Taking Care of Mom and Dad, Part 2

By Betty Booker | March 2nd, 2014

It can be done well – and reasonably – or it can be, well, a disaster. Here’s how to make the wise choices.


‘The Cheat Sheet’

An aid for busy people in the midst of caring for others:

1. MEDICARE does not pay for long-term, at-home, assisted living or nursing home daily care.

2. LONG-TERM CARE is paid for with private insurance and/or assets.LONG-TERM CARE INSURANCE helps cover the types of services Medicare doesn’t, both for your parents and/or for you.

3. If assets are reduced to a minimum, you may qualify for MEDICAID, the biggest payer of nursing home care. Protecting assets and still qualifying for Medicaid requires expert advice.

4. For elders who choose to remain at home or live with family, HOME-CARE COMPANIES can be hired to help with bathing, dressing, medication management, meals and more.

5. Some ADULT DAY SERVICES include all-inclusive day care and medical programs.

6. A universal design or Certified-Aging-In-Place remodeler (to adjust the home to specific needs), occupational therapist or mobility product expert can extend a person’s ABILITY TO REMAIN AT HOME.

7. MONEY MANAGEMENT is crucial – the earlier the better – involving trusted financial and/or legal experts.

8. IMPORTANT FINANCIAL ASPECTS include: power of attorney, advanced medical directive, will, trustee and executor communications, money management, bill paying, understanding of possible benefits, including government and/or veteran benefits.

9. If a HOUSING MOVE is involved, there are realtors and movers who work specifically with the unique needs of the elderly.

10. REVERSE MORTGAGES are a possible source of income.

11. For the reluctant, a SHORT-TERM STAY at a retirement community can be a trial option.

RETIREMENT HOUSING OPTIONS:

• Apartments whose rents are set as a percentage of income.

• Seniors tax-credit apartments: designed for seniors’ needs at a lower rent than conventional apartments. Many include van transportation and social activities and can accommodate pets. Leases are for seniors with moderate/modest incomes. Check with the community for further details.

• Conventional apartment communities: for people of any age or income.

• Continuing Care Retirement Community (CCRC): a community that includes all levels of care, where a resident might enter in an independent stage, living in an apartment or cottage, and later take advantage of a full range of care and services without needing to relocate.

• Independent Living Retirement Community: a retirement community for people who can live independently, yet desire some nonmedical services.

• Assisted Living Retirement Community: a retirement community with both nonmedical and modest medical care, generally between independent living and skilled nursing care.

• Memory Care: a facility home for people with Alzheimer’s or dementia.

• Skilled Nursing Care: full-time care delivered in a facility designed for recovery from a hospital treatment or needed medical assistance.

• Palliative Care: a medical expert team care approach for people of any age and any stage of a serious illness that can be provided along with curative treatments. Can be provided on outpatient basis, at a long-term-care facility, or hospital.

• Hospice: a Medicare benefit that provides palliative care for terminally ill patients who may have only months to live and are no longer receiving curative treatments.

[Editor’s note: Betty Booker, an expert writer on aging, concludes a two-issue series examining the caregiving challenges facing baby boomers. This issue: some of the most useful solutions.] 

The  best preparation for getting good care when you need it is to develop the habit of being kind.

At an assisted living facility, I heard a resident announce, “It’s all about me.” Maybe that’s why her only child stays away, I thought. Mama has dementia. She pays for good professional care but has alienated the relative whose affection she craves.

Unlike the 91-year-old patient described by professor and social worker Wendy Lustbader in her book, Life Gets Better: The Unexpected Pleasures of Growing Older:

The nursing home staff vied with one another to take care of her. She had few outside visitors. She had no children and had outlived most friends and relatives. The secret of her popularity: A genuine interest in others. She listened. Her warmth was an irresistible magnet.

Thoughts from the Experts

“Life is rich with opportunities to enjoy each day to its fullest. But, if boomers only focus on today and overlook tomorrow’s needs, they could leave themselves and their loved ones vulnerable to unintended financial hardship without harmonic balance.”

– Judith O’Brien, Capital Financial Partners 

KNOW THE QUESTIONS, KNOW THE BASICS

Still, there are also other issues to consider, ideally before you need assistance:

• How can you frugally get help with housekeeping, cooking and transportation?

• Can you alter your residence now to make it disability-friendly and maybe stay there for life?

• What care options are available at home? And elsewhere? How will you pay for assistance?

Let’s start with the biggest misconception: Medicare, the federal health insurance for seniors, does NOT pay for long-term at-home, assisted living, or nursing home daily care that many elders need in late life.

That news shocks most families when they confront the disturbing reality that Mama and Papa (maybe you someday) need help, often after hospitalization when seniors are unable to remain alone, said Joan Shifflett, of Always Best Care, a home-care agency.

Except for limited Medicare benefits, long-term care is paid for with private insurance and/or assets. Long-term care insurance helps cover the types of services Medicare doesn’t – both for your parents, and, eventually, for you. Various policies can cover at-home, assisted living and nursing home care. For an overview of what this form of insurance can do, make a free, unbiased, confidential appointment with the Department for the Aging’s Virginia Insurance Counseling and Assistance Program (VICAP): vda.virginia.gov/vicap2.asp.

Other places to find reputable agents are the insurance manager at your doctor’s office, friends who are happy with their policies and online research, including the Virginia Bureau of Insurance, which lists insurers licensed to do business in Virginia. Also, check your human resources department. Group policies are usually cheaper. Don’t overlook insurance under the Virginia Long-term Care Insurance Partnership, which covers long-term care without depleting all your assets.

If assets are reduced to a minimum, you may qualify for Medicaid, the state-federal health insurance for the poor. Medicaid is the biggest payer of nursing home care.

Protecting assets and still qualifying for Medicaid requires expert advice, said ThompsonMcMullan’s R. Shawn Majette, a nationally known elder lawyer.

FIRST OPTION: HELP IN STAYING AT HOME

Since most boomers and their parents want to live at home until they leave feet first, the AARP reports, the likelihood is high that you’ll need at-home services from relatives and home-care agencies.

Some children or siblings move into the family home to help relatives. Or the seniors move in with them. (Seek another solution if you don’t get along.)

Caregivers can arrange with home-care companies for paid help that includes bathing, dressing and medications. Another option is an adult day program, where services often include meals, personal care, exercise, dementia programming and health and medical therapies. Among such adult day services in the Richmond area are Circle Center Adult Day Services, A Grace Place and Riverside Richmond PACE, an all-inclusive day care and medical program.

A one-level home is best for retirement, but in any house, a must is a first-floor, wheelchair-accessible bathroom and a room that can become a bedroom, said Remax Realtor Gordon Laroussini.

A universal design remodeler, occupational therapist or some home-health specialists can analyze your dwelling to make it safer. For example, your house needs bathroom grab bars and light bulbs you can reach to replace.

You can go even further with adaptations such as stair lifts, elevators, ramps and wheel chair and ceiling lifts, even vehicle modifications, said Kaye Crenshaw, president of Mobility Supercenter of Virginia.

Word-of-mouth recommendations are a good way to find low-cost helpers – and every other senior service. The Fan Village volunteers assist senior Fan District Association members with small chores. Check your neighborhood association. Some churches, home-care companies and volunteer support groups like the Shepherd’s Center know community resources.

Ask neighbors about possible housekeepers and cooks, teen yard workers and neighbors who might provide transportation. Metro Richmond, for example, has taxis and private and public van transit services.

Call your local area agency on aging. In central Virginia, call Senior Connections, (804) 343-3000. Its care coordinators know resources for each jurisdiction.

Thoughts from the Experts

“Many people feel that if they did not retire from the military, they are not entitled to any benefits. But if you served and were honorably discharged, it probably would behoove you to get in touch with intake people at McGuire or the Department of Veterans Services or its offices throughout the state to determine what you might be entitled to.”

– Kim Elliott, Sitter & Barfoot Veterans Care Center 

THE MONEY BEAST CAN BE TAMED, STEP BY STEP

Money management is an important issue, but, says personal business manager Gene White, it is best to prepare now for what may come.

White recommends developing a trust relationship with a professional financial adviser to help maintain control over personal affairs or help children who are overseeing parents’ bills and taxes. An adviser can prevent or detect fraud and maintain critical records for taxes and estate filing, said White, president of Guidelight Money Management.

While you’re at it, make sure your power of attorney, trustee and executor know where your financial records and computer passwords are.

Begin simply: Off the top of your head, write down all of your assets on a piece of paper; fill in details later, suggested attorney Edward Barnes, of Barnes & Diehl, family law specialists.

“Do your relatives and survivors a favor:” Compile everything they’ll need when you aren’t there to tell them, he said.

Business owners should plan carefully, said Kevin Deckert, president of Deckert Financial, a fee-based wealth management firm. Selling a company requires analysis so the owner can protect the company viability and reap income from the sale. If you don’t plan, he added, the result is “collapse, failure” of the asset.

Costs typically rise faster than retirees’ incomes, leaving seniors strapped for cash. Hunt for benefits online, such as BenefitsCheckUp.org, the National Council on Aging’s website that pinpoints resources you may qualify for.

Thoughts from the Experts

“You get much better care when you’re nice.”

– Dr. E. Ayn Welleford, Virginia Commonwealth University

MORE MONEY AND/OR MOVING TIPS

• Day care for adults, including those with memory problems, is one way to transition from home alone to assisted living – or to avoid moving altogether, said Laroussini, a senior real estate specialist.

• Reluctant elders may be introduced to retirement living through a short stay at a retirement community or assisted living facility.

• Another income source is a reverse mortgage that allows home owners age 62 and older to tap a percentage of their home’s appraised valuation, said Dennis Smith, an owner of Reverse Mortgage Pro. Owners may use the income for everything from paying off their original mortgage to a credit line for future needs, including home care, Smith said. The owner retains ownership, doesn’t have to repay the loan as long as this is their principal residence and can bequeath the property. Heirs can opt to repay the loan, often with remaining equity.

• If a parent is reluctant to move, but really should, “be prepared and educate yourself on the possible options … so that the conversation has a direction to go in,” suggested Tara Davis-Ragland, executive director of The Towers Retirement & Assisted Living.

• Among housing resources are apartments whose rents are set at percentages of income. Some religious denominations and nonprofits sponsor senior housing, some on a sliding fee scale.

• Another option is a tax credit apartment, which gets a favorable tax treatment for renting some of its units to low-income tenants. Check “LIHTC” properties at huduser.org.

• Don’t overlook possible veterans’ services, even if you served only a couple of years, said Kim Elliott, director of admissions and marketing for Sitter & BarfootVeterans Care Center. Veterans, service members and their families may hunt online for benefits, Elliott said, but it’s easy to ask for an intake coordinator at McGuire VA Medical Center (804-675-5000) or the closest field office of the Department of Veterans Services. Find offices at dvs.virginia.gov/fieldoffices or by calling 804-786-0286.

Thoughts from the Experts

“A rightsizing transition from your home to a smaller place should be a team sport. You need help to do it. Outside help is best because I find that people generally behave much better with strangers, especially those who have experience.”

– Katie Hamann, Door to Door Solutions 

By pre-planning, you give yourself and your family the peace of mind of knowing that everything has already been taken care of and that the funeral arrangements are what you wanted them to be.” 

– David Gilliam, Hollywood Cemetery

“Moving to a retirement community is one of the biggest decisions you will ever make. You need to get out and look. Communities are all different. Spend some time there, have a meal, talk to the residents.”

– Jill Kuslits, The Crossings at University Park 

‘THE SMARTEST ONES’

Moving triggers what Laroussini calls “unwinding the house” – culling a lifetime’s accumulation into what you need for new, smaller quarters.

That job may be beyond the time or physical constraints of the owner and caregiver, a common situation for children who live far from their aging parents or whose careers leave no free time, according to Katie Hamann, senior move manager with Door to Door Solutions.

If you can’t socialize, “which is critical to aging,” it can be lonely to live in a house by yourself, Laroussini said. “The people who are ready to let it go are the smartest ones.”

Betty Booker, a retired Richmond Times-Dispatch reporter and columnist, can be reached at Betty@TheBoomerMagazine.com. 

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