework
Many communities in the United States have services for their older citizens. This can be important if your parent/relative wants to remain at home. It's also less expensive. You need to make sure you know who to call should your parent have a need for any of the following:

Meal Delivery Programs - seniors don't always eat nutritious meals, particularly if they're living alone. Fees are usually quite reasonable. v Transportation Services - giving up driving is always a major concession as we get on in years. Transit systems or senior centers frequently provide a low-cost way for seniors to get around. Find out the routes and how much it costs.

Grocery Delivery Services - if dealing with groceries is a bit too much for your parent, check to see if any grocery delivery services exist. The smart grocers will offer and expand such services in the future.

Emergency Response System - this will enable your parent or relative to call for help if there's an emergency. By pressing on a transmitting device that hangs around his or her neck, the local police or hospital will be alerted so that help is dispatched immediately. This kind of service will give you tremendous peace of mind, especially if you live far away.

Home Health Aide - figure out which local agency you'd hire to help your parent with dressing, bathing, preparing meals and monitoring nutrition, etc.

Social Worker - this is a trained individual who can help with the emotional aspects of a parent's illness. Such a person can also help you access and coordinate community resources. Your parent's doctor may be able to provide some names.

What If Staying At Home Isn't an Option?
Since the cost of maintaining a home only goes up, I'd recommend you find out if there are property tax abatement or deferral programs in the city where your parent lives. Fuel assistance and home repair programs may also be available. Anything you can do to help save money will be a plus.

If staying at home just isn't practical anymore, investigate and discuss the following housing options:

• Congregate Housing - separate apartments but residents share meals
• Senior Housing - lower rents usually subsidized by cities or states
• Assisted Living - individual bedrooms, shared meals, regular monitoring of needs, and 24-hour staffing
• Continuing Care Community - offers a range of housing options and usually requires a substantial entry payment in additional to a monthly fee. Your parent will probably have to sell his or her house to go this route
• Nursing Home - discussing this won't be easy. If you can start the discussion early enough, your parent/relative can be involved in choosing the best location. That way, everyone can get used to the idea. Many nursing homes have separate wings for residents needing skilled nursing care if they have Alzheimer's. Custodial or rest-home care will be for those who don't need regular care of a nurse.

How Will It All Be Paid For?
Your parent may be reluctant to discuss his or her finances. Being in this situation is a tough pill for anyone to swallow. But it's important to discuss, because keeping your eyes open is the best way to plan for your loved one. So, do an inventory of assets and income.

Next, a misconception about Medicare. It covers only the first 100 days in a nursing home. After that, you're on your own. And, if your parent already has a long term care insurance (LTCi) policy, he/she has an advantage over those who don't. Many assisted living, continuing care and nursing homes require a LTCi policy in order to help guarantee payment. Without LTCi, you're limiting your options to facilities that accept Medicaid. (Medicaid is welfare. It's become the payment option of last resort for millions of seniors and $2,000 is the maximum assets allowed by most states.) Spending down your parent's assets in order to qualify for Medicaid is not a smart option. Many states are aggressively going after assets or disqualifying seniors when financial shenanigans are suspected. It's not worth the risk.

Reverse mortgages are another option worth considering. With this kind of mortgage, your parent will receive a monthly payment from the home's equity.

Meeting with an eldercare attorney may also be a smart move. Above all, start early and plan. Your parents took care of you many years ago. Returning the favor now is just the right thing to do.